沖擊波治療骨肌疾病課件

1、讓疼痛遠(yuǎn)離我和我的家人沖擊波治療儀第1頁，共51頁。手柄表面，高能流密度surface, high ED0,35 mJ/mm2深度，低能流密度depth, low ED 探頭Transmitter在組織中傳播spreads in the tissueED: 能流密度ED: energy flux density有效治療范圍Radial Extension第2頁，共51頁。絕對禁忌癥ABSOLUTE CONTRAINDICATIONS妊娠Pregnancy血栓癥thrombosis血凝固紊亂（血友?。ヽoagulation disorders (haemophilia)腫瘤疾病tumour di

2、seases 急性炎癥acute inflammation目標(biāo)治療區(qū)膿腫pus focus in the target area第3頁，共51頁。相對禁忌癥RELATIVE CONTRAINDICATIONS抗凝血劑使用者，特別是苯丙香豆素（維生素K拮抗劑） use of anticoagulants, especially marcumar (vitamin k antagonist)有多發(fā)性神經(jīng)病的糖尿病 polyneuropathy in case of diabetes mellitus可的松治療結(jié)束六周后才能使用體外沖擊波治療 cortisone therapy up to 6 we

3、eks before first ESWT treatment風(fēng)濕性疾病 rheumatic disease第4頁，共51頁。腫脹swelling變紅reddening血腫haematomas瘀點(diǎn)petechiae灼傷般疼痛感pain like sunburn治療初期病情惡化first worsening副作用SIDE EFFECTS第5頁，共51頁。沖擊波治療的益處Benefits of Shock Wave Treatment 幾次治療后，疼痛即得到緩解/減輕 pain relief/ reduction after a few treating sessions 治療依從性好 the c

4、ompliance is very good 治療后病人能直接感受到第一療效 the patients can feel first effects directly after the treatment 能治療復(fù)雜癥狀及相關(guān)適應(yīng)癥 treatment of complex symptoms/ indications possible第6頁，共51頁。治療結(jié)締組織 treatment of connective tissue活化淋巴系統(tǒng) activation of lymphatic system大面積治療 treatment of large areas possible作用于神經(jīng)系統(tǒng)（門

5、控制、疼痛記憶） effects on the nervous system (gate control, pain memory?)沖擊波治療的益處Benefits of Shock Wave Treatment第7頁，共51頁。經(jīng)典適應(yīng)癥CLASSIC INDICATIONS第8頁，共51頁。經(jīng)典適應(yīng)癥Classic Indications Calcific tendonitis/ shoulder pain鈣化性肌腱炎/肩痛Achillodynia 跟腱痛Plantar fasciitis 足底筋膜炎Ulnar humeral epicondylitis肱骨內(nèi)上踝炎Tibial stre

6、ss syndrome脛骨壓力癥候群Radial humeral epicondylitis肱骨外上髁炎Trochanteric tendonitis轉(zhuǎn)子肌腱炎Patellar tendonitis髕腱炎第9頁，共51頁。治療方法 PROTOCOL 查找主要痛點(diǎn)和其他痛點(diǎn)look for the main and other pain points 與病人密切交談close dialogue with the patient 生物反饋biofeedback 2000次發(fā)散式?jīng)_擊波 radial shocks 2000 多數(shù)學(xué)派的治療方法protocol of the most studies

7、傳統(tǒng)派old school新派：聯(lián)合療法，治療扳機(jī)點(diǎn) new: combined therapy, trigger points第10頁，共51頁。治療方法PROTOCOL治療間隔：5-7天 interval5 7days治療次數(shù)：3-5次 sessions3 5最晚在第5次治療后進(jìn)入休息期 break latest after 5th session第11頁，共51頁。鈣化肌腱炎/肩痛Calcific tendonitis/Shoulder pain前期超聲或X線定位/決定治療區(qū)域與深度Preliminary ultrasound orx-ray localization/ determin

8、ation of penetration depth and treatment area在皮膚上標(biāo)記出治療區(qū)域Marking of therapeutic window on the skin在90%的例子中，旋轉(zhuǎn)套的岡上肌腱感染，需要治療。In approx. 90% of the casesthe supraspinatus tendon of the rotator cuff is affected and has to be treated 第12頁，共51頁。鈣化肌腱炎/肩痛Calcific tendonitis/Shoulder pain第13頁，共51頁。鈣化肌腱炎/肩痛Cal

9、cific tendonitis/Shoulder pain第14頁，共51頁。鈣化肌腱炎/肩痛Calcific tendonitis/Shoulder pain第15頁，共51頁。鈣化肌腱炎/肩痛Calcific tendonitis/Shoulder pain第16頁，共51頁。肱骨內(nèi)上髁炎Radial humeral epicondylitis DD第17頁，共51頁。Ulnar humeral epicondylitis 肱骨內(nèi)上髁炎Sessions 治療次數(shù)Energy 能級(bar)Pulses/session 每次治療使用脈沖數(shù)Freq 頻率(Hz)Transmitter 探頭T

10、endon insertion (painful spot) 腱附著端1. Pain points 痛點(diǎn)5 81.8 4.01500 300012 15R15Adjacent upper arm and forearm muscles鄰近的上臂與前臂的肌肉2. Muscles 肌肉1.8 3.02000 300015 21D20-STreatment interval: 5 - 7 days 治療間隔：5 - 7 天Supine patient positioning Flexion of elbow joint approx. 30 to 40 degree, supination posi

11、tion. R-SW (R15) application at the tendon insertion. 病人仰臥位 肘關(guān)節(jié)彎曲大約30-40度，手心向上。R-SW(R15)應(yīng)用于腱附著端。Supine patient positioning Extension of elbow joint, supination position. Smoothing of forearm muscles with D20-S.病人仰臥位 肘關(guān)節(jié)外展，手心向上。用D20-S按摩前臂肌肉。 肱骨內(nèi)上髁炎Ulnar humeral epicondylitis僅使用發(fā)散性沖擊波療法Only radial sho

12、ck wave therapy 第18頁，共51頁。肱骨內(nèi)上髁炎Ulnar humeral epicondylitis病人仰臥位-肘關(guān)節(jié)外展。用V-ACTOR按摩鄰近肌肉。Supine patient positioning Extension of elbow joint. Smoothing of surrounding muscles with the V-ACTOR。第19頁，共51頁。Preliminary ultrasound/x-ray for localization,determination of penetrationdepth 前期超聲或X線定位，確定治療深度Marki

13、ng of therapy region 標(biāo)記治療區(qū)域轉(zhuǎn)子肌腱炎Trochanteric Tendonitis ESWT New Treatment Guide第20頁，共51頁。轉(zhuǎn)子肌腱炎Trochanteric Tendonitis DD第21頁，共51頁。Patellar tendonitis (Jumpers Knee) 髕骨肌腱炎（跳躍膝）Preliminary ultrasound/x-ray for localization,determination of penetrationdepth 前期超聲或x線定位，確定治療深度Marking of therapy region 標(biāo)記

14、治療區(qū)域第22頁，共51頁。髕骨肌腱炎（跳躍膝）Patellar tendonitis (Jumpers Knee)第23頁，共51頁。Patellar tendonitis 髕骨肌腱炎Sessions 治療次數(shù)Energy 能級(bar)Pulses/session 每次治療使用脈沖數(shù)Freq 頻率(Hz)Transmitter 探頭Patella, tibial tendon insertion 髕骨、脛骨腱附著端1. Pain points 痛點(diǎn)6 82.8 3.52000 300015 21R15, DI15Adjacent muscles 相鄰肌肉2. Muscles 肌肉2.0 3

15、.52000 400021D20-S, D35-STreatment interval: 5 - 7 days 治療間隔：5 - 7 天Supine patient positioning with the knee on a half roll. Fixation of patellar zone with a cuff. R-SW (R15) application at the patella (tip, basis) and tibial tendon insertion.病人仰臥位，膝蓋置于半圓柱形物上。用一條繃帶固定髕骨區(qū)。R-SW(R15)應(yīng)用于髕骨（尖部、底部）及脛骨腱附著端。

16、Supine patient positioning with the knee on a half roll. Fixation of paellar zone with a cuff. Smoothing of adjacent muscles with D20.病人仰臥位，膝蓋置于半圓柱形物上。用一條繃帶固定髕骨區(qū)。用D20按摩相鄰肌肉。髕骨肌腱炎Patellar tendonitis (Jumpers Knee) 僅使用發(fā)散式?jīng)_擊波療法Only radial shock wave therapy 第24頁，共51頁。 Preliminary ultrasound/ x-ray 前期超聲

17、/X線定位 Marking of therapy region 標(biāo)記治療區(qū)域脛骨壓力綜合征（脛骨疲勞性骨膜炎）Tibial stress syndrome (Shin splint) ESWT New Treatment Guide第25頁，共51頁。Tibial stress syndrome 脛骨壓力綜合征Sessions 治療次數(shù)Energy 能級(bar)Pulses/session 每次治療使用脈沖數(shù)Freq 頻率(Hz)Transmitter 探頭Medial, inner edge of shin bone 脛骨內(nèi)緣1. Pain points 痛點(diǎn)6 82.8 3.52000

18、300015 21R15, DI15Adjacent muscles 相鄰肌肉2. Muscles 肌肉2.0 3.52000 400021D20-S, D35-STreatment interval: 5 - 7 days 治療間隔：5 - 7 天Supine patient positioning with knee on a half roll. R-SW application.病人仰臥位，膝蓋置于半圓柱形物上。使用R-SW。脛骨壓力綜合征（脛骨疲勞性骨膜炎） Tibial stress syndrome (Shin splint)僅使用發(fā)散式?jīng)_擊波療法Only radial shoc

19、k wave therapy 第26頁，共51頁。跟腱痛AchillodyniaPreliminary ultrasound / x-ray 前期超聲/x線定位Marking of therapy region 標(biāo)記治療區(qū)域第27頁，共51頁。跟腱痛Achillodynia第28頁，共51頁。跟腱痛Achillodynia第29頁，共51頁。足底筋膜炎Plantar fasciitisPreliminary ultrasound/ x-ray 前期超聲/x線定位Localization of pain points withbio-feedback 根據(jù)人體生物反饋定位痛點(diǎn)Marking of

20、 therapy region 標(biāo)記治療區(qū)域第30頁，共51頁。足底筋膜炎，跟骨骨刺Plantar fasciitis, Heel Spur第31頁，共51頁。足底筋膜炎，跟骨骨刺Plantar fasciitis, Heel Spur第32頁，共51頁。足底筋膜炎，跟骨骨刺Plantar fasciitis, Heel Spur第33頁，共51頁。研究Studies第34頁，共51頁。Improvement %改善度RSW發(fā)散式?jīng)_擊波2 month2個月55.26 month6個月72.912 month12個月84.02000次沖擊波，治療3次，一周一次2000, 3 sessions,

21、1/ week跟骨骨刺Heel Spur第35頁，共51頁。Improvement %改善度Verum沖擊波治療組Control對照組1 week1周73284 weeks4周634852 weeks52周81發(fā)散式?jīng)_擊波，2000次，治療3次，1周1次RSW, 2000, 3 sessions, 1/ week肱骨外上髁炎HER第36頁，共51頁。%Pain free 無疼痛感Improvement有明顯改善Unchanged無變化Worse惡化4 weeks 4周25.7 54.314.25.73 month 3個月5014.330.710.76 month 6個月59.325.914.8

22、012 month 12個月80.319.2RSW, 5 sessions, 1/ weekCalcium deposit % 鈣沉積Gone鈣化消失Disintegration分解No Change無變化4 weeks 4周17.620.961.53 month 3個月44.86.948.36 month 6個月65.34.430.412 month 12個月7525RSW, 2000, 3 sessions, 1/ week 發(fā)散式?jīng)_擊波，2000次，治療3次，1周1次肩袖鈣化性肌腱炎Calcific Tendinitis of Rotator Cuff第37頁，共51頁。After 1

23、year1年之后反饋Recalcification再鈣化5 %OP骨質(zhì)疏松5 %Resorption骨吸收90 %鈣化性肌腱炎，聚焦式?jīng)_擊波Tendinosis Calcarea, FSW第38頁，共51頁。Follow up追蹤觀察Verum 沖擊波治療組Placebo安慰劑組Mid中期75.4 % good 良好52.3 %Long term長期80.7 %40.9 %夾擠綜合癥，聚焦式?jīng)_擊波Impingement Syndrome, FSW第39頁，共51頁。1 yearfollow up1年后反饋Achillodynia跟腱痛Patella tip syndrome髕骨尖綜合征Tibi

24、alis anterior syndrome脛前綜合征Pain free 疼痛消失60 %40 %58.8 %Improvement 有改善12.5 %24.4 %17.7 %No change 無明顯變化27.5 %35.6 %23.5 %發(fā)散式?jīng)_擊波，治療5次，1周1次RSW, 5 sessions, 1/ week疼痛治療Sports-Induced Diseases第40頁，共51頁。肌筋膜疼痛綜合癥Myofascial pain syndrome扳機(jī)點(diǎn)治療Trigger point treatment第41頁，共51頁。肌筋膜疼痛綜合征Myofascial pain syndrome

25、可用RSWT成功治愈的骨科適應(yīng)癥 Orthopaedic indications which can be treated successfully with RSWT 上位及低位頸部綜合征Upper and lower Cervical-Syndrome肩周痛Periarticular shoulder pain前臂屈伸肌腱炎Tendomyosis in the extensor and flexor region of the forearm 上踝病變Epicondylopathy背痛Dorsalgia (Back pain)臀肌痛Glutealgia第42頁，共51頁。 內(nèi)收肌疼痛Pai

26、n in the adductor muscles 股屈伸肌痙攣Shortenings in the femoral flexor and extensor muscles 小腿筋膜間室綜合征Peroneal compartment syndrome脛前綜合征Tibial anterior syndrome 脛骨壓力綜合征（脛骨疲勞性骨膜綜合征）Tibial stress syndrome (Shin splint)伴有/不伴有跟腱痛的小腿肌肉萎縮Shortening of the calf muscle with and without Achillodynia 跖骨痛Metatarsalg

27、ia肌筋膜疼痛綜合征Myofascial pain syndrome可用RSWT成功治愈的骨科適應(yīng)癥 Orthopaedic indications which can be treated successfully with RSWT第43頁，共51頁。肌筋膜疼痛綜合征Myofascial pain syndrome治療長度Length of treatment取決于肌肉刺激的持續(xù)范圍和時間Depending on the extent and duration of the muscle irritation早期疼痛可經(jīng)過1-2次治療成功治愈。Early stage complaints

28、can be treated successfully with 1 - 2 treatments sessions 多數(shù)案例中，痛點(diǎn)的緩解/解除需要4-8次治療（一周12次治療）In most cases several treatment sessions (4 - 8) are required to release/eliminate the pain points (1 -2 treatments / week).建議盡早采用扳機(jī)點(diǎn)治療It is recommended to start trigger point treatment at the most possible ear

29、ly stage第44頁，共51頁。肌筋膜疼痛綜合征Myofascial pain syndrome 沖擊波治療的優(yōu)點(diǎn)Benefits of shock wave therapy 促進(jìn)組織再生Strong regenerative effect on the tissue可深入組織治療，而不傷皮膚Penetrate deep inside the tissue without harming the skin 因此沖擊波操作方便，易于重復(fù)治療?？杀淮蠖鄶?shù)患者接受。Therefore shock wave therapy can be easily repeated and is well tolerated by most patients.第45頁，共51頁。 超聲波掃描術(shù)Sonography 給病人提供最安全的治療方案 Gives the patients the most possible treatment safety 可識別不可采用ESWT治療的結(jié)構(gòu)改變（例如腫瘤） Structural modifications which must not be treated with RSW