1、冲击波治疗骨肌疾病冲击波治疗骨肌疾病绝对禁忌症绝对禁忌症ABSOLUTE CONTRAINDICATIONS 妊娠妊娠Pregnancy 血栓症血栓症thrombosis 血凝固紊乱（血友病）血凝固紊乱（血友病）coagulation disorders(haemophilia)肿瘤疾病肿瘤疾病tumour diseases 急性炎症急性炎症acute inflammation 目标治疗区脓肿目标治疗区脓肿pus focus in the target area相对禁忌症相对禁忌症RELATIVE CONTRAINDICATIONS 抗凝血剂使用者，特别是苯丙香豆素（维生素抗凝血剂使用者，特别
2、是苯丙香豆素（维生素K拮抗剂）拮抗剂）use of anticoagulants,especially marcumar(vitamin k antagonist)有多发性神经病的糖尿病有多发性神经病的糖尿病 polyneuropathy in case of diabetes mellitus 可的松治疗结束六周后才能使用体外冲击波治疗可的松治疗结束六周后才能使用体外冲击波治疗 cortisone therapy up to 6 weeks before first ESWT treatment 风湿性疾病风湿性疾病 rheumatic disease 肿胀肿胀swelling 变红变红re
3、ddening 血肿血肿haematomas 瘀点瘀点petechiae 灼伤般疼痛感灼伤般疼痛感pain like sunburn 治疗初期病情恶化治疗初期病情恶化first worsening副作用副作用SIDE EFFECTS冲击波治疗的益处冲击波治疗的益处Benefits of Shock Wave Treatment 几次治疗后，疼痛即得到缓解几次治疗后，疼痛即得到缓解/减轻减轻 pain relief/reduction after a few treating sessions 治疗依从性好治疗依从性好 the compliance is very good 治疗后病人能直接感受
4、到第一疗效治疗后病人能直接感受到第一疗效 the patients can feel first effects directly after the treatment 能治疗复杂症状及相关适应症能治疗复杂症状及相关适应症 treatment of complex symptoms/indications possible 治疗结缔组织治疗结缔组织 treatment of connective tissue 活化淋巴系统活化淋巴系统 activation of lymphatic system 大面积治疗大面积治疗 treatment of large areas possible 作用于
5、神经系统（门控制、疼痛记忆）作用于神经系统（门控制、疼痛记忆）effects on the nervous system(gate control,pain memory?)冲击波治疗的益冲击波治疗的益处处Benefits of Shock Wave Treatment经典适应症经典适应症CLASSIC INDICATIONS经典适应症经典适应症Classic Indications Calcific tendonitis/shoulder pain钙化性肌腱炎/肩痛Achillodynia 跟腱痛Plantar fasciitis 足底筋膜炎Ulnar humeral epicondylit
6、is肱骨内上踝炎Tibial stress syndrome胫骨压力症候群Radial humeral epicondylitis肱骨外上髁炎Trochanteric tendonitis转子肌腱炎Patellar tendonitis髌腱炎治疗方法治疗方法 PROTOCOL 查找主要痛点和其他痛点查找主要痛点和其他痛点look for the main and other pain points 与病人密切交谈与病人密切交谈close dialogue with the patient 生物反馈生物反馈biofeedback 2000次发散式冲击波次发散式冲击波 radial shocks
7、2000 多数学派的治疗方法多数学派的治疗方法protocol of the most studies 传统派传统派old school新派：联合疗法，治疗扳机点新派：联合疗法，治疗扳机点 new:combined therapy,trigger points治疗方法治疗方法PROTOCOL 治疗间隔：治疗间隔：5-7天天 interval5 7days 治疗次数：治疗次数：3-5次次 sessions3 5 最晚在第最晚在第5次治疗后进入休息期次治疗后进入休息期 break latest after 5th session钙化肌腱炎钙化肌腱炎/肩痛肩痛Calcific tendonitis/
8、Shoulder pain前期超声或前期超声或X线定位线定位/决定治疗决定治疗区域与深度区域与深度Preliminary ultrasound orx-ray localization/determination of penetration depth and treatment area在皮肤上标记出治疗区域在皮肤上标记出治疗区域Marking of therapeutic window on the skin在在90%的例子中，旋转套的冈的例子中，旋转套的冈上肌腱感染，需要治疗上肌腱感染，需要治疗。In approx.90%of the casesthe supraspinatus te
9、ndon of the rotator cuff is affected and has to be treated 钙化肌腱炎钙化肌腱炎/肩痛肩痛Calcific tendonitis/Shoulder pain钙化肌腱炎钙化肌腱炎/肩痛肩痛Calcific tendonitis/Shoulder pain钙化肌腱炎钙化肌腱炎/肩痛肩痛Calcific tendonitis/Shoulder pain钙化肌腱炎钙化肌腱炎/肩痛肩痛Calcific tendonitis/Shoulder pain肱骨内上髁炎肱骨内上髁炎Radial humeral epicondylitis DDTreatm
10、ent interval:5-7 days 治疗间隔：治疗间隔：5-7 天天Supine patient positioning Flexion of elbow joint approx.30 to 40 degree,supination position.R-SW(R15)application at the tendon insertion.病人仰卧位病人仰卧位 肘关节弯曲大约肘关节弯曲大约30-40度，手心向上。度，手心向上。R-SW(R15)应用于腱附着端。应用于腱附着端。Supine patient positioning Extension of elbow joint,sup
11、ination position.Smoothing of forearm muscles with D20-S.病人仰卧位病人仰卧位 肘关节外展，手心向上。用肘关节外展，手心向上。用D20-S按摩前臂肌肉。按摩前臂肌肉。肱骨内上髁炎肱骨内上髁炎Ulnar humeral epicondylitis仅使用发散性冲击波疗法Only radial shock wave therapy 肱骨内上髁炎肱骨内上髁炎Ulnar humeral epicondylitis病人仰卧位病人仰卧位-肘关节外展。肘关节外展。用用V-ACTOR按摩邻近肌肉。按摩邻近肌肉。Supine patient position
12、ing Extension of elbow joint.Smoothing of surrounding muscles with the V-ACTOR。Preliminary ultrasound/x-ray for localization,determination of penetrationdepth 前期超声或X线定位，确定治疗深度Marking of therapy region 标记治疗区域转子肌腱炎转子肌腱炎Trochanteric Tendonitis ESWT New Treatment Guide转子肌腱炎转子肌腱炎Trochanteric Tendonitis D
13、DPatellar tendonitis(Jumpers Knee)髌骨肌腱炎（跳跃膝）髌骨肌腱炎（跳跃膝）Preliminary ultrasound/x-ray for localization,determination of penetrationdepth 前期超声或x线定位，确定治疗深度Marking of therapy region 标记治疗区域髌骨肌腱炎（跳跃膝）髌骨肌腱炎（跳跃膝）Patellar tendonitis(Jumpers Knee)Treatment interval:5-7 days 治疗间隔：治疗间隔：5-7 天天Supine patient positi
14、oning 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.病人仰卧位，膝盖置于半圆柱形物上。用一条绷带固定髌骨区。病人仰卧位，膝盖置于半圆柱形物上。用一条绷带固定髌骨区。R-SW(R15)应用于髌骨（尖部、底部）及胫骨腱附着端。应用于髌骨（尖部、底部）及胫骨腱附着端。Supine patient positioning with the knee on a ha
15、lf roll.Fixation of paellar zone with a cuff.Smoothing of adjacent muscles with D20.病人仰卧位，膝盖置于半圆柱形物上。用一条绷病人仰卧位，膝盖置于半圆柱形物上。用一条绷带固定髌骨区。用带固定髌骨区。用D20按摩相邻肌肉。按摩相邻肌肉。髌骨肌腱炎髌骨肌腱炎Patellar tendonitis(Jumpers Knee)仅使用发散式冲击波疗法Only radial shock wave therapy Preliminary ultrasound/x-ray 前期超声/X线定位 Marking of therap
16、y region 标记治疗区域胫骨压力综合征（胫骨疲劳性骨膜炎）胫骨压力综合征（胫骨疲劳性骨膜炎）Tibial stress syndrome(Shin splint)ESWT New Treatment GuideTreatment interval:5-7 days 治疗间隔：治疗间隔：5-7 天天Supine patient positioning with knee on a half roll.R-SW application.病人仰卧位，膝盖置于半圆柱形物上。使用病人仰卧位，膝盖置于半圆柱形物上。使用R-SW。胫骨压力综合征（胫骨疲劳性骨膜炎）胫骨压力综合征（胫骨疲劳性骨膜炎）Ti
17、bial stress syndrome(Shin splint)仅使用发散式冲击波疗法Only radial shock wave therapy 跟腱痛跟腱痛AchillodyniaPreliminary ultrasound/x-ray 前期超声/x线定位Marking of therapy region 标记治疗区域跟腱痛跟腱痛Achillodynia跟腱痛跟腱痛Achillodynia足底筋膜炎足底筋膜炎Plantar fasciitisPreliminary ultrasound/x-ray 前期超声/x线定位Localization of pain points withbio-
18、feedback 根据人体生物反馈定位痛点Marking of therapy region 标记治疗区域足底筋膜炎，跟骨骨刺足底筋膜炎，跟骨骨刺Plantar fasciitis,Heel Spur足底筋膜炎，跟骨骨刺足底筋膜炎，跟骨骨刺Plantar fasciitis,Heel Spur足底筋膜炎，跟骨骨刺足底筋膜炎，跟骨骨刺Plantar fasciitis,Heel Spur研究研究Studies2000次冲击波，治疗3次，一周一次2000,3 sessions,1/week跟骨骨刺跟骨骨刺Heel Spur发散式冲击波，2000次，治疗3次，1周1次RSW,2000,3 sessi
19、ons,1/week肱骨外上髁炎肱骨外上髁炎HERRSW,5 sessions,1/weekRSW,2000,3 sessions,1/week 发散式冲击波，2000次，治疗3次，1周1次肩袖钙化性肌腱炎肩袖钙化性肌腱炎Calcific Tendinitis of Rotator Cuff钙化性肌腱炎，聚焦式冲击波钙化性肌腱炎，聚焦式冲击波Tendinosis Calcarea,FSW夹挤综合症，聚焦式冲击波夹挤综合症，聚焦式冲击波Impingement Syndrome,FSW发散式冲击波，治疗5次，1周1次RSW,5 sessions,1/week疼痛治疗疼痛治疗Sports-Induc
20、ed Diseases肌筋膜疼痛综合症Myofascial pain syndrome扳机点治疗Trigger point treatment肌筋膜疼痛综合征肌筋膜疼痛综合征Myofascial pain syndrome可用可用RSWT成功治愈的骨科适应症成功治愈的骨科适应症 Orthopaedic indications which can be treated successfully with RSWT 上位及低位颈部综合征上位及低位颈部综合征Upper and lower Cervical-Syndrome肩周痛肩周痛Periarticular shoulder pain前臂屈伸肌腱
21、炎前臂屈伸肌腱炎Tendomyosis in the extensor and flexor region of the forearm 上踝病变上踝病变Epicondylopathy背痛背痛Dorsalgia(Back pain)臀肌痛臀肌痛Glutealgia 内收肌疼痛内收肌疼痛Pain in the adductor muscles 股屈伸肌痉挛股屈伸肌痉挛Shortenings in the femoral flexor and extensor muscles 小腿筋膜间室综合征小腿筋膜间室综合征Peroneal compartment syndrome胫前综合征胫前综合征Tibi
22、al anterior syndrome 胫骨压力综合征（胫骨疲劳性骨膜综合征）胫骨压力综合征（胫骨疲劳性骨膜综合征）Tibial stress syndrome(Shin splint)伴有伴有/不伴有跟腱痛的小腿肌肉萎缩不伴有跟腱痛的小腿肌肉萎缩Shortening of the calf muscle with and without Achillodynia 跖骨痛跖骨痛Metatarsalgia肌筋膜疼痛综合征肌筋膜疼痛综合征Myofascial pain syndrome可用可用RSWT成功治愈的骨科适应症成功治愈的骨科适应症 Orthopaedic indications whi
23、ch can be treated successfully with RSWT肌筋膜疼痛综合征肌筋膜疼痛综合征Myofascial pain syndrome治疗长度Length of treatment取决于肌肉刺激的持续范围和时间Depending on the extent and duration of the muscle irritation早期疼痛可经过1-2次治疗成功治愈。Early stage complaints can be treated successfully with 1-2 treatments sessions 多数案例中，痛点的缓解/解除需要4-8次治疗（
24、一周12次治疗）In most cases several treatment sessions(4-8)are required to release/eliminate the pain points(1-2 treatments/week).建议尽早采用扳机点治疗It is recommended to start trigger point treatment at the most possible early stage肌筋膜疼痛综合征肌筋膜疼痛综合征Myofascial pain syndrome 冲击波治疗的优点Benefits of shock wave therapy 促进
25、组织再生Strong regenerative effect on the tissue可深入组织治疗，而不伤皮肤Penetrate deep inside the tissue without harming the skin 因此冲击波操作方便，易于重复治疗。可被大多数患者接受。Therefore shock wave therapy can be easily repeated and is well tolerated by most patients.超声波扫描术超声波扫描术Sonography 给病人提供最安全的治疗方案 Gives the patients the most po
26、ssible treatment safety 可识别不可采用ESWT治疗的结构改变（例如肿瘤）Structural modifications which must not be treated with RSWT(e.g.tumors)will be recognized肌筋膜疼痛综合征肌筋膜疼痛综合征Myofascial pain syndrome 冲击波治疗前的诊断Diagnostics before shock wave therapy 上位及低位颈部综合征上位及低位颈部综合征Upper and lower Cervical-Syndrome 臂痛、背痛、头痛with brachia
27、lgia,dorsalgia and cephalgia 半棘肌半棘肌/夹肌，夹肌，C3以下以下Semispinalis/Splenius muscle,caudal C3 上位及低位颈部综合征上位及低位颈部综合征Upper and lower Cervical-Syndrome 臂痛、背痛、头痛with brachialgia,dorsalgia and cephalgia 半棘肌半棘肌/夹肌，夹肌，C3以下以下Semispinalis/Splenius muscle caudal C3 Recommended treatment:Radial 使用发散性治疗使用发散性治疗上位及低位颈部综合征上位及低位颈部综合征Upper and lower Cervical-Syndrome 臂痛、背痛、头痛with brachialgia,dorsalgia and cephalgia 三角肌三角肌Deltoid muscle 肩周痛肩周痛Periarticular shoulder pain hfy19861225126谢谢！
