冲击波疼痛治疗.ppt

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1、RSWT WORKSHOP体外冲击波疗法体外冲击波疗法有效治疗范围有效治疗范围Radial ExtensionHandpiece 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 探头Transmitter在组织中传播spreads in the tissueED:能流密度ED:energy flux density生物效应生物效应Biological effects声学边界的能量释放Energy release at acoustic boundaries空化作用Cavitation 增加细胞壁的通透性Increase of c

2、ell wall permeability刺激微循环（血液、淋巴）Stimulation of Microcirculation(Blood,Lymph)释放P物质Release of Substance P 减少非髓鞘神经Reduction of unmyelinated nerves释放一氧化氮（血管舒张，细胞新陈代谢增加，血管新生，抗炎作用）Release of Nitric oxide(vasodilation,increased cell metabolism,neoangogenesis,anti-inflammatory effect)抗菌作用Antibacterial effe

3、ct 刺激生长因子（血管、骨骼、胶原蛋白新生）Stimulation of Growth factors(neogenesis of vessels,bone,collagen)刺激干细胞Stimulation of Stem cells 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

4、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 cortis

5、one 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reddening 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 p

6、ain 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冲击波治疗的益冲击波治疗的益处处Benefits of Shock W

7、ave Treatment 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?)经典适应症经典适应症CLASSIC INDICATIONS经典适应症经典适应症Classic Indications Calc

8、ific tendonitis/shoulder pain钙化性肌腱炎/肩痛Achillodynia 跟腱痛Plantar fasciitis 足底筋膜炎Ulnar humeral epicondylitis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 poin

9、ts 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 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 ses

10、sions3 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/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

11、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 tendon 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

12、 pain钙化肌腱炎钙化肌腱炎/肩痛肩痛Calcific tendonitis/Shoulder painCalcific tendonitis/Shoulder pain 钙化性肌腱炎钙化性肌腱炎/肩痛肩痛Sessions 治疗治疗次数次数Energy 能级能级(bar)Pulses/session 每每次治疗使用脉冲数次治疗使用脉冲数Freq 频率频率(Hz)Trans-mitter 探头探头Supraspinatus tendon 冈上肌腱1.Pain points 痛点3 51.8 4.01500 300012 15R15,DI152.Muscles 肌肉1.8 3.02000 300

13、015 21D20-STreatment interval:5-7day 治疗间隔：治疗间隔：5-7天天病人仰卧位病人仰卧位 R-SW应用应用 于腹外侧位于腹外侧位Supine patient positioning R-SW application in ventrolateral position 钙化性肌腱炎钙化性肌腱炎/肩痛肩痛Calcific tendonitis/Shoulder pain 仅使用发散性冲击波疗法Only with radial shock wave therapyTenderness in the region of thelateral epicondyle确定

14、上踝侧 位区柔软度Greatest tension is elicited withthe elbow in extension,forearmin pronation,and wrist in flexion肘部外展、前臂转至手掌向下、腕关节弯曲，造成最大张力状态Preliminary ultrasound/x-ray for localization ofepicondyle 前期上踝超声或x线定位Marking of therapy region 标记治疗区域 肱骨外上踝炎肱骨外上踝炎Radial humeral epicondylitis肱骨内上髁炎肱骨内上髁炎Radial humer

15、al epicondylitis DDRadial humeral epicondylitis 肱骨外上髁炎肱骨外上髁炎Sessions 治疗治疗次数次数Energy 能级能级(bar)Pulses/session 每次治疗使用每次治疗使用脉冲数脉冲数Freq 频率频率(Hz)Transmitter 探头探头Tendon insertion(painful spot)腱附着端（痛点）1.Pain points 痛点5 81.8 4.01500 300012 15R151.8 3.02000 300015 21D20-SAdjacent upper arm and forearm muscles

16、邻近的上臂与前臂的肌肉邻近的上臂与前臂的肌肉2.Muscles 肌肉Treatment interval:5-7 days 治疗间隔：治疗间隔：5-7天天病人仰卧位病人仰卧位 肘部弯曲大约肘部弯曲大约130度，手掌向下。度，手掌向下。R-SW（R15）应用于腱附着端。接着使用）应用于腱附着端。接着使用D20-S治疗邻近的上臂与前臂的肌肉。治疗邻近的上臂与前臂的肌肉。肱骨外上髁炎肱骨外上髁炎Radial humeral epicondylitis 仅使用发散性冲击波疗法Only with radial shock wave therapy 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 positioning Extension of elbow joint.Smoothing of surrounding muscles with the V-ACTOR.肱骨外上髁炎Radial humeral epicondylitisESWT New Treatment GuidePreliminary ultrasound