冲击波疼痛治疗.ppt

rswt workshop,体外冲击波疗法,有效治疗范围 radial extension,handpiece 手柄,表面，高能流密度 surface, high ed 0,35 mj/mm2,深度，低能流密度 depth, low ed,探头transmitter,在组织中传播 spreads in the tissue,ed: 能流密度 ed: energy flux density,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 cell 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 effect 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 absolute contraindications,妊娠pregnancy 血栓症thrombosis 血凝固紊乱（血友病）coagulation disorders (haemophilia) 肿瘤疾病tumour diseases 急性炎症acute inflammation 目标治疗区脓肿pus focus in the target area,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k拮抗剂） use of anticoagulants, especially marcumar (vitamin k antagonist) 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 cortisone therapy up to 6 weeks before first eswt treatment 风湿性疾病 rheumatic disease,肿胀swelling 变红reddening 血肿haematomas 瘀点petechiae 灼伤般疼痛感pain like sunburn 治疗初期病情恶化first worsening,副作用 side effects,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/减轻 pain relief/ reduction after a few treating sessions 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 the patients can feel first effects directly after the treatment 能治疗复杂症状及相关适应症 treatment of complex symptoms/ indications possible,冲击波治疗的益处 benefits of shock wave treatment,治疗结缔组织 treatment of connective tissue 活化淋巴系统 activation of lymphatic system 大面积治疗 treatment of large areas possible 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 classic indications,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 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 protocol,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close dialogue with the patient 生物反馈biofeedback 2000次发散式冲击波 radial shocks 2000 多数学派的治疗方法protocol of the most studies 传统派old school 新派：联合疗法，治疗扳机点 new: combined therapy, trigger points,治疗方法 protocol,治疗间隔：5-7天 interval 5 7days 治疗次数：3-5次 sessions 3 5 最晚在第5次治疗后进入休息期 break latest after 5th session,钙化肌腱炎/肩痛 calcific tendonitis/shoulder pain,前期超声或x线定位/决定治疗区域与深度preliminary ultrasound or x-ray localization/ determination of penetration depth and treatment area 在皮肤上标记出治疗区域marking of therapeutic window on the skin 在90%的例子中，旋转套的冈上肌腱感染，需要治疗。in approx. 90% of the cases the supraspinatus tendon of the rotator cuff is affected and has to be treated,钙化肌腱炎/肩痛 calcific tendonitis/shoulder pain,钙化肌腱炎/肩痛 calcific tendonitis/shoulder pain,钙化肌腱炎/肩痛 calcific tendonitis/shoulder pain,钙化肌腱炎/肩痛 calcific tendonitis/shoulder pain,treatment interval: 5 - 7day 治疗间隔：5 -7天,病人仰卧位 r-sw应用 于腹外侧位 supine patient positioning r-sw application in ventrolateral position,钙化性肌腱炎/肩痛calcific tendonitis/shoulder pain 仅使用发散性冲击波疗法only with radial shock wave therapy,tenderness in the region of the lateral epicondyle确定上踝侧 位 区柔软度greatest tension is elicited with the elbow in extension, forearm in 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 of epicondyle 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radial humeral epicondylitis,肱骨内上髁炎radial humeral epicondylitis dd,treatment interval: 5 - 7 days 治疗间隔： 5 - 7天,病人仰卧位 肘部弯曲大约130度，手掌向下。r-sw（r15）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。,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-肘关节外展。 用v-actor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 epicondylitis,eswt new treatment guide,preliminary ultrasound/ x-ray for localization of epicondyle 前期上髁超声或x线定位 marking of therapy region 标记治疗区域,肱骨内上髁炎 ulnar humeral epicondylitis,eswt new treatment guide,treatment interval: 5 - 7 days 治疗间隔：5 - 7 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 肘关节弯曲大约30-40度，手心向上。r-sw(r15)应用于腱附着端。,supine patient positioning extension of elbow joint, supination position. smoothing of forearm muscles with d20-s. 病人仰卧位 肘关节外展，手心向上。用d20-s按摩前臂肌肉。,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ulnar humeral epicondylitis,病人仰卧位-肘关节外展。 用v-actor按摩邻近肌肉。 supine patient positioning extension of elbow joint. smoothing of surrounding muscles with the v-actor。,preliminary ultrasound/ x-ray for localization, determination of penetration depth 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trochanteric tendonitis,eswt new treatment guide,转子肌腱炎trochanteric tendonitis dd,treatment interval: 5 - 7 days 治疗间隔： 5 - 7天,lateral patient positioning smoothing of associated muscles with d35. 病人侧卧位 用d35按摩相关肌肉。,lateral patient positioning r-sw application (di15) on the tip of the trochanter, m. piriformis and associated muscles. 病人侧卧位 r-sw（di15）应用于转子尖、梨状肌及相关肌肉。,转子肌腱炎 trochanteric tendonitis 仅使用发散式冲击波疗法only radial shock wave therapy,patellar tendonitis (jumpers knee) 髌骨肌腱炎（跳跃膝）,preliminary ultrasound/ x-ray for localization, determination of penetration depth 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） patellar tendonitis (jumpers knee),treatment interval: 5 - 7 days 治疗间隔：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。,supine patient positioning with the knee on a half roll. fixation of paellar zone with a cuff. smoothing of adjacent muscles with d20. 病人仰卧位，膝盖置于半圆柱形物上。用一条绷带固定髌骨区。用d20按摩相邻肌肉。,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 therapy region 标记治疗区域,胫骨压力综合征（胫骨疲劳性骨膜炎） tibial stress syndrome (shin splint),eswt new treatment guide,treatment interval: 5 - 7 days 治疗间隔：5 - 7 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r-sw。,胫骨压力综合征（胫骨疲劳性骨膜炎） tibial stress syndrome (shin splint) 仅使用发散式冲击波疗法only radial shock wave therapy,跟腱痛 achillodynia,preliminary ultrasound / x-ray 前期超声/x线定位 marking of therapy region 标记治疗区域,跟腱痛 achillodynia,跟腱痛 achillodynia,足底筋膜炎plantar fasciitis,preliminary ultrasound/ x-ray 前期超声/x线定位 localization of pain points with bio-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plantar fasciitis, heel spur,足底筋膜炎，跟骨骨刺 plantar fasciitis, heel spur,足底筋膜炎，跟骨骨刺plantar fasciitis, heel spur,abdominal patient position with foot on a half roll. r-sw (di15) application. localization of patients with bio-feedback. 病人腹卧们，脚置于半圆柱形物上。使用r-sw(di15)。利用生物反馈进行痛点定位。,treatment interval: 5 - 7 days 治疗间隔： 5 - 7天,足底筋膜炎plantar fasciitis 仅使用发散式冲击波疗法only radial shock wave therapy,研究 studies,2000次冲击波，治疗3次，一周一次 2000, 3 sessions, 1/ week,跟骨骨刺heel spur,肱骨外上髁炎her,发散式冲击波，2000次，治疗3次，1周1次 rsw, 2000, 3 sessions, 1/ week,肩袖钙化性肌腱炎 calcific tendinitis of rotator cuff,rsw, 5 sessions, 1/ week,rsw, 2000, 3 sessions, 1/ week 发散式冲击波，2000次，治疗3次，1周1次,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 impingement syndrome, fsw,sports-induced diseases,发散式冲击波，治疗5次，1周1次 rsw, 5 sessions, 1/ week,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myofascial pain syndrome 可用rswt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 上踝病变epicondylopathy 背痛dorsalgia (back pain) 臀肌痛glutealgia,肌筋膜疼痛综合征myofascial pain syndrome 可用rswt成功治愈的骨科适应症 orthopaedic indications which can be treated successfully with rswt,内收肌疼痛pain in the adductor muscles 股屈伸肌痉挛shortenings in the femoral flexor and extensor muscles 小腿筋膜间室综合征peroneal compartment syndrome 胫前综合征tibial anterior syndrome 胫骨压力综合征（胫骨疲劳性骨膜综合征）tibial stress syndrome (shin splint) 伴有/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metatarsalgia,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（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myofascial pain syndrome 冲击波治疗的优点benefits of shock wave therapy,促进组织再生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sonography 给病人提供最安全的治疗方案 gives the patients the most possible 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upper and lower cervical-syndrome 臂痛、背痛、头痛with brachialgia, dorsalgia and cephalgia,trapezius muscle 斜方肌,recommended treatment: radial. 使用发散式治疗,上位及低位颈部综合征upper and lower cer