冲击波疼痛治疗课件.ppt

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1、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 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 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

2、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 e

3、ffect 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

4、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

5、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 directl

6、y 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 cont

7、rol, 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 tendoniti

8、s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 interval5 7days治疗次

9、数：3-5次 sessions3 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 orx-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。

10、In approx. 90% of the casesthe 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 - 7d

11、ay 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 thelateral epicondyle确定上踝侧 位区柔软度Greatest tension is elicited withthe elbow in ex

12、tension, 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

13、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 epico

14、ndylitis,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. 3

15、0 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 epicond

16、ylitis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 penetrationdepth 前期超声或X线

17、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 applicat

18、ion (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 penetrat

19、iondepth 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 ti

20、bial 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

21、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 applicatio

22、n.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

23、声/x线定位Localization of pain points withbio-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. Localizat

24、ion 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 s

25、essions, 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

26、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

27、 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 s

28、yndrome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

29、 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 recommende

30、d 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

31、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 p

32、ain 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 Cervical-Syndrome臂痛、背痛、头痛with brachialgia, dorsalgia and cep

33、halgia,半棘肌/夹肌，C3以下Semispinalis/Splenius muscle, caudal C3,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/夹肌，C3以下Semispinalis/Splenius muscle caudal C3,Recommended treatment: Radial 使用发散性治疗,上位及低位颈部综合征Upper and lower Cervical-Syndrome 臂痛、背痛、头痛with bra

34、chialgia, dorsalgia and cephalgia,三角肌Deltoid muscle,肩周痛Periarticular shoulder pain,三角肌Deltoid muscle,Recommended treatment: Focused and radial. 使用发散式治疗。,肩周痛Periarticular shoulder pain,Recommended treatment: Mainly radial.使用发散式治疗,前臂屈伸肌腱炎Tendomyosis in the extensor and flexor region of the forearm,Rec

35、ommended treatment: radial. 使用发散式治疗。,臀肌痛 Glutealgia,Recommended treatment: Mainly radial.使用发散式治疗。,股屈伸肌痉挛Shortenings in the femoral extensor and flexor muscles 髌骨软骨炎或髌骨肌腱炎in case of patellar chondropathy / patellar tendonitis,Recommended treatment: Mainly radial. 使用发散式治疗。,股屈伸肌痉挛Shortenings in the femoral extensor and flexor muscles髌骨软骨炎或髌骨肌腱炎in case of patellar chondropathy / patellar tendonitis,Thank you,