(完整版)冲击波疼痛治疗
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Trochanteric tendonitis 转子肌腱炎
Patellar tendonitis 髌腱炎
Tibial stress syndrome 胫骨压力症候群
Calcific tendonitis/ shoulder pain 钙化性肌腱炎/肩痛
Achillodynia 跟腱痛 Plantar fasciitis 足底筋膜炎
➢ 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
• 能治疗复杂症状及相关适应症
treatment of complex symptoms/ indications possible
China_2010-08-29
冲击波治疗的益处
Benefits of Shock Wave Treatment
• 治疗结缔组织
treatment of connective tissue
China_2010-08-29
经典适应症
CLASSIC INDICATIONS
China_2010-08-29
经典适应症
Classic Indications
Radial humeral epicondylitis 肱骨外上髁炎
Ulnar humeral epicondylitis 肱骨内上踝炎
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
China_2010-08-29
China_2010-08-29
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
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
表面，高能流密度 surface, high ED
0,35 mJ/mm2
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
体外冲击波疗法
China_2010-08-29
有效治疗范围
Radial Extension
在组织中传播
spreads in the tissue
探头Transmitter
深度，低能流密度 depth, low ED
China_2010-08-29
Handpiece 手柄
ED: 能流密度 ED: energy flux density
China_2010-06-23
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
• 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?)
• 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
China_2010-08-29
相对禁忌症
RELATIVE CONTRAINDICATIONS
• 抗凝血剂使用者，特别是来自百度文库丙香豆素（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
副作用
SIDE EFFECTS
• 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
China_2010-08-29
冲击波治疗的益处
Benefits of Shock Wave Treatment
Patellar tendonitis 髌腱炎
Tibial stress syndrome 胫骨压力症候群
Calcific tendonitis/ shoulder pain 钙化性肌腱炎/肩痛
Achillodynia 跟腱痛 Plantar fasciitis 足底筋膜炎
➢ 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
• 能治疗复杂症状及相关适应症
treatment of complex symptoms/ indications possible
China_2010-08-29
冲击波治疗的益处
Benefits of Shock Wave Treatment
• 治疗结缔组织
treatment of connective tissue
China_2010-08-29
经典适应症
CLASSIC INDICATIONS
China_2010-08-29
经典适应症
Classic Indications
Radial humeral epicondylitis 肱骨外上髁炎
Ulnar humeral epicondylitis 肱骨内上踝炎
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
China_2010-08-29
China_2010-08-29
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
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
表面，高能流密度 surface, high ED
0,35 mJ/mm2
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
体外冲击波疗法
China_2010-08-29
有效治疗范围
Radial Extension
在组织中传播
spreads in the tissue
探头Transmitter
深度，低能流密度 depth, low ED
China_2010-08-29
Handpiece 手柄
ED: 能流密度 ED: energy flux density
China_2010-06-23
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
• 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?)
• 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
China_2010-08-29
相对禁忌症
RELATIVE CONTRAINDICATIONS
• 抗凝血剂使用者，特别是来自百度文库丙香豆素（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
副作用
SIDE EFFECTS
• 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
China_2010-08-29
冲击波治疗的益处
Benefits of Shock Wave Treatment