【文档说明】冲击波治疗骨肌疾病课件.ppt，共(41)页，8.708 MB，由小橙橙上传

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冲击波治疗骨肌疾病绝对禁忌症ABSOLUTECONTRAINDICATIONS•妊娠Pregnancy•血栓症thrombosis•血凝固紊乱（血友病）coagulationdisorders(haemophilia)•肿瘤疾病tumourdisea

ses•急性炎症acuteinflammation•目标治疗区脓肿pusfocusinthetargetarea相对禁忌症RELATIVECONTRAINDICATIONS•抗凝血剂使用者，特别是苯丙香豆素（维生素K拮抗剂）useofanticoagulants,especiallymarc

umar(vitaminkantagonist)•有多发性神经病的糖尿病polyneuropathyincaseofdiabetesmellitus•可的松治疗结束六周后才能使用体外冲击波治疗cortisonetherapyupto6weeksbeforefirstESWTt

reatment•风湿性疾病rheumaticdisease•肿胀swelling•变红reddening•血肿haematomas•瘀点petechiae•灼伤般疼痛感painlikesunburn•治疗初期病情恶化firstworsening副作用SIDEEFFECTS冲击波治疗的益处Ben

efitsofShockWaveTreatment•几次治疗后，疼痛即得到缓解/减轻painrelief/reductionafterafewtreatingsessions•治疗依从性好thecomplianceisverygoo

d•治疗后病人能直接感受到第一疗效thepatientscanfeelfirsteffectsdirectlyafterthetreatment•能治疗复杂症状及相关适应症treatmentofcomplexsymptoms/indicationspossible•治疗

结缔组织treatmentofconnectivetissue•活化淋巴系统activationoflymphaticsystem•大面积治疗treatmentoflargeareaspossible•作用于神经系统（门控制、疼痛记忆）effectsonthenervoussystem(ga

tecontrol,painmemory?)冲击波治疗的益处BenefitsofShockWaveTreatment经典适应症CLASSICINDICATIONS经典适应症ClassicIndicationsCalcifictendonitis/shoulderpain钙化性肌腱炎/肩痛Ac

hillodynia跟腱痛Plantarfasciitis足底筋膜炎Ulnarhumeralepicondylitis肱骨内上踝炎Tibialstresssyndrome胫骨压力症候群Radialhumeralepicondylitis肱骨外上髁炎Trochan

terictendonitis转子肌腱炎Patellartendonitis髌腱炎治疗方法PROTOCOL➢查找主要痛点和其他痛点lookforthemainandotherpainpoints➢与病人密切交谈closedialoguewiththepatient➢生物反馈biofeedback➢

2000次发散式冲击波radialshocks2000➢多数学派的治疗方法protocolofthemoststudies传统派oldschool新派：联合疗法，治疗扳机点new:combinedtherapy,triggerpoints治疗方法PROTOCOL➢治疗

间隔：5-7天interval5–7days➢治疗次数：3-5次sessions3–5➢最晚在第5次治疗后进入休息期breaklatestafter5thsession钙化肌腱炎/肩痛Calcific

tendonitis/Shoulderpain前期超声或X线定位/决定治疗区域与深度Preliminaryultrasoundorx-raylocalization/determinationofpenetrationdepthandtreatmentarea在皮肤上标记出治疗区域Mark

ingoftherapeuticwindowontheskin在90%的例子中，旋转套的冈上肌腱感染，需要治疗。Inapprox.90%ofthecasesthesupraspinatustendonoftherotatorcuffisaffectedandh

astobetreated钙化肌腱炎/肩痛Calcifictendonitis/Shoulderpain钙化肌腱炎/肩痛Calcifictendonitis/Shoulderpain钙化肌腱炎/肩痛Calcifictendonitis/Shoulderpain钙化肌腱

炎/肩痛Calcifictendonitis/Shoulderpain肱骨内上髁炎Radialhumeralepicondylitis–DDTreatmentinterval:5-7days治疗间隔：5-7天Supinepatientpositioning–Fle

xionofelbowjointapprox.30to40degree,supinationposition.R-SW(R15)applicationatthetendoninsertion.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。Supinepatientpositioning–Extensionofelbowjoint,supinationposition.SmoothingofforearmmuscleswithD20-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Ulnarhumeralepicondylitis仅使用发散性冲击波疗法OnlyradialshockwavetherapyPreliminaryultrasound/x-rayforloca

lization,determinationofpenetrationdepth前期超声或X线定位，确定治疗深度Markingoftherapyregion标记治疗区域转子肌腱炎TrochantericTendonitis

ESWTNewTreatmentGuide转子肌腱炎TrochantericTendonitis–DDPatellartendonitis(Jumper’sKnee)髌骨肌腱炎（跳跃膝）Preliminaryultrasound/x-rayforlocali

zation,determinationofpenetrationdepth前期超声或x线定位，确定治疗深度Markingoftherapyregion标记治疗区域髌骨肌腱炎（跳跃膝）Patellartendonitis(Jumper’

sKnee)Treatmentinterval:5-7days治疗间隔：5-7天Supinepatientpositioningwiththekneeonahalfroll.Fixationofpatellarzonewithacuff.R-SW(R15)applicat

ionatthepatella(tip,basis)andtibialtendoninsertion.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。Supinepatientpositioning

withthekneeonahalfroll.Fixationofpaellarzonewithacuff.SmoothingofadjacentmuscleswithD20.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Patellartendonitis(Jumper’sKnee)仅使用发散式冲击波疗法OnlyradialshockwavetherapyPreliminaryultrasound/x-ray前期超声/X线定位Markingofth

erapyregion标记治疗区域胫骨压力综合征（胫骨疲劳性骨膜炎）Tibialstresssyndrome(Shinsplint)ESWTNewTreatmentGuideTreatmentinterval:5-7days治疗间隔：5

-7天Supinepatientpositioningwithkneeonahalfroll.R-SWapplication.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）Tibialstresssyndrome(S

hinsplint)仅使用发散式冲击波疗法Onlyradialshockwavetherapy跟腱痛AchillodyniaPreliminaryultrasound/x-ray前期超声/x线定位Markingofther

apyregion标记治疗区域跟腱痛Achillodynia跟腱痛Achillodynia足底筋膜炎PlantarfasciitisPreliminaryultrasound/x-ray前期超声/x线定位Localizationofpainpo

intswithbio-feedback根据人体生物反馈定位痛点Markingoftherapyregion标记治疗区域足底筋膜炎，跟骨骨刺Plantarfasciitis,HeelSpur足底筋膜炎，跟骨骨刺Plant

arfasciitis,HeelSpur足底筋膜炎，跟骨骨刺Plantarfasciitis,HeelSpur肌筋膜疼痛综合症Myofascialpainsyndrome扳机点治疗Triggerpoi

nttreatment肌筋膜疼痛综合征Myofascialpainsyndrome可用RSWT成功治愈的骨科适应症OrthopaedicindicationswhichcanbetreatedsuccessfullywithRSWT上位及低位

颈部综合征UpperandlowerCervical-Syndrome肩周痛Periarticularshoulderpain前臂屈伸肌腱炎Tendomyosisintheextensorandflexorregionoftheforearm上踝病变Epicondylopa

thy背痛Dorsalgia(Backpain)臀肌痛Glutealgia内收肌疼痛Painintheadductormuscles股屈伸肌痉挛Shorteningsinthefemoralflexorandextensormuscles

小腿筋膜间室综合征Peronealcompartmentsyndrome胫前综合征Tibialanteriorsyndrome胫骨压力综合征（胫骨疲劳性骨膜综合征）Tibialstresssyndrome(Shinsplint)伴有/不伴有跟腱痛的小腿肌肉萎缩Shortening

ofthecalfmusclewithandwithoutAchillodynia跖骨痛Metatarsalgia肌筋膜疼痛综合征Myofascialpainsyndrome可用RSWT成功治愈的骨科适应症Orthopaedicindicationswhichcan

betreatedsuccessfullywithRSWT肌筋膜疼痛综合征Myofascialpainsyndrome治疗长度Lengthoftreatment取决于肌肉刺激的持续范围和时间Dependingontheextentanddurationofthemusclei

rritation早期疼痛可经过1-2次治疗成功治愈。Earlystagecomplaintscanbetreatedsuccessfullywith1-2treatmentssessions多数案例中，痛点的缓解/解除需要4-8次治疗（一周1—2次治疗）Inmostcas

esseveraltreatmentsessions(4-8)arerequiredtorelease/eliminatethepainpoints(1-2treatments/week).建议尽早采用扳机点治疗Itisrecommendedtosta

rttriggerpointtreatmentatthemostpossibleearlystage上位及低位颈部综合征UpperandlowerCervical-Syndrome臂痛、背痛、头痛withbrachialgia,dorsalgiaandcep

halgia半棘肌/夹肌，C3以下Semispinalis/Spleniusmuscle,caudalC3上位及低位颈部综合征UpperandlowerCervical-Syndrome臂痛、背痛、头痛withbrachialgia,dorsalg

iaandcephalgia半棘肌/夹肌，C3以下Semispinalis/SpleniusmusclecaudalC3Recommendedtreatment:Radial使用发散性治疗上位及低位颈部综合征UpperandlowerCervica

l-Syndrome臂痛、背痛、头痛withbrachialgia,dorsalgiaandcephalgia三角肌Deltoidmuscle肩周痛Periarticularshoulderpainhfy19861225126

谢谢！