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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(haem

ophilia)•肿瘤疾病tumourdiseases•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,especiallymarcumar(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cortisonetherapyupto6weeksbeforefirstESWTtreatment•风湿性疾病rheumaticdisease•肿胀swelling•变红reddening•血肿haematomas•瘀点petechiae•灼伤般疼痛感painlikesunb

urn•治疗初期病情恶化firstworsening副作用SIDEEFFECTS冲击波治疗的益处BenefitsofShockWaveTreatment•几次治疗后，疼痛即得到缓解/减轻painrelie

f/reductionafterafewtreatingsessions•治疗依从性好thecomplianceisverygood•治疗后病人能直接感受到第一疗效thepatientscanfeelfirsteffectsdirectlyafterthetre

atment•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ac

tivationoflymphaticsystem•大面积治疗treatmentoflargeareaspossible•作用于神经系统（门控制、疼痛记忆）effectsonthenervoussystem(gatecontrol,painmemory?)冲击波治疗的益处Benef

itsofShockWaveTreatment经典适应症CLASSICINDICATIONS经典适应症ClassicIndicationsCalcifictendonitis/shoulderpain钙化性肌腱炎/肩痛Achillodynia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Trochanterictend

onitis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inte

rval5–7days➢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Calcifictendonitis/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Markin

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

tatorcuffisaffectedandhastobetreated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Calcifi

ctendonitis/Shoulderpain钙化肌腱炎/肩痛Calcifictendonitis/Shoulderpain肱骨内上髁炎Radialhumeralepicondylitis–DDTreatmentinterv

al:5-7days治疗间隔：5-7天Supinepatientpositioning–Flexionofelbowjointapprox.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–Extensio

nofelbowjoint,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Ulnarhumera

lepicondylitis仅使用发散性冲击波疗法OnlyradialshockwavetherapyPreliminaryultrasound/x-rayforlocalization,determinationofpenetrationdep

th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TrochantericTendonitisESWTNewTreatmentGuide转子肌腱炎TrochantericTendonitis–DDPatellartendonitis

(Jumper’sKnee)髌骨肌腱炎（跳跃膝）Preliminaryultrasound/x-rayforlocalization,determinationofpenetrationdepth前期超声或x线定位，确定治疗深度Markingofth

erapyregion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)applicationatthepatella(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。Supinepatientpositioningwiththekneeonahalfroll.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Onlyradialshockwavetherapy

Preliminaryultrasound/x-ray前期超声/X线定位Markingoftherapyregion标记治疗区域胫骨压力综合征（胫骨疲劳性骨膜炎）Tibialstresssyndrome(Shinsplint)ESWTNewTreatmentGuideTreatmen

tinterval: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(Shinsplint)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Markingoftherapyregion标记治疗区域跟腱痛Achillodynia跟腱痛Achillodynia足底筋膜炎PlantarfasciitisPreliminaryultrasound/x-ra

y前期超声/x线定位Localizationofpainpointswithbio-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Triggerpointtreatment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Epic

ondylopathy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Shor

teningofthecalfmusclewithandwithoutAchillodynia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Orthopaedicindicationswhichcanb

etreatedsuccessfullywithRSWT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Dependingontheext

entanddurationofthemuscleirritation早期疼痛可经过1-2次治疗成功治愈。Earlystagecomplaintscanbetreatedsuccessfullywith1-2tre

atmentssessions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）Inmostcasesseveraltreatmentsessions(4-8)arerequiredtorelease/eliminatet

hepainpoints(1-2treatments/week).建议尽早采用扳机点治疗Itisrecommendedtostarttriggerpointtreatmentatthemostpossibleearlystag

e上位及低位颈部综合征UpperandlowerCervical-Syndrome臂痛、背痛、头痛withbrachialgia,dorsalgiaandcephalgia半棘肌/夹肌，C3以下Semispi

nalis/Spleniusmuscle,caudalC3上位及低位颈部综合征UpperandlowerCervical-Syndrome臂痛、背痛、头痛withbrachialgia,dorsalgiaandcephalgia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UpperandlowerCervical-Syndrome臂痛、背痛、头痛withbrachialgia,dorsalgi

aandcephalgia三角肌Deltoidmuscle肩周痛Periarticularshoulderpainhfy19861225126谢谢！