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China_2010-08-29RSWTWORKSHOP体外冲击波疗法China_2010-08-29有效治疗范围RadialExtensionHandpiece手柄表面，高能流密度surface,highED0,35mJ/mm2深度

，低能流密度depth,lowED探头Transmitter在组织中传播spreadsinthetissueED:能流密度ED:energyfluxdensityChina_2010-06-23生物效应Biologicaleff

ects▪声学边界的能量释放Energyreleaseatacousticboundaries▪空化作用Cavitation▪增加细胞壁的通透性Increaseofcellwallpermeability▪刺激微循环（

血液、淋巴）StimulationofMicrocirculation(Blood,Lymph)▪释放P物质ReleaseofSubstanceP▪减少非髓鞘神经Reductionofunmyelinatednerves▪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）R

eleaseofNitricoxide(vasodilation,increasedcellmetabolism,neoangogenesis,anti-inflammatoryeffect)▪抗菌作用Antibacterialeffect▪刺激生长因

子（血管、骨骼、胶原蛋白新生）StimulationofGrowthfactors(neogenesisofvessels,bone,collagen)▪刺激干细胞StimulationofStemcellsChina_2010-08-29绝对禁忌症ABSOLUTECONTRAI

NDICATIONS•妊娠Pregnancy•血栓症thrombosis•血凝固紊乱（血友病）coagulationdisorders(haemophilia)•肿瘤疾病tumourdiseases•急性炎

症acuteinflammation•目标治疗区脓肿pusfocusinthetargetareaChina_2010-08-29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rheumaticdiseaseChina_2010-08-29•肿胀swelling•变红re

ddening•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SIDEEFFECTSChina_2010-08-29冲击波治疗的益处BenefitsofShockWa

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

•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/indicationspossibleChina_2010-

08-29冲击波治疗的益处BenefitsofShockWaveTreatment•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(gatecontrol,painmemory?)China_2010-08-29经典适应症CLASSICINDICATIONSChina_201

0-08-29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Tibi

alstresssyndrome胫骨压力症候群Radialhumeralepicondylitis肱骨外上髁炎Trochanterictendonitis转子肌腱炎Patellartendonitis髌腱炎Chi

na_2010-08-29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➢20

00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,triggerpointsChina_2010-08-29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breaklatestafter5thsessionChina_2010-08-29钙化肌腱炎/肩痛Calcifictendonit

is/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Marking

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

astobetreatedChina_2010-08-29钙化肌腱炎/肩痛Calcifictendonitis/ShoulderpainChina_2010-08-29钙化肌腱炎/肩痛Calcifictendonitis/ShoulderpainCh

ina_2010-08-29钙化肌腱炎/肩痛Calcifictendonitis/ShoulderpainChina_2010-08-29钙化肌腱炎/肩痛Calcifictendonitis/ShoulderpainChina_2010-08-29

Calcifictendonitis/Shoulderpain钙化性肌腱炎/肩痛Sessions治疗次数Energy能级(bar)Pulses/session每次治疗使用脉冲数Freq频率(Hz)Trans-mitt

er探头Supraspinatustendon冈上肌腱1.Painpoints痛点3–51.8–4.01500–300012–15R15,DI152.Muscles肌肉1.8–3.02000–300015–21D20-STreatmentinterval:5-7day治疗间隔：5-7天病人仰卧

位–R-SW应用于腹外侧位Supinepatientpositioning–R-SWapplicationinventrolateralposition钙化性肌腱炎/肩痛Calcifictendonitis/Shoulderpain仅使用发散性冲击波疗法Onlywithradials

hockwavetherapyChina_2010-08-29Tendernessintheregionofthelateralepicondyle确定上踝侧位区柔软度Greatesttensioniselicitedwiththeel

bowinextension,forearminpronation,andwristinflexion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Preliminaryultrasound/x-rayfor

localizationofepicondyle前期上踝超声或x线定位Markingoftherapyregion标记治疗区域肱骨外上踝炎RadialhumeralepicondylitisChina_2010-

08-29肱骨内上髁炎Radialhumeralepicondylitis–DDChina_2010-08-29Radialhumeralepicondylitis肱骨外上髁炎Sessions治疗次数Energy能级(bar)P

ulses/session每次治疗使用脉冲数Freq频率(Hz)Transmitter探头Tendoninsertion(painfulspot)腱附着端（痛点）1.Painpoints痛点5–81.8–4.01500–300012–15R151.8–3.02000–

300015–21D20-SAdjacentupperarmandforearmmuscles邻近的上臂与前臂的肌肉2.Muscles肌肉Treatmentinterval:5-7days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Radialhumeralepicondylitis仅使用发散性冲击波疗法OnlywithradialshockwavetherapyChina_2010-08-29Preliminaryultrasound

/x-rayforlocalizationofepicondyle前期上髁超声或x线定位Markingoftherapyregion标记治疗区域肱骨内上髁炎UlnarhumeralepicondylitisESWTNewTreatmentGuideChina_2010-08-29Ul

narhumeralepicondylitis肱骨内上髁炎Sessions治疗次数Energy能级(bar)Pulses/session每次治疗使用脉冲数Freq频率(Hz)Transmitter探头Tendoninsertion(painfulspot)腱附着端1.Painpoi

nts痛点5–81.8–4.01500–300012–15R15Adjacentupperarmandforearmmuscles邻近的上臂与前臂的肌肉2.Muscles肌肉1.8–3.02000–300015–21D20-STreatmentinterval:5-7

days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–Ex

tensionofelbowjoint,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O

nlyradialshockwavetherapyChina_2010-08-29Preliminaryultrasound/x-rayforlocalization,determinationofpenetrationdepth前期超声或X线定位，确定治疗深度Markingoftherap

yregion标记治疗区域转子肌腱炎TrochantericTendonitisESWTNewTreatmentGuideChina_2010-08-29转子肌腱炎TrochantericTendonitis–DDChina_2010-08-29Trochantericte

ndonitis转子肌腱炎Sessions治疗次数Energy能级(bar)Pulses/session每次治疗使用脉冲数Freq频率(Hz)Transmitter探头Tendoninsertion腱附着端1.Painpoints痛点6–82.8–3.52000–300015–21R

15,DI15Adjacentmuscles相关肌肉2.Muscles肌肉2.0–3.52000–400021D20-S,D35-STreatmentinterval:5-7days治疗间隔：5-7天Lateralpatientpos

itioning–SmoothingofassociatedmuscleswithD35.病人侧卧位–用D35按摩相关肌肉。Lateralpatientpositioning–R-SWapplication

(DI15)onthetipofthetrochanter,M.piriformisandassociatedmuscles.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TrochantericT

endonitis仅使用发散式冲击波疗法OnlyradialshockwavetherapyChina_2010-08-29Patellartendonitis(Jumper’sKnee)髌骨肌腱炎（跳跃膝）Prelimi

naryultrasound/x-rayforlocalization,determinationofpenetrationdepth前期超声或x线定位，确定治疗深度Markingoftherapyregion标记治疗区域China_2010

-08-29髌骨肌腱炎（跳跃膝）Patellartendonitis(Jumper’sKnee)China_2010-08-29Patellartendonitis髌骨肌腱炎Sessions治疗次数Energy能级(bar)Pulses/session每次治疗

使用脉冲数Freq频率(Hz)Transmitter探头Patella,tibialtendoninsertion髌骨、胫骨腱附着端1.Painpoints痛点6–82.8–3.52000–300015–21R15,DI15Adjacentmuscles相邻肌肉2.Muscles肌肉2.0

–3.52000–400021D20-S,D35-STreatmentinterval:5-7days治疗间隔：5-7天Supinepatientpositioningwiththekneeonahalfroll.Fixat

ionofpatellarzonewithacuff.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.Fixationofpael

larzonewithacuff.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OnlyradialshockwavetherapyChina_2010-08-29Preliminaryultrasound/x-ray前期超声/X线定位Markingoftherapyregio

n标记治疗区域胫骨压力综合征（胫骨疲劳性骨膜炎）Tibialstresssyndrome(Shinsplint)ESWTNewTreatmentGuideChina_2010-08-29Tibialstresssyndrome胫骨压力综合征Sessions治疗次数Energy能级(bar

)Pulses/session每次治疗使用脉冲数Freq频率(Hz)Transmitter探头Medial,inneredgeofshinbone胫骨内缘1.Painpoints痛点6–82.8–3.52000–300015–21R15,

DI15Adjacentmuscles相邻肌肉2.Muscles肌肉2.0–3.52000–400021D20-S,D35-STreatmentinterval:5-7days治疗间隔：5-7天Supinepatien

tpositioningwithkneeonahalfroll.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OnlyradialshockwavetherapyChina_2010-08-29跟腱痛AchillodyniaPreliminaryultrasound/x-ray前期超声/x线定位Marki

ngoftherapyregion标记治疗区域China_2010-08-29跟腱痛AchillodyniaChina_2010-08-29跟腱痛AchillodyniaChina_2010-08-29足底筋膜炎PlantarfasciitisPreliminaryultra

sound/x-ray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China_2010-08-29足底筋膜炎，跟骨骨刺

Plantarfasciitis,HeelSpurChina_2010-08-29足底筋膜炎，跟骨骨刺Plantarfasciitis,HeelSpurChina_2010-08-29足底筋膜炎，跟骨骨刺Plantarfasciitis,HeelSpurCh

ina_2010-08-29Plantarfasciitis足底筋膜炎Sessions治疗次数Energy能级(bar)Pulses/session每次治疗使用脉冲数Freq频率(Hz)Transmitter探头Acuteandchronicpain急性与慢性疼痛1.Painpoi

nts痛点3-52.0–3.03000–350012–15R15,DI152.Muscles肌肉1.8–3.02000–300015–21D20-SAbdominalpatientpositionwithfootonahalfroll.R-SW(DI15)application.Localiz

ationofpatientswithbio-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。Treatmentinterval:5-7days治疗间隔：5-7天足底筋膜炎Plantarfasciitis仅使用发散式冲击波疗法Onlyra

dialshockwavetherapyChina_2010-08-29肌筋膜疼痛综合症Myofascialpainsyndrome扳机点治疗TriggerpointtreatmentChina_2010-08-29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Epicondylopathy背痛Dorsalgia(Backpain)臀肌痛Glutealgi

aChina_2010-08-29肌筋膜疼痛综合征Myofascialpainsyndrome可用RSWT成功治愈的骨科适应症Orthopaedicindicationswhichcanbetreatedsuccessfu

llywithRSWT内收肌疼痛Painintheadductormuscles股屈伸肌痉挛Shorteningsinthefemoralflexorandextensormuscles小腿筋膜间室综合征Peronealcompartmentsyndr

ome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Shorteningofth

ecalfmusclewithandwithoutAchillodynia跖骨痛MetatarsalgiaChina_2010-08-29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Depe

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

treatmentssessions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/eli

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

stpossibleearlystageChina_2010-08-29上位及低位颈部综合征UpperandlowerCervical-Syndrome臂痛、背痛、头痛withbrachialgia,dorsalgi

aandcephalgiaChina_2010-08-29Trapeziusmuscle斜方肌Trapeziusmuscle斜方肌Sessions治疗次数Energy能级(bar)Pulses/ses

sion每次治疗使用脉冲数Freq频率(Hz)Trans-mitter探头Totalpulses/treatment每疗程总脉冲数1.Painpoints痛点4–81.2–3.04000-600010–15R15,D20-SPulses/triggerpoint每扳机点脉

冲数2.Painpoints痛点1.2–3.0300-100010–15R15,D20-SSmoothingmusclesoverlargearea大面积肌肉按摩3.Muscles肌肉1.2–2.8200010–21R15,D20-SRecommendedtreat

ment:radial.使用发散式治疗上位及低位颈部综合征UpperandlowerCervical-Syndrome臂痛、背痛、头痛withbrachialgia,dorsalgiaandcephalgiaChina_2010-08-29半棘肌/夹肌，C3以下Semispinalis/Spl

eniusmuscle,caudalC3上位及低位颈部综合征UpperandlowerCervical-Syndrome臂痛、背痛、头痛withbrachialgia,dorsalgiaandcephalgiaChina_2010-08-29

半棘肌/夹肌，C3以下Semispinalis/SpleniusmusclecaudalC3Semispinalismuscle半棘肌Sessions治疗次数Energy能级(bar)Pulses/session每次治疗使用脉冲数Fre

q频率(Hz)Trans-mitter探头Totalpulses/treatment每疗程总脉冲数1.Painpoints痛点4–81.2–2.44000–600010–15R15,D20-SPulses/triggerpoint每扳机点脉冲数2.Painpoints痛点1.2–2.4300–

100010–15R15,D20-SSmoothingmusclesoverlargearea大面积肌肉按摩3.Muscles肌肉1.2–2.2100010–21R15,D20-SRecommendedtreatment:Radial使用发散性治疗上位及低位颈部综合征Uppe

randlowerCervical-Syndrome臂痛、背痛、头痛withbrachialgia,dorsalgiaandcephalgiaChina_2010-08-29三角肌Deltoidmuscle肩周痛Periarti

cularshoulderpainChina_2010-08-29三角肌DeltoidmuscleDeltoidmuscle三角肌Sessions治疗次数Energy能级(bar)Pulses/session每次治疗使用脉冲数Freq频率(Hz)Tr

ans-mitter探头Totalpulses/treatment每疗程总脉冲次数1.Painpoints痛点4–81.2–3.04000–600010–15R15,D20-SPulses/triggerpoint每扳机点脉冲数2.Painpoints痛点1.2–3.

0300–100010–15R15,D20-SSmoothingmusclesoverlargearea大面积肌肉按摩3.Muscles肌肉1.2–2.8100010–21R15,D20-SRecommendedtreatment:Focus

edandradial.使用发散式治疗。肩周痛PeriarticularshoulderpainChina_2010-08-29Recommendedtreatment:radial.使用发散式治疗。Glutealmuscles臀肌Sessions治疗次数Energy能级(bar)P

ulses/session每次治疗使用脉冲数Freq频率(Hz)Trans-mitter探头Totalpulses/treatment每疗程总脉冲次数1.Painpoints痛点4–81.2–4.04000–600010–15R15,DI15,D35-S

Pulses/triggerpoint每扳机点脉冲数2.Painpoints痛点1.2–4.0300–100010–15R15,DI15,D35-SSmoothingmusclesoverlargearea大

面积肌肉按摩3.Muscles肌肉1.2–3.8200010–21R15,DI15,D35-S臀肌痛GlutealgiaChina_2010-08-29femoralmuscles股肌Sessions治疗次数Energy能级(bar)Pulses/session每次治疗使用脉冲数

Freq频率(Hz)Trans-mitter探头Totalpulses/treatment每疗程总脉冲次数1.Painpoints痛点4–81.2–4.08000–1000010–15R15,D20-S,D35-SPulse

s/triggerpoint每扳机点脉冲数2.Painpoints痛点1.2–4.0300–100010–15R15,D20-S,D35-SSmoothingmusclesoverlargearea大面积肌

肉按摩3.Muscles肌肉1.2–3.8500010–21R15,D20-S,D35-SRecommendedtreatment:Mainlyradial.使用发散式治疗。股屈伸肌痉挛Shorteningsinthefemoralextensor

andflexormuscles髌骨软骨炎或髌骨肌腱炎incaseofpatellarchondropathy/patellartendonitisChina_2010-08-29Recommendedtreatment:Mainlyradial.使用发散式治疗。fem

oralmuscles股肌Sessions治疗次数Energy能级(bar)Pulses/session每次治疗使用脉冲数Freq频率(Hz)Trans-mitter探头Totalpulses/treatment每疗程总脉冲次数1.Painpoints

痛点4–81.2–4.08000–1000010–15R15,D20-S,D35-SPulses/triggerpoint每扳机点脉冲数2.Painpoints痛点1.2–4.0300–100010–15R15,D20-S,D35-SSmoothingmusclesoverlargeare

a大面积肌肉按摩3.Muscles肌肉1.2–3.8500010–21R15,D20-S,D35-S股屈伸肌痉挛Shorteningsinthefemoralextensorandflexormuscles髌骨软骨炎或髌

骨肌腱炎incaseofpatellarchondropathy/patellartendonitisChina_2010-08-29