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SONOTHERA体外冲击波疼痛治疗系统ExtracorporealShockWaveTherapy????????????SONOTHERA体外冲击波疼痛治疗系统ExtracSONOTHERA体外冲击波疼痛治疗系统是韩国HANIL-TM公司研发的一款双弹道多功能型冲击波疼痛治疗系统，

该产品是目前全球拥有最多治疗模式的体外冲击波骨科治疗仪，SONOTHERA的【激波针灸技术】在全球首创开创了无创针灸技术新纪元！是全球唯一具有【激波针灸技术】的冲击波治疗系统。SONOTHERA体外冲击波疼痛治疗系统是韩国HANIL-SONOTHER

A医学机理???????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）Stimulationof

Microcirculation(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）ReleaseofNitricoxide(vasodilation,increasedcellmetabolism,neoangogenesis,anti-inflammatoryeffect)??抗菌作用Antibacterialeff

ect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Stimulationo

fStemcellsSONOTHERA医学机理???????声学边界的能量释绝对禁忌症ABSOLUTECONTRAINDICATIONS??????妊娠Pregnancy血栓症thrombosis血凝固紊乱（血友病）coagul

ationdisorders(haemophilia)肿瘤疾病tumourdiseases急性炎症acuteinflammation目标治疗区脓肿pusfocusinthetargetarea绝对禁忌症ABSOLUTECONTRAINDICATIO相对禁忌症RELATIVECONTRAIND

ICATIONS?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相对禁忌症RELATIVECONTRAINDICATI副作用SIDEEFFECTS?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SIDEEFECTS?肿胀sweling冲击波治疗的益处BenefitsofShockWave

Treatment?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thepatientscanfe

elfirsteffectsdirectlyafterthetreatment?能治疗复杂症状及相关适应症treatmentofcomplexsymptoms/indicationspossible冲击波治疗的益处BenefitsofShockWav

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?)冲击波治疗的益处BenefitsofShockWav经典适应症CLASSICINDICATIONS经典适应症

CLASICINDICATIONS经典适应症ClassicIndicationsRadialhumeralepicondylitis肱骨外上髁炎Ulnarhumeralepicondylitis肱骨内上踝炎Trochanterictendonitis转子肌腱炎Patellartendonit

is髌腱炎Tibialstresssyndrome胫骨压力症候群Calcifictendonitis/shoulderpain钙化性肌腱炎/肩痛Achillodynia跟腱痛Plantarfasciitis足底筋膜炎经典适应症ClasicIndication

sR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biofee

dback?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PR

OTOCOL?查找主要痛点和其他痛点lo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治疗方法PROTOCOL?治疗间隔：5

-7天钙化肌腱炎/肩痛Calcifictendonitis/Shoulderpain前期超声或X线定位/决定治疗区域与深度Preliminaryultrasoundorx-raylocalization/deter

minationofpenetrationdepthandtreatmentarea在皮肤上标记出治疗区域Markingoftherapeuticwindowontheskin在90%的例子中，旋转套的冈上肌腱感染，需要治疗。

Inapprox.90%ofthecasesthesupraspinatustendonoftherotatorcuffisaffectedandhastobetreated钙化肌腱炎/肩痛Calcificten

donitis/S钙化肌腱炎/肩痛Calcifictendonitis/Shoulderpain钙化肌腱炎/肩痛Calcifictendonitis/S钙化肌腱炎/肩痛Calcifictendonitis/Shoulderpain钙化肌腱炎/肩痛Calcifictend

onitis/S钙化肌腱炎/肩痛Calcifictendonitis/Shoulderpain钙化肌腱炎/肩痛Calcifictendonitis/钙化肌腱炎/肩痛Calcifictendonitis/Shoulderpain钙化肌腱炎/肩痛Calcifictendonitis/S钙化性肌腱炎/肩

痛Calcifictendonitis/Shoulderpain仅使用发散性冲击波疗法Onlywithradialshockwavetherapy病人仰卧位–R-SW应用于腹外侧位Supinepatientpositioning–R-SWapplicationinvent

rolateralpositionCalcifictendonitis/Shoulderpain钙化性肌腱炎/肩痛Sessions治疗次Energy能级Pulses/session每Freq频率(bar)数次治疗使用脉冲数(Hz)Trans-mitter探头R15,DI151.Painpoint

s痛点Supraspinatustendon冈上肌腱2.Muscles肌肉3–51.8–4.01500–300012–151.8–3.02000–300015–21D20-STreatmentinterval:5-7day治疗间隔：5-7天钙化性肌腱炎/肩痛Ca

lcifictendonitis/肱骨外上踝炎RadialhumeralepicondylitisTendernessintheregionofthelateralepicondyle确定上踝侧位区柔软度Gre

atesttensioniselicitedwiththeelbowinextension,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-rayforlocalizationofepicondyle前期上踝超声或x线定位Markingoftherapyregion标记治疗区域肱骨外上踝炎Radialhumeralepicondy肱骨内上髁炎Radialhumeralepicondylitis–DD

肱骨内上髁炎Radialhumeralepicondyl肱骨外上髁炎Radialhumeralepicondylitis仅使用发散性冲击波疗法Onlywithradialshockwavetherapy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。Radialhumeralepicondylitis肱骨外上髁炎Tendoninsertion(pain

fulspot)腱附着端（痛点）Adjacentupperarmandforearmmuscles邻近的上臂与前臂的肌肉Sessions治疗Energy能级(bar)次数1.Painpoints痛点5

–81.8–4.0Pulses/session每次治疗使用脉冲数Freq频率(Hz)Transmitter探头1500–300012–15R152.Muscles肌肉1.8–3.02000–300015–21D20-STre

atmentinterval:5-7days治疗间隔：5-7天肱骨外上髁炎Radialhumeralepicondyl肱骨内上髁炎UlnarhumeralepicondylitisPreliminaryultrasound/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Ulnarhumeralepicondyl肱骨内上髁炎Ulnarhumeralepicondylitis仅使用发散性冲击波疗法Only

radialshockwavetherapySupinepatientpositioning–Flexionofelbowjointapprox.30to40degree,supinationposition.R-SW(R15)applicationatthetendonin

sertion.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。Ulnarhumeralepicondylitis肱骨内上髁炎Tendoninsertion(painfulspot)腱附着端Ad

jacentupperarmandforearmmuscles邻近的上臂与前臂的肌肉1.Painpoints痛点2.Muscles肌肉Supinepatientpositioning–Extensionofelbowjoint,su

pinationposition.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。Sessions治疗Energy能级(bar)次数5–81.8–4.01.8–

3.0Pulses/session每次治疗使用脉冲数Freq频率(Hz)Transmitter探头R15D20-S1500–30002000–300012–1515–21Treatmentinterval:5-7days治疗间隔：5-7天肱骨内上髁炎Ulnarhumeralepic

ondyl转子肌腱炎TrochantericTendonitisPreliminaryultrasound/x-rayforlocalization,determinationofpenetrationdepth前期超声

或X线定位，确定治疗深度Markingoftherapyregion标记治疗区域转子肌腱炎TrochantericTendonitis转子肌腱炎TrochantericTendonitis–DD转子肌腱炎TrochantericTendoniti

s–转子肌腱炎TrochantericTendonitis仅使用发散式冲击波疗法OnlyradialshockwavetherapyLateralpatientpositioning–R-SWapplication(DI15)o

nthetipofthetrochanter,M.piriformisandassociatedmuscles.病人侧卧位–R-SW（DI15）应用于转子尖、梨状肌及相关肌肉。Lateralpatientpositio

ning–SmoothingofassociatedmuscleswithD35.病人侧卧位–用D35按摩相关肌肉。Trochanterictendonitis转子肌腱炎Tendoninsertion腱附着端Adjacentmuscles相关肌肉1.Painpoints痛点Session

s治疗Energy能级(bar)次数2.8–3.56–82.Muscles肌肉2.0–3.5Pulses/session每次治疗使用脉冲数Freq频率(Hz)Transmitter探头R15,DI15D20-S,D35-S2000–30002000

–400015–2121Treatmentinterval:5-7days治疗间隔：5-7天转子肌腱炎TrochantericTendonitisPatellartendonitis(Jumper'sKnee)髌骨肌腱炎（跳跃膝）Preliminaryultrasou

nd/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Patelartendonitis(Jumper's髌骨肌腱炎（跳跃膝）Patella

rtendonitis(Jumper'sKnee)髌骨肌腱炎（跳跃膝）Patelartendonitis髌骨肌腱炎Patellartendonitis(Jumper'sKnee)仅使用发散式冲击波疗法OnlyradialshockwavetherapySupinepati

entpositioningwiththekneeonahalfroll.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.Smoothingofadjacentmuscl

eswithD20.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。Patellartendonitis髌骨肌腱炎Patella,tibialtendoninsertion

髌骨、胫骨腱附着端Adjacentmuscles相邻肌肉1.Painpoints痛点2.Muscles肌肉Pulses/Sessions治Energy能级sessionFreq频率每次治疗使(Hz)(bar)疗次数用脉冲数Transmitter探头R15,DI

15D20-S,D35-S6–82.8–3.52.0–3.52000–300015–212000–400021Treatmentinterval:5-7days治疗间隔：5-7天髌骨肌腱炎Patelartendonitis(Jump胫骨压力综合征（胫骨疲劳性

骨膜炎）Tibialstresssyndrome(Shinsplint)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）Tibialstres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OnlyradialshockwavetherapySupinepatientpositioningwi

thkneeonahalfroll.R-SWapplication.病人仰卧位，膝盖置于半圆柱形物上。使用R-SW。Tibialstresssyndrome胫骨压力综合征Medial,inneredgeofshinbone胫骨内缘Adjacentmus

cles相邻肌肉1.Painpoints痛点6–82.Muscles肌肉2.0–3.52000–400021D20-S,D35-SSessions治疗Energy能级(bar)次数2.8–3.5Pulses/session每次治疗使用脉冲数Freq频率(Hz)Transmitt

er探头2000–300015–21R15,DI15Treatmentinterval:5-7days治疗胫骨压力综合征（胫骨疲劳性骨膜炎）Tibialstres跟腱痛AchillodyniaPreliminaryultr

asound/x-ray前期超声/x线定位Markingoftherapyregion标记治疗区域跟腱痛AchilodyniaPreliminaryu跟腱痛Achillodynia跟腱痛Achilodynia跟腱痛Achillod

ynia跟腱痛Achilodynia足底筋膜炎PlantarfasciitisPreliminaryultrasound/x-ray前期超声/x线定位Localizationofpainpointswithbio-feedback根据人体生物反馈定位痛点Markingoftherap

yregion标记治疗区域足底筋膜炎PlantarfascitisPrelimi足底筋膜炎，跟骨骨刺Plantarfasciitis,HeelSpur足底筋膜炎，跟骨刺Plantarfascitis,H足底筋膜炎，跟骨骨刺Plantarfasciitis,HeelSpur足底筋膜炎

，跟骨刺Plantarfascitis,足底筋膜炎，跟骨骨刺Plantarfasciitis,HeelSpur足底筋膜炎，跟骨刺Plantarfascitis,H足底筋膜炎Plantarfasciitis仅使用发散式冲击波疗法On

lyradialshockwavetherapyAbdominalpatientpositionwithfootonahalfroll.R-SW(DI15)application.Localizationofpatie

ntswithbio-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。Plantarfasciitis足底筋膜炎1.Painpoints痛点Acuteandchronicpain急性与慢性疼痛2.Muscles肌肉S

essions治疗次数Energy能级(bar)2.0–3.0Pulses/session每次治疗使用脉冲数Freq频率(Hz)Transmitter探头R15,DI15D20-S3000–35002000–300012–1515–213-51.8–3.0

Treatmentinterval:5-7days治疗间隔：5-7天足底筋膜炎Plantarfascitis仅使用发散式肌筋膜疼痛综合症Myofascialpainsyndrome扳机点治疗Triggerpointtreatment肌筋膜疼痛综合症Myofascialpainsyndr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Dor

salgia(Backpain)臀肌痛Glutealgia肌筋膜疼痛综合征Myofascialpainsyndro肌筋膜疼痛综合征Myofascialpainsyndrome可用RSWT成功治愈的骨科适应症Orthopaedicindicationswhichca

nbetreatedsuccessfullywithRSWT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Shorteningofthecalfmuscl

ewithandwithoutAchillodynia跖骨痛Metatarsalgia肌筋膜疼痛综合征Myofascialpainsyndro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Dependingontheextentanddurationofthemuscleirritation早期疼痛可经过1-2次治疗成功治愈。Earlystagecomplaintscanbetreatedsucc

essfullywith1-2treatmentssessions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）Inmostcasesseveraltreatmentsessions(4-8)arerequiredtorelease/eliminatethepainpoint

s(1-2treatments/week).建议尽早采用扳机点治疗Itisrecommendedtostarttriggerpointtreatmentatthemostpossibleearlystage肌筋膜疼痛综合征Myofascialpainsyndr上位及低位颈部综合征Up

perandlowerCervical-Syndrome臂痛、背痛、头痛withbrachialgia,dorsalgiaandcephalgia上位及低位颈部综合征UperandlowerCerv上位及低位颈部综合征

UpperandlowerCervical-Syndrome臂痛、背痛、头痛withbrachialgia,dorsalgiaandcephalgiaTrapeziusmuscle斜方肌Recommendedtreatment:ra

dial.使用发散式治疗Trapeziusmuscle斜方肌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/tr

eatment每疗程1.Painpoints痛点总脉冲数Pulses/triggerpoint每扳机点脉冲数Smoothingmusclesoverlargearea大面积肌肉按摩2.Painpoints痛点3.Muscles肌肉4–81.2–3.01.2–3.01.

2–2.84000-6000300-1000200010–1510–1510–21R15,D20-SR15,D20-SR15,D20-S上位及低位颈部综合征UperandlowerCerv上位及低位颈部综合征Uppera

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

erandlowerCerv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/Spleniusmusclecaud

alC3Recommendedtreatment:Radial使用发散性治疗Semispinalismuscle半棘肌Totalpulses/treatment每疗程总脉冲数SessionsEnergy能级(bar)治疗次数1.P

ainpoints痛点4–81.2–2.41.2–2.41.2–2.2Pulses/session每次治疗使用脉冲数Freq频率(Hz)Trans-mitter探头R15,D20-SR15,D20-SR15,D20

-S4000–6000300–1000100010–1510–1510–21Pulses/triggerpoint每扳机点脉2.Painpoints痛点冲数Smoothingmusclesoverlargearea大面积肌肉按摩3.Muscl

es肌肉上位及低位颈部综合征UperandlowerCerv肩周痛Periarticularshoulderpain三角肌Deltoidmuscle肩周痛Periarticularshoulderpain肩周痛Periartic

ularshoulderpain三角肌DeltoidmuscleRecommendedtreatment:Focusedandradial.使用发散式治疗。Deltoidmuscle三角肌Totalpulses/treatment每疗程总脉冲次数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1.Painpoints痛点4–81.2–3.01.2–3.01.2–2.84000–6000300–1000100010–1510–1510–21R15,D20-

SR15,D20-SR15,D20-SPulses/triggerpoint每扳机点脉2.Painpoints痛点冲数Smoothingmusclesoverlargearea大面积肌肉按摩3.Muscles肌肉肩周痛Periarticularshou

lderpain臀肌痛GlutealgiaRecommendedtreatment:radial.使用发散式治疗。Glutealmuscles臀肌Totalpulses/treatment每疗程总脉1.Painpoints痛点冲次数Pulses/triggerpoint每扳机点脉冲数Sm

oothingmusclesoverlargearea大面积肌肉按摩Sessions治疗次数Pulses/Energy能级session每次治疗使用脉冲(bar)数Freq频率(Hz)Trans-mitter探头1.2–4.04000–600010–15

R15,DI15,D35-SR15,DI15,D35-SR15,DI15,D35-S2.Painpoints痛点4–81.2–4.0300–100010–153.Muscles肌肉1.2–3.8200010–21臀肌痛Glute

algiaRecomendedtr股屈伸肌痉挛Shorteningsinthefemoralextensorandflexormuscles髌骨软骨炎或髌骨肌腱炎incaseofpatellarchondropathy/patellartend

onitisRecommendedtreatment:Mainlyradial.使用发散式治疗。femoralmuscles股肌Totalpulses/treatment每疗程总脉冲次数Pulses/trig

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点2.Painpoints痛点1.2–4.01.2–4.08000–10000300–100010–1510–15R15,D20-S,D35-SR15,D20-S,D35-S4–8Smoothingmuscl

esoverlargearea3.Muscles肌肉大面积肌肉按摩1.2–3.8500010–21R15,D20-S,D35-S股屈伸肌痉挛Shorteningsinthefemo股屈伸肌痉挛Shorteningsinthefemoralextensorandfle

xormuscles髌骨软骨炎或髌骨肌腱炎incaseofpatellarchondropathy/patellartendonitisRecommendedtreatment:Mainlyradial.使用发散式治疗。femoralmuscles股肌Totalpulses/treatmen

t每疗程总脉冲次数Sessions治疗次数Energy能级Pulses/session每次治疗使用脉冲数(bar)Freq频率(Hz)Trans-mitter探头1.Painpoints痛点4–81.2

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erpoint每扳机点脉2.Painpoints痛点冲数Smoothingmusclesoverlargearea大面积肌肉按摩3.Muscles肌肉股屈伸肌痉挛Shorteningsinthefemo谢谢谢