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1、Extracorporeal Shock Wave Therapy 体外冲击波体外冲击波疼痛治疗系统疼痛治疗系统SONOTHERASONOTHERA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 医学机理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I
2、ncrease 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 Nitric oxide (vasodilation, increased cell metabolism, neoangogenesis, anti-inflammatory effect)抗菌作
3、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 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
4、 focus in the target area相对禁忌症 RELATIVE CONTRAINDICATIONS 抗凝血剂使用者，特别是苯丙香豆素（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
5、disease 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副作用 SIDE EFFECTS冲击波治疗的益处 Benefits of Shock Wave Treatment 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
6、 first effects directly after the treatment 能治疗复杂症状及相关适应症treatment of complex symptoms/ indications possible冲击波治疗的益处 Benefits of Shock Wave Treatment 治疗结缔组织treatment of connective tissue 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 nervo
7、us system (gate control, pain memory?)经典适应症 CLASSIC INDICATIONS经典适应症 Classic Indications Calcific tendonitis/ shoulder pain 钙化性肌腱炎/肩痛Achillodynia 跟腱痛Plantar fasciitis 足底筋膜炎Ulnar humeral epicondylitis 肱骨内上踝炎Tibial stress syndrome 胫骨压力症候群Radial humeral epicondylitis 肱骨外上髁炎Trochanteric tendonitis 转子肌腱炎
8、 Patellar tendonitis 髌腱炎治疗方法 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 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 new: combined therapy, trigger points治疗方法 PROTOCOL 治疗间隔：5-7天
9、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 break latest after 5th session钙化肌腱炎/肩痛 Calcific tendonitis/Shoulder pain前期超声或X线定位/决定治疗 区域与深度Preliminary ultrasound or x-ray localization/ determination of penetration depth and treatment area在皮肤上标记出治疗区域 Marking of therapeutic window on the skin在90%
10、的例子中，旋转套的冈 上肌腱感染，需要治疗。In approx. 90% of the cases the supraspinatus tendon of the rotator cuff is affected and has to be treated 钙化肌腱炎/肩痛 Calcific tendonitis/Shoulder pain钙化肌腱炎/肩痛 Calcific tendonitis/Shoulder pain钙化肌腱炎/肩痛 Calcific tendonitis/Shoulder pain钙化肌腱炎/肩痛 Calcific tendonitis/Shoulder painCal
11、cific tendonitis / Shoulder pain 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- mitter 探头Supraspinatus tendon 冈上肌腱1. Pain points 痛 点3 51.8 4.01500 300012 15R15, DI152. Muscles 肌肉 1.8 3.02000 300015 21D20-STreatment interval: 5 - 7day 治疗间隔：5 -7天病人仰卧位 R-SW应用 于腹外侧位Su
12、pine patient positioning R-SW application in ventrolateral position钙化性肌腱炎/肩痛Calcific tendonitis/Shoulder pain仅使用发散性冲击波疗法Only with radial shock wave therapyTenderness in the region of the lateral epicondyle确定上踝侧 位区柔软度Greatest tension is elicited with the elbow in extension, forearm in pronation, and
13、wrist in flexion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 Preliminary ultrasound/ x-ray for localization of epicondyle 前期上踝超声或x线定位Marking of therapy region 标记治疗区 域肱骨外上踝炎Radial humeral epicondylitis肱骨内上髁炎Radial humeral epicondylitis DDRadial humeral epicondylitis 肱骨外上髁炎Sessions 治疗 次数Energy 能级 (bar)Pulses/ sessio
14、n 每次治疗使用 脉冲数Freq 频率 (Hz)Transmitter 探头Tendon insertion (painful spot) 腱附着端（痛点）1. Pain points 痛点5 8 1.8 4.01500 300012 15R151.8 3.02000 300015 21D20-S Adjacent upper arm and forearm muscles邻近的上臂与前臂的肌肉2. Muscles 肌 肉Treatment interval: 5 - 7 days 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D
15、20-S 治疗邻近的上臂与前臂的肌肉。肱骨外上髁炎Radial humeral epicondylitis 仅使用发散性冲击波疗法Only with radial shock wave therapy 病人仰卧位-肘关节外展。用V-ACTOR按摩邻近肌肉。Supine patient positioning Extension of elbow joint. Smoothing of surrounding muscles with the V-ACTOR. 肱骨外上髁炎 Radial humeral epicondylitisESWT New Treatment GuidePrelimina
16、ry ultrasound/ x-ray for localization of epicondyle 前期上髁超声或x线定位Marking of therapy region标记治疗区域肱骨内上髁炎 Ulnar humeral epicondylitis Ulnar humeral epicondylitis 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Tendon insertion (painful spot) 腱附着端1. Pain points 痛 点5 81.8 4.01500 300012 15R15Adjacent
