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1、体外冲击波疗法,有效治疗范围 Radial Extension,Handpiece 手柄,表面，高能流密度 surface, high ED 0,35 mJ/mm2,深度，低能流密度 depth, low ED,探头Transmitter,在组织中传播 spreads in the tissue,ED: 能流密度 ED: energy flux density,生物效应Biological effects,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Increase of cell wall pe
2、rmeability 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) 抗菌作用Antibacterial effec
3、t 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 focus in the targe
4、t 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 disease,肿胀swelling 变
5、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 first effects direc
6、tly 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 nervous system (gate cont
7、rol, 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,Patellar te
8、ndonitis 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biofeedback2000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 interval 5 7
9、days 治疗次数：3-5次sessions 3 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%的例子中，旋转套
10、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 pain,Treatmen
11、t interval: 5 - 7day 治疗间隔：5 -7天,病人仰卧位 R-SW应用 于腹外侧位 Supine 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 therapy,Tenderness in the region of the lateral epicondyle确定上踝侧 位 区柔软度Greatest tension is elicited
12、 with the elbow in extension, forearm in pronation, and 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 DD,Treatment interval:
13、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D20-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
14、.,肱骨外上髁炎 Radial humeral epicondylitis,ESWT New Treatment Guide,Preliminary 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,ESWT New Treatment Guide,Treatment interval: 5 - 7 days 治疗间隔：5 - 7 天,Supine patient positioning F
15、lexion of elbow joint approx. 30 to 40 degree, supination position. R-SW (R15) application at the tendon insertion. 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。,Supine patient positioning Extension of elbow joint, supination position. Smoothing of forearm muscles with D20-S. 病人仰卧位 肘关节外展，手心向上。用D20-S按摩前
16、臂肌肉。,肱骨内上髁炎Ulnar humeral epicondylitis 仅使用发散性冲击波疗法Only radial shock wave therapy,肱骨内上髁炎Ulnar humeral epicondylitis,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。,Preliminary ultrasound/ x-ray for localization, determination of penetration depth前期超声或X线定位，确定治疗深度 Marking of therapy region标记治疗区域,转子肌腱炎Trochanteric Tendonitis,
