冲击波治疗骨肌疾病.ppt

让疼痛远离我和我的家人冲冲击波治波治疗仪2024/5/8 周三1.手柄表面，高能流密度surface,high ED0,35 mJ/mm2深度，低能流密度depth,low ED 探头Transmitter在组织中传播spreads in the tissueED:能流密度ED:energy flux density有效治有效治疗范范围Radial Extension2024/5/8 周三2.绝对禁忌症禁忌症ABSOLUTE CONTRAINDICATIONS妊娠妊娠Pregnancy血栓症血栓症thrombosis血凝固紊乱（血友病）血凝固紊乱（血友病）coagulation disorders(haemophilia)肿瘤疾病瘤疾病tumour diseases 急性炎症急性炎症acute inflammation目目标治治疗区区脓肿pus focus in the target area2024/5/8 周三3.相相对禁忌症禁忌症RELATIVE CONTRAINDICATIONS抗凝血抗凝血剂使用者，特使用者，特别是苯丙香豆素（是苯丙香豆素（维生素生素K拮抗拮抗剂）use of anticoagulants,especially marcumar(vitamin k antagonist)有多有多发性神性神经病的糖尿病病的糖尿病 polyneuropathy in case of diabetes mellitus可的松治可的松治疗结束六周后才能使用体外冲束六周后才能使用体外冲击波治波治疗 cortisone therapy up to 6 weeks before first ESWT treatment风湿性疾病湿性疾病 rheumatic disease2024/5/8 周三4.肿胀swelling变红reddening血血肿haematomas瘀点瘀点petechiae灼灼伤般疼痛感般疼痛感pain like sunburn治治疗初期病情初期病情恶化化first worsening副作用副作用SIDE EFFECTS2024/5/8 周三5.冲冲击波治波治疗的益的益处Benefits of Shock Wave Treatment 几次治几次治疗后，疼痛即得到后，疼痛即得到缓解解/减减轻 pain relief/reduction after a few treating sessions 治治疗依从性好依从性好 the compliance is very good 治治疗后病人能直接感受到第一后病人能直接感受到第一疗效效 the patients can feel first effects directly after the treatment 能治能治疗复复杂症状及相关适症状及相关适应症症 treatment of complex symptoms/indications possible2024/5/8 周三6.治治疗结缔组织 treatment of connective tissue活化淋巴系活化淋巴系统 activation of lymphatic system大面大面积治治疗 treatment of large areas possible作用于神作用于神经系系统（门控制、疼痛控制、疼痛记忆）effects on the nervous system(gate control,pain memory?)冲冲击波治波治疗的益的益处Benefits of Shock Wave Treatment2024/5/8 周三7.经典适典适应症症CLASSIC INDICATIONS2024/5/8 周三8.经典适典适应症症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 tendonitis髌腱炎2024/5/8 周三9.治治疗方法方法 PROTOCOL 查找主要痛点和其他痛点找主要痛点和其他痛点look for the main and other pain points 与病人密切交与病人密切交谈close dialogue with the patient 生物反生物反馈biofeedback 2000次次发散式冲散式冲击波波 radial shocks 2000 多数学派的治多数学派的治疗方法方法protocol of the most studies 传统派派old school新派：新派：联合合疗法，治法，治疗扳机点扳机点 new:combined therapy,trigger points2024/5/8 周三10.治治疗方法方法PROTOCOL治治疗间隔：隔：5-7天天 interval5 7days治治疗次数：次数：3-5次次 sessions3 5最晚在第最晚在第5次治次治疗后后进入休息期入休息期 break latest after 5th session2024/5/8 周三11.钙化肌腱炎化肌腱炎/肩痛肩痛Calcific tendonitis/Shoulder pain前期超声或前期超声或X线定位定位/决定治决定治疗区域与深度区域与深度Preliminary ultrasound orx-ray localization/determination of penetration depth and treatment area在皮肤上在皮肤上标记出治出治疗区域区域Marking of therapeutic window on the skin在在90%的例子中，旋的例子中，旋转套的套的冈上肌腱感染，需要治上肌腱感染，需要治疗。In approx.90%of the casesthe supraspinatus tendon of the rotator cuff is affected and has to be treated 2024/5/8 周三12.钙化肌腱炎化肌腱炎/肩痛肩痛Calcific tendonitis/Shoulder pain2024/5/8 周三13.钙化肌腱炎化肌腱炎/肩痛肩痛Calcific tendonitis/Shoulder pain2024/5/8 周三14.钙化肌腱炎化肌腱炎/肩痛肩痛Calcific tendonitis/Shoulder pain2024/5/8 周三15.钙化肌腱炎化肌腱炎/肩痛肩痛Calcific tendonitis/Shoulder pain2024/5/8 周三16.肱骨内上髁炎肱骨内上髁炎Radial humeral epicondylitis DD2024/5/8 周三17.Ulnar humeral epicondylitis 肱骨内上髁炎肱骨内上髁炎Sessions 治治疗次数次数Energy 能能级(bar)Pulses/session 每次治每次治疗使用使用脉冲数脉冲数Freq 频率率(Hz)Transmitter 探探头Tendon insertion(painful spot)腱附着端1.Pain points 痛点5 81.8 4.01500 300012 15R15Adjacent upper arm and forearm muscles邻近的上臂与前臂的肌肉2.Muscles 肌肉1.8 3.02000 300015 21D20-STreatment interval:5-7 days 治治疗间隔：隔：5-7 天天Supine patient positioning Flexion of elbow joint approx.30 to 40 degree,supination position.R-SW(R15)application at the tendon insertion.病人仰卧位病人仰卧位 肘关肘关节弯曲大弯曲大约30-40度，手心向上。度，手心向上。R-SW(R15)应用于腱附着端。用于腱附着端。Supine patient positioning Extension of elbow joint,supination position.Smoothing of forearm muscles with D20-S.病人仰卧位病人仰卧位 肘关肘关节外展，手心向上。用外展，手心向上。用D20-S按摩前臂肌肉。按摩前臂肌肉。肱骨内上髁炎肱骨内上髁炎Ulnar humeral epicondylitis仅使用发散性冲击波疗法Only radial shock wave therapy 2024/5/8 周三18.Preliminary ultrasound/x-ray for localization,determination of penetrationdepth 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子肌腱炎Trochanteric Tendonitis ESWT New Treatment Guide2024/5/8 周三20.转子肌腱炎子肌腱炎Trochanteric Tendonitis DD2024/5/8 周三21.Patellar tendonitis(Jumpers Knee)髌骨肌腱炎（跳骨肌腱炎（跳跃膝）膝）Preliminary ultrasound/x-ray for localization,determination of penetrationdepth 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2024/5/8 周三22.髌骨肌腱炎（跳骨肌腱炎（跳跃膝）膝）Patellar tendonitis(Jumpers Knee)2024/5/8 周三23.Patellar tendonitis 髌骨肌腱炎骨肌腱炎Sessions 治治疗次数次数Energy 能能级(bar)Pulses/session 每次治每次治疗使使用脉冲数用脉冲数Freq 频率率(Hz)Transmitter 探探头Patella,tibial tendon insertion 髌骨、胫骨腱附着端1.Pain points 痛点6 82.8 3.52000 300015 21R15,DI15Adjacent muscles 相邻肌肉2.Muscles 肌肉2.0 3.52000 400021D20-S,D35-STreatment interval:5-7 days 治治疗间隔：隔：5-7 天天Supine patient positioning with the knee on a half roll.Fixation of patellar zone with a cuff.R-SW(R15)application at the patella(tip,basis)and tibial tendon insertion.病人仰卧位，膝盖置于半病人仰卧位，膝盖置于半圆柱形物上。用一条柱形物上。用一条绷带固定固定髌骨区。骨区。R-SW(R15)应用于用于髌骨（尖部、底部）及骨（尖部、底部）及胫骨腱附着端。骨腱附着端。Supine patient positioning with the knee on a half roll.Fixation of paellar zone with a cuff.Smoothing of adjacent muscles with D20.病人仰卧位，膝盖置于半病人仰卧位，膝盖置于半圆柱形物上。用一条柱形物上。用一条绷带固定固定髌骨区。用骨区。用D20按摩相按摩相邻肌肉。肌肉。髌骨肌腱炎骨肌腱炎Patellar tendonitis(Jumpers Knee)仅使用发散式冲击波疗法Only radial shock wave therapy 2024/5/8 周三24.Preliminary ultrasound/x-ray 前期超声/X线定位 Marking of therapy region 标记治疗区域胫骨骨压力力综合征（合征（胫骨疲骨疲劳性骨膜炎）性骨膜炎）Tibial stress syndrome(Shin splint)ESWT New Treatment Guide2024/5/8 周三25.Tibial stress syndrome 胫骨骨压力力综合征合征Sessions 治治疗次数次数Energy 能能级(bar)Pulses/session 每次治每次治疗使用使用脉冲数脉冲数Freq 频率率(Hz)Transmitter 探探头Medial,inner edge of shin bone 胫骨内缘1.Pain points 痛点6 82.8 3.52000 300015 21R15,DI15Adjacent muscles 相邻肌肉2.Muscles 肌肉2.0 3.52000 400021D20-S,D35-STreatment interval:5-7 days 治治疗间隔：隔：5-7 天天Supine patient positioning with knee on a half roll.R-SW application.病人仰卧位，膝盖置于半病人仰卧位，膝盖置于半圆柱形物上。使用柱形物上。使用R-SW。胫骨骨压力力综合征（合征（胫骨疲骨疲劳性骨膜炎）性骨膜炎）Tibial stress syndrome(Shin splint)仅使用发散式冲击波疗法Only radial shock wave therapy 2024/5/8 周三26.跟腱痛跟腱痛AchillodyniaPreliminary ultrasound/x-ray 前期超声/x线定位Marking of therapy region 标记治疗区域2024/5/8 周三27.跟腱痛跟腱痛Achillodynia2024/5/8 周三28.跟腱痛跟腱痛Achillodynia2024/5/8 周三29.足底筋膜炎足底筋膜炎Plantar fasciitisPreliminary ultrasound/x-ray 前期超声/x线定位Localization of pain points withbio-feedback 根据人体生物反馈定位痛点Marking of therapy region 标记治疗区域2024/5/8 周三30.足底筋膜炎，跟骨骨刺足底筋膜炎，跟骨骨刺Plantar fasciitis,Heel Spur2024/5/8 周三31.足底筋膜炎，跟骨骨刺足底筋膜炎，跟骨骨刺Plantar fasciitis,Heel Spur2024/5/8 周三32.足底筋膜炎，跟骨骨刺足底筋膜炎，跟骨骨刺Plantar fasciitis,Heel Spur2024/5/8 周三33.肌筋膜疼痛综合症Myofascial pain syndrome扳机点治疗Trigger point treatment2024/5/8 周三41.肌筋膜疼痛肌筋膜疼痛综合征合征Myofascial pain syndrome可用可用RSWT成功治愈的骨科适成功治愈的骨科适应症症 Orthopaedic indications which can be treated successfully with RSWT 上位及低位上位及低位颈部部综合征合征Upper and lower Cervical-Syndrome肩周痛肩周痛Periarticular shoulder pain前臂屈伸肌腱炎前臂屈伸肌腱炎Tendomyosis in the extensor and flexor region of the forearm 上踝病上踝病变Epicondylopathy背痛背痛Dorsalgia(Back pain)臀肌痛臀肌痛Glutealgia2024/5/8 周三42.内收肌疼痛内收肌疼痛Pain in the adductor muscles 股屈伸肌股屈伸肌痉挛Shortenings in the femoral flexor and extensor muscles 小腿筋膜小腿筋膜间室室综合征合征Peroneal compartment syndrome胫前前综合征合征Tibial anterior syndrome 胫骨骨压力力综合征（合征（胫骨疲骨疲劳性骨膜性骨膜综合征）合征）Tibial stress syndrome(Shin splint)伴有伴有/不伴有跟腱痛的小腿肌肉萎不伴有跟腱痛的小腿肌肉萎缩Shortening of the calf muscle with and without Achillodynia 跖骨痛跖骨痛Metatarsalgia肌筋膜疼痛肌筋膜疼痛综合征合征Myofascial pain syndrome可用可用RSWT成功治愈的骨科适成功治愈的骨科适应症症 Orthopaedic indications which can be treated successfully with RSWT2024/5/8 周三43.肌筋膜疼痛肌筋膜疼痛综合征合征Myofascial pain syndrome治疗长度Length of treatment取决于肌肉刺激的持续范围和时间Depending on the extent and duration of the muscle irritation早期疼痛可经过1-2次治疗成功治愈。Early stage complaints can be treated successfully with 1-2 treatments sessions 多数案例中，痛点的缓解/解除需要4-8次治疗（一周12次治疗）In most cases several treatment sessions(4-8)are required to release/eliminate the pain points(1-2 treatments/week).建议尽早采用扳机点治疗It is recommended to start trigger point treatment at the most possible early stage2024/5/8 周三44.上位及低位上位及低位颈部部综合征合征Upper and lower Cervical-Syndrome 臂痛、背痛、头痛with brachialgia,dorsalgia and cephalgia 2024/5/8 周三47.半棘肌半棘肌/夹肌，肌，C3以下以下Semispinalis/Splenius muscle,caudal C3 上位及低位上位及低位颈部部综合征合征Upper and lower Cervical-Syndrome 臂痛、背痛、头痛with brachialgia,dorsalgia and cephalgia 2024/5/8 周三48.半棘肌半棘肌/夹肌，肌，C3以下以下Semispinalis/Splenius muscle caudal C3 Semispinalis muscle 半棘肌半棘肌Sessions治治疗次数次数Energy 能能级(bar)Pulses/session 每次治每次治疗使用脉使用脉冲数冲数Freq 频率率(Hz)Trans-mitter 探探头Total pulses/treatment 每疗程总脉冲数1.Pain points 痛点4 81.2 2.44000 6000 10 15R15,D20-SPulses/trigger point 每扳机点脉冲数2.Pain points 痛点1.2 2.4300 100010 15R15,D20-SSmoothing muscles over large area 大面积肌肉按摩3.Muscles 肌肉1.2 2.2100010 21R15,D20-SRecommended treatment:Radial 使用使用发散性治散性治疗上位及低位上位及低位颈部部综合征合征Upper and lower Cervical-Syndrome 臂痛、背痛、头痛with brachialgia,dorsalgia and cephalgia 2024/5/8 周三49.三角肌三角肌Deltoid muscle 肩周痛肩周痛Periarticular shoulder pain 2024/5/8 周三2024/5/8 周三51.后面内容直接删除就行资料可以编辑修改使用资料可以编辑修改使用资料仅供参考，实际情况实际分析2024/5/8 周三52.感感谢您的您的观看和下看和下载The user can demonstrate on a projector or computer,or print the presentation and make it into a film to be used in a wider field2024/5/8 周三53.