体外冲击波治疗在慢性前列腺炎/慢性盆腔疼痛综合征中的应用进展及其潜在作用机制

慢性前列腺炎/慢性盆腔疼痛综合征(CP/CPPS)是泌尿男科常见病之一,治疗后易复发。近年来,在传统药物疗效局限的情况下,体外冲击波治疗(ESWT)应用于CP/CPPS患者的安全性和有效性得到广泛证实。研究结果显示ESWT短期(≤ 12周)疗效令人满意,但缺乏长期(> 12周)的随访数据。此外,适应证不统一、作用机制未...     

体外冲击波治疗慢性跟腱炎的临床疗效

[目的]探讨体外冲击波治疗（extracorporeal shock wave therapy, ESWT）慢性跟腱炎的疗效。[方法]回顾性分析2017年6月—2021年10月于骨科门诊行ESWT治疗慢性跟腱炎患者187例。所有患者均接受5次ESWT，间隔1周，每次2000个脉冲（0.45 mJ/mm2,10Hz）。采用疼痛VAS和AOFAS踝与后足评分评价临床效果。[结果]所有患者治疗期间无严重不良反应，随访12个月以上。患者能够恢复运动情况，治疗后3个月为20.9%,6个月为69.0%,12个月时为86.1%。末次随访时，135例疼痛完全缓解，占72.2%;26例低强度运动时不引起疼痛，只在高强度运动时疼痛，占13.9%;10例日常生活不引起疼痛，只在体育运动时疼痛，占5.3%;16例仍然主诉疼痛，占8.6%。随时间推移（治疗前，治疗后3个月，治疗后6个月，治疗后12个月）患者VAS评分显著减小[(7.3±0.9)分,(2.8±0.7)分,(2.4±0.5)分,(2.0±0.7)分, P<0.05]，而AOFAS评分显著增加[(72.1±4.7)分,(83.2±4.7)分,(...     

中医电针联合体外冲击波治疗创伤性桡骨茎突狭窄性腱鞘炎的临床疗效

目的观察电针联合体外冲击波疗法(extracorporeal shock wave therapy,ESWT)治疗创伤性桡骨茎突狭窄性腱鞘炎的临床疗效。方法选取2013年1月至2015年3月在新疆体育职业技术学院附属运动创伤医院门诊收治确诊的36例创伤性桡骨茎突狭窄性腱鞘炎患者,随机分为ESWT组、电针组和联合组,每组12例。ESWT组只进行ESWT治疗;电针组只进行电针治疗;联合组采用ESWT联合电针交替治疗,即首日采用ESWT治疗,次日采用电针治疗,治疗期间如此循环交替。三组患者在治疗前和治疗后的第1、2、4和8周分别进行VAS疼痛评分,并且在治疗后第8周采用VAS评分加权值评定临床疗效。结果 (1)三组患者VAS评分在治疗后各时间点均比治疗前明显下降,并且联合组又低于ESWT组和电针组(P0.05);ESWT组在治疗后第8周VAS评分改善优于电针组(P0.05);ESWT组及联合组VAS评分逐渐下降,但电针组第8周VAS评分却有升高;(2)联合组治愈率明显优于ESWT组和电针组,ESWT组治愈率优于电针组(P0.05)。结论 ESWT和电针对治疗创伤性桡骨茎突狭窄性腱鞘炎均具有临床疗效,但二者联合治疗明显优于单一治疗,具有近期和远期疗效方面的双重优势,不但可以让ESWT发挥即时的镇痛效果,还能弥补电针治疗远期疗效差的不足。     

体外冲击波治疗Ⅲ型前列腺炎(CP/CPPS)疗效研究

目的 探讨体外冲击波(ESWT)在治疗Ⅲ型前列腺炎中的临床疗效和应用价值.方法 2009年8月至2010年1月我院选择符合美国国立卫生研究院(NIH)诊断标准的Ⅲ型前列腺炎患者22例,行ESWT治疗,工作电压范围11～15kV,冲击频率25次/分,每次冲击2000次,每周1次,4次为1个疗程.随访治疗前及治疗后4周患者的NIH-CPSI、IPSS、IIEF、MPQ评分改变,研究ESWT在Ⅲ型前列腺炎中的治疗作用.结果 所有病人均行门诊治疗,随访过程中没有发现任何不良反应,22例病人治疗后与治疗前相比依据CPSI评分、IPSS评分、IIEF评分有效率分别为62.63%、31.81%、22.72%.ESWT在缓解疼痛、改善生活质量方面有显著的统计学差异,在缓解下尿路梗阻症状、改善性功能方面差异无统计学意义.结论 体外冲击波治疗Ⅲ型前列腺炎对改善患者疼痛症状效果确切,能显著改善患者生活质量,是一种安全、有效、廉价的治疗方法.     

体外冲击波治疗慢性骨盆疼痛综合征的研究进展

慢性前列腺炎/慢性骨盆疼痛综合征(CP/CPPS)是一种在男性群体中发病比较高的泌尿系统疾病,患者以盆底区的持续不适或疼痛为主要表现。目前临床上常用的药物治疗效果均不满意,急需寻找一种新的有效治疗方法。近年来有很多将体外冲击波治疗(ESWT)用于CP/CPPS治疗的报道。ESWT可明显改善CP/CPPS患者的盆底区疼痛和排尿困难等症状,其治疗作用可能与促进血管再生和封闭痛觉神经有关。现将ESWT治疗CP/CPPS的研究进展做一全面回顾。     

超声定位在体外冲击波疗法治疗肩部疾患的价值

目的探讨彩色超声定位在体外冲击波疗法(extracorporealshockwave therapy,ESWT)治疗肩部疾患的应用价值,比较超声定位及痛点定位ESWT的疗效差异。方法151例肩部疾患患者,病程均在3个月以上,且症状及体征较重。其中肩峰下滑囊炎65例,肱二头肌长头腱鞘炎86例,均行ESWT治疗。超声定位法采用彩色多普勒诊断仪探测确定冲击点,痛点定位法以触痛点结合解剖结构体表定位确定冲击点。65例肩峰下滑囊炎患者,采用超声定位25例,痛点定位40例;86例肱二头肌长头腱鞘炎患者,采用超声定位31例,痛点定位55例。采用0.12～0.16mJ/mm治疗能量,以超声及痛点定2位点为冲击点,每次治疗选1～2个冲击点,每个冲击点冲击800～1000次,一般做2～5次治疗,每次治疗间隔5d。对应用超声定位ESWT与痛点定位ESWT治疗肩峰下滑囊炎及肱二头肌长头腱鞘炎的疗效进行比较。结果随访6个月,超声定位ESWT治疗肩峰下滑囊炎及肱二头肌长头腱鞘炎的优良率分别为89.6%、92.3%;痛点定位ESWT治疗肩峰下滑囊炎及肱二头肌长头腱鞘炎的优良率分别为67.6%、73.6%。超声定位ESWT的优良率均高于痛点定位ESWT,两者比较差异有统计学意义。结论超声定位可通过观察肩部疾患的声像图特征,准确定位,提高ESWT治疗肩部疾患的疗效。     

体外震波疗法治疗佩罗尼氏病:一种新的替代治疗法?

目的:回顾分析体外震波疗法(ESWT)治疗佩罗尼氏病(Peyronie's disease)患者的安全性和有效性。方法:53名稳定佩罗尼氏病人接受了 ESWT 治疗(组1),与组1患者基本特征相符的另外15名病人作为对照不接受治疗(组2)。记录组1病人勃起前后和组2病人随访期的勃起功能(5项国际勃起功能指标[IIEF-5]评分)、疼痛度(可视性评分标准,VAS)、斑块大小、阴茎弯曲角度。结果:组1和组2的平均随访时间分别为32个月(6—64个月)和35个月(9—48个月),所有病人都接受了随访。组1病人用 ESWT 治疗前后的勃起功能和斑块大小无显著差异(P>0.05)。组1中共有39名病人(74%)报告经 ESWT 治疗后疼痛度明显降低。但总体考虑疼痛改善程度、IIEF-5评分、斑块大小,未发现两组间有显著差异。组1中有21人(40%)阴茎偏移角度减少超过10.所有病人平均阴茎偏移角度为11(6—20).ESWT 治疗未引起严重并发症。结论:ESWT 治疗佩罗尼氏病伤害小、安全性高,但对阴茎疼痛、性功能、斑块大小的疗效仍有待商榷。     

麒麟丸治疗男科疾病有奖征文通知

<正>为进一步探索和验证麒麟丸在男科疾病治疗的临床应用疗效和现代药理作用,交流麒麟丸临床应用经验,推动祖国传统中医药为男性健康服务。《中华男科学杂志》编辑部与太安堂集团公司联合主办"麒麟丸治疗男科疾病有奖征文活动"。具体安排如下:1.未在公开发行的杂志上发表过的论文(包括论著和病例研究)。2.征文内容麒麟丸治疗男科疾病的临床疗效研究。     

体外冲击波治疗骨不连的方法选择与影响因素全文替换

[目的]研究不同体外冲击波疗法（extracorporeal shock wave therapy, ESWT）治疗深部、较深部及浅部骨不连的疗效，并探讨其影响因素。[方法] 2011年11月—2022年9月采用ESWT治疗各类骨不连87例。深部骨不连选择聚焦式ESWT(focused ESWT, fESWT)，浅部选择发散式ESWT (radial ESWT, rESWT)，较深部选择聚焦式联合发散式ESWT (f-rESWT)。观察骨折愈合情况，同时分析影响愈合率的相关因素。[结果] 87例患者在治疗期间均无不良事件发生。至末次随访时，深部骨不连愈合24例，愈合率75.0%；较深部愈合36例，愈合率78.3%；浅部愈合7例，愈合率77.8%。按治疗方法，三组间年龄、性别、骨不连分型、临床愈合时间和影像不同时间点愈合率的差异均无统计学意义（P>0.05）。按末次随访时患者是否达到影像愈合分组，愈合组的年龄显著小于不愈合组[(34.3±10.5)岁vs (40.5±10.1)岁, P=0.042]，而愈合组治疗次数显著多于不愈合组[(22.6±9.8)次vs (8.3±3.6)次...     

麒麟丸治疗男科疾病有奖征文通知

<正>为进一步探索和验证麒麟丸在男科疾病治疗的临床应用疗效和现代药理作用,交流麒麟丸临床应用经验,推动祖国传统中医药为男性健康服务。《中华男科学杂志》编辑部与太安堂集团公司联合主办"麒麟丸治疗男科疾病有奖征文活动"。具体安排如下:1.未在公开发行的杂志上发表过的论文(包括论著和病例研究)。2.征文内容麒麟丸治疗男科疾病的临床疗效研究。①麒麟丸对少弱精子症的治疗。②麒麟丸对少弱畸精子症的治疗。     

An innovative mobile lithotripter for extracorporeal shock wave lithotripsy and therapy

INTRODUCTION: To assess the performance of a new mobile device for extracorporeal shock wave lithotripsy (ESWL) and therapy (ESWT). MATERIALS AND METHODS: 278 patients underwent 399 treatment for stone disease. 28 patients received 64 treatments for orthopaedic issues such as pseudarthrosis or enthesiopathies resistant to conservative treatment. RESULTS: During ESWL, minor pain symptoms were well resolved with analgesics intravenously. 45% of patients were stone-free and 50% had irrelevant fragments at the time of discharge. 66% of patients underwent a single treatment. Auxiliary measures after ESWL were necessary in 5%. After ESWT, pain symptoms of all patients were reduced on average to 5.2 points on a numerical rating scale from 1 to 10. Patients with bony nonunions produced callus if the bone scan before ESWT showed activity. No complication related to either form of treatment was observed. CONCLUSIONS: This innovative mobile lithotripter fulfils all expectations a user can have in an upt-to-date equipment: good disintegration, low side effects, easy handling, fast installation, dual imaging and suitability for ESWL and ESWT.     

Extracorporeal shockwave therapy for Peyronie's disease does not correct penile deformity

To evaluate whether extracorporeal shockwave therapy (ESWT) offers an effective treatment for the main complications of Peyronie's disease (PD), that is, penile deformity and angulation, painful erection and most importantly unsatisfied sexual intercourse. From September 1999 to January 2001, 52 patients with PD were treated with ESWT. Pain during erection was assessed with a visual analogue scale. Penile deviation was determined by photographs with a goniometer. Five treatment sessions were performed at weekly intervals. Each consisted of 3000 shockwaves with an emission frequency of 120 shockwaves/min and a mean intensity of 0.17 mJ/mm(2). A Storz Minilith SL 1 with integrated inline ultrasound probe was used. In all, 52 patients were evaluated 6 weeks after ESWT for early follow-up. Before ESWT intercourse was difficult or impossible for 40 men; 29 patients suffered mainly from penile deformity, 14 from painful erection and eight mainly from loss of distal rigidity. A total of 30 patients mentioned painful erection before treatment. In 28 patients (93%) pain reduction was achieved. A total relief of pain was observed in 19 patients (63%). Mean pain score dropped from 4.2 to 1.3 in patients who suffered predominantly from painful erections. Intercourse satisfaction improved in 11 patients after therapy. Mean angulation before (40 degrees ) and after (37 degrees ) ESWT did not change significantly. Late follow-up after 11.1 months (4-17 months) could be completed in 36 patients. In total, 19 men reported that ESWT improved their PD. Of these, 16 noted no change. Only one of the patients noticed a worsening of his disease during or after treatment. Complication rate was low with only minor side effects such as minimal skin bruising; one urethral bleeding occurred. ESWT did reduce pain during erection in patients suffering mainly from painful erection due to PD. However, penile angulation did not improve significantly in our setup and thus intercourse difficulties did improve only in 28% of the patients. Therefore, we do not recommend ESWT as a primary treatment for PD.     

Extracorporeal shock-wave therapy (ESWT) with a new-generation pneumatic device in the treatment of heel pain. A double blind randomised controlled trial

Although low-energy extracorporeal shock wave therapy (ESWT) is widely used to treat a variety of soft tissue disorders, no precise algorithm has been accepted in clinical management. Furthermore, the clinical use of a new generation pneumatic device has not yet been evaluated. We performed a double blind randomised controlled trial on a group of 25 patients with heel pain from chronic plantar fasciitis, to assess the efficacy of ESWT. The main outcome measure was the patients' subjective assessment of pain by means of a Visual Analog Scale (VAS) and the Roles and Maudsley Score before ESWT, early after treatment and six months later. There appeared to be a significant placebo effect with low-energy ESWT in patients with heel pain, and there was also lack of evidence for the efficacy of ESWT when compared to sham therapy.     

Extracorporeal shock wave therapy for calcifying tendinitis of the shoulder

We prospectively studied extracorporeal shock wave therapy (ESWT) for calcific tendinitis of the shoulder in 46 consecutive patients. All patients were randomly divided into 2 groups: treatment and control. The 33 patients in the treatment group received 2 courses of ESWT at the energy density of 0.55 mJ/mm(2) (1000 impulses). The control group underwent sham treatment with a dummy electrode (13 patients). Evaluation included the Constant score, pain scale, and radiographs. The ESWT results were good to excellent in 87.9% of shoulders (29/33) and fair in 12.1% (4/33), and the control results were fair in 69.2% (9/13) and poor in 30.1% (4/13). Among ESWT patients, calcium deposits were completely eliminated in 7 cases (21.2%), partially eliminated in 11 (36.3%), and unchanged in 15 (45.4%). In contrast, elimination was partial in 2 control patients (15.3%) and unchanged in 11 (84.7%). There was no significant difference between G?rtner type I and type II groups in the Constant score (P > .05). ESWT shows promise for pain relief and functional restoration of calcific tendinitis with negligible complications.     

Repetitive low-energy shock wave application without local anesthesia is more efficient than repetitive low-energy shock wave application with local anesthesia in the treatment of chronic plantar fasciitis.

BACKGROUND: It remains unclear whether application of local anesthesia (LA) interferes with clinical efficacy of extracorporeal shock wave therapy (ESWT) for chronic plantar fasciitis. Aims: To evaluate the effect of local anesthesia on the clinical outcome after repetitive low-energy ESWT for chronic plantar fasciitis. METHODS: Eighty-six patients with chronic plantar fasciitis were randomly assigned to receive either low-energy ESWT without LA, given weekly for three weeks (Group I, n=45; 3 x 2000 pulses, total energy flux density per shock 0.09 mJ/mm2) or identical ESWT with LA (Group II, n=41). Primary outcome measure was: Reduction of pain from baseline to month 3 post-treatment in a pain numeric rating scale [0-10 points] during first steps in the morning, evaluated by an independent blinded observer. Calculations were based on intention-to-treat. RESULTS: No difference was found between the groups at baseline. At 3 months, the average pain score was 2.2+/-2.0 points for patients of Group I, and 4.1+/-1.5 points for patients of Group II. The mean between-group difference was 1.9 points (95% CI: [1.1-2.7 points]; P<.001). Significantly more patients of Group I achieved 50% reduction of pain compared to Group II (67% vs 29%, P<.001). CONCLUSION: ESWT as applied should be done without LA in patients suffering from chronic heel pain. LA applied prior treatment reduced the efficiency of low-energy ESWT.     

Extracorporeal shockwave therapy for Peyronie＇s disease： an alternative treatment？

Aim： To determine retrospectively the safety and efficacy of extracorporeal shock wave therapy （ESWT） in patients with Peyronie＇s disease. Methods： Fifty-three patients with stable Peyronie＇s disease underwent ESWT （group 1）. Fifteen patients matched with the baseline characteristic of the patients in group 1, who received no treatment, were used as the control （group 2）. The patients＇ erectile function （International Index of Erectile Function [IIEF-5] score）, pain severity （visual analog scale）, plaque size and degree of penile angulation were assessed before and after the treatment in group 1 and during the follow-up in group 2. Results： The mean follow-up time was 32 months （range： 6-64 months） in group 1 and 35 months （range： 9-48 months） in group 2. All the patients were available for the follow-up. Considering erectile function and plaque size, no significant changes （P 〉 0.05） were observed in group 1 before or after the ESWT. A total of 39 patients （74%） reported a significant effect in pain relief in group 1 after ESWT. However, regarding improvement in pain, IIEF-5 score and plaque size, no significant differences were observed between the two groups. In 21 patients （40%） of group 1, the deviation angle was decreased more than 10° with a mean reduction in all patients of 11° （range： 6-20°）. No serious complications were noted considering ESWT procedure. Conclusion： ESWT is a minimally invasive and safe alternative procedure for the treatment of Peyronie＇s disease. However, the effect of ESWT on penile pain, sexual function and plaque size remains questionable.     

Effectiveness of extra-corporeal shock wave therapy (ESWT) vs methylprednisolone injections in plantar fasciitis

IntroductionIn Plantar Fasciitis, the main concern of the patients is the pain that disturbs their day to day activities. Different modalities of treatments are being used for its pain management. This study seeks to investigate and compare decrease in level of pain following treatment with Methylprednisolone injections (DMP) Vs Extra-Corporeal Shock Wave Therapy (ESWT) in plantar fasciitis.MethodsThis prospective comparative non randomized study was conducted in 60 patients of any age presenting with Plantar Fasciitis at B&B Hospital, Kathmandu. Patients were divided into 2 groups (30 each) based on patients preference. Methylprednisolone injection was given to one group and another group received ESWT. Follow up of both groups were carried out at 6 weeks, 3 months and 6 months and the outcome was measured with Visual Analogue Pain Scale (VAS). Statistical analysis wasdone using SPSS software, version 13. Chi-square and Independent t-test were applied to look for significant variations in outcome.ResultsFollow-up at 6 weeks revealed 26 (86.7%) patients attaining VAS < 5 in ESWT group in comparison to 16 (53.3%) patients of DMP group (p = 0.005). At the end of 6 months, 5 patients in DPM group still had significant pain (VAS ≥ 5) compared to 2 patients in ESWT group (p = 0.02). However 11 patients of DMP group and 23 of ESWT group received single episode of treatment only and had persistent symptomatic pain relief (VAS < 5) during all follow ups at 6 weeks, 3 months and 6 months (p = 0.004).ConclusionsPlantar fasciitis was more prevalent in overweight population and females. Significant improvement in pain was observed with both ESWT and DMP Injections. However, ESWT was found to be more effective than DMP Injections for treatment of Plantar Fasciitis.     

Extracorporeal shock wave treatment for Peyronie''s disease using EDAP LT-02; preliminary results

Abstract Background : Peyronie's disease is an idiopathic fibrosis of the tunica albuginea of the penis, which often causes erectile dysfunction. No effective therapy except surgery has been available for Peyronie's disease. We investigated the clinical efficacy of extracorporeal shock wave treatment (ESWT) using EDAP LT-02 as an alternative method of treatment for Peyronie's disease.
Methods : Five patients aged 35–65 years were treated by ESWT. All patients had undergone unsuccessful medical treatment before ESWT. Each patient was treated by ESWT (7–40 storages at an energy density of 45–96 MPa) between three and five times at 4-week intervals. Although no patient needed anesthesia, all were administered diclofenac suppository (50 mg) before ESWT.
Results : Of the five patients, four were eligible for evaluation. The penile plaque disappeared in one patient (25%). In the other three patients (75%), the penile plaque did not disappear, but softened. Although no improvement of erectile penile curvature was recognized, erectile penile pain disappeared in all patients.
Conclusions : These results indicate that ESWT is a possible alternative to surgery in the treatment of Peyronie's disease.     

Clinical Outcomes After Extracorporeal Shock Wave Therapy for Chronic Plantar Fasciitis in a Predominantly Active Duty Population

Chronic plantar fasciitis is a common cause of foot pain, with conservative treatment providing relief for most patients. However, because of the common occurrence of this pathology, this leaves many patients dissatisfied. The purpose of the present study was to determine the effectiveness of extracorporeal shock wave therapy (ESWT) to treat chronic plantar fasciitis (PF) in a largely active duty population. A review of 82 patients (115 heels) who had undergone ESWT for chronic PF was performed. Outcome data were obtained by patient telephone interviews. All ESWT was conducted at 24 kV for 2000 shocks. Of the 82 patients (115 heels), 76 (93%; 111 heels) agreed to participate. Their mean age was 42?±?10 years, with 41 males (54%) and 35 females (46%). The mean follow-up period was 42?±?22 months. Of the patients, 73.6% were active duty military personnel. The mean preoperative pain score of 7.8?±?2 had improved to 2.5?±?2 at the last follow-up visit (p?<.0001). Active duty patients reported a mean improvement in pain of 4.8?±?3 compared with 6.8?±?3 in non-active duty patients (p?=?.005). Of the 76 patients, 75 (98%) underwent 1 ESWT session, and 1 (2%) requiring 2 sessions. Overall, 74% of patients rated the outcome of their procedure as either good or excellent, with 87% stating that ESWT was successful. Ten patients (18%) left the military because of continued foot pain, with 76% able to return to running. For patients with chronic PF, these results support the use of ESWT to relieve pain in >85% of patients, with a preponderance for better pain relief in patients who are not active duty military personnel.     

Extracorporeal shockwave therapy (ESWT) in tendinosis calcarea of the rotator cuff. Long-term results and efficacy

Calcifying tendinitis (TC) of the rotator cuff is a transient shoulder disease with a high rate of spontaneous resorption of the deposit. Therefore, primary treatment should be conservative. In cases of persistent pain despite conservative treatment, extracorporeal shock wave therapy (ESWT) can be performed as an alternative minimally invasive method. Various short-term studies have demonstrated the efficiency of ESWT for TC. To evaluate the short- and long-term results, complications, and the number of operations avoided by ESWT, a prospective study with 115 patients was performed over a period of 4 years. The patients had received high-energy ESWT once (group A: n = 56) or twice (group B: n = 59). Six months after therapy, 47% in group A and 77% in group B showed evidence of disappearance or disintegration of the calcium deposits. Pain relief was achieved in 45% of group A and 53% of group B. Four years after treatment, 20% of the patients had undergone surgery on the involved shoulder. Of the remaining patients, 59% (68 patients) were seen for follow-up. Subjectively, 78% of group A and 87% of group B judged the treatment to be successful. X-ray examination revealed complete or partial resorption of the calcium deposit in 93% in both groups. The Constant score increased from 45 before treatment to 88 in group A and 85 in group B after treatment. ESWT was successful for about 70% of the treated patients with no long-term complications seen.