发散式体外冲击波治疗膝关节鹅足肌腱炎的疗效分析

[目的]评价发散式体外冲击波治疗膝关节鹅足肌腱炎的临床效果,为进一步推广应用提供参考。[方法]随访2013年3月～2015年4月至本科门诊治疗的膝关节鹅足肌腱炎患者174例。按照治疗方法,采用体外发散式冲击波治疗组78例(冲击波组),采用常规中药消痛贴外用治疗96例(中药组)。比较两组患者治疗前、治疗后3周和3个月的疼痛视觉模拟评分(VAS评分)及膝关节功能评分(Lysholm评分),记录随访过程中并发症,评定临床效果。[结果]两组患者随时间推移VAS评分显著下降,而Lysholm评价显著增加,不同时间点间差异有统计学意义(P0.05)。治疗后3周,冲击波组的VAS和Lysholm评分显著优于中药组(P0.05),但治疗后3个月,两组上述评分的差异均无统计学意义(P0.05)。随访期间,冲击波组出现皮肤红斑4例,外用中药组皮疹28例,冲击波组并发症发生率显著低于中药组(P0.05)。治疗后3周冲击波组总体有效率为97.44%,而中药组为57.29%,两组间差异有统计学意义(P0.05)。[结论]发散式冲击波治疗鹅足肌腱炎比外用中药的治疗方法,可以更快地缓解膝关节内侧疼痛,改善膝关节功能,且不良反应发生率低。     

肩关节镜手术治疗钙化性冈上肌肌腱炎

 目的探讨钙化性冈上肌肌腱炎的病理特点和肩关节镜手术的疗效。方法 2009年 3月至 2010年 10月采用关节镜下手术治疗钙化性冈上肌肌腱炎 34例。根据法国关节镜协会分类方法将钙化灶分成三组: 小(20 mm)。所有病例均行关节镜下钙化灶清除术和肩峰下滑囊切除术.同时行肩峰成形术(8例).肩袖修补术(10例)。所有研究病例均在术前及术后随访时采用 Constant评分、疼痛视觉模拟评分(visual analog scale.VAS)评估其疗效.手术前后均摄肩关节 X线片和 MR检查.其中 9例行组织学和透射电镜检查。结果 34例患者获得平均 11.5个月的随访。术前 1个月、术前 2天和末次随访时 Constant评分分别为(36.1±6.9)分、(55.6±12.4)分和(89.7±2.7)分. VAS评分分别为(8.2±0.8)分、(7.03±0.7)分和(1.7±0.3)分.治疗前后评分的差异均有统计学意义.而三组间(小、中和大钙化灶)疗效的差异无统计学意义。患者在术后随访期间均未复发。病理检查发现钙化灶周围组织未见胶原纤维退变.周围可见新生胶原.细胞未见坏死溶解。结论正确认识钙化性肌腱炎的临床特点并准确把握手术时机是取得良好疗效的关键。肩关节镜手术是治疗钙化性肌腱炎安全、有效且微创的方法。对不同大小的钙化灶.术后均可取得满意的效果。     

关节镜下治疗慢性冈上肌钙化性肌腱炎的早期随访研究

目的:探讨关节镜下治疗慢性冈上肌钙化性肌腱炎的早期疗效。方法:2013年3月至2015年9月为16例冈上肌钙化性肌腱炎患者行关节镜下冈上肌肌腱钙化灶清除术,术前及术后第3、6、12、18个月随访,采用美国肩肘外科协会评分系统(American shoulder and elbow surgeons scores,ASES)、Constant-Murley评分(Constant-Murley scores,CMS)及视觉模拟评分法(visual analogue scale,VAS)评价手术疗效,记录患者恢复功能锻炼的时间。结果:16例患者术后随访18~24个月,平均(20.4±1.7)个月。ASES评分由术前的(48.32±9.45)分提高至术后末次随访的(89.15±4.84)分,差异有统计学意义(t=-15.35,P0.01);CMS评分由术前的(54.69±7.25)分提高至末次随访的(95.34±5.06)分,差异有统计学意义(t=-11.78,P0.05);VAS疼痛评分由术前的(8.26±1.37)分减少至末次随访的(2.13±1.05)分,差异有统计学意义(t=-14.89,P0.01)。16例患者平均于术后(16.9±2.4)d恢复正常肩关节活动,术后肩部症状改善明显,关节活动度较前明显增加。结论:关节镜治疗保守无效的慢性冈上肌钙化性肌腱炎具有手术创伤小、患者康复快、病灶清除彻底的优点,早期随访结果满意,是可靠、有效的治疗方法。     

体外冲击波联合拔罐治疗肩部钙化性肌腱炎

目的 体外冲击波联合拔罐治疗肩部钙化性肌腱炎的疗效分析。方法 对30例肩部钙化性肌腱炎行体外冲击波及拔罐治疗,采用体外放射冲击波进行治疗,选用痛点,治疗压力1.8-2.5 Bar,频率8-10 Hz,冲击次数2 500-3 000次,冲击治疗后留罐15 min,1周治疗1次,3-5次为1个疗程。结果 30例均获得随访0.5年,症状明显改善,VAS评分明显下降,影像学检查显示钙化灶较前明显缩小,总有效率达93.33%。结论 体外冲击波联合拔罐治疗肩部钙化性肌腱炎疗效好,操作简单,无副作用。     

体外冲击波联合常规康复治疗肩关节周围炎

目的 观察体外冲击波(extracorporeal shockwave therapy,ESWT)联合常规康复治疗和单纯常规康复治疗对肩关节周围炎患者的疗效.方法 回顾性分析2016年7月～2021年1月就诊于本科室的200例肩关节周围炎患者.其中对照组94例予以常规康复治疗,治疗组106例予以体外冲击波联合常规康复治疗.评估患者治疗前、治疗后和随访时的VAS评分、Constant Murley肩关节评分(Constant Murley shoulder score,CMS)和疗效.结果 在治疗后及随访时,两组患者在VAS评分、关节活动度、CMS评分方面均较治疗前明显改善(P<0.05),对照组临床治疗总有效率达81.91％,治疗组总有效率达94.34％,均取得了较满意的治疗效果.其中治疗组在各项评定中的改善效果更优于对照组(P<0.05).结论 体外冲击波联合常规康复治疗肩关节周围炎能缓解患者肩关节疼痛,改善肩关节综合功能,疗效优于单纯常规康复治疗.     

发散式体外冲击波治疗颈肩肌筋膜疼痛综合征

目的评价发散式体外冲击波治疗颈肩肌筋膜疼痛综合征的安全性和有效性。方法自2012年5月至2012年8月通过发散式体外冲击波治疗仪(AGD-800)治疗颈肩肌筋膜疼痛综合征36例患者,每位患者都以痛点定位冲击点,每次治疗一个或多个冲击点(疼痛区域),每个冲击点次数2 000次,治疗周期7 d/次,连续治疗3次,分别为0、7、14 d,治疗时间为5~10 min,并随访记录治疗前、治疗后、7 d、14 d、21 d的疼痛视觉模拟评分(visual analogue scale,VAS)、医生评价评分、患者反应评分及总体评分。结果 36例患者中32例获得完全随访,均无不良事件发生。VAS评分随着时间延长、治疗次数增加逐渐改善,治疗前后比较差异有统计学意义。患者对治疗效果较满意,总有效率末次随访达到50%。结论冲击波技术无明显损伤、安全、简便、有一定的疗效,可作为颈肩肌筋膜疼痛综合征综合治疗中的一种辅助治疗,值得推广。     

体外震波仪治疗肌腱末端病的临床研究

[目的]评价体外震波疗法对肌腱末端病的临床作用.[方法]使用HK.ESWL - VI碎石机对共24例网球肘、跟腱炎、手屈肌腱鞘炎和肩周炎的病人进行了治疗,工作电压10～14 Hz/s,每次冲击800 ～1 000次,治疗次数1～3次,间隔3～4 d,治疗时间跨度为2周内.使用疼痛评定方法(VAS)和临床疗效判断标准评定震波治疗效果.[结果]随访6 ～12个月,利用VAS (visual analog scale)疼痛评分法进行评估疼痛,治疗前后VAS评分经x2检验,P ＜0.05.临床疗效判定,18例病人达到临床治愈;5例病人达到临床显效;1例病人为临床无效.[结论]体外震波治疗具有无创、无副作用等优点,可以用于治疗肌腱末端病,近期效果较好,其远期疗效尚需观察.     

手法治疗冈上肌肌腱炎116例

冈上肌肌腱炎是临床上常见的一种以肩部疼痛为主的病症。笔者用按摩手法治疗本病症，取得了满意疗效，现小结如下：临床资料ｌ．一般资料；１１６例中男７８例，女３８例；年龄在２０岁以下５例，ＺＩ～３０岁１９例，３１～４０岁２６例，４１～５０岁４３例，５０岁以上２３例；病程７天～３年有外伤史３９例，慢性劳损７７例。２．治疗方法：第一步揉法：患者取坐位，患肩自然下垂并稍内收姿势下，医者站在患者患侧用揉和搞法放松肩部同上肌，以舒通血脉、活血化瘀。或取患者俯卧位，医者站在患者患侧用按压、揉法放松肩背部网上肌。第二…     

肩部慢性钙化性肌腱炎的体外冲击波疗法

体外冲击波疗法(ESWT)在过去的几年中已被引入骨外科用于肩部钙化性肌腱炎的治疗,但关于其治疗效果的文献报道并不一致。该文作者对30例(平均年龄56.6岁)肩部慢性钙化性肌腱     

体外震波仪治疗肌腱末端病

体外震波治疗（ESWT）源于20年前,开始仅用于碎石.1990年初德国医生将其用于治疗网球肘、跟腱炎等末端病和其它软组织损伤,取得了较为满意的结果,并逐渐得到广泛应用,是目前欧美治疗运动损伤的主要手段之一.作者自2004年1月以来,使用新一代的EMS治疗仪对部分网球肘、肩周炎等病人进行了治疗,取得了近期较好的效果.     

Efficacy of extracorporeal shockwave therapy for knee osteoarthritis: a randomized controlled trial

Background

Extracorporeal shockwave therapy (ESWT) has been widely used for pain relief and treatment of musculoskeletal disorders. We aimed to assess ESWT for knee osteoarthritis (OA) over 12 wk by comparison with placebo treatment.

Materials and methods

We randomized 70 patients to receive placebo (n = 36) or ESWT (n = 34). For ESWT, patients received 4000 pulses of shockwave at 0.25 mJ/mm² weekly for 4 wk. In the placebo group, patients received shockwave at 0 mJ/mm² in the same area. The effect on OA was assessed by pain on a visual analog scale and disability on the Lequesne index, Western Ontario and McMaster University Osteoarthritis Index, and patient perception of the clinical severity of OA. Evaluation was performed at baseline and after 1, 4, and 12 wk.

Results

We found no adverse events during and after ESWT. ESWT was more effective than placebo in reducing pain on movement at each period (P < 0.01). The mean visual analog scale score with ESWT was 3.83 at 12 wk versus 7.56 at baseline (P < 0.01). The Lequesne index and the Western Ontario and McMaster University Osteoarthritis Index score were reduced with ESWT. Moreover, patient perception of clinical severity of OA was significantly greater with ESWT than that with placebo (P < 0.01).

Conclusions

ESWT is effective in reducing pain and improving knee function, with better results than placebo during the 12-wk treatment. However, further pilot studies are needed to determine whether ESWT should be recommended at an early or later stage of OA or combined with conventional therapies.     

布洛芬联合体外冲击波治疗膝骨关节炎的随机对照研究

目的探讨布洛芬缓释胶囊联合体外冲击波对膝关节骨关节炎的治疗效应。 方法2018年9月至2019年9月,从重庆市人民医院纳入膝关节骨关节炎患者作为前瞻性随机对照临床研究。纳入标准：初治单侧膝关节骨关节炎;依从性良好者。排除标准：既往有其他膝关节疾患;膝关节强(僵)直;Kellgren-Lawrence分级为Ⅳ级的患者;对非甾体类抗炎药(NSAIDs)类药物禁忌或过敏的患者;合并其他内科系统疾病等。共198例患者通过随机数字表法分别分入联合组、布洛芬组、冲击波组。联合组给予布洛芬缓释胶囊联合体外冲击波治疗;布洛芬组给予单纯布洛芬缓释胶囊治疗;冲击波组给予单纯体外冲击波治疗,疗程5周。于治疗开始后8周时采用膝关节损伤和骨关节炎评分(KOOS)、加拿大西安大略和麦克玛斯特大学骨关节炎指数(WOMAC)及SF-12生活质量评分对三组患者进行评价,并记录三组患者并发症发生率。结果用单因素方差分析、LSD-t检验、配对t检验和卡方检验进行分析。 结果布洛芬缓释胶囊联合体外冲击波治疗可显著改善骨关节炎患者膝关节KOOS、WOMAC及SF-12生活质量评分。联合组患者的疼痛(F＝174.5,P<0.001)、症状(F＝12.991,P<0.001)及功能评分(F＝6.009,P＝0.003)等显著改善,效应较单纯给予布洛芬缓释胶囊或体外冲击波治疗更佳。同时,并不明显增加治疗相关并发症的发生率(χ²＝2.479,P>0.05)。 结论布洛芬缓释胶囊联合体外冲击波对骨关节炎具有良好的治疗效应,效果优于单用布洛芬缓释胶囊或冲击波治疗。     

Dextrose prolotherapy versus radial extracorporeal shock wave therapy in the treatment of chronic plantar fasciitis: A randomized,controlled clinical trial

In the recent years, prolotherapy is increasingly being used in the field of musculoskeletal medicine. However, few studies have investigated its effectiveness in plantar fasciitis (PF). The purpose of this study was to compare the effectiveness of ultrasound-guided dextrose prolotherapy with radial extracorporeal shock wave therapy (ESWT) in the treatment of chronic PF. This randomized controlled trial was conducted on 59 patients with chronic PF. Patients were randomly assigned into two groups receiving three sessions of radial ESWT (29 patients) vs. two sessions of ultrasound-guided intrafascial 2 cc dextrose 20% injection (30 patients). The following outcome measures were assessed before and then six weeks and 12 weeks after the treatments: pain intensity by visual analog scale (VAS), daily life and exercise activities by Foot and Ankle Ability Measure (FAAM), and the plantar fascia thickness by ultrasonographic imaging. The VAS and FAAM scales showed significant improvements of pain and function in both study groups 6 weeks and 12 weeks after the treatments. A significant reduction was noted for plantar fascia thickness at these intervals (all p < .05). The inter-group comparison revealed that except for the FAAM-sport subscale which favored ESWT, the interaction effects of group and time were not significant for other outcome measures. Dextrose prolotherapy has comparable efficacy to radial ESWT in reducing pain, daily-life functional limitation, and plantar fascia thickness in patients with PF. No serious adverse effects were observed in either group.Level of evidenceLevel I, randomized controlled trial.     

Efficacies of extracorporeal shockwave therapy and low-level laser therapy in patients with plantar fasciitis

BackgroundVarious conservative treatment methods can be administered in the early stages of plantar fasciitis (PF). The aim of the treatment is to enable the patient to return to the physical activity as soon as possible.AimIn this study it was aimed to compare efficacies of Extracorporeal Shockwave Therapy (ESWT) and Low-Level Laser Therapy (LLLT) on patients with PF.DesignA local prospective cross-sectional studySettingDepartment of Physical Medicine and Rehabilitation Outpatient Clinic of Sakarya University, Faculty of MedicinePopulationPatients aged 18–70 years, having ongoing heel pain for at least 3 months, and not using oral and/or parenteral corticosteroids in the last 6 months.MethodsA total of 40 patients with PF included in the current study. Visual Analog Scale (VAS), Roles and Maudsley Score (RMS), American Orthopedic Foot and Ankle Association Score (AOFAS) and Foot Function Index (FFI) questionnaire were performed for all patients. ESWT and LLLT groups comprised of 22 (55%) and 18 (45%) patients, respectively.ResultsWe found significant improvements in scores based on the VAS, RMS, AOFAS, FFI in patients with PF and it was sustained for 3 months (p = 0.001, for all scores). While decrease in scores based on the VAS and FFI in LLLT group was statistically more significant compared to ESWT group (p = 0.014, p = 0.013), there was statistically less significant decrease in scores on the AOFAS in LLLT group than that of ESWT group (p = 0.032).ConclusionsThe results of this study indicated significant improvements in terms of pain, functional status and daily life activities following the administration of either of the treatments. Furthermore, LLLT was found to be significantly more effective for alleviating pain than ESWT in the treatment of PF.     

电子聚焦式高能体外冲击波联合常规口服药物治疗强直性脊柱炎

目的：探讨体外冲击波联合常规口服药物治疗强直性脊柱炎患者疾病活动度及骶髂关节影像学进展,寻找一种新的安全有效的治疗方法。方法：对2018年1月至2018年12月收治的30例强直性脊柱炎患者进行回顾性分析,其中男20例,女10例,年龄18~50（34.50±9.60）岁。30例患者治疗前MRI上均伴有不同程度的骶髂关节骨髓水肿情况。30例患者根据治疗方法的不同分为治疗组和对照组,其中对照组15例,采用非甾体抗炎药和柳氮磺吡啶肠溶片治疗;治疗组15例,在对照组基础上加电子聚焦式高能体外冲击波。对两组患者的病程、年龄及治疗前后血沉、C-反应蛋白进行分析,并采用疼痛视觉模拟评分（visual analogue scale,VAS）,加拿大脊柱骨关节研究协会（spondyloarthritis research consortium Canada,SPARCC）评分系统分别评估骶髂关节疼痛及骶髂关节结构损伤情况,同时计算Bath强直性脊柱炎疾病活动指数（Bath ankylosing spondylitis disease activity index,BASDAI）。结果：所有病例获得3个月以上随访。（1）治疗1个月后VAS、SPARCC评分治疗组明显优于对照组（P<0.05）。（2）治疗1个月后,BASDAI、血沉、C-反应蛋白两组差异无统计学意义（P>0.05）。（3）所有患者治疗后的VAS、BASDAI、SPARCC评分及血沉、C-反应蛋白较治疗前明显改善（P<0.01）。结论：电子聚焦式高能体外冲击波联合常规药物治疗强直性脊柱炎在快速缓解疼痛、改善疾病活动度、阻止影像学进展方面具有较好的临床效果,并且安全性高、无创,值得临床推广应用。     

超声影像灰度分析评估冈上肌腱病的初步研究

目的探索计算机灰度平均值对冈上肌腱病患者的评估作用。 方法纳入广州医科大学附属第五医院康复科治疗的单侧冈上肌腱病患者46例,排除双侧肩痛和其他非肌腱因素所致的肩痛患者。按性别分为男性组16例、女性组30例;按年龄分为青壮年组10例、中年组19例、老年组17例;按病程分为急性期组13例、慢性期组19例、慢性迁延期组14例。触诊冈上肌腱行VAS评分并定位标记主要压痛点和次要压痛点。以改良Crass体位对冈上肌腱行超声摄片,对主要及次要压痛点短轴图行患侧健侧等面积截图,行计算机灰度分析测其灰度平均值。采用配对t检验,比较主要压痛点和次要压痛点,患侧和健侧灰度平均值的差异;采用单因素方差分析,比较不同性别、年龄、病程组间,主要压痛点和次要压痛点灰度平均值的差异。采用计算机灰度分析方法定量评价超声视觉评估无特异性病变的冈上肌腱压痛点回声差异。 结果冈上肌腱存在多个压痛点,根据VAS评分可分为主要和次要压痛点。女性主压痛点VAS评分高于男性(t＝2.175,P<0.05),老年组主压痛点VAS评分高于中年组和青壮年组(F＝3.851,P<0.05)。冈上肌腱主要及次要压痛点灰度平均值均小于健侧(t＝8.109、4.816,均为P<0.001)。患侧冈上肌腱,按年龄性别或者病程分组,主要压痛点灰度平均值较健侧均明显下降(P<0.05)。健侧冈上肌腱,其灰度平均值女性低于男性(t＝3.881,P<0.001),老年组低于中年组和青壮年组(F＝14.000,P<0.001)。 结论冈上肌腱病常有多个压痛点,需要对所有压痛点进行超声检查。对于超声视觉评估无特征性征象的冈上肌腱压痛点,灰度平均值较健侧下降可提示冈上肌腱病,此方法可量化肩袖肌腱病变程度,有望为该病的诊断提供参考依据。     

Effectiveness of extracorporeal shockwave therapy in three major tendon diseases

Background

Extracorporeal shockwave therapy is a conservative treatment for several painful musculoskeletal disorders. The aim of the study was the assessment of the relief from pain by the shockwave therapy in a population of consecutive patients affected by specific pathologies.

Materials and methods

A group of consecutive patients were studied and treated. They were affected by calcific tendonitis of the shoulder (129 patients), chronic Achilles tendinopathy (102 patients), and lateral epicondylitis of the elbow (80 subjects). Each patient had 3 applications with a monthly interval, and was followed up at 1, 6, and 12 months after treatment. Results were evaluated by the numeric rating scale (NRS) in all cases, the Constant Murley Score for the assessment of the shoulder function, the American Orthopaedic Foot and Ankle Society Score for subjects affected by chronic Achilles tendinopathy, and the Oxford Elbow Score for those affected by a lateral epicondylitis of the elbow.

Results

One year after treatment, the results were considered satisfactory with an almost complete resolution of symptoms. There were statistically significant results at the 12-month follow-ups regarding the mean NRS score (from 6.25 to 0.2), the Constant Murley Score (from 66.7 to 79.4), the Oxford Elbow Score (from 28 to 46), and the AOFAS (from 71 to 86).

Conclusions

Extracorporeal shockwave therapy may be considered a safe, economic, and effective treatment for several chronic musculoskeletal disorders, allowing satisfactory pain relief and improvement of function ability.

Level of evidence

Level IV.

     

体外震波治疗在男科疾病中的应用

体外震波治疗(ESWT)自1983年首次被用于治疗泌尿系结石以来已被广泛应用于各个领域。近年来,ESWT在男科疾病中的应用逐渐增多。现有研究显示:ESWT治疗Peyronie氏病可使83%的患者感到疼痛减轻,66%的患者对治疗持正面评价;ESWT在治疗器质性勃起功能障碍时能显著改善患者性生活的质量;ESWT在治疗慢性非细菌性前列腺炎时具有较好的疗效,尤其在缓解疼痛方面疗效明显。ESWT为男科疾病的治疗提供了新的思路和选择。ESWT治疗男科疾病的作用机制尚未明确,需要深入进行基础研究来阐明和开展多中心、大样本的临床随机对照试验来验证。     

低能级体外冲击波碎石治疗肾鹿角形结石

目的探讨低能级体外冲击波碎石(extracorporeal shock wave lithortripsy,ESWL)治疗肾鹿角形结石的效果. 方法对18例鹿角形结石进行体外冲击波治疗.碎石能级1～3级,冲击次数1 800～3 000次,脉冲间隔60 ～80次/min,工作电压10～12.75 kV. 若结石直径>3 cm,在碎石前预先插入双J管,防止石街形成.对直径>4 mm的残余结石,再次行ESWL,直至结石完全消失. 结果所有病人耐受良好,治疗结束能自行回家.除1例碎石失败外,余17例经ESWL治疗成功.治疗3～9次,至完全排除结石.66例次(66/77,85.7%)术后有1～2次肉眼血尿.5例出现石街,长1.9～5.2 cm,4例石街经再次碎石成功,1例输尿管镜取石. 结论低能级ESWL治疗肾鹿角形结石是一种安全、有效的方法.     

Extracorporeal shockwave therapy (ESWT) for refractory Achilles tendinopathy: A prospective audit with 2-year follow up

BackgroundAchilles tendinopathy (AT) represents a triad of tendon pain, swelling and impaired performance. Extracorporeal shockwave therapy (ESWT) has been endorsed by the National Institute for Health and Care Excellence (NICE) for refractory AT. This audit investigates the long-term outcomes of patients treated with ESWT for refractory AT.MethodsForty-six patients treated with ESWT for AT between October 2010 and August 2011 completed visual analogue, satisfaction scores and functional assessment questionnaires over two years. Patients were subdivided into two groups depending on whether their AT was insertional (IAT) or non-insertional (NAT).ResultsForty-six patients (mean age 58 years) completed all treatments and full 2 year follow up. There was significant improvement in pain at rest, on activity and of function within both NAT and IAT groups over the two-year period. Satisfaction scores were significant in the NAT group but not in the IAT group.ConclusionsESWT appears to be of benefit in the long term improvement of pain at rest, on activity and functional outcome in patients with refractory AT. However, subjective patient opinion may not match the perceived clinical outcome observed in this audit in all patients and individuals should be counselled regarding this prior to treatment.