药刀靶向微创治疗肱二头肌长头肌腱腱鞘炎75例报告

肱二头肌长头肌腱腱鞘炎多见于中年人,主要表现为肩痛,影响患侧上肢的提物和外展功能.年龄较大者常伴有肩部其它疾患,如冻结肩、滑囊炎等.笔者自1983-2007年用药刀靶向微创治疗肱二头肌长头肌腱腱鞘炎75例,获满意疗效,现总结如下.     

肩部撞击症70例诊治体会

肩部撞击症７０例诊治体会李永才肩部撞击症又称肩峰下疼痛弧综合症。是肩关节外展活动时，肩峰下间隙内结构与像肩韧带穹之间反复摩擦撞击而产生的一种慢性肩部疼痛综合症［１］，是中年以上者的常见病。门诊中大多以肩峰下滑囊炎、冈上肌腱炎及肱二头肌长头腱鞘炎为主要...     

肩周痛点推拿按穴摇肩防治肩周炎

笔者从1991年1月以来,采用肩周痛点推拿后按穴摇肩法治疗软组织性肩周痛97例,疗效满意,总结如下。1　临床资料　　本组97例中男51例,女46例;年龄36～50岁;左肩者45例,右肩者52例。病程3～90天。本组病例均诉有单侧肩部痛,其中主诉有肩关节活动受限者56例。查体肱二头肌短头(喙突)处压痛46例;肱二头肌长头(肱骨结节间沟)处压痛9例;肩峰下压痛16例;冈上肌、冈下肌、大圆肌处压痛6例;肩峰下喙突处均压痛20例。托肘摇肩均无阻力。2　治疗方法21　肩内痛点　以右肩为例。患者坐于方凳上,医者左脚踏在患者坐凳旁,患肩肘部搁医者膝上部,用右手固定…     

超声引导下单点穿刺法行多部位注射治疗冻结肩疗效观察

目的:比较超声引导下单点穿刺注射法与传统多点穿刺注射法治疗冻结肩的临床疗效。方法:门诊接受注射治疗的100例冻结肩患者,采用随机数字表法将患者分为单点穿刺组（S组）和多点穿刺组（M组）,每组50例。两组患者均接受超声引导下盂肱关节腔联合肩峰下滑囊及肱二头肌长头腱鞘注射治疗。记录治疗前和治疗后第4周、第8周、第12周肩关...     

小针刀治疗二头肌长头腱鞘炎66例报告

小针刀治疗二头肌长头腱鞘炎６６例报告刘春荣，满秀云肱二头肌腱鞘炎是一种常见病，多发病。多见于上肢活动频繁工作和中老年人。往往与肩周炎相混淆，久治不愈。我们自８８年共诊治单纯性肱二头肌长头腱鞘炎６６例，效果满意，报告如下。１临床资料本组共６６例，男４８...     

肩周炎的治疗现状和命名商榷

肩周炎是目前影响中老年人生活和工作的常见病,1872年由Duplay首次命名,由于该诊断名词对病变部位及性质含义不清,治疗方法也各不相同,故难以提高疗效。近年来由于解剖、病理、病因学知识的积累和诊断治疗技术的进步,肩周炎的名词已逐渐被“肱二头肌长头腱鞘炎”、“喙突炎”、“冈上肌腱炎”、“肩峰下滑囊炎”、“冻结肩”、“肩撞击综合征”等具体定位定性名词所替代。本文特呼吁对19世纪命名的肩周炎名词已完成历史使命,临床工作者应从模糊概念走向精确,以确定单一诊断,有针对性予以治疗,才能提高疗效。     

肩周炎的分类诊断和治疗

自1872年Duplay首次提出肩周炎的诊断后,国内外学者都把肩周围软组织病变引起的肩关节疼痛和功能障碍,统称为肩关节周围炎,简称肩周炎。但由于诊断名词对病变部位及性质含义不清,治疗方法也各不相同,故难以提高和比较疗效。近年来由于科学技术的进步和临床实践探索,肩周炎的名词已逐渐被“肱二头肌长头腱鞘炎”、“喙突炎”、“冈上肌腱炎和冈上肌腱钙化”、“肩峰下滑囊炎或三角肌下滑囊炎”、“冻结肩”、“肩撞击综合征”等具体定位定性名词所替代。本文分别阐述以上六种疾病的解剖特点,分类诊断,鉴别诊断和治疗方法,以供临床工作参考。     

加压局部注射疗法治疗肱二头肌长头腱鞘炎200例

我院于1987年7月至1990年7月采用加压局部注射疗法治疗肱二头肌长头腱鞘炎200例,经1～3年观察,疗效比较满意,报导如下。     

超声检查在肩部的应用进展

超声在肩部的应用至今已超过20年,最初只限于对肩袖的检杳,随着超声仪器性能的改进,以及检查技术和超声下解剖结构认识的提高,超声在肩部其他部位的检查中也得到开益广泛的应用.超声下可以看到肩袖改变、肩部骨折、滑囊和关节腔积液,同时作为一种动态性检查,超声还可以辨别肱二头肌长头腱半脱位、肩峰撞击等病变.     

锚钉重建修复肱二头肌长头腱断裂

临床上肱二头肌长头腱断裂并不常见,但会导致屈肘肌力下降和肩关节疼痛[1].2004年6月至2009年1月,我们对26例肱二头肌长头腱断裂的患者,采用锚钉进行重建修复,术后疗效满意. 1.一般资料:本组26例,男24例,女2例;年龄34～63岁,平均46.2岁.左侧16例,右侧6例.急性创伤性断裂18例,慢性劳损或病理性断裂8例,其中2例分别在发病前3个月和4个月因肩部疼痛、弹响诊断为肱二头肌长头腱鞘炎,行局部封闭治疗1次,症状缓解.受伤距手术时间为3 h至14 d,平均5.4 d.所有患者均通过肩关节及肱骨X线片或CT检查,排除骨关节疾病.     

Extracorporal shock wave treatment of the achilles tendinitis: Experimental and preliminary clinical results

OBJECTIVE: Various studies have shown the benefit of extracorporal shock wave therapy (ESWT) in the treatment of soft tissue pathologies. The aim of this prospective study was to compare the results of ESWT with the operative treatment for achilleus tendopathy. Furthermore mechanical effects of the shock waves on the achilleus tendon were analysed by an in-vitro model. METHOD: The achilleus tendons of common pigs treated with 1500 impulses twice using an energy varying from 0.23 - 0.54 mJ/mm (2) were histologically examined. The clinical results of two patient groups of which the first (n = 28) was treated with 2000 impulses (0.23 mJ/mm (2)) once and the second (n = 26) underwent surgery for achilleus tendopathy were compared. RESULTS: The in-vitro model demonstrated that an EFD of 0.42 and 0.54 mJ/mm (2) can lead to tendon lesions. One year follow-up showed good and excellent results in 69 % and satisfactory results in 15 % of the operated group and good and excellent results in 29 % and satisfactory results in 43 % of the ESWT group. We could show a time-dependent effect of the shock wave treatment on the clinical outcome. CONCLUSIONS: Follow-ups show acceptable results with little side effects when an energy flow density (EFD) under 0.23 mJ/mm (2) is used. ESWT offers a non-invasive therapeutic concept that can seriously be contemplated before operative treatment, but lower success rates in comparison to the operative results can be expected.     

Extracorporeal shock wave therapy for chronic calcifying tendinitis of the shoulder

Over the past few years, extracorporeal shock wave therapy (ESWT) has been introduced for the treatment of some orthopedic diseases. The aim of this study was to assess the efficacy of ESWT on chronic calcifying tendinitis of the shoulder through a prospective study. We studied 30 patients (mean age, 56.6 years) with chronic calcifying tendinitis of the shoulder. The patients were treated for a mean of 6 sessions, with 1400 impulses for each session. We used the new device Electro Medical Systems-Swiss Dolorclast (Electro Medical Systems, Nyon, Switzerland), which emits radial expanded shock waves, pneumatically generated. Patients were evaluated before treatment and after a mean of 10 weeks on a patient-oriented questionnaire (Dawson shoulder questionnaire, validated Italian version) and by radiological and ultrasound examinations. Radiographic disintegration and partial resorption of the calcium deposit were respectively recorded in 50% and 30% of cases, and the ultra-sound image showed modification of echogenicity in all cases. Clinically a good response to pain and to joint movement was recorded; the questionnaire also showed a statistically significant improvement. Shock wave therapy for calcifying tendinitis of the shoulder is effective from the patient's perspective and according to imaging outcomes. It could be considered an effective therapy for chronic calcifying tendinitis of the shoulder. Received: 14 January 2002/Accepted: 15 March 2002     

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.     

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.     

Application of extracorporeal shock wave treatment to enhance spinal fusion: a rabbit experiment

BACKGROUND: Extracorporeal shock wave treatment has been used to treat many orthopedic disorders. However, the effect of extracorporeal shock waves on spinal fusion has not been reported. METHODS: Fifteen rabbits were used in this study. Spinal fusion was performed with decortication of bilateral L5 and L6 transverse processes, and placement of the bone chips onto the ipsilateral L5-L6 intertransverse space. The right L5 and L6 transverse processes in all animals were treated with 1000 impulses of ESWT at 14 kV (equivalent to 0.18 mJ/mm(2)) at 3 and 6 weeks after surgery. The left transverse processes did not receive ESWT, and were served as controls. Radiographic examinations of the spines were performed at 3, 6, and 12 weeks. Computed tomography was performed at 12 weeks. The rabbits were killed at 12 weeks, and the spinal segments were harvested for histomorphological examination. RESULTS: Radiographs of the tested rabbits taken at different post-ESWT stages demonstrated repairing effect of ESWT on the fusion gap of the treated (right) sides. Statistical analysis of the image studies indicated that 11 (73%) of 15 rabbits showed superior fusion mass on the ESWT (right) side than that of control (left) side (P < .001). The remaining 4 (27%) rabbits showed no discernable fusion difference between the ESWT side and the control side. Histomorphological examination showed good new bone formation in 9 fusion masses. All of these cases were noted on the ESWT (right) sides. Statistical analysis showed that ESWT sides had better new bone formation than the control sides (P = .001). CONCLUSIONS: Results of this study demonstrated that ESWT is effective in promoting spinal fusion in rabbits.     

Influence of local anesthesia and energy level on the clinical outcome of extracorporeal shock wave-treatment of chronic plantar fasciitis

BACKGROUND: The efficacy of low energy extracorporeal shock wave treatment (ESWT) for chronic plantar fasciitis is discussed controversially. It is unclear whether the simultaneous application of local anesthesia (LA) interferes with clinical outcome. METHODS: 60 patients with a chronic plantar fasciitis were enrolled in a triple-arm (20 patients per group), prospective randomized and observer-blinded pilot trial. The patients were randomly assigned to receive either active ESWT without LA (;3 x 1 500 shocks, total energy flux density [EFD] per shock 0.09 mJ/mm(2) [Group A]), ESWT with LA (3 x 1 500 shocks, EFD 0.18 mJ/mm(2) per shock [Group B]) or ESWT with LA (3 x 1 500 shocks, EFD 0.09 mJ/mm(2) [Group C]). Main outcome measures were: pain during first stepps in the morning (measured on a 0-10 point visual analogue scale) and number of patients with > 50 % reduction of pain and no further therapy needed, measured at 6 weeks after the last ESWT. RESULTS: Group A improved in the VAS from 6.4 (SD: 1.7) to 2.2 (SD: 2.6) points, group B from 6.7 (SD: 1.5) to 4.1 (SD: 2.4) points, group C from 6.2 (SD: 1.6) to 3.8 (SD: 2.5) points. A reduction of pain of at least 50 % was achieved in 60 % of group A, in 36 % of group B and in 30 % of group C. Group A without LA showed a significantly higher improvement in the VAS and subjective evaluation than groups B (p = 0.007) and C (p = 0.016). CONCLUSION: At 6 weeks success rates after low-energy ESWT with local anesthesia were significantly lower than after identical low-energy ESWT without local anesthesia. Higher energy levels could not balance the disadvantage of this effect. LA significantly influenced the clinical results after low energy ESWT in a negative way. Blinding patients by LA in ESWT studies must therefore be considered a systematic error in study design.     

高能体外震波(ESWT)治疗长骨骨不连

[目的] 探讨使用高能体外震波（ESWT）治疗长骨骨不连的效果。[方法] 本组20例长骨骨折切开复位内固定或石膏外固定治疗后骨不连，2例萎缩型，18例增生型。采用C臂机结合Ossatron ESWT治疗仪，分别取尺、桡骨24kv，肱骨26kv，胫骨、股骨28kv的震波强度，尺、桡骨1500次，肱骨3000次，股骨及胫骨6000次。[结果] 平均随访15．2个月。8例3个月后骨愈合，6例4个月后骨愈合，3例5个月后骨愈合，1例6个月后仍未愈合，再次行ESWT治疗后4个月愈合，2例6个月后未愈合，行切开复位内固定＋植骨后愈合。平均愈合时间为3．9个月，愈合率达90％。[结论] ESWT可以做为治疗长骨骨不连及骨延迟愈合的有效治疗方法。     

Comparison of Extracorporeal Shock Wave Therapy and Ultrasound-Guided Shoulder Injection Therapy in Patients with Supraspinatus Tendinitis

BackgroundThe present study compared the clinical effect of extracorporeal shock wave therapy (ESWT) with that of ultrasound (US)-guided shoulder steroid injection therapy in patients with supraspinatus tendinitis. We hypothesized that the two treatments would show comparable results.MethodsThe inclusion criteria were age over 20 years and diagnosis of supraspinatus tendinitis using US. Ultimately, 26 patients were assigned using blocked randomization: 13 in the US-guided shoulder injection group and 13 in the ESWT group. Treatment outcomes were evaluated using the pain visual analog scale (pVAS), the American Shoulder and Elbow Society (ASES) score, and the Constant score at baseline and at 1 and 3 months after the procedure.ResultsAt 1 month after the intervention, pVAS, ASES, and constant score were significantly higher in the US-guided shoulder injection group than in the ESWT group, but not at 3 months after the intervention. Both groups showed clinically significant treatment effects at 3 months after the intervention compared to baseline. No significance was shown using equivalence testing.ConclusionsUS-guided shoulder injection therapy was not superior to ESWT therapy. Considering the complications and rebound phenomenon of steroid injections, interventions using ESWT may be a good alternative to treat patients with supraspinatus tendinitis.     

Extracorporeal shock wave therapy vs surgical treatment in calcifying tendinitis and non calcifying tendinitis of the supraspinatus muscle

The authors performed a study to compare the short-term clinical outcome between three methods for failed conservative treatment of the supraspinatus muscle tendinitis, extracorporeal shock wave therapy (ESWT) and open or arthroscopical subacromial decompression.60 patients treated by ESWT or treated surgically (14 open, 16 arthroscopically) were included and assessed preoperatively and 3 months postoperatively with the subjective shoulder rating system (SSRS score). Another parameter investigated was a cost analysis with emphasis on the time of unfitness for work.There was a considerable score increase in all three groups three months after intervention with a change of 24 and 25 points in the surgical subgroups and of 14 points in the ESWT group. This lead to 40% good/very good results in the open surgical group, 62% good/very good results in the arthroscopically treated group and 67% good/very good results in the ESWT group. The time of unfitness for work and costs for treatment were lowest in the ESWT group.ESWT appears to be an effective and relatively inexpensive treatment for supraspinatus muscle tendinitis and should be considered before surgical treatment is employed.     

Basic research of applying extracorporeal shockwaves on the musculoskeletal system. An assessment of current status

Detailed knowledge concerning the action of extracorporeal shock waves on the locomotor system as well as concerning possible side effects of extracorporeal shock wave therapy (ESWT) are crucial to optimize the clinical use of ESWT for the treatment of illnesses such as calcific tendinitis of the shoulder, tennis elbow, plantar fasciitis, aseptic pseudarthrosis, and aseptic hip necrosis. This study presents the current knowledge gained from animal experiments, which have yielded important findings, in particular concerning possible side effects of ESWT. Very recent studies have also provided valuable insights into the molecular actions of extracorporeal shock waves on the locomotor system. Further intensified experimental animal research will greatly improve the scientific basis for the clinical use of ESWT in the near future.