低能量冲击波预处理预防碎石引起的肾损伤

研究者用6-8周雌猪建立冲击波肾损伤模型,其中两组实验动物一侧肾极分别给予12 kV、2000次和12 kV、500次预处理,然后对侧肾极分别给予24 kV、2000次标准治疗剂量,另外两组动物一侧肾极给予12 kV、500次和12 kV、100次预处理,然后同侧肾极给予24 kV、2000次标准治疗剂量。检测各肾极肾损伤指标并进行统计分析,结果发现给予低能量冲击波预处理后,同侧及对侧肾极损伤程度均明显减轻,说明低能量冲击波预处理可以降低标准剂量冲击波引起的肾损伤,对同侧和对侧肾极均有保护作用,同时作者认为可引起保护作用的预处理冲击次数域值可能小于100次,…     

冲击波治疗骨折不愈合和延迟愈合23例报告

[目的]探讨体外冲击波对骨折不愈合和延迟愈合的治疗作用及安全性。[方法]采用冲击波骨科治疗机治疗23例骨折不愈合或延迟愈合患者，冲击电压为7．0～12．0kV，冲击能量0．056～0．250mJ／mm^2，冲击1000～3600次，焦点压力10．2～37．2MPa。根据患者情况治疗5～8次，每次间隔3～7d。[结果]治疗后随访12～18个月，定期复查X线片，23例中，5例无效，18例有明显骨痂生长并最终骨折完全愈合，骨折愈合时间平均为14周，12个月后有效率78．1％，治疗后未观察到明显血管神经损伤、内固定断裂等并发症。用冲击波治疗骨折不愈合和延迟愈合简单有效、安全经济，可作为首选方法。     

体外冲击波对肾脏生物学效应的实验研究

雄性家兔４５只，分为３组，分别接受三个能量级（２０ｋＶ，７５０ＳＷ；１４ｋＶ，１５００ＳＷ；１０ｋＶ，３０００ＳＷ）体外冲击波处理。结果表明，２组动物急性肾损伤程度较其它两组病变轻微。体外冲击波对肾脏的生物学效应表现为尿酶γＧＴ升高；超微结构显示肾小管上皮细胞变性坏死；组织学显示肾内和肾周出血。实验第２８天的生物学效应表现为吸收和（或）纤维化修复。体外冲击波能量（包括电压和冲击次数）与其对肾脏生物学效应程度相关。     

复式冲击波组织损伤的实验研究

目的　探讨复式冲击波对组织损伤的作用程度。　方法　采用活体猪进行系列液电式复式冲击波与单式冲击波以及电磁式冲击波冲击 ,对比分析组织损伤范围及组织学改变。　结果　8kV冲击 10 0 0次条件下 ,单式冲击波与复式冲击波肾脏损伤范围分别为 18mm× 15mm× 3mm和14mm× 11mm× 2mm ,输尿管损伤范围分别为 4 2mm和 30mm。病理检查显示 ,复式和单式冲击波对肾脏及输尿管的各层结构都可造成以出血为特征的可逆性损伤 ,很少产生瘢痕组织。与电磁式冲击波比较 ,复式冲击波碎石效果更好 ,并不增加组织的损伤。　结论　与液电式单式冲击波和电磁式冲击波相比 ,复式冲击波并不增加肾和输尿管组织损伤。     

高能冲击波与肾脏损伤量效关系的实验研究

实验应用体外冲击波碎石技术复制家兔肾脏高能冲击波伤动物模型，以肾脏出血组织体密度作为肾脏损伤程度的定量参数。应用体现学方法定量测定了不同冲击次数、频率条件下肾脏出血组织体密度。结果表明：肾脏损伤程度与冲击次数、频率存在显著正相关性。提示在临床粉碎肾脏结石时应采用低冲击次数，慢冲击频率可有效减轻肾脏的损伤。     

体外冲击波对大鼠胸段脊髓影响的初步研究

目的:初步探讨体外冲击波(ESW)对大鼠胸段脊髓的影响.方法:雄性SD大鼠126只,随机分为4组,直接冲击组(A组,48只),不做椎板切除手术,直接进行冲击波冲击,冲击参数:发射电压10kV,冲击能量0.250mJ/mm2冲击频率60次/min,冲击次数1000次;手术后冲击组(B组,48只),切除T7～T10椎板,皮肤愈合后行冲击波处理,参数同A组;手术后不冲击组(C组,24只),切除T7～T10椎板,不行冲击波处理;正常对照组(D组,6只),不进行任何处理.A、B、C组义分为处理后4h、8h、24h、72h共4个时间点,D组不分时间点.A、B、C组处理前、后及D组行BBB评分,并经灌注后取T7～T10脊髓标本,切片行HE染色观察脊髓损伤情况,用免疫组化方法观察脊髓C-fos蛋白的表达.结果:A组和B组大鼠处理后8h、24h、72h时BBB评分均有下降,以8h最低,分别为16.8±0.8分和14.5±1.0分,处理后各时间点两组间均有显著性差异(P<0.01),A组和B组8h、24h、72h时BBB评分均明显低于C组和D组(P<0.01),但C组和D组之间无显著性差异(P0.05).A组和B组HE染色均可见脊髓出血、水肿,神经元变性坏死,且B组较A组损伤程度重;组及D组未见明显脊髓损伤表现.B组脊髓中C-fos蛋白表达最强,其次为A组,均以24h表达最强,平均光密度值分别为0.396±0.008和0.293±0.013,两组比较有显著性差异(P<0.01);组及D组表达均不明显,与A组和B组比较有显著性差异(P<0.01),C组和D组之间无显著性差异(P0.05).结论:发射电压10kV、冲击能量0.250mJ/mm2的ESW可造成大鼠胸段脊髓一定程度的损伤,冲击时椎板可起到一定保护脊髓的作用.     

复式脉冲碎石机治疗儿童上尿路结石

目的探讨低能量复式脉冲碎石机对儿童上尿路结石治疗的可行性。方法采用国产BH-VG低能量复式脉冲碎石机治疗儿童上尿路结石21例，男童11例，女童10例；学龄前儿童（2-7岁）13例；学龄期儿童（8-16岁）8例。肾结石每次治疗不超过2500次，治疗电压3-7．5kV；输尿管结石每次治疗不超过3500次，治疗电压4-8kV。结果肾结石粉碎率100％，两周内结石排空率100％；输尿管结石粉碎率100％，两周内结石排空率100％。结论低能量复式脉冲碎石机治疗儿童上尿路结石是一种安全、有效的治疗方法。     

B超定位低能量ESWL治疗尿路结石4512例报告

目的：探讨B超定位低能量体外冲击波碎石术（ESWL）治疗尿路结石的优势、技术特点、治疗效果与副作用。方法：采用WD－ESWL－91型B超定位体外冲击波碎石机治疗尿路结石4512例,冲击电压10－12kV,平均 冲击次数2500次。结果：总碎石成功率为98．8％,3个月结石排净率为83．5％。结论：B超定位低能量ESWL具有定位准确、成功率高、组织损伤小、无严重并发症等特点,特别是尿路阴性结石患者,B超定位更具有独到之处,值得推广。     

不同能量体外冲击波冲击兔肾近期病理损伤与尿r－谷氨酰转肽酶的对应变化

选用健康雄性家兔２３只，用Ｅ＿２型碎石机冲击波轰击右肾，不同能量冲击波冲击后，兔肾近期病理损伤与冲击能量成正比。肾小管空泡变性、坏死较被膜下血肿或肾小球出血更明显地引起尿ｒＧＴ活性增高。尿ｒＧＴ／肌酐比值及尿ｒＧＴ％两种报告方式均能相应反映肾损伤的轻重。以ｒＧＴ／肌酐比值较灵敏，阳性率与病理符合率也高。此法可取一次尿５ｍｌ检测，方便、及时、准确。对门诊随诊或实验研究尤为方便。     

放射状冲击波疗法在电脑所致重复性使力损伤中的治疗作用:前瞻性单盲随机对照研究（英文）

目的评价低能量放射状体外冲击波疗法在电脑所致重复性使力损伤中的疗效。方法采用前瞻性单盲随机对照研究的方法,应用瑞士EMS Dolorclast放射状冲击波治疗机电脑所致重复性使力损伤82例,随机分为研究组和对照组,每组病例41例。研究组以痛点为中心,行体外冲击波治疗,治疗处方为:压力2.0 bar,能量0.08 m J/mm2,频率2 000次,治疗时间3至5周;对照组治疗处方为压力2.0 bar,能量0.08 m J/mm2,频率20次,治疗时间3至5周。对治疗前,治疗后和治疗后3个月的随访。观察指标包括视觉模拟评分(VAS)和功能障碍的水平。结果电脑所致重复性使力损伤经冲击波治疗后的优良率为56%,3个月后随访优良率为76%。结论放射状冲击波治疗电脑所致重复性使力损伤安全、有效。     

不同能流密度体外冲击波对骨质疏松兔股骨髁部松质骨影响的实验研究

目的 观察不同能流密度体外冲击波对骨质疏松兔股骨髁部松质骨成骨作用的差异.方法 采用卵巢切除法(OVX)对30只5月龄雌性新西兰兔去势,5个月后建立骨质疏松模型.将所有骨质疏松兔随机分为3组,每组10只,其中一组为空白对照组(A组),一组为体外冲击波(ESW)能流密度0.28 mJ/mm~2处理组(B组),另一组为体外冲击波能流密度0.47 mJ/mm~2处理组(C组),脉冲次数均为2000次,在实验组兔右侧股骨髁部进行体外冲击波(ESW)处理.于处理后4、8周时分二批每组处死5只动物,分离右侧股骨远端,进行显微CT(micro-CT)测量分析.结果 micro-CT三维重建分析表明,不同能流密度冲击波处理后4周时B组和C组在骨组织体积比(BV/TV)、骨小梁数目(Tb.N)等指标之间的差异有统计学意义;8周时B组和C组分别在骨密度(BMD)、骨矿含量(BMC)和BV/TV、骨表面积体积比(BS/BV)、骨小梁连接密度(Connectivity Density)等指标之间的差别有统计学意义,其中C组的BMD和BMC分别较B组增高16.8%和10.6%,尽管C组在其他骨小梁立体测量学等指标方面均较B组优,但两组测量结果 的差别无统计学意义.结论 不同能流密度体外冲击波对骨质疏松局部治疗后,不同时间,其成骨作用不同,较高能流密度的体外冲击波在治疗后8周时,促进骨质疏松被处理局部骨小梁的改建、改善骨小梁的三维结构、增加骨密度作用较优.     

Efficacy of poly(adenosine diphosphate-ribose) polymerase inhibition in extracorporeal shock wave-induced renal injury

Objectives: Extracorporeal shock wave lithotripsy (ESW) induces renal damage by excessive production of free oxygen radicals. Free Oxygen radicals cause cellular injury by inducing nicks in DNA. The enzyme poly(adenosine diphosphate-ribose) polymerase (PARP) involved in the process of repair of DNA in damaged cells. However, its activation in damaged cells can lead to adenosine triphosphate depletion and death. Thus, we designed a study to evaluate the efficacy of 3-aminobenzamide (3-AB), a PARP inhibitor, against extracorporeal shock wave induced renal injury. Methods: Twenty-four Sprague-Dawley rats were divided into three groups: control, ESW, ESW?+?3-AB groups. All groups except control group were subjected to ESW procedure. ESW?+?3-AB group received 20?mg/kg/day 3-aminobenzamide intraperitoneally at 2?h before ESW and continued once a day for consecutive 3 days. The surviving animals were sacrificed at the 4th day and their kidneys were harvested for biochemical and histopathologic analysis. Blood samples from animals were also obtained. Results: Serum ALT and AST levels, serum neopterin and tissue oxidative stress parameters were increased in the ESW group and almost came to control values in the treatment group (p?p?Conclusion: Our data showed that PARP inhibition protected renal tissue against ESW induced renal injury. These findings suggest that it would be possible to improve the outcome of ESW induced renal injury by using PARP inhibitors as a preventive therapy.     

Pathologic effects of ESWL on canine renal tissue

The introduction of extracorporeal shock wave lithotripsy (ESWL) has provided an avenue for dealing with many urinary stones noninvasively. The margin of safety for the kidney during shock wave administration is largely undefined. A pilot study was performed where six kidneys in five female mongrel dogs were shocked. Group A kidneys were given 1,776, 4,500, 6,000, or 8,000 shocks, respectively, at 18-24 kV. Group B kidneys received 1,600 and 8,000 shocks (18-24 kV). The number of shocks per electrode ranged from 500 to 4,538 and averaged 2,490. The dogs were sacrificed forty-eight to seventy-two hours (Group A) or twenty-eight to thirty-two days (Group B) post-treatment. Modest damage (hematoma and/or interstitial hemorrhage) was noted in all kidneys. Evidence of permanent change (fibrosis) was noted in both Group B kidneys. Complete necrosis of the kidney was not seen after administration of 8,000 shocks. These preliminary data indicate that lithotripsy can, in some circumstances, produce renal damage in the canine model.     

Histopathologic effects of extracorporeal shock wave lithotripsy on rabbit kidney

Summary Despite the widespread clinical use of the lithotriptor, the margin of safety for the kidney during shock wave application is substantially unknown. Although a series of pilot studies have been performed in laboratory animals, long-term follow-up is mandatory to establish the effect of extracorporeal shock wave lithotripsy (ESWL) and subsequent dose-dependent changes on the kidneys. An experimental study was performed in 45 rabbits; to define and compare the early and late complications of ESWL in the kidneys. The rabbits were divided into three groups of 15 animals each that received 1000, 1500 or 3000 shock waves respectively at 15–20 kV. The rabbits in each group were killed and necropsy performed within 24 h for the first 5 animals, 1 week for the second 5 animals and 2 months post-ESWL for the last 5 animals. Dose-dependent moderate damage (subcapsular hemorrhage, interstitial hemorrhage, capsular tension and perirenal hemorrhage) were noted in all kidneys at 24 h after treatment. Evidence of permanent changes (some fibrosis, tubular and glomerular damage, chronic inflammatory alterations) was noted in long-term follow up. Complete necrosis of the treated kidney was not encountered in this study.     

电磁式体外冲击波碎石的应用体会和输尿管镜碎石治疗输尿管结石的差别

目的比较电磁式体外冲击波碎石与输尿管镜碎石治疗输尿管结石的效果。方法选择我科室2015年7月至2017年10月就诊的150例输尿管结石患者,随机分为2组,体外冲击波组75例采用电磁式体外冲击波碎石术治疗,输尿管镜组75例采用输尿管镜碎石术治疗,对比两组临床疗效、结石大小、手术时间及并发症发生情况。结果体外冲击波组结石直径1 cm碎石成功率为95.24%,输尿管镜组结石直径1 cm为73.33%,差异具有统计学意义(P0.05),结石直径≥1 cm且2 cm和结石直径≥2 cm两组差异无统计学意义(P0.05),体外冲击波组总碎石成功率合计88.00%,输尿管镜组为72.00%,两组差异具有统计学意义(P0.05);体外冲击波组术后并发症发生率为9.33%,输尿管镜组为21.33%,差异具有统计学意义(P0.05)。结论电磁式体外冲击波碎石治疗对于1.0 cm的输尿管结石效果较好,且减少并发症发生。     

Effect of extracorporeal shock waves on calcaneal bone spurs

In a prospective study of 435 patients with chronic proximal plantar fasciitis, 283 (65%) had an inferior calcaneal bone spur of variable size evident prior to treatment with electrohydraulic high-energy extracorporeal shock waves (ESW). This included 308 patients who received extracorporeal shock wave treatments and 127 placebo (sham control) patients. At both initial (3 months) and final (12 months) evaluations after receiving ESW, no patient who received shock wave applications had significant disappearance or change in the radiographic appearance of the heel spur. Clinical outcome after ESW was satisfactory in 168 patients (82%) with a radiographically demonstrable inferior heel spur and in 81 patients (79%) without such a heel spur. The results showed no correlation between the presence or absence of the heel spur and the eventual treatment outcome.     

Effect of high-energy extracorporeal shock waves on the immature epiphysis in a rabbit model

Introduction We investigated the effect of high-energy extracorporeal shock wave (ESW) on immature tibial epiphysis in a rabbit model. Materials and methods Twenty New Zealand white immature rabbit were used in this study. Animals were divided into two groups and they received 14 kW, 0.6 mJ/mm², 1,500 or 3,000 shots for three times with an interval of 7 days. After 6 weeks all rabbits were killed. The all tibia epiphysis were assessed by histology. The epiphyseal plaque thickness of right tibiae of the 3,000-shot ESW group was significantly higher than those of the 1,500-shot ESW group and the left tibia epiphyses of the 1,500- and 3,000-shot ESW groups as controls (P < 0.05). Results The epiphyseal plaque thickness of right tibiae of the 1,500-shot ESW group was significantly higher than that of the left tibia epiphyses of the 1,500- and 3,000-shot ESW groups as controls (P < 0.05). Discussion We demonstrated that high-energy ESW stimulated the growth of immature rabbit epiphysis. The long-term effect of shock wave on the immature rabbit epiphysis deserves further study.     

体外冲击波碎石对肾结石患者血清肿瘤坏死因子的影响

目的探讨体外冲击波碎石（ESWL）对肾结石患者血清肿瘤坏死因子的影响及可能的机制。方法选择经X线或CT结合腹部B超确诊为肾结石无症状患者30例,观察体外冲击波碎石对肾结石患者血清肿瘤坏死因子（TNFα）的影响及尿N-乙酰-β-葡萄糖苷酶（NAG）和γ-谷氨酰胺转肽酶（γ-GT）、β2-微球蛋白（β2-MG）的变化。站果ESWL后血清TNFα值迅速升高,24h达最高值（P〈0.05）,1周时仍高于碎石前水平（P〈0.05）。尿NAG值逐渐升高,24h达高峰（P〈0.05）,1周降至ESWL前水平（P〉0.05）;尿γ-GT值逐渐升高,24h达高峰（P〈0.05）,72h降至ESWL前水平（P〉0.05）;尿β2-MG值迅速达高峰（P〈0.05）,24h降至ESWL前水平（P〉0.05）。结论ESWL导致肾结石患者血清TNFα水平升高,并与肾小管上皮细胞功能损伤相关。     

体外冲击波对兔骨-人工股骨柄界面生物力学的影响

目的探索体外冲击波(ESW)对骨-内植物界面生物力学的影响。方法将34只日本大白兔的双侧股骨随机分成三组：松动组、对照组、冲击组。麻醉下将预先制好的人工股骨柄插入股骨上段骨髓腔内,术后6周对松动组及冲击组的人工股骨柄进行机械松动,冲击组的人工股骨柄在松动后1周开始接受冲击波治疗。各组均于最后一次手术后8周处死,取出股骨标本,进行力学测试。结果无论最大拔出力,还是最大扭转力,冲击组与松动组均有显著差异(冲击组大于松动组)。最大扭转力冲击组与对照组无显著差异,最大拔出力冲击组大于对照组。结论ESW治疗有使松动的人工股骨柄再稳定的倾向。     

Evaluation of a system for classification of stones and their sites in kidneys treated with extracorporeal shock wave lithotripsy

The results of treatment with extracorporeal shock wave lithotripsy (ESWL) were recorded in 1067 patients with renal calculi during their first admission to hospital. All treatments were performed in an unmodified Dornier HM3 lithotripter according to the original recommendations whereby the generator voltage was usually set between 18 and 23 kV. The stones in kidneys treated with ESWL alone were first classified into four different types (A. B. C. D) and after which a further subgrouping was carried out according to the number and sites of stones in the renal pelvis or calyces. The number of shock-waves. the energy index. the duration of treatment, and length of hospital stay as well as the therapeutic results after four weeks and six months were recorded for the different subgroups. An approximate estimate of the stone volume was calculated from measurements on a plain abdominal radiograph. The mean stone volume, number of shock waves, energy index, duration of treatment, and length of hospital stay increased progressively and significantly from group A to group D. The stone volumes and the energy indexes in the different subgroups within each type were distributed around levels that clearly differed between the types. Although minor variations were observed similar patterns also were recorded for the retreatment rate, the total duration of treatment, and the length of hospital stay. The therapeutic result, expressed as satisfactory disintegration, showed roughly similar results within each group but, as expected, the success rate decreased when more complicated stones were treated. Although stones located in the renal pelvis were often bigger than calyceal stones, the former seemed to disintegrate more easily.(ABSTRACT TRUNCATED AT 250 WORDS)