Antibacterial effects of extracorporeal shock waves

Despite considerable knowledge about effects of extracorporeal shock-wave therapy (ESWT) on eukaryotic tissues, only little data are available concerning their effect on prokaryotic microorganisms. The objective of the present study was to determine the bactericidal activity as a function of energy flux density and shock-wave impulse number. Standardised suspensions of Staphylococcus aureus ATCC 25923 were exposed to different impulse numbers of shock waves with an energy flux density (ED) up to 0.96 mJ mm(-2) (2 Hz). Subsequently, viable bacteria were quantified by culture and compared with an untreated control. After applying 4000 impulses, a significant bactericidal effect was observed with a threshold ED of 0.59 mJ mm(-2) (p < 0.05). A threshold impulse number of more than 1000 impulses was necessary to reduce bacterial growth (p < 0.05). Further elevation of energy and impulse number exponentially increased bacterial killing. ESWT proved to exert significant antibacterial effect in an energy-dependent manner. Certain types of difficult-to-treat infections could offer new applications for ESWT.     

Shock waves do more than just crush stones: extracorporeal shock wave therapy in plantar fasciitis

Heel pain is a common orthopaedic problem, The cause of this clinical entity remains an enigma. The overall prognosis is good, however, and the symptoms generally settle well with time. There appears to be little evidence of the effectiveness of local steroid injections and dorsiflexion night splints. Extracorporeal shock wave therapy (ECSW) has been used in orthopaedics since the 1980s. With this, a new tool has become available for the treatment of plantar fasciitis, achillis tendinitis, shoulder pain and tendinosis of the elbow. In our pilot study we found good results with the use of ECSW therapy in resistant plantar fasciitis. Additional controlled studies are required to define the precise role of this new modality in the treatment of chronic plantar fasciitis.     

Percussion after extracorporeal shock wave lithotripsy.

ESWL does not remove the kidney stone, but pulverizes it into tiny particles so that it can be excreted with the urine. Drainage and percussion treatment after ESWL helps excrete particles from the kidney to the ureter much more rapidly and with less trauma, pain, and blood urine, and fewer medications for pain are needed as the particles pass through the urine. Teaching the principles behind this treatment will lead to greater patient compliance and success.     

A survey of the acoustic output of commercial extracorporeal shock wave lithotripters

A survey of the pressures and intensities generated by different commercial extracorporeal shock wave (ESWL) lithotripters is reported. The lithotripters included in the survey are the Dornier HM3, Wolf Piezolith 2200 and 2300, Siemens Lithostar, Technomed Sonolith 2000 and 3000, and EDAP LT-01. Measurements were made using a polyvinylidene difluoride (PVdF) membrane hydrophone in water. The zero crossing frequency of one complete cycle of the focused pulse from ESWL equipment is in the range 0.1 to 1 MHz. Spatial-peak temporal-peak positive and negative pressures up to 114 MPa and 10 MPa, respectively, have been measured and the rise times of the positive pressure half cycle at maximum output settings are 30 ns or less. The mean spatial-peak temporal-average intensity of the lithotripters is 5.0 x 10(2) W m-2 when operated at a pulse repetition frequency of 1 Hz. The spatial-peak pulse-average intensity ranges from 6.6 x 10(7) to 1.24 x 10(9) W m-2. The estimated acoustic energy in a single pulse (at the focus) at the maximum output setting of the lithotripters varies from 2.0 x 10(-3) J to about 9.0 x 10(-2) J. The beam area in the focal plane varies by a factor of 100 on different lithotripters and the temporal-peak pressure at the position of the skin at the entry point of the beam by a factor of 30. Measurement problems associated with hydrophone damage and the uncertainties in the hydrophone calibration at high pressures are discussed and an estimate of the total uncertainty in the absolute measurements of the spatial-peak temporal-peak positive pressure is given as +/- 36%.     

骨科体外冲击波疗法应用体会

体外冲击波疗法(extracorporeal shock wave therapy,ESWT)是一种非侵入性治疗方法,用于治疗骨骼、肌肉系统疾病.该疗法具有病人不必住院、治疗后疼痛明显减低、无副反应、治疗风险低于外科手术、治愈率高等特点[1],被称为骨科疾病的绿色疗法.我科于2010年5月开展ESWT,共治疗病人229 例,临床效果满意.但在治疗过程中有一些问题需注意,现总结如下.     

体外冲击波刺激成骨作用对骨不连间隙的影响

目的：观察有刺激成骨作用的体外冲击波对新西兰大白兔骨不连模型的治疗效果。方法：实验于2003-10／2004-10在广西壮族自治区实验动物中心、广西医科大学医学实验动物中心完成。选用清洁级（二级）雌性新西兰大白兔16只，体质量3.0-3.5kg，兔龄五六个月，每只动物右前肢桡骨为实验肢，左前肢桡骨为对照肢。无菌操作麻醉下截除双侧桡骨中段1cm，缝合伤口，3个月后摄X线片证实骨不连模型形成。麻醉下采用德国多尼尔小王子体外冲击波碎石机对新西兰大白兔实验肢骨不连进行治疗，冲击波焦点能量为0．5mJ／mm^2，频率为70-80次／min，冲击量为800次，焦点聚焦范围为1．5cm^2，在透视下调整冲击焦点，分别对骨折远、近端边缘进行冲击。对照肢不作任何治疗。采用数码成像X射线机分别于冲击波治疗前及治疗后第3天，第2，4，6，8，12周摄实验肢和对照肢前肢正位X射线片，在计算机上精确测量治疗前后骨折间隙的宽度；同时各处死动物1只，取骨折间隙组织进行光学检查，选择第2，6，8周组织作电镜检查。比较实验肢和对照肢以及治疗前后骨折间隙的变化，观察光镜-成骨细胞、骨小梁的数量和排列的形成及电镜-成骨细胞的有丝分裂，线粒体等细胞器的活跃程度。结果：①X线片检测：实验肢4周后可见骨折问隙密度增高，呈云雾状，间隙缩小。12周后，骨折间隙基本骨性连接，骨纹理出现较规律的纵向排列，髓腔开始再通。对照肢织无明显变化。②组织光学及电镜检查显示：实验肢第3天光镜下可见活跃的圆形或类圆形成骨细胞，间隙两端见大量的微小碎骨屑。第2周见大量的活跃的成骨细胞、成纤维细胞和间充质细胞，形成骨样组织，软骨细胞增生活跃。电镜下可见有丝分裂，胞质内见较多的线粒体、高尔基体、粗面内质网。第6～8周时成骨细胞继续活跃成骨，骨样组织逐渐骨化，纤维组织逐渐转化成软骨组织，并出现钙化和骨化；电镜下可见大量成熟的骨细胞形成，细胞器消失。第12周见大量新生骨小梁，排列规则、致密，形成成熟的骨结构。对照肢各时问度所取骨折间隙组织无明显变化，未见成骨细胞，可见慢性炎症浸润、纤维结缔组织增生。③冲击波治疗前后动物模型骨不连间隙的变化：实验肢骨折间隙变化治疗前与第4，6，8，12周比较差异显著[（6．02&;#177;2．11），（7．05&;#177;1．91），（7．35&;#177;1．24），（7．51&;#177;1．57），（8．62&;#177;1．48）mm;t=2．561，3．543，3．922，5．659，P〈0．05-0．001]；实验肢与对照肢治疗后第4，6，8，12周比较差异显著[（6．36&;#177;1．89），（6.42&;#177;2.02），（6．40&;#177;2．12），（6．51&;#177;2．31）mm；t=2．376，2．531,3．744，5．126，P〈0．05]。结论：实验肢经冲击波治疗后骨不连间隙成骨活跃，不同时段摄X线片显示骨折逐渐达骨性愈合，说明体外冲击波是一种治疗骨不连创伤小、效果确切的方法。     

体外冲击波刺激成骨作用对骨不连间隙的影响

目的:观察有刺激成骨作用的体外冲击波对新西兰大白兔骨不连模型的治疗效果。方法:实验于2003-10/2004-10在广西壮族自治区实验动物中心、广西医科大学医学实验动物中心完成。选用清洁级(二级)雌性新西兰大白兔16只,体质量3.0～3.5kg,兔龄五六个月,每只动物右前肢桡骨为实验肢,左前肢桡骨为对照肢。无菌操作麻醉下截除双侧桡骨中段1cm,缝合伤口,3个月后摄X线片证实骨不连模型形成。麻醉下采用德国多尼尔小王子体外冲击波碎石机对新西兰大白兔实验肢骨不连进行治疗,冲击波焦点能量为0.5mJ/mm2,频率为70～80次/min,冲击量为800次,焦点聚焦范围为1.5cm2,在透视下调整冲击焦点,分别对骨折远、近端边缘进行冲击。对照肢不作任何治疗。采用数码成像X射线机分别于冲击波治疗前及治疗后第3天,第2,4,6,8,12周摄实验肢和对照肢前肢正位X射线片,在计算机上精确测量治疗前后骨折间隙的宽度;同时各处死动物1只,取骨折间隙组织进行光学检查,选择第2,6,8周组织作电镜检查。比较实验肢和对照肢以及治疗前后骨折间隙的变化,观察光镜-成骨细胞、骨小梁的数量和排列的形成及电镜-成骨细胞的有丝分裂,线粒体等细胞器的活跃程度。结果:①X线片检测:实验肢4周后可见骨折间隙密度增高,呈云雾状,间隙缩小。12周后,骨折间隙基本骨性连接,骨纹理出现较规律的纵向排列,髓腔开始再通。对照肢织无明显变化。②组织光学及电镜检查显示:实验肢第3天光镜下可见活跃的圆形或类圆形成骨细胞,间隙两端见大量的微小碎骨屑。第2周见大量的活跃的成骨细胞、成纤维细胞和间充质细胞,形成骨样组织,软骨细胞增生活跃。电镜下可见有丝分裂,胞质内见较多的线粒体、高尔基体、粗面内质网。第6～8周时成骨细胞继续活跃成骨,骨样组织逐渐骨化,纤维组织逐渐转化成软骨组织,并出现钙化和骨化;电镜下可见大量成熟的骨细胞形成,细胞器消失。第12周见大量新生骨小梁,排列规则、致密,形成成熟的骨结构。对照肢各时间度所取骨折间隙组织无明显变化,未见成骨细胞,可见慢性炎症浸润、纤维结缔组织增生。③冲击波治疗前后动物模型骨不连间隙的变化:实验肢骨折间隙变化治疗前与第4,6,8,12周比较差异显著[(6.02±2.11),(7.05±1.91),(7.35±1.24),(7.51±1.57),(8.62±1.48)mm;t=2.561,3.543,3.922,5.659,P<0.05～0.001];实验肢与对照肢治疗后第4,6,8,12周比较差异显著[(6.36±1.89),(6.42±2.02),(6.40±2.12),(6.51±2.31)mm;t=2.376,2.531,3.744,5.126,P<0.05]。结论:实验肢经冲击波治疗后骨不连间隙成骨活跃,不同时段摄X线片显示骨折逐渐达骨性愈合,说明体外冲击波是一种治疗骨不连创伤小、效果确切的方法。     

体外冲击波穴位冲击疗法治疗偏瘫肩痛的临床疗效

目的:观察体外冲击波穴位冲击疗法治疗偏瘫肩痛(HSP)的临床疗效。方法:选取符合标准的54例HSP患者,随机分为3组,每组各18例。对照组采用常规康复治疗,观察A组在对照组的基础上加用体外冲击波痛点治疗,观察B组在观察A组基础上加用体外冲击波穴位治疗。比较3组治疗前、治疗后和随访时的疼痛视觉模拟评分(VAS),上肢Fugl-Meyer运动功能评分(U-FMA),肩关节屈曲、外展和外旋无痛被动关节活动度(PROM)。结果:治疗后和随访时,3组的VAS评分均较治疗前降低(P<0.05),U-FMA评分和屈曲、外展和外旋无痛PROM均较前治疗增高(P<0.05)。治疗后,观察A组和观察B组的VAS评分低于对照组(P<0.05),观察A组的屈曲无痛PROM和观察B组的屈曲、外展无痛PROM高于对照组(P<0.05)。随访时,观察A组和观察B组的VAS评分低于对照组(P<0.05),且观察B组的VAS评分低于观察A组(P<0.05);观察A组和观察B组的U-FMA评分高于对照组(P<0.05);观察A组和观察B组的屈曲、外展无痛PROM高于对照组(P&l...     

Management of the extracorporeal shock wave lithotripsy patient.

Over 2 million Americans experience kidney and urinary stone disease each year. Early treatments resulted in high mortality and morbidity rates. With the advent of extracorporeal shock wave lithotripsy less than 20 years ago, treatment for this disease has become far safer with more rapid recovery and fewer complications. The selection of patients eligible for extracorporeal shock wave lithotripsy is dependent on the location and size of the stones and the overall health of the patient. This article discusses the different treatment modalities used for stone disease and the different methods currently available for extracorporeal shock wave lithotripsy. Preprocedure preparation of the patient and postoperative care for this population is reviewed in detail.     

Treatment of heterotopic ossification by extracorporeal shock wave: 26 patients]

OBJECTIVES: To evaluate the effects of extracorporeal shockwave therapy (ESWT) on heterotopic ossification leading to functional limitations in the short and medium term. METHODS: Twenty-six patients with heterotopic ossification received sessions of ESTW (4000 shocks, 3/s), with an energy ranging from 0.54 to 1.06 mJ/mm2, once a week for 4 consecutive weeks. Intermediary assessments performed 1 month after the last session related to pain (on a visual analog scale [VAS]), range of motion, functional independence (FIM), walking distance (whenever possible), radiology, and blood calcium and alkaline phosphatase levels. Eighteen patients with total hip arthroplasty (THA) were followed up by quiz, at 11 months, on average. RESULTS: Heterotopic ossification was neurogenic in 5 patients and nonneurogenic in 21. The length of evolution of ossification was 32+/-21 months. The measurements showing significant improvement in the short term were pain, with a mean decrease of 4.32 to 1.14 on a VAS; joint flexion, with an mean increase of 8.18+/-11.9 degrees; and walking distance, with a mean increase from 1126 to 2776 m. The treatment was tolerated for the most part. THA cases showed a decline in factors initially shown to be improved. However, the long-term results were superior to clinical status before treatment. CONCLUSION: ESWT might be an interesting treatment for heterotopic ossification and can be a complement to usual medical treatment, physiotherapy, and before surgery.     

Recent advances in the treatment of spasticity: extracorporeal shock wave therapy

BACKGROUND AND OBJECTIVE Spasticity is a common sequala of the upper motor neuron lesions. For instance, it often occurs in the first 4 weeks after stroke and is seen in more than one-third of stroke survivors after 12 months. In recent years, extracorporeal shock wave therapy (ESWT) has been recognized as a safe and effective method for reducing muscle spasticity. Possible/relevant mechanisms include nitric oxide production, motor neuron excitability reduction, induction of neuromuscular transm...