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Resumen La fascitis plantar (FP) es una patología frecuente e invalidante que puede tratarse con ondas de choque focalizadas. El objetivo principal del estudio fue valorar la eficacia del tratamiento con ondas de choque focalizadas en la FP según la densidad de energía utilizada. Se incluyeron 82 pacientes con diagnóstico clínico de FP que fueron asignados mediante muestreo aleatorio simple a dos grupos de tratamiento: densidad de energía media- alta (0,59mJ/mm2) y densidad de energía media-baja (0,27mJ/mm2). Se evaluaron el dolor y la funcionalidad, mediante las escalas EVA (Escala Visual Analógica) y AOFAS (American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale) respectivamente, al inicio del estudio (consulta base), y al primer, tercer y sexto mes tras el tratamiento. Por último, se evaluó el grado de satisfacción de los pacientes mediante la escala de Roles y Maudsley. Se compararon los resultados de las escalas en las revisiones posteriores al tratamiento, obteniéndose significación estadística para las variables principales del estudio (dolor y funcionalidad) en cada grupo de intervención. Aunque los niveles de dolor y la funcionalidad mejoraron en ambos grupos de estudio, se obtuvo una respuesta analgésica y funcional mayor y más precoz en el grupo tratado con densidad de energía media-alta.
Abstract Plantar fasciitis (FP) is a frequent and disabling condition that can be treated with focused extracorporeal shock waves. The main objective of this study was to assess the effectiveness of focused extracorporeal shockwave treatment in FP according to the energy density used. Eighty-two patients with a clinical diagnosis of FP were included and assigned, by simple random sampling, to two treatment groups: medium-high energy density (0.59mJ/mm2) and low-medium energy density (0.27mJ/mm2). Pain and functionality were assessed using the VAS (Visual Analogical Scale) and AOFAS (American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale) scales, respectively, at the start of the study (baseline consultation), and at the first, third and sixth month post-treatment. Finally, the degree of patient satisfaction was evaluated using the Roles and Maudsley score. The results of the scales in the post-treatment reviews were compared, and statistical significance was obtained for the main study variables (pain and functionality) in each intervention group. Although pain levels and functionality improved in both study groups after treatment, a greater and earlier analgesic and functional response was obtained for the medium-high energy density group.
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Objective:To observe any curative effect of combining hydraulic dilatation with radial extracorporeal shock waves on scapulohumeral periarthritis.Methods:A total of 132 patients with scapulohumeral periarthritis were randomly divided into a hydraulic dilatation group, a shock wave group and a combination group. The three treatments were applied for 3 weeks, before and after which shoulder range of motion was evaluated. Shoulder function was quantified using the Japanese Orthopaedic Association′s (JOA′s) shoulder function scoring, pain was reported using a visual analogue scale (VAS), and ability in the activities of daily living (ADL) was also quantified. Serum prostaglandin E2 (PGE2), β-endorphin (β-EP), interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α) were assayed.Results:The treatment response rate of the combination group (95%) was significantly higher than those of the hydraulic dilatation group (70%) and the shock wave group (82%). After the treatment, the average shoulder range of motion, JOA and ADL scores, and β-EP level in all 3 groups had improved significantly, while the average VAS score, and the PGE2, IL-6 and TNF-α levels had decreased significantly, but in each case the improvement in the combination group′s average was significantly greater than those of the other 2 groups. During the treatment there were no such adverse events as intra-articular infection, skin redness, numbness or palpitations.Conclusions:Combining hydraulic dilatation with radial extracorporeal shock waves significantly improves the treatment of scapulohumeral periarthritis. It can effectively promote the recovery of shoulder function and improve quality of life. Its greater effectiveness may be related to improving levels of PGE2, β-EP, IL-6 and TNF-α, and relieving pain and inflammation.
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Objective To observe the clinical effect of combining extracorporeal shock waves with pulsed radiofrequency irradiation of the dorsal root ganglia in the treatment of spinal cord-derived abdominal pain. Methods A total of 88 patients were randomly divided into a control group, a shock wave group, a pulsed irradiation group and a combination group, each of 22. All of the patients were given etocoxib and pregabalin medication for 3 weeks. In ad-dition to the drugs, the shock wave group received extracorporeal shock wave therapy, and the irradiation group re-ceived pulsed radio frequency irradiation of the dorsal root ganglia. The combination group received both. A visual an-alogue scale was used to assess perceived pain. The quality of life short form 36 ( QOL-SF36) , Hamilton anxiety scale and Hamilton depression scale were administered to all 4 groups before the treatments and after 1, 4 and 12 weeks of the treatments. The development of diseases, gastrointestinal function, medical treatment and medical expenses of the 4 groups were observed for two years after the treatments. Results After 4 weeks of treatment, the average scores of all four groups in all of the evaluations had improved significantly compared with before the treatment. In combination group′s average results were significantly better than those of the other 3 groups from 4 weeks until 12 weeks after the treatment. During the subsequent two years that group′s gastrointestinal symptoms, hospital visits and medical expen-ses were all significantly lower, on average, than those of the other groups. Conclusion Extracorporeal shock waves combined with pulsed radio frequency irradiation of the dorsal root ganglia has significant clinical efficacy for alleviating spinal cord-derived abdominal pain. It can significantly reduce medical costs and is worthy of clinical pro-motion.
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Objective@#To observe the clinical effect of shock waves combined with movement therapy in the treatment of temporomandibular joint dysfunction.@*Methods@#Forty patients with class-Ⅲ temporomandibular joint function disorders were randomly divided into an observation group and a control group, each of 20. In addition to the exercise therapy, the observation group was provided with extracorporeal shock wave therapy, while the control group was given ultrashortwave therapy. The intervention lasted for 4 weeks for both groups. Before and after the intervention, discomfort was quantified using a visual analogue scale, and maximum mouth opening and Fricton′s temporomandibular joint function index were measured for both groups.@*Results@#There was no significant difference between the two groups before the intervention. After the treatment the average discomfort rating and maximum mouth opening were significantly better in the observation group. The observation group′s average Fricton index was also significantly better.@*Conclusion@#Extracorporeal shock waves can be combined with movement therapy to significantly relieve the pain of patients with temporomandibular joint dysfunction. It can improve their maximum mouth opening and the functioning of the temporomandibular joint.
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Objective To observe the effect of extracorporeal shock waves (ESW) therapy on avascular necrosis of femoral head (AN-FH) of stage IV. Methods 72 hips of 44 patients with ANFH of stage IV, according to Association Research Circulation Osseous, were ran-domly divided into treatment group (n=37) and control group (n=35). The control group received routine therapy, while the treatment group received ESW in addition, 2.0-4.0 bar, 10 Hz, 6000 times. They were evaluated with Harris Hip Score, Manual Muscle Test (MMT) and Short Form of health survey (SF-36) before and 1 month after treatment. Results The scores of Harris Hip Score and MMT improved more in the treatment group than in the control group (P<0.05) after treatment, as well as the scores of SF-36 except physical health and vitality (P<0.05). Conclusion The ESW can obviously improve the motor function and quality of life of patients with ANFH of stage IV.
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@#Objective To observe the effect of extracorporeal shock waves (ESW) therapy on avascular necrosis of femoral head (ANFH) of stage IV. Methods 72 hips of 44 patients with ANFH of stage IV, according to Association Research Circulation Osseous, were randomly divided into treatment group (n=37) and control group (n=35). The control group received routine therapy, while the treatment group received ESW in addition, 2.0-4.0 bar, 10 Hz, 6000 times. They were evaluated with Harris Hip Score, Manual Muscle Test (MMT) and Short Form of health survey (SF-36) before and 1 month after treatment. Results The scores of Harris Hip Score and MMT improved more in the treatment group than in the control group (P<0.05) after treatment, as well as the scores of SF-36 except physical health and vitality (P<0.05). Conclusion The ESW can obviously improve the motor function and quality of life of patients with ANFH of stage IV.
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Objective To investigate the effect of extracorporeal shock waves (ESWs) combined with expanding bone marrow autografts in treating nonunion of femoral shaft fractures with interlocking intramedullary nails.Methods Thirty patients with femoral shaft fractures which had not united were divided into an ESW group,an expanding bone marrow group,and a combined treatment group using a table of random numbers.Each group had 10 cases.In the ESW group,no expanding bone marrow was employed in fixing the intramedullary nails and ESW therapy was begun at day 14 after the operation.In the expanding bone marrow group,bone marrow was grafted around the broken ends of fractured bones.In the combined treatment group patients underwent both treatments.The conditions of the callus and the fracture lines in the 3 groups were separately evaluated using X-rays at the 4th,8th,12th and 16th week after the operation.Results At week 4,the average callus and fracture line scores in the combined treatment and expanding bone marrow groups were significantly better than those in the ESW group.At the 8th week after the operation,the average callus and fracture line scores in the combined treatment group were significantly higher than in the ESW group and expanding bone marrow groups.Later,the callus and fracture scores in all 3 groups continued to rise significantly.At the 12th and 16th week the scores in the combined treatment group were significantly better than those in the ESW group and the expanding bone marrow group,while the scores in the ESW group were significantly better than those in the expanding bone marrow group.The cure rates in the ESW,bone marrow and combined treatment groups were 60％,50％ and 100％ respectively at week 16.Conclusions The combined treatment was significantly more effective than either treatment alone.There was no significant difference in effectiveness between the ESW and expanding bone marrow treatments.ESW combined with expanding bone marrow autograft is an effective way to promote bone knitting in the treatment of nonunion of femoral shaft fractures with interlocking intramedullary nails.
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Objective To compare the clinical effects of extracorporeal shock wave treatment (ESWT) on lumbar ramus posterior nervorum spinalium syndrome and to compare the effectiveness of applying it in X-ray orientation with pain-point orientation.MethodsSixty patients with lumbar ramus posterior nervorum spinalium syndrome were randomly divided into an X-ray orientation group and a pain-point orientation group with 30 subjects in each group.The two groups then received ESWT with the X-ray orientation and pain-point orientation,respectively.The ESWT was delivered at the energy of 0.12 to 0.20 mJ/cm2 and the frequency of 60-80 pulses per minutes.A total of 1000-1500 shock wave pulses were delivered every time.Three sessions of ESWT were administered,with a 3-5 days of interval between each session.The results were rated using the 75 scores of the lumbar function quantification index recommended by Greenough.Ratings were done before treatment,and after the first,the second and the third treatment.ResultsThere was no significant difference between the groups' average index scores before treatment.There were however significant differences from the baseline scores after the first,the second and the third treatments.There was no significant difference in average lumbar function quantification scores between the groups after the first treatment,but the inter-group differences were statistically significant after the second and the third treatments.After three treatments the cure rate in the X-ray orientation group was 76.7％ and overall effectiveness was 93.3％.Both were significantly higher than in the pain-point orientation group (33.3％ and 76.7％ respectively).ConclusionsThe advantages of X-ray orientation when administering ESWT for lumbar rami posterior nervorum spinalium syndrome are more exact positioning and more effective treatment.The effect was obviously better than with pain-point orientation.
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Objective To assess the effect of extracorporeal shock waves(ESWs)as a treatment for ⅢB chronic prostatitis(CP).Methods Forty-six men with ⅢB CP were randomly divided into an experimental group (n=34)and a control group(n=12).The patients in experimental group received low energy ESW treatment,20000 impulses in 10 sessions over 2 weeks.The patients in control group received sham ESW treatment without shock waves energy under the same other conditions as in experimental group.Pain,urination and quality of life/impact were assessed with National Institutes of Health-chronic prostatitis symptom index(NIH-CPSI).Both groups were assessed at baseline,post-treatment and at a 4-week follow-up.Resuits The total NIH-CPSI scores,pain scores and quality of life/impact scores in experimental group decreased significantly post-treatment(P＜0.01),but urination scores did not(P＞0.05).Similar decreases of these scores were also found in control group post-treatment.The total NIH-CPSl scores and pain scores maintained at a lower level at the 4-week follow-up in experimental group,but the scores returned to the level as pre-treatment in control group.The effectiveness rates and prominent effectiveness rates in experimental group were significantly higher than those in control group post-treatment and at the 4-week follow-up(all P＜0.05). Conclusions ESWs was effective in the treatment for ⅢB CP.After ESWs treatment pain alleviated,symptoms reducea and quality of life improved.
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[Objective]To explore the effects of extracorporeal shock waves(ESW) therapy on tendon-bone healing after reconstruction of the anterior cruciate ligament(ACL).[Method]Animal model of reconstruction of the anterior cruciate ligament in 18 healthy F/M New Zealand white rabbits(2～3 months old) were established using digital long extensor tendon and randomly classified into 2 groups.The ESW group was given extracorporeal shock waves therapy on 24 hours after reconstruction of the anterior cruciate ligament while the control group with only reconstruction of the anterior cruciate ligament but no more therapy.All animals were sacrificed at 2、4、8 weeks after operation for histological examinations.The specimens were stained with hematoxylin-eosin and Masson trichrome to investigate pathology change of the tendon-bone healing tissue.The ink intravascular injection was used to observe the neo-vascularization of tendon-bone healing tissue.[Result]The histological examination revealed that at 4 weeks after operation,the ESW group,tendon-bone interface was filled with proliferated fibroblasts and chondroblasts,the collagen fibers were obviously increased and regularly arranged.At 8 weeks after operation,the healing tissue at the bone-tendon interface had developed into dense connective tissue,the collagen fibers were formed in abundance and the perpendicular collagen fibers were regularly and longitudinally arranged.The transition zones of collagen fibers,fibrocartilage and bone(the structure alike a direct ligamentous insertion) occurred in the local region of tendon-bone interface.The histological observations showed that the tissue healing at tendon-bone interface of the ESW group were quicker than those of the control group.The proportion of neo-vessels at the tendon-bone interface of the ESW group were significantly higher than those of the control group at 4 and 8 weeks after operation(respectively P=0.028,P=0.008).[Conclusion]Extracorporeal shock wave treatment can significantly improve the tendon-bone early healing after reconstruction of the anterior cruciate ligament in rabbits.
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Objective To investigate whether or not extracorporeal shock wave (ESW) treatment is safe for treating low back pain caused by lumbar facet joint degeneration by observing its effects on the lumbar segment of the spinal cord.Methods Five adult dogs were used for this study.ESWs were focused on their right L_(4～5) facet joints. The energy output was set at 40% of the maximum output,and a total of 1000 shocks were delivered at a frequency of 120/min.Before and 3 days after the treatment,the somatosensory evoked potentials (SEPs) induced by stimulating the tibial nerve were recorded from the animals' scalps,and the motor function of their hind limbs was evaluated with Tarlov's scale.The animals were then sacrificed and the L_(4～5) segments of their spinal cords were taken for histopatho- logical observation,with the T_(12) segments taken as controls.Results Three days after ESW treatment,the left and the right hind limbs scored 5 and 4 on the Tarlov scale.The amplitude of SEPs decreased and their latency increased. Histopathological observation showed mild swelling of the L_(4～5) segment of the spinal cord with congested veins on the surface.Erythrocyte and leukocyte exudation as well as myelin sheath swelling in the spinal cord were also observed un- der the microscope,but with no demyelination.Conclusion ESW had some adverse effects on the spinal cord when focused on the facet joint.Further studies of the safety range of ESW energy and distance are needed.
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PURPOSE: To demonstrate by CT scanning the effect of extracorporeal shock wave lithotripsy (ESWL) on pancreatic duct stones in patients with chronic pancreatitis. MATERIALS AND METHODS: Pancreatic duct stones in 11 patients with chronic pancreatitis were subject to ESWL using an electrohydraulic lithotripter. Endoscopic stone removal using a basket had failed in ten patients, and in one, endoscopy was impossible due to a previous Whipple's operation. CT scans obtained before and after ESWL were evaluated by two radiologists: the longest and shortest diameters of the target stone were measured, and according to the degree of fragmentation, determined by comparing the area of the stone before and after ESWL, a grade (1-5) was assigned. In each case, the pre- and post- treatment diameter of the main pancreatic duct, measured at the pancreatic body, was also compared. RESULTS: Disintegration of the target stone was achieved in all patients: grade 1 (over 75% of the area remained, compared with that of the initial stone) was assigned in two patients; grade 2 (51-75% of the original area) in one; grade 3 (26-50%) in four; grade 4 (under 25%) in two; and grade 5 (complete clearance of the target stone) in two. The mean area decreased from 175 mm2 to 69 mm2 after ESWL (p<0.05); a decrease of more than 50% was observed in eight patients (73%). The mean diameter of the main pancreatic duct decreased from 7.36 to 4.81 mm (p<0.05). No severe adverse effects or complications were noted, and all patients showed clinical improvement. Follow-up studies indicated that pancreatic duct stones recurred in three patients. CONCLUSION: ESWL can cause the fragmentation of pancreatic duct stones without significant complications, and should be considered where endoscopic stone removal has failed. CT is a suitable non-invasive and accurate tool for evaluating the therapeutic results of ESWL.