ZI20SHIJI90NIANDAICHUWENXIANBAODAOYINGYONGTIWAICHONGJIBOJISHUCUJINGUZHEYUHEYILAI[1]，GUONEIWAIYOUGUANGAIJISHUZHILIAOGUJIJIBINGDEBAODAOZHUJIANZENGDUO，BINGYICHENGWEIYANJIUREDIAN[2-12]。JINNIANLAI，TONGGUOBUDUANSHENRUYANJIUJIWANSHAN，GAIJISHUYICHENGWEIYIZHONGXINLIAOFA——TIWAICHONGJIBOLIAOFA（extracorporeal shock wave therapy，ESWT）[13]。YOUYUGAILIAOFAJUYOUWEICHUANG、ANQUAN、YOUXIAODETEDIAN，YIZAIGUJIJIBINGLINCHUANGZHILIAOLINGYUGUANGFANYINGYONG。RANER，ESWTLINCHUANGYINGYONGBUGUIFAN，ZHILIAOGUANJIANJISHUHEZHILIAOFANGANBUTONGYI，DAOZHIESWTWUFAGENGHAODITUIGUANGYINGYONG。WEICI，2014NIAN6YUE，ZHONGGUOYANJIUXINGYIYUANXUEHUICHONGJIBOYIXUEZHUANYEWEIYUANHUIZUZHIZHUANJIACANKAOGUOJI、GUONEIZUIXINWENXIAN，JIEHEGUONEISHIJIQINGKUANG，JINGGUODUOCITAOLUNHOUZHIDINGLE《GUJIJIBINGTIWAICHONGJIBOLIAOFAZHUANJIAGONGSHI》[14]（DI1BAN），WEIGUIFANGAILIAOFAZAIGUONEIDETUIGUANGYINGYONGTIGONGLEZHIDAOYIJIAN。JINNIANLAI，ESWTKUAISUFAZHAN，JILEILEDALIANGXINDEZHILIAOJINGYANHEYANJIUCHENGGUO，2016NIAN10YUE，GUOJICHONGJIBOYIXUEXUEHUIGENGXINLEESWTDESHIYINGZHENGHEJINJIZHENG。WEIJINYIBUTUIDONGESWTDEGUIFANHUAYINGYONG，CUJINCHONGJIBOYIXUEDEFAZHAN，JINGZHONGGUOYANJIUXINGYIYUANXUEHUICHONGJIBOYIXUEZHUANYEWEIYUANHUIHEGUOJICHONGJIBOYIXUEXUEHUIZHONGGUOBUZUZHIZHUANJIATAOLUN，DUI《GUJIJIBINGTIWAICHONGJIBOLIAOFAZHUANJIAGONGSHI》（DI1BAN）JINXINGXIUDING，ZENGJIALEESWTDESHIYINGZHENG，BUCHONGWANSHANLEYUSHIYINGZHENGXIANGDUIYINGDELINCHUANGYINGYONGZHINAN，DIAOZHENGLEBUFENZHILIAOCANSHU。

ESWT 物理学特性及生物学效应

       CHONGJIBOSHIYIZHONGTONGGUOZHENDONG、GAOSUYUNDONGDENGDAOZHIJIEZHIJIDUYASUOERJUJICHANSHENGNENGLIANGDEJUYOULIXUETEXINGDESHENGBO，KEYINQIJIEZHIDEYAQIANG、WENDU、MIDUDENGWULIXINGZHIFASHENGTIAOYUESHIGAIBIAN。ESWTWULITEXINGBAOKUO：①JIXIEXIAOYING，JIDANGCHONGJIBOJINRURENTIHOU，ZAIBUTONGZUZHIDEJIEMIANCHUSUOCHANSHENGDEXIAOYING；②KONGHUAXIAOYING，JICUNZAIYUZUZHIJIANYETIZHONGDEWEIQIHEKONGHUAPAOZAICHONGJIBOZUOYONGXIAFASHENGZHENDONG，DANGCHONGJIBOQIANGDUCHAOGUOYIDINGZHISHI，FASHENGDESHENGZHANGHEBENGKUISUOCHANSHENGDEXIAOYING；③REXIAOYING，JICHONGJIBOZAISHENGWUTINEICHUANBOGUOCHENGZHONG，QIZHENDONGNENGLIANGBUDUANBEIZUZHIXISHOUSUOCHANSHENGDEXIAOYING[13]。

1.1　描述冲击波常用的物理参数及生物学效应

       CHONGJIBOYALIFENBUDECELIANGXUYAOBUTONGDEWULICANSHU，ZHUYAOCANSHUBAOKUO：CHONGJIBONENGLIANG、YALICHANGJINENGLIUMIDU。CHONGJIBONENGLIANGSHIDUIMEIYIGEYALICHANGTEDINGWEIZHINEIDEYALI/ SHIJIANHANSHUJINXINGSHIJIANJIFENHOU，ZAIJINXINGTIJIJIFENHOUJISUANCHUDE，DANWEIWEIHAOJIAO（mJ）；YALICHANGSHIHUANRAOZHILIAOTOUDEDUICHENGZHOUQUYU，BUTONGLEIXINGDECHONGJIBOZHILIAOJIYALICHANGYEBUTONG，YEDIANSHICHONGJIBOCHANGCHENGTUOYUANXING，DIANCISHICHONGJIBOCHANGCHENGFANGCHUIXING，YADIANSHICHONGJIBOCHANGCHENGYUANXING，DANWEIWEIZHAOPA（MPa），1 MPa ＝10 bar ；NENGLIUMIDUSHIMIAOSHUCHONGJIBONENGLIANGDEZUICHANGYONGCANSHU，MIAOSHUDANWEIMIANJINENGLIANGDEJIZHONGDU，JILIANGDANWEIYIHAOJIAO/ PINGFANGHAOMI（mJ/mm2）BIAOSHI。

1.2　冲击波波源的产生方式和传递形式

1.2.1　产生方式　①YEDIANSHICHONGJIBOYUAN；②YADIANJINGTICHONGJIBOYUAN；③DIANCISHICHONGJIBOYUAN；④QIYADANDAOSHICHONGJIBOYUAN。

1.2.2　传递形式　冲击波波源能量的传递形式可分为聚焦式、发散式、平波、水平聚焦等，如图1 所示。

ESWT适应证、禁忌证及不良反应

2.1　ESWT适应证

2.1.1　适应证　①GUZUZHIJIBING：GUZHEYANCHIYUHEJIGUBULIAN、CHENGRENGUGUTOUHUAISI、YINGLIXINGGUZHE；②RUANZUZHIMANXINGSUNSHANGXINGJIBING：GANGSHANGJIJIANYAN、GONGGUWAISHANGKEYAN、GONGGUNEISHANGKEYAN、ZUDIJINMOYAN、GENJIANYAN、GONGERTOUJIZHANGTOUJIJIANYAN、GUGUDAZHUANZIHUANANGYANDENG。

2.1.2　相对适应证　GUXINGGUANJIEYAN、GUSUISHUIZHONG、JINGGUJIEJIEGURUANGUYAN、JUGUGURUANGUSUNSHANG、JIANQIAOYAN、JIANFENGXIAHUANANGYAN、BINQIANHUANANGYAN、BINJIANYAN、DANXIANGKUAN、JIJINGLUAN、JIROULASHANG、WANGUANZONGHEZHENG、GUHUAISIXINGJIBING（YUEGUHUAISI、JUGUHUAISI、ZHOUZHUANGGUHUAISI）、GUZHISHUSONGZHENGDENG。

2.2　ESWT禁忌证

2.2.1　整体因素

2.2.1.1　JINJIZHENG　①CHUXUEXINGJIBING：NINGXUEGONGNENGZHANGAIHUANZHEKENENGYINQIJUBUZUZHICHUXUE，WEIZHILIAO、WEIZHIYUHUOBUNENGZHIYUDECHUXUEXINGJIBINGHUANZHEBUYIXINGESWT；②XUESHUANXINGCHENGHUANZHE：GAILEIHUANZHEJINZHISHIYONGESWT，YIMIANZAOCHENGXUESHUANSHUANZITUOLUO，YINQIYANZHONGHOUGUO；③SHENGZHANGTONGHUANER：SHENGZHANGTONGHUANERTENGTONGBUWEIDUOWEIYUGUHOUFUJIN，WEIBIMIANYINGXIANGGUHOUFAYU，BUYIXINGESWT；④YANZHONGRENZHIZHANGAIHEJINGSHENJIBINGHUANZHE。

2.2.1.2　XIANGDUIJINJIZHENG　XIALIEJIBINGZAISHIYONGGAONENGJUJIAOSHICHONGJIBOZHILIAOJISHIWEIXIANGDUIJINJIZHENG，ERDINENGLIANGCHONGJIBOZHILIAOJIBUWANQUANSHOUXIALIEJINJIZHENGXIANZHI：①YANZHONGXINLVSHICHANGHUANZHE；②YANZHONGGAOXUEYAQIEXUEYAKONGZHIBUJIAHUANZHE；③ANZHUANGXINZANGQIBOQIHUANZHE；④EXINGZHONGLIUYIDUOCHUZHUANYIHUANZHE；⑤RENSHENNVXING；⑥GANJUEGONGNENGZHANGAIHUANZHE；⑦QITA。

2.2.2　局部因素　JINJIZHENG：①JIJIAN、JINMODUANLIEJIYANZHONGSUNSHANGHUANZHE；②TIWAICHONGJIBOJIAODIANWEIYUNAOJIJISUIZUZHIZHE、WEIYUDAXUEGUANJIZHONGYAOSHENJINGGANZOUXINGZHE、WEIYUFEIZUZHIZHE；③GUQUESUN＞2 cmDEGUBULIANHUANZHE；④GUANJIEYESHENLOUHUANZHE：YIYINQIGUANJIEYESHENCHUJIAZHONG；⑤QITA。

2.3　ESWT不良反应

①ZHILIAOBUWEIJUBUXUEZHONG、YUZI、DIANZHUANGCHUXUE；②ZHILIAOBUWEITENGTONGFANYINGZENGQIANG；③ZHILIAOBUWEIJUBUMAMU、ZHENCIGAN、GANJUEJIANTUI。

ESWT能量选择和定位方法

3.1　ESWT能量选择

JINXINGCHONGJIBOZHILIAOSHI，GUANJIANSHIJIANGSHIYIDENENGLIANGZUOYONGYUZHUNQUEDEBUWEI。CAIYONGSHIYIDENENGLIANGHEXUANZEZHUNQUEDEBUWEIZHIJIEJUEDINGJIBINGDEZHILIAOXIAOGUO。NENGLIANGGUODIDABUDAOZHILIAOXIAOGUO，ERNENGLIANGGUOGAOZECHANSHENGBULIANGFANYING。ANNENGLIANGDENGJIJIANGCHONGJIBOHUAFENWEIDI、ZHONG、GAO3GENENGJI：DINENGLIANGFANWEIWEI0.06～0.11 mJ/mm2，ZHONGNENGLIANGFANWEIWEI0.12～0.25 mJ/mm2，GAONENGLIANGFANWEIWEI0.26～0.39 mJ/mm2，KEGENJUSHEBEIZHIZAOSHANGTIGONGDEBUTONGNENGLIANGCANSHUFANWEI、HUANSUANFANGSHIHUANSUANCHENGNENGLIUMIDU[13]。

　　ANZHAOESWTNENGLIANGHUAFEN：DINENGLIANGHEZHONGNENGLIANGDUOYONGYUZHILIAORUANZUZHIMANXINGSUNSHANGXINGJIBING、RUANGUSUNSHANGXINGJIBINGJIWEIZHIQIANBIAOXINGGUBULIAN；GAONENGLIANGDUOYONGYUZHILIAOWEIZHIJIAOSHENDEGUBULIANJIGUZHEYANCHIYUHEHEGUGUTOUHUAISIDENGCHENGGUZHANGAIXINGJIBING。

　　ANZHAOESWTBOYUANCHUANDIFANGSHIHUAFEN：JUJIAOSHICHONGJIBO、SHUIPINGJUJIAOSHICHONGJIBODUOYONGYUZHILIAOGUBULIANJIGUZHEYANCHIYUHE、GUGUTOUHUAISIDENGCHENGGUZHANGAIXINGJIBINGHEWEIZHIJIAOSHENDEGURUANGUSUNSHANGXINGJIBING；FASANSHICHONGJIBODUOYONGYUZHILIAOMANXINGRUANZUZHISUNSHANGXINGJIBING、QIANBIAODEGUJIRUANGUSUNSHANGJIBINGJIHUANJIEJIROUJINGLUAN；PINGBOSHICHONGJIBODUOYONGYUZHILIAOWEIZHIBIAOQIANDEMANXINGRUANZUZHISUNSHANGXINGJIBING、SHANGKOUKUIYANGJIBANHENDENG。

3.2　ESWT定位方法

ZHUNQUEDEDINGWEISHIESWTQUDELIANGHAOLIAOXIAODEQIANTI，CHANGYONGDEDINGWEIFANGFABAOKUOTIBIAOJIEPOUBIAOZHIJIEHETONGDIANDINGWEI、XXIANDINGWEI、CHAOSHENGDINGWEIJICIGONGZHENCHENGXIANG（magnetic resonance imaging，MRI） JIEHETIBIAOJIEPOUBIAOZHIDINGWEI。

　　（1）TIBIAOJIEPOUBIAOZHIJIEHETONGDIANDINGWEISHIGENJUHUANZHETONGDIANJIJUBUJIEPOUBIAOZHIJINXINGDINGWEIDEFANGFA，CHANGYONGYUMANXINGRUANZUZHISUNSHANGJIBINGDINGWEI，RUGONGGUNEISHANGKEYAN、GONGGUWAISHANGKEYANDENG。

　　（2）XXIANDINGWEISHITONGGUOXXIANJIJIANGZHILIAODIANYUJUJIAOSHICHONGJIBOZHILIAOJIDIERJIAODIANOUHE，ZHUYAOYONGYUGUZUZHIJIBINGDINGWEI，RUGUBULIAN、GUGUTOUHUAISIDENG。

　　（3）CHAOSHENGDINGWEISHITONGGUOCHAOSHENGJIANCHAQUEDINGZHILIAOBUWEIDEDINGWEIFANGFA，KEYONGYUGU、RUANZUZHIJIBINGDINGWEI，RUGONGERTOUJIZHANGTOUJIJIANYAN、GENJIANYAN、GANGSHANGJIJIANYANDENG。

　　（4）MRIJIEHETIBIAOJIEPOUBIAOZHIDINGWEISHIGENJUHUANZHEMRIYINGXIANGXUEBIAOXIANJIJUBUJIEPOUBIAOZHIJINXINGDINGWEIDEFANGFA，CHANGYONGYUGU、RUANGUJIBINGDINGWEI，RUJUGUGURUANGUSUNSHANG、GUSUISHUIZHONG、YINGLIXINGGUZHEDENG。DINGWEISHI，ZHILIAODIANYINGBIKAINAOJIJISUIZUZHI、DAXUEGUANJIZHONGYAOSHENJINGGAN、FEIZUZHI，TONGSHIYINGBIMIANNEIGUDINGWUZHEDANG。

骨肌疾病ESWT临床应用指南

4.1　骨不连及骨折延迟愈合

4.1.1　 适应证　SHIYONGYUDADUOSHUGUBULIANJIGUZHEYANCHIYUHE。

4.1.2    禁忌证　CHUQUANSHENJINJIZHENGWAI，DADUANGUQUESUN、JIXINGGANRANXINGGUBULIAN、BINGLIXINGGUBULIAN、GUZHEDUANDUANYANZHONGYINGYANGBULIANGXINGGUBULIANZHE。

4.1.3　 定位　CAIYONGXXIANDINGWEI，SHIYONGJUJIAOSHICHONGJIBOZHILIAOSHI，TONGGUOXXIANJIJIANGZHILIAODIANYUJUJIAOSHICHONGJIBOZHILIAOJIDIERJIAODIANOUHE；SHIYONGFASANSHICHONGJIBOZHILIAOQIANBIAOBUWEIGUBULIANSHI，GENJUXXIANDINGWEIJIEGUOYUTIBIAOZUOHAOBIAOJI。RUYOUNEIGUDINGWUCUNZAI，XUANZEZHILIAODIANSHI，YINGBIKAINEIGUDINGWUDEWEIZHI。MEICIZHILIAODEZHILIAODIANZUIHAOBUZHONGFU，YIMIANSUNSHANGPIFU。MEIGENGHUANYIGEZHILIAODIANQIAN，YINGJINXINGXXIANDINGWEI。

4.1.4　治疗方法　HUANZHETIWEIYISHUSHIFANGBIANZHILIAOWEIYUANZE，YIBANCAIQUZUOWEIHUOWOWEI。FANSHETIHUOZHILIAOTOUYIBANYINGFANGZHIZAIZHITIXUEGUANSHENJINGJIAOSHAODEYICE，TONGSHIYINGBIKAINEIGUDINGWUWEIZHI，RUBINGBIANTESHU，KEGENJUBINGBIANBUWEIJILINCHUANGJINGYANXUANZEFANSHETIHUOZHILIAOTOUDEWEIZHI，YIYOULIYUBINGBIANBUWEIXISHOUZUIDANENGLIANGCHONGJIBOWEIYUANZE。ZHILIAOQUYUBIXUTUMOOUHEJI，BUNENGYOUKONGQICUNZAI，YIMIANSUNSHANGPIFU。

　　TONGCHANGCAIQUSHILIANGDUOCIFA，GENJUGUZHEBUWEIBUTONG，XUANZEBUTONGDENENGLIUMIDU，TENGTONGMINGANZHEKECONGDINENGLIANGCHONGJIBOKAISHI、YIHUANZHENENGGOUNAISHOUWEIYUANZE，ZAIHOUXUDEZHILIAOGUOCHENGZHONGZHUBUZENGQIANGCHONGJIBONENGLIANG。WEIZHIJIAOSHENDEGUBULIANDUOCAIYONGJUJIAOSHICHONGJIBOZHILIAOJI，ZHILIAOCANSHUWEI0.25～0.39 mJ/mm2；WEIZHIJIAOQIANDEGUBULIANYEKECAIYONGFASANSHIGUKECHONGJIBOZHILIAOJI，ZHILIAOCANSHUWEI0.15～0.30 mJ/mm2。MEICIZHILIAOXUANZE2～4GEZHILIAODIAN，MEIGEDIANCHONGJI1000CI，GONGCHONGJI2000～4000CI，MEICIZHILIAOJIANGE1TIAN，5～10CIWEIYILIAOCHENG。JIANYIZHILIAO3～5GELIAOCHENG，JIANGE2～3GEYUE，ZAIZHILIAOQIANJIZHILIAOHOU3、6、12GEYUE，SHEZHENGCEWEIXXIANPIANHUOXINGCTJIANCHA，LEJIEGUZHEYUHEQINGKUANG[12,23,35-41]。

4.2　股骨头坏死

4.2.1　适应证　CHENGRENZAOQIGUGUTOUHUAISI，GUGUTOUWEITAXIANZHE（ARCO ⅠQI、ⅡQI）。XIANGDUISHIYINGZHENG：ARCO ⅢQIJIBUFENⅣQIGUGUTOUHUAISIZHE，BUYUANHUOBUNENGSHOUSHU；GUGUTOUHUAISIBANYOUKUANGUANJIECHUANGSHANGXINGGUANJIEYANZHE；KUANJIUGUZHE、GUGUTOUGUZHEKENENGFASHENGGUGUTOUXUEYUNZHANGAIZHE。

4.2.2　 禁忌证　CHUQUANSHENJINJIZHENGWAI，JUBUZHILIAOQUYUYOUJIXINGRUANZUZHIGANRANHUOPIFUPOSUN。

4.2.3　 定位　CAIYONGX XIANJICHAOSHENGDINGWEI，DANXUJIEHEMRIJIANCHASUOSHIHUAISIQUYUQUEDINGZHILIAOBUWEI，YAOQIUCHONGJIBOZHILIAODIANYUXXIANJIMRIJIANCHAXIANSHIDEGUGUTOUHUAISIBUWEIZHUNQUEOUHE。ZHILIAOZHONGYINGSUISHIJIANSHIDINGWEI，JISHIJIUZHENGZHILIAODIANPIAOYI。

4.2.4　治疗方法　HUANZHEQUWOWEI，FANSHETIZHIYUKUANGUANJIECEFANGHUOQIANFANG，ZHUYIBIKAIZHONGYAOXUEGUANSHENJINGZUZHI，RUYOUNEIGUDINGWUYINGBIKAI，ZHILIAOYINGYOUDINENGJIKAISHI，GENJUHUANZHEDUITENGTONGDEMINGANDUZHUJIANZENGJIAZHISUOXUNENGJI，NENGLIUMIDUWEI0.20～0.35 mJ/mm2，TONGSHIZAIZHILIAOGUOCHENGZHONG，YINGDINGSHISHIYONGXXIANTOUSHIHUOCHAOSHENGJINXINGZHUNQUEDINGWEI。

　　TONGCHANGCAIYONGSHILIANGDUOCIFA，YIGUGUTOUHUAISIBUJIQIBIANYUANWEIZHILIAODIAN，MEICIZHILIAOYIBANXUAN2～3GEZHILIAODIAN，MEIGEDIANCHONGJI1000CI，MEITIANHUOGE1TIANZHILIAO1CI，5CIWEIYILIAOCHENG，CHONGJIZONGLIANGWEI8000～15 000CI。KEGENJUBINGQINGSHILIANGZENGJIA。

　　HUANKUAN3GEYUENEIBUFUZHONG，6GEYUENEIJIANSHAOFUZHONG。JIANYIZHILIAO5～8GELIAOCHENG，JIANGE2～3GEYUE，HUANZHEFENBIEZAIZHILIAOQIANJIZHILIAOHOU3、6、12GEYUESHEGUGUTOUJINGZHENGCEWEIXXIANPIANJISHUANGKUANMRIJIANCHA，LEJIEGUGUTOUHUAISIBIANHUAQINGKUANG[42-49]。

4.3　骨髓水肿

4.3.1　适应证　JINGMRIJIANCHA，ZHENGSHIWEIGUSUISHUIZHONGHUANZHE。

4.3.2　禁忌证　GUGANRAN、GUZHONGLIU、XUEYEXITONGJIBINGZAOCHENGDEGUSUISHUIZHONGBIAOXIAN。

4.3.3　定位　GUSUISHUIZHONGZHINENGYIKAOMRIJIANCHAFAXIAN，GENJUMRIJIEGUOJIEHETIBIAOBIAOZHIQUEDINGSHUIZHONGQUYU，TONGSHIZHUYIBIKAIZHONGYAODEXUEGUANHESHENJING。

4.3.4　治疗方法　GENJUSHUIZHONGQUYUDAXIAO，XUANQU2～5GEZHILIAODIAN，GENJUHUANZHEDUITENGTONGDEMINGANDU，YOUDINENGJIZHUJIANZENGJIAZHISUOXUNENGJI，NENGLIUMIDUWEI0.18～0.25 mJ/mm2，MEIGEDIANCHONGJI800～1500CI；JIANGE3～5TIANZHILIAO1CI，5CIWEIYILIAOCHENG。LIAOCHENGJIESHUHOU3GEYUEXINGMRIJIANCHA，LEJIEBINGBIANJINZHAN，KEXINGDUOLIAOCHENGZHILIAO。ZHILIAOQIJIANBIMIANQITAKENENGDAOZHIGUSUISHUIZHONGJIAZHONGDEYINSUCIJI[50,51]。

4.4　胫骨结节骨软骨炎

4.4.1　适应证　QUEZHENWEIJINGGUJIEJIEGURUANGUYANDEHUANZHE。

4.4.2　禁忌证　JUBUGUGANRAN、GUZHONGLIU、PIFUPOSUN、BINRENDAISILIE。

4.4.3　定位　YIBANCAIYONGX XIANDINGWEIJIEHETONGDIANDINGWEI。

4.4.4　治疗方法　HUANZHEQUYANGWOWEI，HUANZHISHENZHI。YIBANJIANYISHIYONGFASANSHICHONGJIBOZHILIAO，SHIYONGJUJIAOSHICHONGJIBOZHILIAOSHI，YINGZHUYIBIMIANJIAODIANZUOYONGYUSHENGZHANGGUHOU。GENJUHUANZHEDUITENGTONGDEMINGANDUZHUJIANZENGJIANENGJI，NENGLIUMIDUWEI0.10～0.18 mJ/mm2，YITONGDIANWEIZHONGXINJINXINGZHILIAO，MEICIZHILIAOCHONGJI1000～2000CI，JIANGE3～5TIANZHILIAO1CI，5CIWEIYILIAOCHENG。KEXINGDUOLIAOCHENGZHILIAO，ZHILIAOQIJIANHUANZHIBIMIANGUODUHUODONG[52,53]。

4.5　距骨骨软骨损伤

4.5.1　适应证　HUAIGUANJIETENGTONGJIQIGONGNENGZHANGAI，MRIZHENDUANWEISHANGWEIFASHENGJUGUTAXIANHepple Ⅰ～ⅢQIDEJUGUGURUANGUSUNSHANG，RUANGUXIAGUJUXIANXINGSHUIZHONGHE（HUO）HUAISI，WUJUDANANGXINGBIANHUANZHE。

4.5.2　禁忌证　CHUQUANSHENJINJIZHENGWAI，JUGUJIXINGSUNSHANG、GANRANHUOJUDAGUNANGZHONG。

4.5.3　定位　CAIYONGMRIJIEHEJIEPOUBIAOZHIDINGWEI，HUANZHEQUZUOWEIHUOYANGWOWEI，HUANZUGUDINGYUZHIJIAHUOZHENTOUSHANG，CHONGFENBAOLUZHILIAOBUWEI。YIMRISUOSHISUNSHANGQUYUZAITIBIAODUIYINGBUWEIWEIDINGWEIDIAN，YATONGDIANZUOWEIFUJIADINGWEIDIAN。

4.5.4　治疗方法　ZHILIAOYINGYIDINGWEIDIANWEIZHONGXIN，GENJUHUANZHEDUITENGTONGDEMINGANDU，YOUDINENGJIZHUJIANZENGJIAZHISUOXUNENGJI，NENGLIUMIDUWEI0.18～0.25 mJ/mm2。TONGCHANGCAIYONGDUOCIZHILIAOFA，MEICIZHILIAOXUANZE2～3GEZHILIAODIAN，MEIGEDIANCHONGJI1000CI，GONGCHONGJI2000～3000CI；JIANGE1TIAN，ZHILIAO5CIWEIYILIAOCHENG。JIANYIZHILIAO3～5GELIAOCHENG，JIANGE2GEYUE。HUANZHEFENBIEZAIZHILIAOQIANJIZHILIAOHOU6、12GEYUEXINGHUAIGUANJIEMRIJIANCHA，LEJIEBINGBIANQINGKUANG[54-56]。

4.6　应力性骨折

4.6.1　适应证　ZHENDUANWEIYINGLIXINGGUZHE，HUOCUNZAIMINGQUEDEGUODULAOSUNBINGSHI，CHUXIANMINGXIANGUTONGHUANZHE，JINGMRIJIANCHA，FAXIANYOUJUBUGUMOFANYINGZHEYEKEYINGYONG。

4.6.2　禁忌证　BINGLIXINGGUZHE、GUZHEMINGXIANYIWEI、JUBURUANZUZHISUNSHANG。

4.6.3　定位　GENJUXXIANHUOMRIJIANCHAJIEGUO，JIEHETONGDIANDINGWEIQUEDINGTIBIAOZHILIAOWEIZHI。SHIYONGFASANSHICHONGJIBOZHILIAOQIANBIAOBUWEISHI，ZHILIAOQIANGENJUXXIANDINGWEIJIEGUOYUTIBIAOZUOHAOBIAOJI；SHIYONGJUJIAOSHICHONGJIBOZHILIAOSHI，TONGGUOXXIANJIJIANGZHILIAODIANYUJUJIAOSHICHONGJIBOZHILIAOJIDIERJIAODIANOUHE。

4.6.4　治疗方法　HUANZHETIWEIYISHUSHIFANGBIANZHILIAOWEIYUANZE，YIBANCAIQUZUOWEIHUOWOWEI。ZHILIAOTOUYIBANYINGFANGZHIZAIZHITIXUEGUANSHENJINGJIAOSHAODEYICE。ZHILIAOQUYUTUMOOUHEJI，BIMIANSUNSHANGPIFU。ZHILIAOCANSHUWEI0.10～0.25 mJ/mm2。MEICIZHILIAOXUANZE2～3GEZHILIAODIAN，MEIGEDIANCHONGJI800～1000CI，GONGCHONGJI2000～3000CI，MEICIZHILIAOJIANGE1TIAN，4～6CIWEIYILIAOCHENG。ZHILIAOHOU2GEYUEXINGXXIANHUOMRIJIANCHA，GUANCHAGUZHEYUHEQINGKUANG，BIYAOSHIKEXINGDUOLIAOCHENGZHILIAO。ZHILIAOQIJIANBIMIANGUZHEBUWEIGUODUFUZHONG[57,58]。

4.7　肱二头肌长头肌腱炎

4.7.1　适应证　QUEZHENWEIGONGERTOUJIZHANGTOUJIJIANYANZHE。

4.7.2　禁忌证　JUBUMINGXIANJIJIANDUANLIE、YANZHONGJIANXIUSUNSHANG、GUZHE、GANRAN、ZHONGLIUJIQUANSHENJINJIZHENGZHE。

4.7.3　定位　HUANZHEQUZUOWEIHUOYANGWOWEI，TONGGUOQUZHOUJIWAIXUANSHANGBEI，SHIGONGGUJIEJIEJIANGOUJIQINEIDEGONGERTOUJIZHANGTOUJIJIANCHAOXIANGJIANGUANJIEQIANFANG，CAIYONGTIBIAOJIEPOUBIAOZHIJIEHETONGDIANDINGWEIHUOCHAOSHENGDINGWEI。YICHUTONGDIANWEIZHONGXINZUOWEIZHILIAODIAN，BIKAIZHONGYAODEXUEGUAN、SHENJING。

4.7.4　治疗方法　ANCHONGJINENGLIANGYOUDIDAOGAOWEIDIAO，YIHUANZHENENGGOURENSHOUWEIYI，NENGLIUMIDUWEI0.10～0.14 mJ/mm2。MEICIZHILIAOXUANDING1GEZHONGXINZHILIAODIAN，CHONGJI1000～2000CI，MEICIZHILIAOJIANGE5～7TIAN，3～5CIWEIYILIAOCHENG，KEXINGDUOLIAOCHENGZHILIAO[59-64]。

4.8　冈上肌腱炎

4.8.1　适应证　QUEZHENWEIGANGSHANGJIJIANYANZHE。

4.8.2　禁忌证　JUBUMINGXIANJIANXIUJIJIANDUANLIE、SHANGYUCHUNSILIE、GUZHE、GANRAN、ZHONGLIUJIQUANSHENJINJIZHENGZHE。

4.8.3　定位　HUANZHEKEQUZUOWEIHUOYANGWOWEI，SHANGBEIZHONGLIWEIHUOQINGDUNEIXUAN，SHIGANGSHANGJIJIANCHAOXIANGJIANGUANJIESHANGFANG，CAIYONGTIBIAOJIEPOUBIAOZHIJIEHETONGDIANDINGWEIHUOCHAOSHENGDINGWEI，YOUMINGXIANGAIHUAZHEKEJIEHEXXIANDINGWEI。YICHUTONGDIANWEIZHONGXINZUOWEIZHILIAODIAN，BIKAIZHONGYAODEXUEGUAN、SHENJING。

4.8.4　治疗方法　ANCHONGJINENGLIANGYOUDIDAOGAOWEIDIAO，YIHUANZHENENGGOURENSHOUWEIYI，NENGLIUMIDUWEI0.10～0.24 mJ/mm2。MEICIZHILIAOXUANDING1GEZHONGXINZHILIAODIAN，CHONGJI1500～3000CI，YOUGAIHUAZAOZHE，KEXUANZEJIAOGAODENENGLIUMIDUHECHONGJICISHU，MEICIZHILIAOJIANGE5～7TIAN，3～5CIWEIYILIAOCHENG，KEXINGDUOLIAOCHENGZHILIAO[64-70]。

4.9　肱骨外上髁炎

4.9.1　适应证　QUEZHENWEIGONGGUWAISHANGKEYANZHE。

4.9.2　定位　YIBANYONGTIBIAOJIEPOUBIAOZHIJIEHETONGDIANDINGWEI，HUANCEZHOUGUANJIEQUQU，BEIBUXUANQIAN，CHUZHENGONGGUWAISHANGKEYATONGDIANJIQIANBEIJITONGDIANBINGBIAOJIZHILIAOQU。

4.9.3　治疗方法　HUANZHEQUZUOWEI，ANCHONGJINENGLIANGYOUDIDAOGAOWEIDIAO，YIHUANZHENENGGOURENSHOUWEIYI，NENGLIUMIDUWEI0.10～0.18 mJ/mm2，MEICICHONGJI1500～2500CI，MEICIZHILIAOJIANGE5～7TIAN，3～5CIWEIYILIAOCHENG，ZAICHONGJIBOZHILIAOHOUYIDINGYAOZHUYIXIUXI，TENGTONGDEDAOHUANJIEFANGNENGZAICIJINXINGZHILIAO[8,71-76]。

4.10　肱骨内上髁炎

4.10.1　适应证　QUEZHENWEIGONGGUNEISHANGKEYANZHE。

4.10.2　定位　YIBANYONGTIBIAOJIEPOUBIAOZHIJIEHETONGDIANDINGWEI，HUANCEZHOUGUANJIEQUQU，BEIBUXUANQIAN，CHUZHENGONGGUNEISHANGKEYATONGDIANJIQIANBEIJITONGDIANBINGBIAOJIZHILIAOQU，YINGJINLIANGBIKAICHISHENJINGGOUNEIDECHISHENJING。

4.10.3　治疗方法　HUANZHEQUZUOWEI，HUANCEZHOU、JIANGUANJIEQUQU，ANCHONGJINENGLIANGYOUDIDAOGAOWEIDIAO，YIHUANZHENENGGOURENSHOUWEIYI，NENGLIUMIDUWEI0.10～0.18 mJ/mm2，MEICICHONGJI1500～2500CI，MEICIZHILIAOJIANGE5～7TIAN，3～5CIWEIYILIAOCHENG[75,77]。

4.11　髌腱炎

4.11.1　适应证　确诊为髌腱炎者。

4.11.2　定位　YIBANYONGTIBIAOJIEPOUBIAOZHIJIEHETONGDIANDINGWEI；YEKEYONGCHAOSHENGDINGWEI，ZAITONGDIANXUNZHAOJINGGUJIEJIECHU，BINGTANCEBINGBIANSHENDUJIFANWEI，JINXINGBIAOJI。

4.11.3　治疗方法　HUANZHEQUZUOWEI，HUANZHIQUQU，NENGLIUMIDUWEI0.12～0.20 mJ/mm2，MEICICHONGJI1000～2000CI，CHONGJICISHUKEGENJUBINGQINGZENGJIAN，MEICIZHILIAOJIANGE5～7TIAN，3～5CIWEIYILIAOCHENG[78-80]。

4.12　慢性跟腱炎

4.12.1　适应证　QUEZHENWEIMANXINGGENJIANYANZHE。

4.12.2　定位　YIBANYONGTIBIAOJIEPOUBIAOZHIJIEHETONGDIANDINGWEI；YEKEYONGJIGUCHAOSHENG，DUIYATONGDIANJINXINGBIAOJI，YINGYONGJIGUCHAOSHENGZAITONGDIANXUNZHAOBINGZAOQU，BINGTANCEBINGBIANSHENDU、FANWEIJISHIFOUYOUGAIHUA。

4.12.3　治疗方法　HUANZHEQUFUWOWEI，XIGUANJIESHENZHIWEI，HUAIGUANJIEFANGSONGWEI，NENGLIUMIDUWEI0.12～0.20 mJ/mm2，MEICICHONGJI1500～2000CI，MEICIZHILIAOJIANGE5～7 TIAN，3～5CIWEIYILIAOCHENG[81-84]。

4.13　跖筋膜炎

4.13.1　适应证　确诊为跖筋膜炎者。

4.13.2　定位　CAIYONGTIBIAOJIEPOUBIAOZHIJIEHETONGDIANDINGWEIHUOCHAOSHENGDINGWEI，ZAIZUGENBUCHUMOYATONGDIAN，YIYATONGDIANWEIZHILIAODIAN，RUYOU2GEYISHANGTONGDIAN，ZEFENBIEJIYUZHILIAO。SHIYONGCHAOSHENGZHUNQUEDINGWEIKETIGAOZHIYULV。

4.13.3　治疗方法　HUANZHEQUXIAZHISHENZHIZUOWEIHUOFUWOWEI，NENGLIUMIDUWEI0.12～0.20 mJ/mm2，MEICICHONGJI1500～3500CI，MEICIZHILIAOJIANGE5～7TIAN，3～6CIWEIYILIAOCHENG[71,85-88]。

4.14　腱鞘炎

4.14.1　适应证　SHOU（ZHI）QUJIJIANQIAOYAN、RAOGUJINGTUXIAZHAIXINGJIANQIAOYAN、CHICEWANQUJIJIANQIAOYANDENG。

4.14.2　定位　YIBANYONGTIBIAOJIEPOUBIAOZHIJIEHETONGDIANDINGWEI。

4.14.3　治疗方法　NENGLIUMIDUWEI0.10～0.16 mJ/mm2，MEICICHONGJI1000～2000CI，MEICIZHILIAOJIANGE5～7TIAN，3～5CIWEIYILIAOCHENG[89-91]。

总结

YOUYUKEXUEJISHUDEBUDUANJINBU，JIBINGZHILIAOJISHUDEZHENGTIFAZHANQUSHISHIZAIJINGZHUNDEJICHUSHANGWEICHUANGJIWUCHUANGHUA。GUJIJIBINGESWTZHENGSHIZHEIYIQUSHIDECHANWU，XIANGXINGAILIAOFABIJIANGCHENGWEICILEIJIBINGZHILIAODEZHONGYAOSHOUDUANJISHOUXUANZHILIAOFANGAN。JINNIANLAI，ESWTJICHUHELINCHUANGYANJIUBUDUANSHENRU，GAILIAOFAYIZHUJIANKUOZHANZHIXINNEIKE（YONGYUZHILIAOCHENJIUXINGXINJIGENGSI[92,93]）、MINIAOWAIKE（YONGYUZHILIAOMANXINGPENQIANGTENGTONG[94]、BOQIGONGNENGZHANGAI[95]）、NEIFENMIKE（YONGYUZHILIAOTANGNIAOBINGZU[96]）、SHAOSHANGZHENGXINGWAIKE（YONGYUZHILIAOPIXIAZHIFANGTUAN[97]、PIFUKUIYANGJIRUANHUABANHEN[98]）、ZHONGLIUKE（YONGYUZHONGLIUBAXIANGZHILIAO[99]）、KOUQIANGKE（YONGYUZHILIAOYAZHOU、HEGUBINGBIAN[100]）DENG，BINGZHANXIANCHUGUANGFANDEYINGYONGQIANJING。YOUYUGAILIAOFAJUYOUFEIQINRUXING、GAOXIAO、FEIYONGDILIAN、YIYUBEIHUANZHEJIESHOUDENGXIANZHUYOUSHI，XIANGXINZAIBUYUANDEJIANGLAI，ESWTBIJIANGFAZHANCHENGWEIYIMENXINDEXUEKE——CHONGJIBOYIXUE。YOUZHONGGUOYANJIUXINGYIYUANXUEHUICHONGJIBOYIXUEZHUANYEWEIYUANHUIZHUCHIXIUDINGDE《GUJIJIBINGTIWAICHONGJIBOLIAOFAZHONGGUOZHUANJIAGONGSHI（DI2BAN）》，JINYIBUTUOZHANLEESWTDEYINGYONGFANWEI，GUIFANLEESWTDELINCHUANGYINGYONGYUYANJIU。XIANGXINYOUGUANESWTDESHIYINGZHENG、JINJIZHENG、ZHILIAOFANGFA、ZHILIAOCANSHUJILINCHUANGYINGYONGFANGANDEJIANLI，JIANGGENGHAODITUIDONGESWTZAILINCHUANGDETUIGUANGYINGYONG，DUICUJINESWTXIANGGUANSHEBEIDESHENGCHANJUYOUZHONGYAOYIYI。SUIZHEZHEIYIJISHUDEYINGYONGYUYANJIUDESHENRU，BIJIANGCUJINCHONGJIBOYIXUEZAIZHONGGUODECHUANBOYUFAZHAN，WEIGUANGDAHUANZHEZAOFU。

中山慧康产品演示