[A pilot investigation into the effects of extracorporeal shock waves on muscular dysfunction in children with spastic movement disorders].
[A pilot investigation into the effects of extracorporeal shock waves on muscular dysfunction in children with spastic movement disorders].
复制标题
[体外冲击波对痉挛性运动障碍儿童肌肉功能障碍影响的初步研究]。
作者：
H. Lohse;M. Kraemer;U. Reime
介绍
体外冲击波（ESW）正越来越频繁地用于治疗肌肉骨骼系统中的狭窄局部疼痛。疼痛通常与肌肉功能障碍有关。从观察到ESW治疗不仅缓解了疼痛，而且缓解了肌肉功能障碍本身开始，尝试用ESW治疗婴儿脑瘫病例中的功能受损。
方法
在35名主要患有痉挛性运动障碍的儿童和年轻人中，用500个低能量ESW非聚焦脉冲治疗产生下肢屈曲挛缩的肌肉的腹部。冲击波本身的焦点（焦点压力10 MPA=0.06 mJ/mm）放置在治疗源（Minilith，Storz Medical，CH-Kreuzlingen）的耦合垫内或倾斜放置在患者体外。通过这种方式，ESW可以分散在整个肌肉中，并将不良反应的风险降至最低。所用能量约为阈值的30%，在该阈值下，在人脐带内皮中观察到ESW聚焦治疗引起的细胞损伤。
结果
一次治疗后，髋关节的运动程度平均增加17度，膝关节增加12.3度，踝关节增加7.1度，每种增加都具有统计学显著性。肌肉僵硬，痉挛性共收缩，肌筋膜粘弹性，以及运动障碍和共济失调症状，减少。似乎有一个系统性的动作进入了运动控制系统。随着一般本体感觉的增加，身体形象、运动的经济性以及未接受治疗的肢体也有所改善。少数患者在治疗后约2天出现欣快反应。在12个月的随访期间未观察到不良反应。治疗是无痛的，因此适合儿童。生物力学的改善持续了几周，这段时间可以用来启动一个改进的运动模式。
结论
ESW适合作为小儿脑性瘫痪物理治疗的辅助器械。在正压力和张力波力和/或空化作用的力方面讨论了ESW对受干扰的外周肌肉的有效作用。在该初步研究中获得的结果显示，肌肉僵硬度特别降低。将进行步态分析和心理控制的对照研究。
INTRODUCTION
Extracorporeal shock waves (ESW) are being used increasingly frequently for the treatment of narrowly localized pain in the musculoskeletal system. Pain is normally associated with muscular dysfunction. Beginning with the observation that not only is the pain soothed by treatment with ESW, but that the muscular dysfunction itself is relieved, an attempt has been made to treat the impaired function in cases of infantile cerebral palsy with ESW.
METHOD
In 35 children and young people with mainly spastic disturbances of movement, the bellies of those muscles producing the flexion contracture of the lower limb were each treated with 500 non-focused pulses of low-energy ESW. The focus (focal pressure 10 MPA=0.06 mJ/mm) of the shock waves itself was placed either within the coupling cushion of the therapy source (Minilith, Storz Medical, CH-Kreuzlingen) or obliquely outside the patient's body. In this way ESW could be dispersed throughout the muscles and the risk of undesirable effects was minimized. The energy used amounted to about 30% of the threshold value at which cellular damage from focused treatment with ESW had been observed in the endothelium of the human umbilical cord.
RESULTS
The degree of movement at the hip joint increased after one treatment by an average of 17 degrees, at the knee joint by 12.3 degrees and at the ankle joint by 7.1 degrees, each increase being statistically significant. Muscular stiffness, spastic co-contractions, and myofascial viscoelasticity, as well as dyskinetic and ataxic symptoms, decreased. It appeared as if a systemic action had entered into the motor control. Together with an increase in general proprioception, there was an improvement in body image, in economy of movement and also in the limbs that had not been treated. A few patients showed euphoric reactions for about 2 days after treatment. No undesirable effects were observed during a follow-up of 12 months. The treatment was painless and is therefore suitable for children. The biomechanical improvement remained for several weeks and this time could be used for initiating an improved pattern of movement.
CONCLUSION
ESW is suitable for use as an additional instrument for physiotherapeutic treatment of infantile cerebral palsy. The effective action of ESW on disturbed peripheral muscles has been discussed in terms of positive pressure and tensile wave forces and/or forces acting by cavitation. The results obtained in this pilot investigation showed particular a decrease in muscle stiffness. A controlled investigation with gait analysis and psychological control is to be undertaken.