目的 观察体外冲击波疗法(ESWT)调节内皮细胞磷酸酶张力蛋白同源物(PTEN)的表达对糖尿病大鼠下肢血管病变的影响及其可能的机制.方法 将24只2月龄健康雄性SD大鼠随机分为3组:对照组(A组)、糖尿病血管病变组(B组)、糖尿病血管病变+ESWT治疗组(C组).B组和C组采用高脂高糖喂养+腹腔注射链脲佐菌素60 mg/kg建立糖尿病血管病变大鼠模型,C组在建模成功后1周(T1)、2周(T2)、3周(T3)、4周(T4)接受ESWT治疗.T4时通过超声测量大鼠股动脉血管病变区血流速度和血管内径.ESWT治疗结束后即刻处死大鼠取下肢股动脉及腓肠肌,在电镜下观察各组股动脉结构.Western blot检测股动脉PTEN、磷脂酰肌醇-3-激酶(PI3 K)和蛋白激酶B(Akt)的表达水平,实时荧光定量逆转录-PCR(qRT-PCR)检测PTEN mRNA的表达水平;免疫荧光检测腓肠肌CD31表达水平.结果 B、C组T4时股动脉收缩期峰值流速及舒张末期血流速度均明显低于A组(P<0.05),但C组高于B组(P<0.05).3组大鼠股动脉内径差异无统计学意义(P>0.05).B、C组PTEN表达水平明显低于A组(P<0.05),但C组高于B组(P<0.05).B组的PI3K、Akt表达水平均明显高于A组(P<0.05),C组低于B组(P<0.05).B、C组PTEN mRNA表达水平明显低于A组(P<0.05),但C组高于B组(P<0.05).电镜下观察到,ESWT治疗后,C组血管内皮细胞损伤较B组明显;B、C组CD31表达水平明显低于A组(P<0.05),但C组高于B组(P<0.05).结论 ESWT可通过上调糖尿病大鼠下肢动脉PTEN,下调PI3K和Akt,改善血管功能,提高糖尿病大鼠股动脉收缩期峰值流速,改善腓肠肌微血管密度.

目的 观察加味独活寄生合剂联合体外冲击波对寒湿痹阳型腰椎间盘突出症的临床疗效,及对NF-κB信号通路的影响.方法 将湖南中医药大学第一附属医院68例寒湿痹阻型腰椎间盘突出症患者按入组顺序随机分为试验组与对照组,每组34例.对照组予体外冲击波治疗,试验组在体外冲击波的基础上给予加味独活寄生合剂治疗,两组均治疗2周.采用疼痛视觉模拟(visual analogue scale,VAS)评分、Oswestry功能量化指数(oswestry disability index,ODI)评分及日本骨科协会评分(Japanese orthopaedic association,JOA)评估两组患者的疗效;用ELISA检测治疗前后血清NF-κB信号通路指标(p50、p65)、白细胞介素-8(Interleukin-8,IL-8)、白细胞介素-10(Interleukin-10,IL-10)、肿瘤坏死因子-α(Tumor Necrosis Factor-alpha,TNF-α)表达含量.结果 治疗后,两组患者NF-κB信号通路指标(p50、p65)、IL-8、TNF-α与治疗前比较均降低(P<0.01),IL-10 明显升高(P<0.01).治疗后,两组患者JOA评分、ODI评分与治疗前比较均显著改善(P<0.01);且试验组效果优于对照组(P<0.01).两组患者VAS评分差异无统计学意义(P>0.05).结论 加味独活寄生合剂联合体外冲击波治疗腰椎间盘突出症可能通过抑制NF-κB信号通路的激活从而影响下游炎症因子表达,减轻LDH患者异常炎症反应,改善腰椎功能.

慢性前列腺炎(CP)/慢性骨盆疼痛综合征(CPPS)又称为Ⅲ型前列腺炎，是男性常见病之一，在中青年男性中发病率较高，约占30%～40%。目前国内外指南认为CPPS的治疗目标主要是缓解疼痛、改善排尿症状和提高生活质量，疗效评价应以症状改善为主，治疗方法仍以药物治疗为主。近些年一些物理治疗方法相继出现，特别是体外冲击波(ESWT)治疗CPPS在临床上得到推荐和研究。目前ESWT治疗主要使用的是聚集式冲击波(fESWT)，近年来也有研究使用放射式冲击波(rESWT)，这些研究报道均表明ESWT治疗CPPS的有效性和安全性，特别是对CPPS患者的疼痛症状有明显缓解作用，对其排尿症状和勃起功能的改善并不明显。ESWT治疗CPPS是一个值得推荐的物理治疗方法，其作用机制和规范的治疗方案仍需进一步研究和讨论。

Purpose:To evaluate the efficacy and safety of radial extracorporeal shock wave therapy (rESWT) according to total number of pulses on hamstring muscle spasticity in children with spastic type cerebral palsy (CP)．Methods:This study is a randomized controlled trial consisting of thirteen patients with spastic CP, 9 males and 4 females, aged 5 to 14 years (mean age 9.2). Twenty-five spastic hamstring muscles were divided in four groups. Group I: 500 pulses, Group II: 1，000 pulses, Group III: 1，500 pulses, and Group IV: 2，000 pulses. Australian Spasticity Assessment Scale (ASAS) was measured at four different time points (pre-ESWT, post-ESWT, 2 weeks post-ESWT, and 4 weeks post-ESWT)．Results:All four groups showed improvement in ASAS relative to pre-treatment, although only significant in Group III (1，500 pulses). There were no statistically significant differences in ASAS between all four groups in pre-ESWT [|2(2)＝3.907, P＝0.272], immediately post-ESWT [|2(2)＝1.250, P＝0.741], 2 weeks post-ESWT vs pre-ESWT [|2(2)＝3.367, P＝0.338], and 4 weeks post-ESWT vs pre-ESWT [|2(2)＝1.566, P＝0.667]． Conclusion:The effect of rESWT on spastic hamstring in children with spastic CP is not dependent on the number of pulses.

目的:探讨体外发散式冲击波(ESWT)联合深部肌肉刺激(DMS)治疗第三腰椎横突综合征的疗效。方法:将60例第三腰椎横突综合征患者按照随机数字表法分为治疗组和对照组，每组30例。对照组采用体外发散式冲击波治疗，治疗组在对照组基础上加用DMS。治疗前、治疗1个月后(治疗后)，采用视觉模拟评分法(VAS)、Oswestry功能障碍指数(ODI)、Barthel指数评分评定2组患者的疼痛程度、腰椎功能及日常生活活动(ADL)能力，采用双盲法检测患者的前屈和后伸活动度。结果:治疗前，2组患者VAS、ODI、ADL评分及腰椎关节活动度比较，差异无统计学意义( P>0.05)。与组内治疗前比较，2组患者VAS、ODI、ADL评分及腰椎关节活动度均有所改善( P<0.05)。与对照组治疗后比较，治疗组患者VAS[(1.34±0.31)分]、ODI[(1.7±1.3)分]、ADL评分[(77.38±5.21)分]及腰椎关节活动度改善更为显著( P<0.05)。 结论:体外发散式冲击波联合DMS能明显缓解第三腰椎横突综合征患者的腰部疼痛，疗效显著。

Background and objectives:In many patients after stroke, spasticity develops over time, resulting in a decrease in the patient′s independence, pain, worsening mood, and, consequently, lower quality of life. In the last ten years, a rich arsenal of physical agents to reduce muscle tone such as extracorporeal shock therapy (ESWT) wave has come through. The aim of this narrative review article is to present the current state of knowledge on the use of ESWT as a supplement to the comprehensive rehabilitation of people after stroke suffering from spasticity.Methods:The PubMed and PEDro databases were searched for papers published in English from January 2000 to December 2020, 22 of which met inclusion criteria for clinical studies related to post-stroke spasticity management with ESWT.Results:A total of 22 studies including 468 post-stroke patients-11 reports with the upper limb (267 patients) and 10 reports within the lower limb (201 patients), as well as one report including both upper and lower limb. We focused our attention on clinical and methodological aspects. Therefore, we performed the assessment of enrolled studies in terms of methodological quality using the PEDro and level of evidence using the National Institute for Health and Clinical Excellence (NICE) guidelines. Furthermore, we indicated implications for clinical practice in using ESWT for post-stroke spasticity management. Moreover, we discussed a suggestion for future research directions.Conclusions:In conclusion, an ESWT effectively reduces muscle tone in people with spastic limb after stroke. Further, ESWT is safe and free of undesirable side effects.The mechanism of action of ESWT on muscles affected by spasticity is still unknown.To date, no standard parameters of ESWT in post-stroke spasticity regarding intensity, frequency, location, and the number of sessions has been established. Further research, meeting the highest standards, is needed to establish uniform muscle stimulation parameters using ESWT.

Objective:To evaluate the effectiveness of radial extracorporeal shock wave therapy on ankle flexor spasticity in stroke survivors and to reveal changes in the fibroelastic components of muscle.Design:Randomized controlled trial.Setting:Inpatient neuro-rehabilitation clinic of a university hospital.Participants:Stroke patients with ankle flexor spasticity.Interventions:Patients were randomized to three groups; radial extracorporeal shock wave therapy, sham, or control. Active and sham therapy were administered two sessions/week for two weeks. All patients received conventional rehabilitation.Main measures:The primary outcome was Modified Ashworth Scale. Secondary outcomes were the Tardieu Scale and elastic properties of plantar flexor muscles assessed by elastography (strain index). All assessments were performed before, immediately after the treatment, and four weeks later at follow-up.Results:Fifty-one participants were enrolled (active therapy n＝17, sham n＝17, control n＝17). Modified Ashworth scores showed a significant decrease in the active therapy group (from 2.47±0.72 to 1.41±0.62) compared to sham (from 2.19±1.05 to 2.06±1.12) and control (from 2.06±0.85 to 2.00±0.73) groups immediately after the treatment ( P<0.001). Tardieu results were also in concordance ( P<0.001), however this effect was not preserved at follow-up. Elastic properties of the ankle flexors were improved in all groups at both assessments after the therapy showing significant decreases in strain index ( P<0.001). However, there was no difference among the groups in terms of improvement in elastography. Conclusion:Radial extracorporeal shock wave therapy has short-term anti-spastic effects on ankle flexor muscles when used as an adjunct to conventional rehabilitation.

体外冲击波治疗（ESWT）具有非侵入性、组织损伤小、疼痛缓解迅速、并发症少、治疗周期短、治疗风险低、治愈率高、费用低廉等诸多优势，已成为一种全新的非手术治疗方法。国际医学冲击波学会于2021年11月对ESWT的适应证和禁忌证进行了重新修订。本文对近年来的临床试验、动物实验结果进行分析，结合现有临床治疗指南，对国际医学冲击波学会2021诊疗共识在骨骼、肌肉系统疾病治疗中的应用进行解读。

目的:探讨肌肉能量技术（MET）联合体外冲击波治疗（ESWT）对前交叉韧带重建术后的疗效影响。方法:前瞻性选取2019年2月至2022年2月在解放军联勤保障部队第九〇一医院行前交叉韧带重建术治疗的男性患者为研究对象，按随机数字表法分为对照组和研究组，每组35例。对照组术后给予MET治疗，研究组在对照组基础上联合ESWT，比较两组入组时、术后1周、术后2周、术后4周视觉模拟量表（VAS）评分、Lysholm评分和膝关节活动度。结果:两组VAS评分在入组时、术后1周、术后2周、术后4周呈下降趋势，研究组术后2、4周VAS评分低于对照组[（3.24 ± 2.18）分比（4.57 ± 1.94）分、（0.87 ± 0.75）分比（2.19 ± 1.06）分]，差异有统计学意义（ P<0.05）。两组Lysholm评分、膝关节活动度在入组时、术后1周、术后2周、术后4周呈上升趋势，研究组术后2、4周Lysholm评分高于对照组[（66.72 ± 8.14）分比（59.85 ± 6.35）分、（80.54 ± 5.82）分比（70.59 ± 6.20）分]，研究组术后2、4周膝关节活动度高于对照组[（128.79 ± 6.14）°比（120.84 ± 7.50）°、（132.46 ± 7.06）°比（126.51 ± 6.82）°]，差异有统计学意义（ P<0.05）。 结论:MET联合ESWT能有效缓解前交叉韧带重建术后患者的疼痛，改善患者膝关节活动度及功能。

肩袖损伤常导致肩关节疼痛及功能障碍。当损伤的肩袖肌腱尚未出现连续性中断时，多采用非手术治疗。由于日常生活中肩关节使用频率高，肩袖肌腱组织血液供应差、自我修复能力较弱，故肩袖损伤一般表现为逐渐加重，最终进展为肩袖完全性撕裂。为逆转肩袖损伤的病理生理改变、促进受损的肩袖肌腱修复，临床上对肩袖损伤的非手术治疗方法进行了一系列探索。体外冲击波疗法（ESWT）就是其中具有代表性的一种，但ESWT促进肩袖修复的分子生物学机制仍不明确。因此，笔者就ESWT治疗肩袖损伤的分子生物学机制和临床应用现状的研究进展进行综述，为今后ESWT的研究及临床应用提供参考。