tailieunhanh - Applications in Musculoskeletal Disorders - part 8

trong 50 bệnh nhân (36%) đã được vận hành trên các triệu chứng liên tục. Spindler et al. (1998) báo cáo ba bệnh nhân không có triệu chứng 2 năm sau khi một ứng dụng sóng xung kích (SWA). Gần đây Loew et al. (1999) bao gồm 195 bệnh nhân trong điều tra tiềm năng của họ | Discussion 59 out of 50 patients 36 had to be operated on for persistent symptoms. Spindler et al. 1998 reports three patients to be asymptomatic 2 years after one shock wave application SWA . Recently Loew et al. 1999 included 195 patients in their prospective investigation and reported subjective recovery in 58 of patients and complete or partial disintegration of the deposits in 72 of patients at 6 months after two sessions of high-energy SWA. Most recently Pigozzi et al. 2000 in a prospective series of 72 patients treated weekly for 8 weeks with 2000 impulses of mJ mm2 found 67 good or excellent results. Radiologically a reduction of the deposit was described in 37 no changes were seen in 63 . The reports by Daecke et al. 1997 and by Krischek et al. 1997 indicate that there is a correlation between radiomorphological features of the deposit the amount of total energy applied and of the rate of disintegration. To increase elimination of the deposit in the patients in the current study Rompe et al. 2001b the energy flux density was doubled to mJ mm2 promoting complete disintegration to 70 in Gaertner Type-II deposits and 28 in Gaertner Type-I deposits compared with an overall 15 in an earlier study Rompe et al. 1995 . Despite the use of shock waves of such a high energy flux density not one case of damage to the rotator cuff carti-lage and bone was observed in radiograph ultrasonography or MRI. The results of the current study underlined once again the importance of complete removal of the calcium. The finding of an association between complete disintegration of the deposit and good outcome Rompe et al. 2000 supports similar observations most recently published by Perlick et al. 1999c . The authors treated two groups of patients two times with 2000 impulses of an energy flux density of mm2 or mm2. With regard to the radiological appearance of the deposits they described an improvement in the values of the Constant and Murley score from