Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Les ondes de choc - retour sur 108 patients traités

1,009 views

Published on

Les ondes de choc - retour sur 108 patients traités

Published in: Health & Medicine
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download Full EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download Full doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THIS can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THIS is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THIS Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THIS the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THIS Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download Full EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download Full doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THIS can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THIS is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THIS Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THIS the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THIS Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://urlzs.com/UABbn } ......................................................................................................................... Download Full EPUB Ebook here { https://urlzs.com/UABbn } ......................................................................................................................... Download Full doc Ebook here { https://urlzs.com/UABbn } ......................................................................................................................... Download PDF EBOOK here { https://urlzs.com/UABbn } ......................................................................................................................... Download EPUB Ebook here { https://urlzs.com/UABbn } ......................................................................................................................... Download doc Ebook here { https://urlzs.com/UABbn } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THIS can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THIS is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THIS Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THIS the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THIS Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download Full EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download Full doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THIS can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THIS is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THIS Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THIS the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THIS Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download Full EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download Full doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THIS can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THIS is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THIS Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THIS the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THIS Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Be the first to like this

Les ondes de choc - retour sur 108 patients traités

  1. 1. LES ONDES DE CHOC étude de 108 dossiers à partir d’un an d’expérience Dr LEVAVASSEUR et Dr POLIN Institut Régional de Médecine du Sport Jeudi 10 mars 2005
  2. 2. PLAN • De l’historique à la technique – Guillaume LEVAVASSEUR • De la technique au mode d’action – Didier POLIN • De l’utilisation aux indications – Guillaume LEVAVASSEUR • Nos résultats , comparaison – Didier POLIN
  3. 3. De l’historique à la technique
  4. 4. HISTORIQUE • ONDES DE CHOC (ODC): utilisées depuis 25 ans en lithotripsie extra-corporelle (ESWT) • Essais au début des années 90 sur les tendinites calcifiantes de l’épaule • Parallèlement développement d’appareils émettant des ONDES DE CHOC dites RADIALES (OCR) ou Radial Shock Wave Therapy ( RSWT)
  5. 5. APPAREILS à ODC électromagnétiques • Appareils lourds, technologie complexe • Haute énergie, pénétration profonde • Appareils peu précis et onéreux
  6. 6. APPAREILS A ONDES DE CHOC RADIALES
  7. 7. APPAREILS A ONDES DE CHOC RADIALES • Sept fois mois puissant que le lithotripteur • limite de l’os : P> 0,26 mJ/mm²
  8. 8. 0,234 0,173,5 0,123 0,072,5 0,032 mJ/mm²Bar Energie du MP100Pain Management
  9. 9. APPAREILS A ONDES DE CHOC RADIALES • ODC de plus faible énergie – (4 bars maximum soit 0.23mJ/mm2) • Pénétration plus superficielle – (3,5 cm de profondeur) • Peu irritant sur les tissus • Appareils mobiles et moins onéreux
  10. 10. De la technique au mode d’action
  11. 11. Onde de choc Onde réfléchie Onde réfléchie Onde transmise Direct effects at interfaces Hopkinson-Effect Désintégration à la surface
  12. 12. Ballistic Pressure Pulse Therapy
  13. 13. Ballistic Pressure Pulse Therapy V1 = 10 m/sV2 = 10m/s Masse mobile Masse immobile; choc élastique
  14. 14. Ballistic Pressure Pulse Therapy V2 = 10m/s Masse mobile Masse immobile; collision inélastique, tissu mou. La peau est étirée et déformée
  15. 15. Ballistic Pressure Pulse Therapy V2 = 10m/s Masse mobile Masse immobile; collision via Une plaque de rebond La peau est protégée
  16. 16. Body Air comprimé 1. Appliquer 2. Tirer Pressure Pulse Therapy Energie CorpsPlaque de rebondPiston Pression Temps5 msVitesse 10 m/sec
  17. 17. 1-10 bar100-1000 bar Pressure Pulse (RSWT) Time Pressure Pressure Time Shock Wave (ESWT) Shock Wave vs Pressure Pulse (1 / 100) (10 000)1-5 ms≈≈≈≈ 300 ns
  18. 18. douleur calcification lithiase Densité d’énergie (mJ/mm2) 0 0.75 1.5 0.12 0.26
  19. 19. MODE D’ACTION • Ce que l’on observe chez nos patients…. – Douleur immédiate diminuant secondairement – Antalgie en fin de séance – Réapparition de la douleur 3 à 24 heures après les ondes de chocs – Amélioration secondaire sur la douleur et la gène fonctionnelle
  20. 20. MODE D’ACTION • Libération locale immédiate de substances antalgiques et anti inflammatoire • Action défibrosante • Création de micro-lésions susceptibles d’induire un processus de cicatrisation Triple effet: - antalgique précoce - pic douloureux secondaire - amélioration retardé ( entre 6 semaines et 3 mois) sur les lésions chroniques
  21. 21. REVUE DE LA LITTERATURE de l’utilisation aux indications
  22. 22. LES ETUDES • Recherche Internet sur le mot-clé RSWT: 7300 réponses • Etudes surtout allemandes ,américaines et canadiennes • En France depuis 1999
  23. 23. • FRÖLICH 1999: 103 patients – épicondylite Amélioration significative à 1 an sur la douleur et la reprise de la vie professionnelle et sportive • ROZENBLAT 2003: 330 patients – association ODC puis cryothérapie Satisfaction à 3 mois minimum (gène fonctionnelle vie quotidienne et pratique sportive) des patients 73%
  24. 24. • GEDERSMEYER 2004: 70 patients – aponévrosite plantaire Diminution significative de la douleur sur l’ EVA à 12 semaines pour le groupe « onde de choc » Amélioration plus importante sur les tendinopathies corporéales que sur les enthésopathies
  25. 25. UTILISATION PRATIQUE • Nombre d’impulsions: 2000 à 3000 chocs • Fréquence: 5 à 15 Hz • Pression: variation entre 1,5 à 4 bars soit 0,02 à 0,23 mJ /mm² PAS DE CONSENSUS Exemples: pathologie d’insertion (2000 -2 b - 10 à 15 Hz) pathologie corporéale (2000 –2,5 b – 5 à 10 Hz)
  26. 26. UTILISATION PRATIQUE • Effets indésirables: DOULEUR lors de la séance, ecchymoses, oedèmes transitoires, irritations cutanées • Une à deux séances par semaine • Association avec la cryothérapie • Arrêt des activités pas systématique car favorise la cicatrisation
  27. 27. INDICATIONS ACTUELLES
  28. 28. INDICATIONS D’AVENIR… • Pseudarthroses ? • Fractures de fatigue ? • Chondropathies ? • Névrome de Morton ?
  29. 29. CONTRE-INDICATIONS • Algodystrophie • Troubles coagulation et AVK • Pathologies tumorales • Infections locales et générales • Prothèses cimentées • Thorax, abdomen, rachis • Grossesse
  30. 30. NOS RESULTATS COMPARAISON
  31. 31. H. DE LABAREYRE et G. SAILLANT, Médecins du Sports 2002 265 patients, évaluation des résultats à 6 semaines au minimum 45553,49Epitrochléite 36644,328Epicondylite 45503,342T. rotulienne 31623,545Aponévrosite plantaire 31694,313T. Achille insertion 25,974,13,6116T. Achille corporéale I+D (%)TS+S (%)Nombre moyen de séances Nombre de cas Pathologies
  32. 32. INSTITUT REGIONAL DE MEDECINE DU SPORT 108 patients traités d’avril à décembre 2004 Résultats au terme des séances 27733.511Périostite 802045Epitrochléite 4.2 4.3 4.4 4.2 4 Nombre moyen de séances 30 6 13 7 33 Nombre de cas 31 17 46 57 34 I+D (%) 69Epicondylite 83Tendinopathie rotulienne 54Aponévrosite plantaire 43T. Achille enthésopathie 66T. Achille corporéale TS+S (%)Pathologies
  33. 33. INSTITUT REGIONAL DE MEDECINE DU SPORT Évolution de l’échelle de BORG Évaluation des résultats à 6 semaines au minimum Tendinopathie Achilléenne corporéale (33 cas) 7.93.74.9initialement 2.922.366%Au terme des séances 1.91.31.976% A 6 semaines minimum Gène pratique sportive Gène fonctionnelle douleurTS+S
  34. 34. INSTITUT REGIONAL DE MEDECINE DU SPORT Évolution de l’échelle de BORG Évaluation des résultats à 6 semaines au minimum Aponévrosite plantaire (13 cas) 9.45.65.6initialement 5.43.43.454%Au terme des séances 2.32.62.260% A 6 semaines minimum Gène pratique sportive Gène fonctionnelle douleurTS+S
  35. 35. INSTITUT REGIONAL DE MEDECINE DU SPORT Évolution de l’échelle de BORG Évaluation des résultats à 6 semaines au minimum Epicondylite (30 cas) 5.26.15.4initialement 2.52.8369%Au terme des séances 2.52.33.162% A 6 semaines minimum Gène pratique sportive Gène fonctionnelle douleurTS+S
  36. 36. PLACE DES ONDES DE CHOC RADIALES… à partir de notre expérience et de vos réflexions…
  37. 37. CONCLUSION • Aide supplémentaire dans l’arsenal thérapeutique du traitement des tendinopathies • Retard en France • Ne se substitue pas à la rééducation • A utiliser en première et en seconde intention • Amélioration de protocoles de traitement • Utilisateur « technicien »

×