EP3256091A1 - Orthosis for the treatment of thorax deformations using negative pressure - Google Patents

Orthosis for the treatment of thorax deformations using negative pressure

Info

Publication number
EP3256091A1
EP3256091A1 EP16702938.8A EP16702938A EP3256091A1 EP 3256091 A1 EP3256091 A1 EP 3256091A1 EP 16702938 A EP16702938 A EP 16702938A EP 3256091 A1 EP3256091 A1 EP 3256091A1
Authority
EP
European Patent Office
Prior art keywords
orthosis
thorax
treatment
depression
bridges
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP16702938.8A
Other languages
German (de)
French (fr)
Inventor
Christian Choux
Bernard Pain
Olivier Tiffet
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Universite Jean Monnet Saint Etienne
Centre Hospitalier Universitaire
Original Assignee
Universite Jean Monnet Saint Etienne
Centre Hospitalier Universitaire
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Universite Jean Monnet Saint Etienne, Centre Hospitalier Universitaire filed Critical Universite Jean Monnet Saint Etienne
Publication of EP3256091A1 publication Critical patent/EP3256091A1/en
Withdrawn legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H9/00—Pneumatic or hydraulic massage
    • A61H9/005—Pneumatic massage
    • A61H9/0057—Suction
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F5/00—Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
    • A61F5/01—Orthopaedic devices, e.g. splints, casts or braces
    • A61F5/03—Corsets or bandages for abdomen, teat or breast support, with or without pads
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F5/00—Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
    • A61F5/01—Orthopaedic devices, e.g. splints, casts or braces
    • A61F5/04—Devices for stretching or reducing fractured limbs; Devices for distractions; Splints
    • A61F5/042—Devices for stretching or reducing fractured limbs; Devices for distractions; Splints for extension or stretching
    • A61F5/048—Traction splints
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F5/00—Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
    • A61F5/01—Orthopaedic devices, e.g. splints, casts or braces
    • A61F5/04—Devices for stretching or reducing fractured limbs; Devices for distractions; Splints
    • A61F5/05—Devices for stretching or reducing fractured limbs; Devices for distractions; Splints for immobilising
    • A61F5/058—Splints
    • A61F5/05833—Splints rigidified by vacuum evacuation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H1/00—Apparatus for passive exercising; Vibrating apparatus; Chiropractic devices, e.g. body impacting devices, external devices for briefly extending or aligning unbroken bones
    • A61H1/008—Apparatus for applying pressure or blows almost perpendicular to the body or limb axis, e.g. chiropractic devices for repositioning vertebrae, correcting deformation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
    • A61H2201/16—Physical interface with patient
    • A61H2201/1602—Physical interface with patient kind of interface, e.g. head rest, knee support or lumbar support
    • A61H2201/1619—Thorax
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2210/00—Anatomical parts of the body
    • A61M2210/10—Trunk
    • A61M2210/101—Pleural cavity

Definitions

  • the invention relates to the non-surgical treatment of funnel depressions of the thorax, called "pectus excavatum", congenital or non-congenital.
  • a treatment orthosis commonly called "bell" which is applied to the thorax extending in a vertical direction from the head to the feet.
  • bell a treatment orthosis
  • the cartilages and costal arches attracts the chest wall, so that, at the end of treatment, the depth of the thoracic funnel is reduced.
  • This non-invasive treatment is carried out by means of various orthoses, the most common of which is that called “Eckart KLOBE”, described in document EP 1 469 804, and called “Suction bell for the non-invasive treatment of the thorax as a funnel. .
  • This prosthesis in the form of an open box turned to the thorax, is composed of a transparent plastic bottom, able to be brought parallel to the vertical plane of the thorax, and a peripheral skirt forming a sealing lip while coming into contact. with the thorax.
  • the skirt is defined between faces, respectively, inner and outer, which go flaring from the bottom.
  • the KLOBE orthosis gives its peripheral lip a variable deformation possibility, greater at the top and on the sides. This is achieved by giving the lip a trapezoidal cross section whose thickness, defined between the faces, respectively, inner and outer, varies depending on the deformability sought to ensure tightness regardless of the configuration of the chest. The variation of deformability is also obtained by modifying the inclination of the faces of the lip
  • the invention aims to remedy this by controlling differently the deformability of adjustment of the prosthesis on the patient.
  • the prosthesis according to the invention has, in a known manner, a general shape of open box and is composed of a bottom, parallel to the thorax, of a peripheral lip of flexible material, elastically deformable, extending around the bottom and adapted to come into sealed contact with the thorax, to form a vacuum treatment space, and at least one suction nozzle, said treatment space being connectable, by a flexible hose with venting valve , to a means generating a depression.
  • the bottom wall is formed by juxtaposed transverse boxes, hollow and rigid, connected to each other by bridges of the same flexible material as that constituting the peripheral lip of the orthosis, these material bridges giving at the bottom wall a possibility of deformation to conform the orthosis to the anatomy of the chest when it is applied vertically against it.
  • the sealing of the orthosis against the thorax does not depend on the variation in deformability of its peripheral lip but on the longitudinal deformability of the bottom bearing this lip.
  • the system of articulated boxes also allows the patient to be able to mobilize and in particular to sit down.
  • the bridges of flexible material between the transverse boxes have a thickness which is increasing since that of the material bridge applying against the upper chest.
  • This embodiment gives the orthosis a greater stiffness in its lower part while its upper part remains more deformable.
  • each of the bridges of flexible material between the transverse boxes has at least one longitudinal duct or channel connecting the processing spaces formed under the juxtaposed boxes.
  • Figures 1 and 2 are perspective views, respectively above and below, of a medium orthosis with four compartments;
  • Figures 3 and 4 are side views in section on an enlarged scale, respectively III-III and IV-IV of Figure 1;
  • Figure 5 is a plan view over a middle orthosis adapted to the female conformation;
  • Figure 6 and 7 are plan views over orthotics for, respectively, large size and small size
  • Figure 8 is a perspective view from below of the orthosis for small size
  • Figure 9 is a perspective view from below of an embodiment of a four-compartment orthosis in which the communication between boxes is provided by channels;
  • Figure 10 is a longitudinal sectional view of the orthosis of Figure 9.
  • Figure 1 1 is a cross-sectional view along XI-XI of Figure 9.
  • the orthosis in the form of a box that is open downwards, is composed of a bottom wall 2 and a peripheral lip 3, made of flexible plastic material, such that in "silicones" or equivalent material.
  • Figures 3 and 4 show that the lip 3 has a substantially trapezoidal cross section of shape, profile and constant dimensions over the entire periphery of the orthosis.
  • the lip 3 is overmolded on the peripheral edges 10 of transverse boxes 4a to 4d, hollow because having a U-shaped cross section returned.
  • These boxes juxtaposed 4 are made of rigid plastic material and are connected to each other by bridges of flexible material, referenced 5a, 5b and 5c in Figures 1 to 3.
  • Figure 3 shows that the thickness E1, E2 and E3 of the material bridges 5a, 5b and 5c is increasing from top to bottom. This reduces the elasticity of these bridges to obtain an increasing variation of the stiffness allowing a better conformation and application on the thorax during the installation.
  • each material bridge is traversed by at least one longitudinal duct 7, in this case three in FIG. 4, communicating the treatment chambers C1 to C4 defined under the caissons 4.
  • Each box 4 comprises, at least locally, a window 8 closed by a glazing 9 of transparent plastic material, such as polycarbonate.
  • This glazing makes it possible to adjust visually the elevation of the sternum, induced by the depression.
  • one of the boxes laterally comprises a bent tubular connection 12, adapted to receive one end of a flexible pipe 13. The provision parallel to the thorax of the air intake, avoids the aspiration of the skin into the orifice, clogging and ulceration by contact with this suction port.
  • the other end of the pipe 13 is connectable to the tip 14 of a suction means, such as a pear 15.
  • this suction equipment is provided with a purge valve 1 6 for at the end of the treatment, to put in the atmosphere the circuit of putting in depression.
  • the orthosis is placed on the funnel formed in the patient's thorax, taking care to place the most flexible compartment C1 at the top, so that the orthosis has a stiffness that increases from top to bottom.
  • the good seal obtained allows, with a starting depression of the order of 0.1 to 0.3 atmosphere, to maintain the treatment for several hours, without fatigue or pain for the patient.
  • the treatment is interrupted by opening the valve 1 6 and after returning compartments C1 to C4 at atmospheric pressure, removing the orthosis.
  • the end boxes 4a and 4d have shapes in a circular segment to give the orthosis rounded ends reducing its size and facilitating installation on the thorax.
  • the boxes 4b and 4c have concave lateral edges conforming to the general shape of the central part of the orthosis , without this modifying the general structure of the orthosis, its design and its elastic zones or with controlled stiffness.
  • the description has been based on a four-box orthosis and three material bridges, for a medium-sized patient, but it is obvious that the arrangements according to the invention also apply to orthoses with five boxes and four material bridges. , as shown in Figure 6, for large patient, and orthoses with three boxes and two bridges of material, as shown in Figure 7 and 8 for small patient.
  • FIGS. 9 to 11 differs from the previous embodiments by:
  • Modifying the stiffness of the material bridges by increasing the thickness of the material of the bridges and / or by adding, in each bridge, a wafer 22a, 22b, 22c, each wafer having a greater rigidity that the plate of the bridge of material which precedes it, either by variation of its thickness or its sectional shape (flat, in U or in O).
  • the prosthesis according to the invention provides the following advantages:
  • material bridges or silicone sleepers constitute molar support bars for the aspirated thorax. This point is also an element of important comfort, since it avoids a support by an abrasive or aggressive material; the lateral organization of the air intake avoiding the ulceration of the skin by contact with the suction port.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • General Health & Medical Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Biomedical Technology (AREA)
  • Vascular Medicine (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Nursing (AREA)
  • Epidemiology (AREA)
  • Pain & Pain Management (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Rehabilitation Therapy (AREA)
  • Orthopedics, Nursing, And Contraception (AREA)
  • Prostheses (AREA)

Abstract

The invention relates to an orthosis comprising a bottom (2), a peripheral lip (3) that is made of flexible, elastically deformable material and is to come in sealing contact with the thorax so as to form a treatment space using negative pressure, and at least one suction head (12) that can be connected to a negative pressure generation means (15). The aim of the invention is to improve the sealing contact of the lip of the orthosis with the patient's thorax by increasing the deformability of the orthosis. In order to achieve said aim, the lip (3) has a constant elasticity along the entire periphery thereof, and the bottom (2) is formed of hollow, rigid, transverse juxtaposed compartments (4a-4d) that are connected to each other by bridges (5a-5c) made of the same flexible material as the peripheral lip (3) of the orthosis. Said bridges (5a-5c) of material allow the bottom to deform in such a way that the shape of the orthosis adapts to the anatomy of the thorax when the orthosis is applied vertically to the thorax.

Description

Orthèse pour un traitement par dépression des déformations du thorax L'invention est relative au traitement non chirurgical des dépressions en entonnoir du thorax, dénommées « pectus excavatum », congénitales ou non.  The invention relates to the non-surgical treatment of funnel depressions of the thorax, called "pectus excavatum", congenital or non-congenital.
Elle concerne plus particulièrement une orthèse de traitement, couramment dénommée « cloche », qui est appliquée sur le thorax en s'étendant selon une direction verticale allant de la tête vers les pieds. Moyennant une dépression agissant sur le sternum, les cartilages et arcs costaux, l'orthèse attire la paroi thoracique, afin que, en fin de traitement, la profondeur de l'entonnoir thoracique soit réduite.  It relates more particularly to a treatment orthosis, commonly called "bell", which is applied to the thorax extending in a vertical direction from the head to the feet. By means of a depression acting on the sternum, the cartilages and costal arches, the orthosis attracts the chest wall, so that, at the end of treatment, the depth of the thoracic funnel is reduced.
Ce traitement non invasif est réalisé au moyen de diverses orthèses dont la plus courante est celle dite d' « Eckart KLOBE », décrite dans le document EP 1 469 804, et dénommée « Cloche d'aspiration pour le traitement non invasif du thorax en entonnoir.  This non-invasive treatment is carried out by means of various orthoses, the most common of which is that called "Eckart KLOBE", described in document EP 1 469 804, and called "Suction bell for the non-invasive treatment of the thorax as a funnel. .
Cette prothèse, en forme de boite ouverte tournée ver le thorax, est composée d'un fond en matière plastique transparente, apte à être amené parallèlement au plan vertical du thorax, et d'une jupe périphérique formant lèvre d'étanchéité en venant en contact avec le thorax. La jupe est définie entre des faces, respectivement, intérieure et extérieure, qui vont en s'évasant depuis le fond.  This prosthesis, in the form of an open box turned to the thorax, is composed of a transparent plastic bottom, able to be brought parallel to the vertical plane of the thorax, and a peripheral skirt forming a sealing lip while coming into contact. with the thorax. The skirt is defined between faces, respectively, inner and outer, which go flaring from the bottom.
Pour qu'une taille d'orthèse puisse bien épouser toute les formes de thorax en entonnoir se rencontrant, l'orthèse KLOBE donne à sa lèvre périphérique une possibilité de déformation variable, plus grande en haut et sur les cotés. Cela est obtenu en donnant à la lèvre une section transversale trapézoïdale dont l'épaisseur, définie entre les faces, respectivement, intérieure et extérieure, varie en fonction de la déformabilité recherchée pour assurer l'étanchéité quelle que soit la configuration du thorax. La variation de déformabilité est aussi obtenue en modifiant l'inclinaison des faces de la lèvre  In order for an orthosis size to match all the shapes of funnel-shaped thoracic joints, the KLOBE orthosis gives its peripheral lip a variable deformation possibility, greater at the top and on the sides. This is achieved by giving the lip a trapezoidal cross section whose thickness, defined between the faces, respectively, inner and outer, varies depending on the deformability sought to ensure tightness regardless of the configuration of the chest. The variation of deformability is also obtained by modifying the inclination of the faces of the lip
Il s'avère à l'usage que les possibilités de déformation élastique de la lèvre varient durant sa fabrication et dans le temps, de sorte qu'elle peut être trop dure, et blesser le patient, ou trop souple et ne pas assurer une étanchéité suffisante pour que la dépression créée exerce l'action antagoniste de redressement des muscles.  It turns out that the possibilities of elastic deformation of the lip vary during its manufacture and over time, so that it can be too hard, and injure the patient, or too soft and not waterproof. sufficient for the created depression to exert the antagonistic action of muscle straightening.
L'invention à pour but de remédier à cela en contrôlant différemment la déformabilité d'ajustement de la prothèse sur le patient. La prothèse selon l'invention, présente, de façon connue, une forme générale de boite ouverte et est composée d'un fond, parallèle au thorax, d'une lèvre périphérique en matière souple, élastiquement déformable, s'étendant autour du fond et apte à venir en contact étanche avec le thorax, pour former un espace de traitement par dépression, et d'au moins un embout d'aspiration, le dit espace de traitement étant raccordable, par un tuyau souple avec vanne de mise à l'atmosphère, à un moyen générant une dépression. The invention aims to remedy this by controlling differently the deformability of adjustment of the prosthesis on the patient. The prosthesis according to the invention, has, in a known manner, a general shape of open box and is composed of a bottom, parallel to the thorax, of a peripheral lip of flexible material, elastically deformable, extending around the bottom and adapted to come into sealed contact with the thorax, to form a vacuum treatment space, and at least one suction nozzle, said treatment space being connectable, by a flexible hose with venting valve , to a means generating a depression.
Selon l'invention, la paroi de fond est formée par des caissons transversaux juxtaposés, creux et rigides, reliés les uns aux autres par des ponts de la même matière souple que celle constituant la lèvre périphérique de l'orthèse, ces ponts de matière donnant à la paroi de fond une possibilité de déformation permettant de conformer l'orthèse à l'anatomie du thorax quand elle est appliquée verticalement contre celui-ci.  According to the invention, the bottom wall is formed by juxtaposed transverse boxes, hollow and rigid, connected to each other by bridges of the same flexible material as that constituting the peripheral lip of the orthosis, these material bridges giving at the bottom wall a possibility of deformation to conform the orthosis to the anatomy of the chest when it is applied vertically against it.
Ainsi, l'étanchéité de l'orthèse contre le thorax ne dépend pas de la variation de déformabilité de sa lèvre périphérique mais de la déformabilité longitudinale du fond portant cette lèvre.  Thus, the sealing of the orthosis against the thorax does not depend on the variation in deformability of its peripheral lip but on the longitudinal deformability of the bottom bearing this lip.
Le système de caissons articulés permet également au patient de pouvoir se mobiliser et notamment s'assoir.  The system of articulated boxes also allows the patient to be able to mobilize and in particular to sit down.
Dans une forme d'exécution de l'invention, les ponts de matière souple entre les caissons transversaux ont une épaisseur qui va en croissant depuis celle du pont de matière venant en applique contre le haut du thorax.  In one embodiment of the invention, the bridges of flexible material between the transverse boxes have a thickness which is increasing since that of the material bridge applying against the upper chest.
Cette réalisation donne à l'orthèse une plus grande raideur dans sa partie inférieure alors que sa partie supérieure reste plus déformable.  This embodiment gives the orthosis a greater stiffness in its lower part while its upper part remains more deformable.
Avantageusement, chacun des ponts de matière souple entre les caissons transversaux présente au moins un conduit longitudinal ou canal mettant en relation les espaces de traitement formés sous les caissons juxtaposés.  Advantageously, each of the bridges of flexible material between the transverse boxes has at least one longitudinal duct or channel connecting the processing spaces formed under the juxtaposed boxes.
Avec cette disposition, tous les espaces de traitement sont équilibrés à la même pression et procurent un traitement homogène.  With this arrangement, all treatment spaces are balanced at the same pressure and provide a homogeneous treatment.
D'autres caractéristiques et avantages ressortiront de la description qui suit, en référence au dessin schématique annexé, représentant plusieurs formes d'exécution de cette orthèse.  Other features and advantages will emerge from the description which follows, with reference to the attached schematic drawing, showing several embodiments of this orthosis.
Figures 1 est 2 sont des vues en perspective, respectivement par-dessus et par-dessous, d'une orthèse moyenne à quatre compartiments ;  Figures 1 and 2 are perspective views, respectively above and below, of a medium orthosis with four compartments;
Figures 3 et 4 sont de vues de coté en coupe à échelle agrandie, suivant respectivement lll-lll et IV-IV de figure 1 ; Figure 5 est une vue en plan par-dessus d'une orthèse moyenne adaptée à la conformation féminine ; Figures 3 and 4 are side views in section on an enlarged scale, respectively III-III and IV-IV of Figure 1; Figure 5 is a plan view over a middle orthosis adapted to the female conformation;
Figure 6 et 7 sont des vues en plan par-dessus d'orthèses pour, respectivement, grande taille et petite taille ;  Figure 6 and 7 are plan views over orthotics for, respectively, large size and small size;
Figure 8 est une vue en perspective par dessous de l'orthèse pour petite taille ;  Figure 8 is a perspective view from below of the orthosis for small size;
Figure 9 est une vue en perspective par dessous d'une forme d'exécution d'une orthèse à quatre compartiments dans laquelle la communication entre caissons est assurée par des canaux ;  Figure 9 is a perspective view from below of an embodiment of a four-compartment orthosis in which the communication between boxes is provided by channels;
Figure 10 est une vue en coupe longitudinale de l'orthèse de figure 9 ; et Figure 10 is a longitudinal sectional view of the orthosis of Figure 9; and
Figure 1 1 est une vue en coupe transversale selon XI-XI de figure 9. Figure 1 1 is a cross-sectional view along XI-XI of Figure 9.
Dans la forme d'exécution représentée aux figures 1 à 4 l'orthèse, en forme de boite ouverte vers le bas, est composée d'une paroi de fond 2 et d'une lèvre périphérique 3, réalisée en matière plastique souple, telle qu'en « silicones » ou matériau équivalent.  In the embodiment shown in FIGS. 1 to 4, the orthosis, in the form of a box that is open downwards, is composed of a bottom wall 2 and a peripheral lip 3, made of flexible plastic material, such that in "silicones" or equivalent material.
Les figures 3 et 4 montrent bien que la lèvre 3 présente une section, sensiblement trapézoïdale de forme, profil et dimensions constantes sur toute la périphérie de l'orthèse.  Figures 3 and 4 show that the lip 3 has a substantially trapezoidal cross section of shape, profile and constant dimensions over the entire periphery of the orthosis.
Dans cette réalisation, la lèvre 3 est surmoulée sur les bordures périphériques 10 de caissons transversaux 4a à 4d, creux car présentant une section transversale en U retourné. Ces caissons juxtaposés 4 sont réalisés en matière plastique rigide et sont reliés le une aux autres par des ponts de matière souple, référencés 5a, 5b et 5c aux figures 1 à 3.  In this embodiment, the lip 3 is overmolded on the peripheral edges 10 of transverse boxes 4a to 4d, hollow because having a U-shaped cross section returned. These boxes juxtaposed 4 are made of rigid plastic material and are connected to each other by bridges of flexible material, referenced 5a, 5b and 5c in Figures 1 to 3.
La figure 3 montre que l'épaisseur E1 , E2 et E3 des ponts de matière 5a, 5b et 5c va en croissant en allant du haut vers le bas. Cela réduit l'élasticité de ces ponts pour obtenir une variation croissante de la raideur permettant une meilleure conformation et application sur le thorax lors de la pose.  Figure 3 shows that the thickness E1, E2 and E3 of the material bridges 5a, 5b and 5c is increasing from top to bottom. This reduces the elasticity of these bridges to obtain an increasing variation of the stiffness allowing a better conformation and application on the thorax during the installation.
Dans cette forme d'exécution, chaque pont de matière est traversé par au moins un conduit longitudinal 7, en l'occurrence trois à la figure 4, faisant communiquer les chambres de traitement C1 à C4 définies sous les caissons 4.  In this embodiment, each material bridge is traversed by at least one longitudinal duct 7, in this case three in FIG. 4, communicating the treatment chambers C1 to C4 defined under the caissons 4.
Chaque caisson 4 comprend, au moins localement, une fenêtre 8 obturée par un vitrage 9 en matière plastique transparente, tel qu'en polycarbonate. Ce vitrage permet de régler visuellement l'élévation du sternum, induite par la dépression. Enfin, et comme montré en détail aux figures 1 et 4, l'un des caissons, par exemple celui central 4d, comporte latéralement un raccord tubulaire coudé 12, apte à recevoir l'une des extrémités d'un tuyau souple 13. La disposition parallèlement au thorax de la prise d'air, évite l'aspiration de la peau dans l'orifice, le colmatage et l'ulcération par contact avec cet orifice d'aspiration. Each box 4 comprises, at least locally, a window 8 closed by a glazing 9 of transparent plastic material, such as polycarbonate. This glazing makes it possible to adjust visually the elevation of the sternum, induced by the depression. Finally, and as shown in detail in Figures 1 and 4, one of the boxes, for example the central one 4d, laterally comprises a bent tubular connection 12, adapted to receive one end of a flexible pipe 13. The provision parallel to the thorax of the air intake, avoids the aspiration of the skin into the orifice, clogging and ulceration by contact with this suction port.
L'autre extrémité du tuyau 13 est raccordable à l'embout 14 d'un moyen d'aspiration, tel qu'une poire 15. De façon connue, cet équipement d'aspiration est muni d'une vanne de purge 1 6 permettant, en fin de traitement, de mettre à l'atmosphère le circuit de mise en dépression.  The other end of the pipe 13 is connectable to the tip 14 of a suction means, such as a pear 15. In known manner, this suction equipment is provided with a purge valve 1 6 for at the end of the treatment, to put in the atmosphere the circuit of putting in depression.
En pratique, l'orthèse est posée sur l'entonnoir formé dans le thorax du patient en prenant soin de placer en haut le compartiment C1 le plus souple, afin que l'orthèse possède une raideur allant en croissant du haut vers le bas.  In practice, the orthosis is placed on the funnel formed in the patient's thorax, taking care to place the most flexible compartment C1 at the top, so that the orthosis has a stiffness that increases from top to bottom.
Dès que le patient appui sur la poire 15, la dépression engendrée dans les compartiments C1 à C4, entre l'orthèse et le thorax, rapproche du thorax la paroi de fond 2, grâce à l'élasticité de la lèvre 3 et de l'étanchéité de son contact avec la peau. Les variations de difformité du thorax sont compensées par la déformation de la paroi 2 de la prothèse par rapport à ses ponts de matière 5a à 5c.  As soon as the patient bears on the bulb 15, the depression generated in the compartments C1 to C4, between the orthosis and the thorax, brings the bottom wall 2 closer to the thorax, thanks to the elasticity of the lip 3 and the tightness of its contact with the skin. The variations in thorax deformity are compensated by the deformation of the wall 2 of the prosthesis with respect to its material bridges 5a to 5c.
La bonne étanchéité obtenue permet, avec une dépression de départ de l'ordre de 0,1 à 0,3 atmosphère, de maintenir le traitement pendant plusieurs heures, sans fatigue ou douleur pour le patient.  The good seal obtained allows, with a starting depression of the order of 0.1 to 0.3 atmosphere, to maintain the treatment for several hours, without fatigue or pain for the patient.
Le traitement est interrompu en ouvrant la vanne 1 6 et, après retour des compartiments C1 à C4 à la pression atmosphérique, en retirant l'orthèse.  The treatment is interrupted by opening the valve 1 6 and after returning compartments C1 to C4 at atmospheric pressure, removing the orthosis.
L'efficacité du traitement obtenu par un port continu de la cloche permet une réduction du traitement de moitié.  The effectiveness of the treatment obtained by continuous wearing of the bell allows a reduction in treatment by half.
On notera que pour former les compartiments extrêmes, les caissons extrêmes 4a et 4d présentent des formes en segment de cercle pour donner à l'orthèse des extrémités arrondies réduisant son encombrement et facilitant son installation sur le thorax.  Note that to form the extreme compartments, the end boxes 4a and 4d have shapes in a circular segment to give the orthosis rounded ends reducing its size and facilitating installation on the thorax.
De même, à la figure 5 montrant une forme d'exécution d'une orthèse pour femme, et devant donc se glisser entre les seins, les caissons 4b et 4c présentent des bords latéraux concaves épousant la forme générale de la partie centrale de 'orthèse, sans que cela ne modifie la structure générale de l'orthèse, sa conception et ses zones élastiques ou avec raideur contrôlée. Jusqu'alors la description a porté sur une orthèse à quatre caissons et trois ponts de matière, pour patient de taille moyenne, mais il est évident que les dispositions selon l'invention s'appliquent aussi aux orthèses avec cinq caissons et quatre ponts de matière, comme montré figure 6, pour patient de grande taille, et aux orthèses à trois caissons et deux ponts de matière, comme montré figure 7 et 8 pour patient de petite taille. Similarly, in Figure 5 showing an embodiment of a female orthosis, and having to slip between the breasts, the boxes 4b and 4c have concave lateral edges conforming to the general shape of the central part of the orthosis , without this modifying the general structure of the orthosis, its design and its elastic zones or with controlled stiffness. Until now, the description has been based on a four-box orthosis and three material bridges, for a medium-sized patient, but it is obvious that the arrangements according to the invention also apply to orthoses with five boxes and four material bridges. , as shown in Figure 6, for large patient, and orthoses with three boxes and two bridges of material, as shown in Figure 7 and 8 for small patient.
La forme d'exécution des figures 9 à 1 1 se différencie des précédentes réalisations par :  The embodiment of FIGS. 9 to 11 differs from the previous embodiments by:
• le remplacement des conduits 7, dans les ponts de matière 5a à 5n entre caissons 4a à 4n, par des canaux longitudinaux 20 formés lors de la réalisation de l'orthèse par surmoulage des caissons, 4a à 4n ;  Replacing the ducts 7, in the material bridges 5a to 5n between boxes 4a to 4n, by longitudinal channels 20 formed during the production of the orthosis by overmoulding the boxes, 4a to 4n;
• la modification de la raideur des ponts de matière par augmentation de l'épaisseur de la matière des ponts et/ou par l'adjonction, dans chaque pont, d'une plaquette 22a, 22b, 22c, chaque plaquette ayant une plus grande rigidité que la plaquette du pont de matière qui la précède, soit par variation de son épaisseur soit sa forme de section (plate, en U ou en O). Modifying the stiffness of the material bridges by increasing the thickness of the material of the bridges and / or by adding, in each bridge, a wafer 22a, 22b, 22c, each wafer having a greater rigidity that the plate of the bridge of material which precedes it, either by variation of its thickness or its sectional shape (flat, in U or in O).
En résumé, par rapport aux prothèses en cloche existantes, la prothèse selon l'invention apporte les avantages suivants : In summary, compared to existing prostheses bell, the prosthesis according to the invention provides the following advantages:
• le remplacement d'une paroi rigide par une paroi composée d'éléments rigides et d'éléments souples, formant des articulations, confère à l'ensemble une possibilité de déformation longitudinale selon l'axe vertical, permettant sa conformation automatique à l'anatomie du thorax, en supprimant les défauts de contact entre lèvre et thorax générateurs de fuites d'aspiration ;  • the replacement of a rigid wall by a wall composed of rigid elements and flexible elements, forming joints, gives the assembly a possibility of longitudinal deformation along the vertical axis, allowing its automatic conformation to the anatomy thorax, by eliminating contact defects between lip and thorax generators of suction leaks;
· un faible encombrement en hauteur et une légèreté permettant le traitement diurne et ambulant ;  · A small footprint and light weight for daytime and walking treatment;
• l'utilisation d'une dépression réduite dans l'orthèse, réduisant la gène du patient et permettant de porter cette orthèse plus longtemps chaque jour, de réaliser un traitement plus doux, moins douloureux et plus confortable pour le patient. De fait, une meilleure observance du traitement par les enfants.  • the use of reduced depression in the orthosis, reducing the patient's gene and allowing this orthosis to be worn longer each day, to achieve a milder, less painful and more comfortable treatment for the patient. In fact, a better observance of the treatment by the children.
• les ponts de matière ou traverses siliconées constituent des barres d'appuis moles pour le thorax aspiré. Ce point est aussi un élément de confort important, puisqu'il évite un appui par un matériau abrasif ou agressif ; l'organisation latérale de la prise d'air évitant l'ulcération de la peau par contact avec l'orifice d'aspiration. • material bridges or silicone sleepers constitute molar support bars for the aspirated thorax. This point is also an element of important comfort, since it avoids a support by an abrasive or aggressive material; the lateral organization of the air intake avoiding the ulceration of the skin by contact with the suction port.

Claims

REVENDICATIONS
1 . ) Orthèse pour un traitement par dépression des déformations du thorax, la dite orthèse destinée à être plaquée contre le thorax suivant une direction allant de la tête vers les pieds, ayant la forme générale d'une boite ouverte venant en applique contre le thorax et présentant une paroi de fond (2), une lèvre périphérique (3) en matière souple et élastiquement déformable, s'étendant autour de la paroi de fond (2) et apte à venir en contact étanche contre le thorax, pour former un espace de traitement par dépression, le dit espace communiquant, par au moins un embout (12) de raccordement à un tuyau souple, à un moyen (15) générant une dépression, caractérisée en ce que son fond (2) est formé par des caissons transversaux juxtaposés (4a à 4d), creux et rigides, reliés les uns aux autres par des ponts (5a à 5c) de la même matière souple que celle constituant la lèvre périphérique (3) de l'orthèse, ces ponts de matière (5a à 5c) donnant à la paroi de fond une possibilité de déformation permettant de conformer l'orthèse à l'anatomie du thorax quand elle est appliquée verticalement contre celui-ci.  1. ) Orthosis for a depression treatment of deformities of the thorax, said orthosis intended to be pressed against the thorax in a direction from the head to the feet, having the general shape of an open box applying against the thorax and having a bottom wall (2), a peripheral lip (3) of flexible and elastically deformable material, extending around the bottom wall (2) and able to come into sealing contact against the thorax, to form a treatment space by depression, said space communicating, by at least one nozzle (12) for connection to a hose, means (15) generating a depression, characterized in that its bottom (2) is formed by juxtaposed transverse boxes ( 4a to 4d), hollow and rigid, connected to each other by bridges (5a to 5c) of the same flexible material as that constituting the peripheral lip (3) of the orthosis, these bridges of material (5a to 5c) giving to the paro There is a possibility of deformation allowing the orthesis to be conformed to the anatomy of the thorax when it is applied vertically against it.
2. ) Orthèse pour un traitement par dépression des déformations du thorax selon la revendication 1 caractérisée en ce que les ponts de matière souple (5a à 5c) entre les caissons transversaux (4a à 4d) ont une épaisseur (E1 à E3) qui va en croissant depuis celle du pont de matière venant en applique contre le haut du thorax.  2.) Orthosis for treatment by depression of the deformations of the thorax according to claim 1 characterized in that the bridges of flexible material (5a to 5c) between the transverse boxes (4a to 4d) have a thickness (E1 to E3) which will in crescent since that of the bridge of material coming against the upper part of the thorax.
3. ) Orthèse pour un traitement par dépression des déformations du thorax selon la revendication 1 caractérisée en ce que les ponts de matière souple (5a à 5c) entre les caissons transversaux (4a à 4d) ont une raideur qui va en croissant depuis celle du pont de matière venant en applique contre le haut du thorax, par adjonction, dans chaque pont, d'une plaquette (22a, 22b, 22c), chaque plaquette ayant une plus grande rigidité que la plaquette du pont de matière qui la précède, soit par variation de son épaisseur, soit par la forme de sa section.  3.) orthosis for treatment by depression of the deformations of the thorax according to claim 1 characterized in that the bridges of flexible material (5a to 5c) between the transverse boxes (4a to 4d) have a stiffness which is increasing since that of a bridge of material coming into application against the top of the thorax, by adding, in each bridge, a plate (22a, 22b, 22c), each plate having a greater rigidity than the plate of the bridge of material which precedes it, either by variation of its thickness, either by the shape of its section.
4. ) Orthèse pour un traitement par dépression des déformations du thorax selon les revendications 1 et 2 prises ensemble, caractérisée en ce que chacun des ponts de matière (5a à 5c) contient au moins un conduit longitudinal (7) ou canal (20) mettant en relation les espaces de traitement (C1 à C4) formés sous les caissons (4a à 4d). 4.) Orthosis for treatment by depression of the thoracic deformities according to claims 1 and 2 taken together, characterized in that each of the bridges of material (5a to 5c) contains at least one longitudinal duct (7) or channel (20) connecting the treatment spaces (C1 to C4) formed under the caissons (4a to 4d).
5. ) Orthèse pour un traitement par dépression des déformations du thorax selon la revendication 1 caractérisée en ce que les caissons transversaux (4a à 4d) ont une section transversale en forme de U retourné. 5.) Orthosis for a depression treatment of chest deformities according to claim 1 characterized in that the transverse boxes (4a to 4d) have a U-shaped cross section returned.
6. ) Orthèse pour un traitement par dépression des déformations du thorax selon la revendication 1 , caractérisée en ce que l'âme de chaque caisson 6.) Orthosis for a depression treatment of chest deformities according to claim 1, characterized in that the core of each box
(4a à 4d) en U retourné comprend, au moins localement, une fenêtre (8) obturée par un vitrage (9) en matière plastique transparente. U-shaped (4a-4d) comprises, at least locally, a window (8) closed by a glazing (9) of transparent plastics material.
7. ) Orthèse pour un traitement par dépression des déformations du thorax selon la revendication 1 caractérisée en ce que au moins l'un des caissons (4b) de l'orthèse est prolongé par un raccord latéral (12) apte à recevoir l'extrémité du tuyau d'aspiration (13) provenant d'un moyen d'aspiration (15).  7.) Orthosis for treatment by depression of the deformations of the thorax according to claim 1 characterized in that at least one of the boxes (4b) of the orthosis is extended by a lateral connection (12) adapted to receive the end the suction pipe (13) from a suction means (15).
EP16702938.8A 2015-02-10 2016-02-04 Orthosis for the treatment of thorax deformations using negative pressure Withdrawn EP3256091A1 (en)

Applications Claiming Priority (2)

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FR1551088A FR3032349B1 (en) 2015-02-10 2015-02-10 ORTHESIS FOR DEPRESSIONAL TREATMENT OF THORAX FUNNEL DEFORMATION
PCT/EP2016/052393 WO2016128292A1 (en) 2015-02-10 2016-02-04 Orthosis for the treatment of thorax deformations using negative pressure

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WO2016128292A1 (en) 2016-08-18
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US20180021208A1 (en) 2018-01-25

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