RU2149662C1 - Method and device for fixing patient to be subjected to rotation radiation therapy with horizontal therapeutic proton beam - Google Patents

Abstract

FIELD: medicine; medical engineering. SUBSTANCE: method involves tightly fastening patient back, feet, hands and forearms as well as head with head rest to corresponding units and members of an armchair. Body members are fixed by applying compression, stress and tension are applied to articulation tissues when moving neighboring body members in forced mode to involve as large number of articulations as it is possible. The armchair has a seat with lateral pelvis support. It is placed on massive horizontal bearing plate having pedestal, movable knee rests and lateral pelvis rests. Backs, unit for fastening arms and unit for stretching the vertebral column are mounted on rigid vertical rod attached to the posterior plate edge. All units are provided with fixing sides. EFFECT: controllable and rigid fixation of a patient in an armchair. 14 cl, 3 dwg

Description

 The invention is used in medical technology for fixing in a certain position of the human body or its parts during radiation therapy.

 When performing rotational radiation therapy of malignant tumors with a beam of ionizing radiation, irradiation is carried out only when the patient is lying down. To do this, a radiation source (for remote gamma therapy) or a waveguide (for irradiation with an electron beam) is rotated around a patient lying on a therapeutic table.

 In the therapeutic use of high-energy proton beams (100-250 MeV), this leads to serious technical difficulties. Due to the large mass and energy of the particles, the devices for rotating the waveguide (vacuum proton conduit) around the patient (the so-called GANTRY) here turn into huge complex structures weighing 50-80-130 tons, costing 3-5 million (Fig. 1, Ponticles, 1992, 10, p. 8). To place them, expensive protective rooms with dimensions of 10 x 10 x 15 m and more are required.

 A known method of precision therapeutic rotational scanning irradiation of large malignant tumors simultaneously with several narrow horizontal beams of heavy charged particles (for example, protons) of high energy, in which the irradiated object (for example, a patient fixed in a chair of a rotational stand) is rotated under the beam around a vertical axis, while simultaneously adjusting range of protons in the irradiated object so that at all horizontal levels of irradiation, the Bragg peak is continuously aligned with the given points s target (cancer) (SU 1662587, 15/7/91).

 This irradiation method allows you to implement the most complex methods of scanning and rotational irradiation with any beams of heavy charged particles without the need to use expensive and bulky GANTRY.

 However, the realization of the potential possibilities of this method of irradiation is possible only if the patient is rigidly fixed during irradiation in the sitting position.

 A device is known as “Therapeutic chair” for placement and reproducible fixation of the patient during radiation treatment in the “sitting” position, manufactured by the American company MED-TEC (Radiation Therapy Sourcebook, 1997-1998, MED-TEC, Inc, p. 25). The chair is the latest development of a well-known company that supplies radiation therapy units in many countries with its immobilizing devices and demonstrates the current level of technology for fixing the patient for radiation in the "sitting" position. The chair consists of a flat seat, a mesh back, a head restraint in the form of a semicircular bowl, armrests and belts fastening the pelvis and the patient's head to the details of the chair.

 The disadvantage of this design is the low rigidity of the fixation of the patient. Given that the human body has almost 20 degrees of freedom, such a device cannot ensure the accuracy and reproducibility of positioning of the patient or individual parts of his body, which is necessary for precision irradiation with a beam of heavy charged particles. The chair does not have fixing devices that would prevent the patient from changing the desired position during the exposure: to “sit” in the chair, taking the “coachman's pose”, bend, change the position of the shoulders, pushing forward or back one of the shoulder joints, raise or lower the chin etc.

 A device for a pneumoencephalographic chair (US 4153841), installed on x-ray equipment with the possibility of its movement, including rotation.

 The disadvantage of this design is the low accuracy of fixing the patient to the rigid elements of the chair, which is mainly provided by flexible safety belts. Given that the human body has almost 20 degrees of freedom, such a device cannot provide the accuracy of positioning of patients or individual parts of his body, which is necessary for precision irradiation with a beam of heavy charged particles.

 The chair does not move or rotate relative to the radiation source. The chair is moved only at the stage of preparation for diagnostic irradiation, after which the chair is stopped and, using a movable x-ray tube and a film cassette, tomography of a fixed patient fixed in a fixed chair is performed.

 The chair also cannot rotate the patient sitting in the chair around a vertical axis parallel to or coinciding with the length of his body, which excludes the rotation-scanning exposure of the patient by a stationary horizontal therapeutic beam of protons or other particles.

 The technical result of the invention is that the patient is fixed in such a way that high rigidity, accuracy and reproducibility of positioning of the patient and individual parts of his body in the chair are ensured, which are necessary for precise irradiation with a beam of heavy charged particles. The method determines the exact characteristics and order of the operations necessary to perform such a fixation. An armchair mounted on a rotational stand with a vertical axis of rotation ensures the rotation-scanning irradiation of a fixed patient by a stationary horizontal therapeutic beam of protons or other heavy particles.

 The essence of the proposed method lies in the fact that the fixation of individual parts of the body is carried out sequentially eliminating physiological gaps between the mating articular surfaces (ie, "physiological gaps" or "backlashes") in as many joints as possible using extremely rigid locking elements, by compression , tension and stretching of the tissues of the joints, which are performed by forcibly moving neighboring parts of the body that bear the articular surfaces included in each given joint. Following this, the areas of these joints are fixed and / or the position of the parts of the body is changed so as to turn the part of the body that includes several joints (for example, the spine) into a prestressed supporting structure, after which the parts of the body are fixed in this position.

 To fix the patient in the irradiation position, he is placed in a chair of a rotational stand, equipped with a foot, seat, back, headrest and armrests. The patient is placed in the chair so that the back surface of his back is in contact with the back of the chair, the back of the head rests on the head restraint, the hips lie on the surface of the seat, the legs are lowered down and the feet are on the foot.

 It is also possible to fix it by successively squeezing the patient’s feet to the heel stops and (using knee stops) pressing the knee joints in the region of the lower edge of the patella so that the force falls along the axis of each patient’s hip, squeeze the patient’s pelvis backward, tightly pressing the back surface of the pelvis to front surface of the lower back of the chair. In this case, the force is transmitted through the knee joint, the long axis of the thigh and the hip joint, which allows to reduce the width of the joint gap to zero, i.e. eliminate "physiological gaps" ("backlashes") in these joints.

 Then (with the lateral supports of the pelvis), the pelvis is evenly squeezed from the sides, excluding its lateral displacements, and, pressing down the areas of the wings of the pelvis (using the stops, each in a vertical section, in the shape of a triangle or trapezium, with the top turned down), press the buttocks of the patient to the seat of the chair .

 After that (shoulder rests), they lower as much as possible downward and take back the areas of the patient’s shoulder joints, eliminating the “physiological gaps” (“backlashes”) in the joints of the shoulder girdle and pressing them to one of the backs of the chair.

 Then, a metered traction of the spine is performed, after which they firmly grab the patient’s head (clamping it between the chin rest and the head restraint) and move it up with a metered effort.

 It is also possible to fix the shoulder girdle and spine by firmly grasping the patient’s head and moving it upward with a metered effort, after which the areas of the patient’s shoulder joints are maximally lowered downward, retracted posteriorly and fixed relative to the details of the chair.

 Finally, at the penultimate stage of fixation, forced lordosis is possible, i.e. quite vigorously (on the verge of pain) they bend the patient’s back anteriorly (using a movable back). Since the patient’s pelvis, shoulder girdle and head are already fixed at this point, the last operation maximally strains the tissues of the intervertebral joints and turns the patient’s spine into a tense, almost motionless structure resembling a bow with a stretched bowstring, where the rigid vertical arm of the chair takes on the role of the bowstring.

 Fixation of the patient results in the immobilization of the shoulder joints, for which they eliminate the remaining "physiological gaps" ("backlashes") between the conjugate articular surfaces. To do this, the forearm of each arm of the patient is placed on the armrest so that it lies on the surface of the armrest and the elbow rests on the elbow rest on the armrest. Then the patient grabs with the hand of the arm a vertical movable pin on the armrest, which the operator moves towards the elbow stop until the patient's elbow is pressed as close as possible to the elbow stop, and the hand (compressed into a fist around the pin) does not bend as far as possible to the external ( lateral) side so that the line connecting the vertical axis of the pin with the center of the elbow rest is lying outside (laterally) from the length of the forearm bones. In this case, the hand, wrist joint and forearm form something similar to a bayonet clamp, in which the compressed (from the outer, back side) and stretched (from the inner, palmar side) joint tissues play the role of a spring. This allows you to eliminate the "physiological gaps" ("backlash") between the conjugate articular surfaces of the joints of both the wrist and elbow and provides rigid fixation of the elbow and wrist of the patient, as well as his forearm. At the same time, in case of emergency, the patient can move the brush upward along the fixing pin and remove the arm from the armrest (for example, to tear off the chin rest and free the head during regurgitation).

 Further, the armrest of the chair is moved back and forth and up and down so that the front surface of the shoulder of the arm is located along the front axillary line, and the humerus supported the shoulder joint from below, eliminating the residual gap in it.

 All of the above operations are provided by the design of the chair.

 The chair for fixing the patient contains a seat, lateral supports of the pelvis, backs, armrests and a vertical bar, on which it is installed, with the possibility of moving along it, a mounting device equipped with brackets carrying a headrest and chin rest, with the possibility of their simultaneous movement, as well as fixation elements of individual parts of the patient’s body and stoppers.

 It is also equipped with a massive horizontal base plate, a rigid vertical bar, a spinal traction device, several independent backs, a shoulder fixation unit, knee stops and side pelvic stops.

 The seat is located on the upper surface of the base plate of the chair. A rod directed vertically upward is fixedly attached to the rear edge of the plate. The foot edges are attached to the front edge of the plate, with the possibility of changing the distance between it and the base plate, and the knee stops, with the possibility of their movement along a line parallel to the anteroposterior axis of symmetry of the seat.

 The lateral supports of the pelvis are attached to the sides of the plate with the possibility of changing the distance between the stops, as well as the armrests, which are rigidly connected to the side supports of the pelvis and move with them to the side of the patient and away from him. It is also possible to additionally move each armrest parallel to itself up and down and back and forth, parallel to the anteroposterior axis of symmetry of the seat. The traction device of the spine, back and shoulder fixation unit are mounted on a vertical bar with the possibility of their movement along the bar. All nodes of the chair and their components are equipped with stoppers that fix them in any of the possible positions.

 The vertical bar may have a rectangular cross-section, which eliminates the angular displacement of the nodes of the chair hung on the bar.

 The spinal traction device can be equipped with brackets carrying a head restraint and chin rest, with the possibility of changing the distance between the last two, as well as with the possibility of their simultaneous movement along a line parallel to the anteroposterior axis of symmetry of the seat. In this case, the chin rest is attached to the brackets at two points, in one of them with a loop, and in the other with a clamp with a variable grip force.

 One of the backs of the chair is made with the possibility of its movement in the direction of the patient sitting in the chair and away from him.

 The fixation unit of the patient’s shoulders consists of a back and shoulder rests made in the form of L-shaped curved triangular or trapezoidal plates. Each plate faces with a narrow end down, and a wide base to the upper part of the back of the node with the ability to change the distance between the shoulder rests and between each shoulder rest and the back of the site.

 The lateral supports of the pelvis can be made in the form of two interchangeable flat plates parallel to each other and the axis of symmetry of the seat. The plates can be moved towards each other above the surface of the seat. The plates may also have a wedge-shaped shape (or the shape of a flat pyramid facing downward), i.e. in vertical section, each may be a triangle pointing downward with apex or trapezoid.

 Each armrest is made in the form of a horizontal rectangular flat or concave platform, on which a stop for the patient's elbow and a vertical pin movable along the long axis of the platform are fixedly mounted. The armrest is mounted on the same carriage as the pelvic side bearing of the same name, and moves with the latter to and from the patient, with the additional possibility of moving the armrest parallel to itself up and down and back and forth, parallel to the anteroposterior axis of symmetry of the seat.

 Knee stops are made in the form of two half rings connected to each other by a jumper and facing their concave, rubberized surface to the knees of the patient. The possibility of changing the height of the half rings relative to the plane of the seat is provided.

 The foot of the chair can have V-shaped stops for the heels of the patient’s shoes and clamps made in the form of two flat half rings connected to each other by a jumper and facing their concave, rubberized surface to raise the patient’s feet. It is possible to change the distance between the clips and stops for heels.

 Plates of the side supports of the pelvis, shoulder rests, head restraint, chin rest, backs can be made of plexiglass or other hard tissue-equivalent material.

 In FIG. 1 shows a side view of a chair.

 In FIG. 2 shows a rear view of a chair.

 In FIG. Figure 3 shows the mount of the patient’s head and traction of the spine.

 The inventive chair has a foot 1 (Fig. 1), a seat, a backrest 2 (Fig. 1) and 2, 3, 4 (Fig. 2), a headrest 5 (Fig. 1, 3) and armrests 6 (Fig. 1, 2 ), equipped with a massive horizontal base plate 7 (Fig. 1, 2), a rigid vertical rod 8 (Fig. 1-3), a spinal traction device 9 (Fig. 1 and 2 and Fig. 3), a shoulder fixation unit 10 (Fig. . 1, 2), the movable lateral stops of the pelvis 11 (Fig. 1), the knee stops 12, and the backs of the chair 2 (Fig. 1) and 2-4 (Fig. 2) are made independent.

 The base plate 7 is rigidly mounted on the rotational stand 13 (Fig. 1). A seat is located on the upper surface of the base plate. To the rear edge of the plate is fixedly attached vertically upward directed rod 8 (Fig. 1-3). The foot 1 is attached to the front edge of the plate (Fig. 1), with the possibility of changing the distance between it and the base plate 7, and the knee stops 12, with the possibility of their movement along a line parallel to the anteroposterior axis of symmetry of the seat. The lateral stops of the pelvis 11 (Fig. 1) are attached to the sides of the plate with the possibility of changing the distance between the stops, as well as the armrests 6 (Fig. 1, 2). Each armrest moves together with the same (right or left) lateral support of the pelvis 11 (Fig. 1) towards the patient and away from him. There is also the possibility of moving each armrest parallel to itself up and down and back and forth, parallel to the anteroposterior axis of symmetry of the seat.

 On the vertical rod 8 (Figs. 1–3), there are installed: a spinal traction device 9 (Figs. 1 and 2 and Fig. 3), backs 2–4 (Fig. 2), and a shoulder fixation unit 10 (Figs. 1, 2) and it is possible to move them along the bar.

 All nodes of the chair or their components are equipped with stoppers that fix them in any of the possible positions.

 The individual nodes of the chair have the following design features.

 The vertical rod 8 (Fig. 1-3) has a rectangular section, which eliminates the angular displacement of the nodes hung on it.

 The spinal traction device 9 (Fig. 1, 3) is mounted on the rod 8 with the possibility of movement along a line parallel to the anteroposterior axis of symmetry of the seat, and is equipped (Fig. 1, 3) with brackets 14 that support the headrest 5 and chin rest 15, with the possibility of changing the distance between the last two. The chin stop 15 (Fig. 3) is rigidly mounted on a strap 16, which is attached to the brackets 14 at two points, in one of them with a loop 17, and in the other with a clamp 18 with a variable grip force.

 On the one hand, this design allows you to compensate for the anatomical structure of the neck of a particular patient (by moving the entire device back and forth along a line parallel to the anteroposterior axis of symmetry of the seat) and rigidly grab the patient’s head (by changing the distance between the headrest 5 and chin rest 15 (Fig. . 3)), and on the other hand, it ensures the safety of the head fastening. So, if, during irradiation, the patient faints and “hangs” on the chin rest 15 or wants to get out of the mount for some other reason, then the patient’s head will be released at the moment when the pressure on the chin rest exceeds the level of gripping force of the strap 16 originally assigned to the clamp 18. In this case, the strap 16, carrying the chin rest, slides out of the clamp 18 and hangs freely on the loop 17.

 The proposed device is equipped with several backs 2-4 (Fig. 2), which allows you to adjust the shape of the supporting surface in accordance with the anatomical features of the back of a particular patient. The backs are made of plexiglass, which provides rigidity of the supporting surface and sufficient "transparency" for a beam of charged particles.

 The backrest 3 is arranged to move it back and forth (using the screw mechanism 19 (Fig. 1)) towards the patient sitting in the chair. This ensures the creation of forced lordosis during the operation to fix the patient.

 The fixation unit of the shoulders 10 (Fig. 1, 2) consists of a back 2 and shoulder rests 20 (Fig. 1), made in the form of L-shaped curved triangular or trapezoidal plexiglass plates, facing narrow ends 21 down, and wide (horizontal ) base 22 (Fig. 1, 2) back, above the level of the upper edge of the backrest 2 of the assembly 10. It is possible to change the distance between the shoulder rests and between each shoulder rest 20 and the back 2 of the assembly 10, as well as the ability to move the entire assembly 10 up and down along the bar 8.

 During the patient’s laying, the height of the location of the fixation unit for the shoulders 10 on the rod 8 is adjusted so that the horizontal parts 22 of the shoulder rests 20 facing the back of the node 10, pressing on the patient’s shoulders, provide the maximum reduction of the area of the shoulder joints down. The distance between the shoulder stops is chosen so that the inner edges 23 (Fig. 1) of their vertical sections 20, 21 are located along the front axillary lines of the patient, and the distance between each shoulder stop 20 and the back 2 of the node 10 is adjusted so that the vertical parts of the shoulder the abutments took the patient’s shoulder joints posteriorly and pressed them tightly against the back of 2 nodes 10.

 The lateral supports of the pelvis 11 (Fig. 1, 2) are made of plexiglas in the form of two interchangeable plates parallel to each other and the axis of symmetry of the seat, with the possibility of moving them towards each other, during which the lower edge of each plate moves above the horizontal level of the seat surface, and the plates may be flat or have a thickened upper edge and in a vertical section each triangle or a trapezoid facing downward.

 When the plates approach each other, their internal (facing the patient) surfaces clamp the patient's pelvis, excluding its lateral displacements. If plates with a thickened upper edge are used, then when the lateral stops approach each other, the upper (thicker) edges of the plates hang over the wings of the pelvis, squeezing the pelvis down and pressing the buttocks of the patient to the seat.

 Each armrest 6 (Fig. 1, 2) is made in the form of a horizontal rectangular flat (or concave) platform 6 (Fig. 1), on which a concave semicircular or U-shaped stop 24 (Fig. 2) for the patient’s elbow is fixed and movable along the long axis of the pad is a vertical pin 25 (Fig. 1).

 The design of the armrest and the method of fixing the wrist and forearm ensure the safety of the patient, since if necessary, the patient will be able to free his hand at any time by moving the wrist up along the vertical pin 25.

 The knee stops 12 (Fig. 1) are made in the form of two half rings connected by a jumper and facing their concave, rubberized surface to the knees of the patient. It is possible to change the height of the semicircles relative to the plane of the seat and the possibility of moving them along a line parallel to the anteroposterior axis of symmetry of the seat.

 On the upper surface of the platform 26 of the foot 1 (Fig. 1), on which the patient places his feet, there are semicircular or U-shaped stops for the heels of the patient’s shoes, as well as clamps 27 made in the form of two flat half rings connected by a jumper, facing their concave, rubberized surface to the lifting of the feet of the patient, with the possibility of changing the distance between the clamps 27 and stops for heels, as well as with the possibility of changing the distance between the foot 1 and the base plate 7 of the chair.

Fixation of individual parts of the body is carried out:
- due to compression of the articular surfaces or tension of the soft tissues of the joint or several joints;
- due to the immobilization of the immediate area of the joint (for example, the area of the shoulder joint) using adjustable clamps;
- by sequentially eliminating physiological gaps ("backlashes") in as many articular joints as possible;
- by turning the main supporting structure of a part of the body (for example, the spine) into a prestressed structure.

 An overly rigid fixation can be dangerous for the patient, since during the session of irradiation with beams of heavy nuclear particles (including protons) the patient is alone in the treatment room. It is separated from the medical staff by a multi-ton security door. If even the staff (on the screens of television monitors) in time notices that something is wrong with the patient, it will only be possible to get to the patient and help him only after 2-3 minutes.

 Therefore, if a patient loses consciousness and “settles” in a chair during irradiation, then he can hang with the whole weight of his body on a rigidly fixed head and damage his cervical spine before the staff can help him.

 With a rigidly fixed head, a raised chin and an elongated neck, unpleasant consequences can also be caused by sudden vomiting (the patient may be choked with vomit).

 In these conditions, for the safety of the patient, the ability to quickly, preferably automatically, release his head and hands is of great importance.

 The inventive device of the chair provides automatic (with a sudden increase in the load on the chin rest) or volitional (at the request of the patient), the release of the head and hands of the patient. In this case, the patient will not be choked with vomit during sudden regurgitation, and a patient who has lost consciousness will not “fall out” of the chair and will not receive additional trauma, since his shoulders, knees and feet will remain fixed.

 Currently, the chair is mounted on the Medical Proton Beam of the DLNP JINR (Dubna) and has been successfully used for proton irradiation of esophageal cancer. It reliably ensured a rigid and safe fixation of the patient during precision rotational scanning proton irradiation of this large, deep-lying tumor in the patient’s “sitting” position.

Claims (14)

 1. A method of fixing a patient for conducting rotational radiation therapy with a horizontal therapeutic proton beam, which consists in placing the patient in a chair containing a seat, foot, back, armrests and head restraint so that the back surface of his back rests firmly on the back of the chair, hips lying on the surface of the seat, the feet with the entire sole stood on a support, the hands and forearms lay on the armrests, and the head rested on the head restraint, with the help of movable fixing elements of the chair, individual parts are fixed and the patient’s body to the corresponding parts and components of the chair, characterized in that the fixation of individual parts of the body is carried out rigidly by compression, tension and stretching of the tissues of the joints, by forcing the neighboring parts of the body bearing the articular surfaces of the joint in series, for as many articular joints as possible.  2. The method according to claim 1, characterized in that the patient’s feet are pressed sequentially to the heel stops and, pressing the area of the knee joints along the axis of each patient’s thigh, the pelvis is pressed posteriorly, pressing the back surface of the latter to the front surface of the lower part of the back of the chair, compress the pelvis from the sides, limiting its lateral displacements and squeezing down the areas of the wings of the pelvis, press the buttocks of the patient to the seat of the chair, after which they lower as much as possible downward and retract the areas of the patient’s shoulder joints, followed by dosing spinal traction, for which they firmly grab the patient’s head and move it upward with a predetermined force, and then perform forced lordosis, support the shoulder joints from below with the shoulder parts of the hands, and the position of all nodes and parts of the chair, with which all of the above actions are performed, are fixed operationally .  3. The method according to claims 1 and 2, characterized in that the patient first firmly grabs the patient’s head and moves it upward with a metered effort, and then the patient’s shoulder joints are maximally lowered down, retracted posteriorly and fixed relative to the details of the chair, and then forced lordosis.  4. The method according to PP. 1 - 3, characterized in that at the final stage of fixation, the forearm of each patient’s arm is placed on the armrest so that the forearm lies on the surface of the armrest, the elbow rests on the elbow rest on the armrest, after which the patient grips the movable vertical pin on the armrest, and the operator moves the pin towards the elbow stop until the patient’s elbow is pressed as close as possible to the elbow stop, and the hand, compressed into a fist around the pin, bends to the back so that the line connecting the vertical axis of the pin to the center of the elbow rest is lying lateral to the length of the forearm bones and fixes the pin in this position, after which the armrest of the chair is moved back and forth and up and down so that the front surface of the shoulder of the arm located on the level and along the front axillary line, and the humerus supported the shoulder joint from below, and the armrests are fixed in this position.  5. Chair for fixing the patient in the irradiated position, comprising a seat with lateral supports of the pelvis, backs, armrests and a vertical bar, on which is mounted, with the possibility of moving along it, a mounting device equipped with brackets carrying a head restraint and chin rest, with the possibility of their simultaneous movement, as well as fixing elements of individual parts of the patient’s body and stoppers, characterized in that the seat is placed on the upper surface of the massive horizontal base plate, which is additionally removed bzhena foot, with the ability to change the distance between it and the base plate, knee rests, made with the possibility of their movement along a line parallel to the front-rear axis of symmetry of the seat, a rigid vertical bar, directed upward and motionless, attached to the rear edge of the plate, and the foot and the knee stops are attached to the front edge of the plate, the side pelvic stops with the possibility of changing the distance between them are attached to its lateral sides, and the armrests are rigidly connected to the side stops of the pelvis and are filled with the possibility of additional movement of each armrest parallel to itself up-down and back-to-back, parallel to the front-back axis of symmetry of the seat, while on the vertical bar with the ability to move along it there are backs, a unit for fixing the shoulders, and the mounting device is made in spinal traction devices, and all the nodes of the chair are equipped with stoppers that fix them in any of the possible positions for them.  6. The chair according to claim 5, characterized in that the vertical bar has a rectangular section.  7. Chair according to claims 5 and 6, characterized in that the spinal traction device is equipped with brackets carrying a head restraint and chin rest, with the possibility of changing the distance between them, as well as with the possibility of their simultaneous movement along a line parallel to the front-back axis of symmetry of the seat moreover, the chin rest is attached to the brackets at two points, in one of them with a loop, and in the other with a clamp with a variable grip force.  8. The chair according to claims 5 to 7, characterized in that one of the backs is made with the possibility of its movement towards the patient sitting in the chair and away from him.  9. The chair according to claims 5 to 8, characterized in that the shoulder fixation unit consists of a back of the fixation unit and shoulder rests made in the form of L-shaped curved triangular or trapezoidal plates facing with narrow ends down and with a wide base to the top of the back site with the ability to change the distance between the shoulder rests, and between each shoulder rest and the back of the site.  10. The chair according to PP.5 to 9, characterized in that the lateral supports of the pelvis are made in the form of two interchangeable plates, flat or wedge-shaped, parallel to each other and the axis of symmetry of the seat, with the possibility of moving the plates towards each other above the surface of the seat.  11. Chair according to claims 5 to 10, characterized in that each armrest is made in the form of a horizontal rectangular flat or concave platform, on which a stop for the patient’s elbow is fixedly mounted and a vertical pin movably along the longitudinal axis of the platform, each armrest mounted on that the same carriage as the pelvic side bearing of the same name, with the possibility of joint movement towards and away from the patient, with the additional possibility of moving the armrest parallel to itself up and down and back and forth, parallel to bottom-rear axle seat symmetry.  12. The chair according to claims 5 to 11, characterized in that the knee stops are made in the form of two half rings connected to each other by a jumper, facing the patient's knees with their concave rubberized surface, with the possibility of changing the height of the half rings relative to the seat plane.  13. The chair according to claims 5 to 12, characterized in that the foot has V-shaped stops for the heels of the patient’s shoes and clamps made in the form of two half rings connected to each other by a bridge, facing their concave rubberized surface to raise the patient’s feet, with the possibility of changing the distance between the clamps and stops for heels.  14. The chair according to claims 5 to 13, characterized in that the plates of the side supports of the pelvis, shoulder rests, head restraint, chin rest, backs are made of plexiglass or other hard tissue-equivalent material.

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