RU2294729C2 - Method and device for curing scoliotic disease of spinal column - Google Patents

Abstract

FIELD: medicine; manual therapy; orthopedics.

SUBSTANCE: asymmetry in disposition of bones of pelvis belt is removed in relation to plane of support. Traction of vertebrae, being adjacent to top one, of primary arc of deformation is removed in cranial and casual directions. De-rotation is performed simultaneously by acting on lateral appendices, being disposed onto convex side of primary arc of deformation. All vertebras of primary arc are subject to de-rotation except vertex ones. Then rotation components are removed in arc disposed above primary one and in arc disposed lower. Device for correction of spinal column has rest for vertebra and rest for sacrum. Rest for vertebra is made in form of rod with recesses for lateral appendices, removable insertion with hole for aristate appendix and pressed-out planks with deepening for aristate appendices in boundary vertebras disposed lower and higher than boundary vertebras. Device is placed onto support for patient. It has drive in form of pressed-in rotary lever.

EFFECT: elimination of multi-plane deformations of spinal column.

2 cl, 4 dwg

Description

The invention relates to medicine, namely to manual medicine, orthopedics, vertebrology.

According to domestic and foreign authors, scoliotic disease occupies up to 30% in the structure of childhood morbidity.

Modern concepts regard scoliotic disease as a disease which is based on metabolic disorders in the connective tissue system, in which a musculoskeletal system causes scoliotic spinal deformity, leading to deformities of the pelvis, limbs, chest, and head. Not only the formation of bone structures, their relative position suffers, the morphology and functional state of other systems, in particular the nervous system, chest organs, abdomen, are violated.

It is proved that changes in connective tissue lead to dysplastic syndrome of bone structures, ligamentous apparatus weakness, myelodysplasia, and dysraphic status. With dysplastic syndrome, spinal deformities are the dominant sign, which combines idiopathic and dysplastic forms of scoliosis, sometimes congenital.

It is universally recognized that there is a primary presence of anomalies in the development of the spine, iliac dysplasia, true shortening of the leg, morphological changes in the nervous system and the secondary nature of disorders of the muscular-ligamentous and dysfunctions of the articular apparatus.

Scoliosis deformation occurs after polio, with neuro-fibromatosis, syringomyelia, muscular dystrophy, Marfan’s disease, Ehlers-Danlos. Under scoliosis understand lateral curvature of the spine. But with these diseases, the leading place is not scoliosis, but damage to other organs, and scoliosis is not dominant in the clinic of the disease, it is detected as a symptom.

From the modern perspective of manual medicine, the main role in conservative treatment is given to the elimination of disorders of the musculo-ligamentous apparatus, believing that its strengthening automatically leads to the elimination of deformations caused by the displacement of bone elements of the spinal column, pelvic ring.

A known method of treating scoliotic disease, including physiotherapy, active correction, massage as a passive correction (physiotherapy and medical supervision under the editorship of V.A. Epifanov, M., Medicine, 1990, p.207-232).

A known method of treating scoliotic disease according to RU 2181277, publ. 04/20/2002, including classic massage, relaxing massage of all muscles in hypertonicity, tonic massage of paralyzed muscles, deep massage of the hip joints, buttocks, abdomen, kneading knees, ankles, feet.

Known methods for conservative treatment of scoliotic disease (scoliosis to simplify terminology) by creating compensatory curvatures and reducing the primary arch of deformation, special stay in sanatoriums, swim, corrective beds, removable functional corrective corsets, physical therapy, massage, physiotherapy, medical diet therapy carried out until the end of the growth period (traumatology and orthopedics under the editorship of H.A. Musalatov, M., Medicine, 1995, 496-498).

There is a method of treating scoliotic disease, including reflex massage with strengthening the trapezius and rhomboid muscles, corrective gymnastics with strengthening the lumbar ileum, back muscles, abdominal wall, stretching the musculo-ligamentous apparatus, manual therapy, which strengthens the muscle corset (RU 2166922, publ. 05/20/2001).

Known methods of treating scoliosis of the 1st degree (characterizing the current level of treatment technology) by observing an orthopedic regimen (horizontal position treatment, wearing an orthopedic corset), developing an optimal static-motor stereotype, using physical therapy and swimming to strengthen muscle corset (Andrianov V.L. Diseases and injuries of the spine in children and adolescents, M., Medicine, 1985, p.130-140; Handbook of children's physiotherapy exercises. Edited by Fonareev MI, M., Medicine, 1983, p. 32 1-327).

The disadvantage of these methods is the focus on the correction of the curvature arc without taking into account the presence of functional blockade in the sacroiliac and pubic joints, which is manifested by functional shortening of one of the legs. This leads to a skew of the pelvis, the result of which is first a violation of posture in the frontal plane, which, in the absence of adequate treatment, can then turn into a fixed curvature of the spine - scoliosis, scoliosis with torsion of the pelvis and shoulder girdle.

The closest in the set of essential features of the proposed invention are the methods of treatment in the initial stages of scoliosis, proposed by A. Stoddart (A. Stoddart, Osteopathic Technique Textbook, Hippocrates Stuttgart, 1983, p.197-216) and A.A. Statnikov and V.A. Statnikov (Statnikov A.A., Statnikov V.A. Manual therapy, massage and electroacupuncture for scoliosis, M., 1993). After identifying the pathology, the method proposed by A. Stoddart, first involves the elimination by manual exposure of the sacroiliac block and thereby pelvic distortion with subsequent elimination of disorders in the spine, and the method of A. A. Statnikov and V. A. Statnikov - manual exposure of the spine with wearing further orthopedic shoes, leveling the difference in the length of the legs.

The disadvantage of these methods is the low effectiveness of the treatment. This is due to the fact that the elimination of pelvic distortion by manual exposure to the sacroiliac joint or orthopedic shoes, eliminating the difference in leg length, does not affect the bone component of scoliotic deformity, and discontinuation of treatment when applying the method proposed by A.A. Statnikov and B. A.Statnikov, leads to a relapse of the disease, because bone deformity in the primary arch of scoliotic curvature is not eliminated. Fixing the skew of the pelvis and shortening one of the limbs with a thicker sole makes the process irreversible.

The disadvantages of the known methods are eliminated by the proposed invention of the method using the device.

The authors believe that the type of scoliosis is determined by the primary arch, and therefore it is advisable to distinguish scoliosis of thoracic, thoracolumbar and lumbar localization. Compensatory-formed scoliotic deformities of the cervical and thoracic spine regress after pelvic alignment and elimination of lumbar scoliosis.

For lumbar scoliosis localization is characteristic:

1. The primary curvature arch is located between the 12 thoracic and 5 lumbar vertebrae with the apex on the 2 lumbar vertebra;

2. secondary, i.e. compensatory, the arc captures the entire thoracic region, in which torsion is not very pronounced;

3. as a compensatory factor, there is a subluxation of 5 lumbar, 1 sacral vertebrae with a tailbone deviation and displacement of the pelvic organs;

4. on the concave side of the curvature, a sharp deepening of the triangle of the waist with protrusion of the iliac crest is determined;

5. Torsion of the vertebrae is detected when the body is tilted forward in the form of a muscular roller;

6. on the convex side of the arc, in addition to rotation, the transverse processes of the vertebrae are located higher than on the concave side;

7. chest deformity is poorly expressed, there is no rib hump.

For thoracic localization of scoliosis is characteristic:

1. the location of the primary arch between 3 and 12 thoracic vertebrae with an apex on 8-9 vertebrae;

2. the formation of secondary arcs, one above the primary, the second below, which is not very pronounced, in connection with which the body leans toward the bulge;

3. a sharp torsion deformation, due to which the plane of the inclined chest leaves the plane of the pelvis, on the concave side of the chest is flattened;

4. the scapula on the convex side of the curvature extends backward, on the concave side - forward.

For lumbar scoliosis localization is characteristic:

1. the curvature arc captures from 6 thoracic to 2 lumbar vertebrae with an apex at 12 thoracic;

2. the distance of the iliac crest on the side of concavity;

3. deepening of the triangle of the waist on the concave side of the curvature;

4. torsion is most pronounced in the lower thoracic region, spreading from the thoracic to the lumbar;

5. two secondary arcs are often found: in the overlying secondary arc (with respect to the primary) there is a rib hump;

6. The body is tilted to the convex side of the primary arc.

Patients with scoliotic deformity are characterized by:

1. the inclination of the head towards the bulge of the chest curvature, the pelvis is shifted in the opposite direction;

2. different installation of the trunk: for example, in patients with combined scoliosis, the trunk is inclined towards the concavity of the chest curvature;

3. with chest scoliosis, the upper shoulder girdle is inclined towards the concavity of the curvature;

4. the pelvis is raised and shifted posteriorly on the side of the convexity of the chest curvature, the shoulder girdle is retracted in the opposite direction, with chest lumbar scoliosis, the pelvis is tilted in the opposite direction;

5. in all patients with scoliosis, the body is tilted forward by 1-3 degrees, legs - by 2-5 degrees;

6. feature of the joint of the thoracic vertebrae with ribs: the second pair of ribs is articulated with 1 and 2 thoracic vertebrae in the fossa between the lower cream of the first and upper edge of the second vertebra. Such an articulation of the head of the rib with the articular platform formed by two vertebrae is available throughout up to 11 thoracic vertebrae. In addition, ten pairs of ribs articulate with fossa of the transverse processes. In the joint cavity there is a ligament of the head, dividing the joint into two parts, which performs a fixing function until the legs and arches merge with the vertebral body. The ligament undergoes morphological changes during the formation of scoliotic deformation, as well as other elements of the joint: on the concave side of the deformation arch, the capsule is wrinkled, pinched by the articular fossa, and the fibrous fibers of the intervertebral disc are impaired, which leads to functional blockade of the joint. On the convex side, the capsule is stretched, the head of the rib is excessively mobile; the ligament of the rib head is stretched, which also leads to joint dysfunction and instability;

7. osteoporosis of the lower lateral segment of the vertebral bodies forming the apex of the convex primary scoliotic arch;

8. A characteristic feature of spinal deformity in the sagittal plane is the flattening of thoracic kyphosis with the formation of a "heart hump" of the chest plate and lumbar lordosis;

9. With scoliosis, the position of the vertices of the physiological bends of the spine changes: the vertex of thoracic kyphosis becomes 5 or 7 vertebrae, and the top of lumbar lordosis 2 or 3. In healthy people, the norm of the vertex is 5 thoracic and 4 lumbar vertebrae, respectively.

Thus, the formation of lateral curvature in the primary arch leads to changes in the compensatory nature of the position of other parts of the spine, which leads to a change in the position of the central longitudinal axis of the body in the frontal plane, and in the sagittal plane to straighten physiological bends.

Considering the revealed osteoporosity of the lower lateral surface of the transverse processes, the vertebral body corps on the top of the convex side of the primary arch of deformation, the displacement of the vertices of the physiological bends of the spine, the problem of eliminating lateral deformation of the spine with body rotation has been solved by creating a method for eliminating scoliotic deformity of the spine and a device for correction of the spine.

The need to create a device that allows you to simultaneously affect 3 spinous processes and simultaneously two transverse, caused by the following:

1. met abnormalities in the development of the spinous process / s and non-fusion of the arches of the spine, absence or deformation of the apex of the spinous as a result of trauma, disease, surgical intervention;

2. the presence of osteoporosis of the vertebral bodies located on the apex of the convex side of the deformity in scoliotic disease, established during the analysis of more than 600 radiographs in patients with scoliotic disease;

3. the anatomical and topographic features of the joints of the vertebral bodies with ribs, when the impact on only one spinous process and on two transverse processes in the cranial direction does not provide mobilization of the vertebral body necessary for counter-rotation action;

4. an increase in the surface area of the impact on the spine, which reduces pain during manipulations and increases the area of local effects on bone structures weakened by osteoporosis.

5. simultaneous exposure in the cranial and caudal directions, which reduces the risk of congruency disturbance during manipulations on both sides relative to the border vertebrae, rigid fixation of the sacrum and pelvis is not required, since the traction-rotational forces acting simultaneously in the cranial and caudal directions balance each other .

The method is as follows.

The patient is laid down on the bench, the sacrector corrector with the figured surface for the crest of the sacrum is placed over the sacral region and pressed against the dorsal surface of the sacrum so that the sacrum can be displaced in the sagittal, frontal and horizontal planes with respect to the patient's body.

The lever of the device (Fig. 1) with the emphasis of the vertebrae is placed over the site of the primary arch of deformation, the emphasis of the vertebrae is set at the necessary angle of influence on the corresponding vertebra, so that the tip of the spinous process of the vertebra is located in the socket of the stop, if necessary, the notches are for the transverse processes on the transverse processes of the vertebrae and squeezing plates were pressed into the interspinous spaces of the overlying and underlying segments of the spine.

The shape of the plates is made in such a way that, when exposed to the plate, they move away from the stop, which at the same time focuses on the spinous process. The lateral plates, pressed between the spinous processes, spontaneously move apart under the influence of force, increasing the intervertebral spaces, abutting the spinous processes above and the lower vertebrae in the cranial and caudal direction, on which the effect is carried out, two intervertebral spaces increase immediately, and there are effects on 3 spinous processes . For the movable attachment of the plates, it is possible to rearrange them higher, lower, taking into account the anatomical features of the vertebrae, for correcting simultaneous pressure on all contact planes. As the interspinous spaces and intervertebral spaces increase (traction), vertebral derotadia of the primary deformity arch occurs simultaneously.

The derotational action with the support of the vertebra is carried out by acting on the transverse processes located on the convex side of the primary arch of deformation, and all vertebrae, except those located on the top of the primary arch of deformation, derotate, since the impact on the osteoporotic transverse processes and vertebral bodies leads to their damage (cleavage flakes, crumple, in children to epiphysiolysis). In this case, the degree of derotation is taken into account: for example, the greatest rotation is observed with thoracic localization, with thoracolumbar localization, rotation increases from top to bottom, i.e. from 6 thoracic to 2 lumbar vertebrae, with lumbar localization of the primary arch of deformation, rotation is less than with the thoracolumbar, and is mainly determined in the compensatory (upper) arch and captures the entire thoracic region.

Having eliminated the rotational component in the primary arch of deformation, they begin to rotate the vertebrae of the secondary arch of deformation, first located higher and then lower located relative to the primary arch of deformation.

It is possible to retain the vertebrae returned to their places only by eliminating the deforming gravitational forces using the proposed method, using a modified device, followed by symmetrical strengthening of the ligamentous-muscular apparatus due to physiotherapy exercises, massage, and in some cases wearing a functional corrective corset.

During mechanical action on the human body, biologically active substances such as histamine and acetylcholine are formed in the tissues exposed. These biologically active substances are involved in vasodilation, which helps to lower blood pressure.

The accumulation in the muscles during the mechanical action of active acetylcholine stimulates muscle activity, as it increases the rate of transmission of nerve excitation from one nerve cell to another and from them to the muscles, the neural-reflex mechanism by which mechanical stimuli are transmitted to the central nervous system during manipulation and regulate it functional state in the necessary direction - calming or exciting.

The impact on the spine causes irritation of the exteroreceptors of the skin, summing up with the irritation of the joint bags lying in the tendons, ligaments, fascia of proprioreceptors, as well as angioreceptors of the walls of blood vessels and interoreceptors of internal organs, is transmitted along sensitive pathways to the central nervous system and reaches the cerebral cortex, where these centripetal afferent impulses in the general reaction of the body, which manifests itself in the form of certain functional changes in various organs and systems of the body.

When carrying out the treatment by the proposed method using the device, the above mechanisms work simultaneously, and the manipulations can have a selective effect, as well as the whole organism.

In addition to the direct effect on the joints of the spine, an indirect indirect positive reaction of the body is carried out: on the skin and subcutaneous tissue; on the central and peripheral nervous system; on the circulatory and lymphatic system; on the muscular system and articular apparatus; for metabolism.

The pathogenetic feasibility of stretching the spine by traction simultaneously in two directions (cranial and caudal) using a device for correction of the spine is due to the fact that

- the height of the intervertebral discs increases,

- reduced intradiscal pressure,

- the height of the intervertebral foramen increases,

- decreases the tone of the vertebral muscles until complete bioelectric silence on EMG with a duration of 1.5-2 hours,

- intervertebral joints are unlocked,

- with the least expenditure of strength and energy both from the side of the doctor, and from the side of the patient, the rotational repositioning of the vertebrae with the elimination of torsion is achieved.

The closest analogue to the claimed device is the device according to the patent of the Russian Federation 2163108, used to implement the method of treatment of osteochondrosis in its clinical manifestations. The known device contains a support for the patient in the form of a platform, on the frame of which a vibroshock drive is installed with an impact element on the spine in the form of a nozzle mounted on the spinal lesion zone. However, this device does not allow to eliminate multi-plane deformations in the form of kyphosis, scoliotic deformation, retralisthesis, compression fractures with a decrease in the height of the vertebral body by 1/3 of its height, increased or decreased physiological lordosis, concomitant deformations of limited movements in the rib-vertebral joints with simultaneous traction in two directions, and the impact on the rotated vertebrae perpendicularly in the sagittal plane increases the degree of rotation.

The technical result of the claimed invention is to eliminate the above disadvantages.

The technical result is provided by a device containing a support for the patient, the frame, the drive and the impact elements due to the fact that the drive is made in the form of a rotary lever, the frame is made in the form of racks mounted on opposite sides of the patient support, connected by a bar with the possibility of its movement and fixing , the lever is located with the possibility of movement on the rod and has the possibility of fixed or spring-loaded fixation of the free end, the elements of the impact on the spine are made in the form of an emphasis of the vertebrae and emphasis resta, having the ability to install on the lever by means of fixation units with a hinged grip, rotating around the lever and moving along it, the emphasis of the vertebrae is made in the form of a rod having, on the one hand, the ability to install in the articulated grip and on the other hand two recesses for the transverse processes of the vertebra between the following, with the possibility of deepening, a movable insert with a hole for the spinous process of the vertebra and pivotally mounted on the sides of the rod with the possibility of controlling the protrusion includes of the transverse processes of the vertebra, squeezing plates with depressions for the spinous processes located lower and higher than the border vertebrae, the squeezing plates made each on one side with a stubborn bulge for articulating on the shaft, the sacrum corrector is made in the form of a bar having a curly on one side surface for the crest of the sacrum, and on the other hand, the possibility of installation in the articulated grip, holes for the telescopically inserted lever for repositioning the sacrum - coccyx in three planes.

The device for correction of the spine is illustrated by the following graphic images:

Figure 1 shows the device in General,

In Fig.2 - view A in Fig.1,

Figure 3 shows the emphasis of the vertebrae in General,

Figure 4 shows the corrector of the sacrum.

The device for correction of the spine contains a support for the patient, a frame, a drive and elements of influence on the spine.

The support for the patient can be made in the form of a banquet 1 having a hole for the face 2 and a loose filler with a surface that allows you to create an anatomically convenient shape corresponding to the bulges of the front of the patient.

The drive is made in the form of a rotary lever 3 with a free end. The frame is made in the form of racks 4 mounted on opposite sides of the banquet 1, connected by a rod 6 with the possibility of its movement and fixing along the racks 4, for example, by means of couplings 7 with locking screws 8. The pivot lever 3 is arranged to move along the rod 6 with, for example, couplings 9 with locking screws 10 and fixing screw 5. The free end of the lever 3 can be fixedly fixed using, for example, a bracket 11 or spring-loaded fixing using, for example, a spring 12 mounted freely on one side m the end of the lever using the sleeve 13, and the other side on the telescopic removable tube 14, placed at the end of the banquet 1. In the banquet 1 there are sockets 15 for installing racks 4 at different levels and a socket 16 for installing the tube 14.

Elements of the effects on the spine are made in the form of an emphasis of the vertebrae and the sacrum corrector, which can be mounted on the lever 3 by means of a fixing unit with a hinged grip 17, which can be rotated around the lever 3 and moved along it, fixed with locking screws 10.

The emphasis of the vertebrae is made in the form of a rod 18, which, on the one hand, can be installed in the articulated grip 17, and on the other hand, two recesses for the transverse processes of the vertebra 19 and located between the latter with the possibility of deepening a removable insert 20 with a hole for the spinous process of the vertebra 21 and articulated squeezing plates 22, 23 mounted on the sides of the rod 18 with the possibility of an adjustable protrusion above the hole 21 with recesses for the spinous processes below and above the border vertebrae, respectively 24 and 25.

The squeeze plates 22 and 23 are each made on one side with a persistent bulge, respectively, 26 and 27 for articulated mounting on the rod 18.

The corrector of the sacrum is made in the form of a rod 28 having on one side a curved surface for the crest of the sacrum 29, and on the other hand, the possibility of installation in the articulated grip 17.

Mutually perpendicular openings 30 are made on the rod 18 and the rod 28 for the possibility of installing a power lever 31 for correction in these holes. A nozzle 32 conveniently adjacent to the palm of the hand can also be used, which can be placed on the shaft 18 or the shaft 28 before being placed in the articulated grip 17 for manual pressure for acting in the absence of a lever.

The device is used as follows.

On the banquet 1, face down the patient.

The lever 3 with mounted on it by means of a hinge 17 of the emphasis of the vertebrae or the corrector of the sacrum is located above the site of deformation of the spine.

The emphasis of the vertebrae is set at the necessary angle of influence on the corresponding vertebra so that the hole 21, if necessary, was located at the apex of the spinous process of the vertebra, the recesses 19 were located on the transverse processes of the vertebra, and the squeezing plates 22 and 23 were pressed by the recesses 24 and 25 into the interspinous spaces above and below the segments of the spine.

The sacral corrector with a curved surface for the crest of the sacrum 29 of the rod 28 is installed over the sacral region and pressed against the dorsal surface of the sacrum, it is displaced in the sagittal, frontal and horizontal planes with respect to the patient’s body with more accurate correction by the telescopically inserted lever 30.

Claims (2)

1. A method for the treatment of scoliotic disease, including physical therapy, swimming, strengthening the muscle corset, characterized in that, using the device for correction of the spine according to claim 2, traction of the primary deformity arc adjacent to the vertex vertebra in the cranial and caudal directions, while achieving an increase between the interspinous spaces, carry out derotation by acting on the transverse processes located on the convex side of the primary arch of deformation, and all vertebrae of the primary arch are derotated The deformations, in addition to those located on the top of the primary arc, then eliminate the rotational components in the secondary deformation arc located above the primary, and finally, in the downstream secondary deformation arc. 2. A device for correcting the spine, containing a support for the patient, a frame, a drive, and elements for acting on the spine, characterized in that the drive is made in the form of a rotary lever, the frame is made in the form of mounted on opposite sides of the support for the patient, racks connected with a bar with the possibility its movement and fixation, the lever is arranged to move along the bar and has the possibility of a fixed or spring-loaded fixation of the free end, the elements of the impact on the spine are made in the form of a stop - a vertebra torus and an abutment - a sacrum corrector that can be mounted on a lever by means of fixation units with a hinged grip that pivots around the lever and moves along it; the vertebral support is made in the form of a rod having the ability to be mounted on the hinge on one side and two on the other recesses for the transverse processes of the vertebra located between the latter with the possibility of deepening a movable insert with a hole for the spinous process of the vertebra and pivotally mounted on the sides of the rod with the possibility of For the purpose of adjustable protrusion above the hole for the spinous process of the vertebra, squeezing plates with depressions for the spinous processes below and above the located border vertebrae, the squeezing plates made each on one side with a stubborn bulge for articulating on the shaft, the sacrum corrector is made in the form of a strap having on the one hand, the figured surface for the crest of the sacrum, and on the other hand, the possibility of installation in the articulated grip.

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