RU2307626C1 - Functional bus for rehabilitation of patients with damaged radial nerve - Google Patents

Abstract

FIELD: medicine; traumatic surgery; orthopedics.

SUBSTANCE: bus has removable joint-immobilizer for forearm provided with belts, wrist clutch, support for removable joint-immobilizer and circular mechanism with removable springs, which mechanism connects removable joint-immobilizer for forearm with wrist clutch. Wrist clutch has palm wrist rest, four rubber threads, rest for putting first finger of right and left hands apart, cuffs for 2-5 fingers disposed at ends of rubber threads, metal plates with grooves for springs of circular mechanism, support arc and metal arc. Metal arc is fastened to support arc and it has base for attaching rubber threads and groove for letting rubber threads go. Full volume of motions in wrist joint as well as motions in small joints of wrist is provided. Load onto muscular unbending apparatus of wrist can be dosed while taking terms after trauma into account.

EFFECT: improved reliability; improved efficiency.

2 dwg, 1 ex

Description

The invention relates to medical equipment, namely to traumatology, orthopedics, and can be used in the treatment of patients with damage to the radial nerve.

The purpose of creating this tire is to develop a functional device for the early rehabilitation of patients with damage to the radial nerve, taking into account the condition of the extensor muscles of the hand and fingers at different times after the injury.

Known tire for the brush USSR author's certificate No. 148202, 1961, the tire is designed to fix the hand and forearm in case of traumatic injuries, however, this device does not allow to develop movements in the wrist and other joints of the hand in case of damage to the radial nerve.

Functional orthopedic apparatus for the upper limb, USSR author's certificate No. 1621918, 1991 - this invention improves the effectiveness of the treatment of flaccid and spastic paralysis of the upper limbs in children, but this apparatus does not allow dosing the load on the paralyzed group of extensor muscles of the hand and fingers at different times after an injury to the radial nerve.

Tire for a brush - USSR author's certificate No. 971315, 1981 - this tire is intended for immobilization and treatment of a burnt brush, however, the device does not allow to develop movements in the wrist and other joints of the brush.

Transport medical tire for the upper limb, USSR author's certificate No. 1588409, 1990 - this tire increases the stability of limb fixation in the mid-physiological position by providing spatial stiffness, but this tire is devoid of circular mechanisms for developing movement in the wrist and other joints of the hand.

Apparatus for the development of metacarpophalangeal joints, USSR author's certificate No. 862938, 1981 - the apparatus can be used in the conservative treatment of injuries of the metacarpophalangeal joints, contractures, however, this device cannot be used to develop movements in the wrist joint.

Tire for the treatment of contractures of the interphalangeal joints of the hand, USSR author's certificate No. 1673107, 1991 - this device is designed to develop movements in the interphalangeal joints, but it does not allow the development of movements in the metacarpophalangeal and wrist joints.

And gypsum immobilization is also known for stabilization of the wrist joint with traumatic injuries and damage to the radial nerve.

We accepted Bryce carpal prototype (orthosis) - European patent publication number EP 0574627, 12/22/1993. However, this device has several disadvantages:

1. does not allow to develop the full range of motion in the wrist joint;

2. does not allow the development of movements in the small joints of the hand;

3. does not allow to dose the load on the muscular extensor apparatus of the hand, taking into account the time after the injury;

The medical and technical result of this tire is to develop the full range of movements in the wrist joint and movements in the small joints of the hand, as well as dosing the load on the muscular extensor apparatus of the hand taking into account the time after the injury. To do this, the existing circular mechanism allows you to dose the load on the entire group of paralyzed muscles, and on individual muscles, excluding the load on others. Using the circular mechanism, you can set the extension angle of the hand from 20 to 75 ° without blocking movements in the wrist joint, as well as blocking movements at any given angle from 20 to 75 ° in order to correctly function a group of muscles innervated by the deep branch of the radial nerve.

The load on the paralyzed muscles of the extensors of the hand and fingers in different periods is determined by the degree of restoration of the function of the damaged neuromuscular apparatus and the ability of the hand and fingers to extend.

Thus, the use of this tire allows you to achieve certain goals: the possibility of its use for early rehabilitation of patients, taking into account the necessary load on the muscles, as well as to activate movements in the wrist, metacarpophalangeal and interphalangeal joints to prevent the development of arthrogenic contractures; the possibility of its use as a means to create optimal conditions for reinnervation of the extensor muscles of the hand and fingers.

The patient can put on a tire on his own, carry out the development of movements in the joints, dose the load on the paralyzed muscles after preliminary consultation with the orthopedist in order to set the necessary parameters. The device is compact, convenient, easy to remove.

Design Description:

The functional tire for the brush is made of polyethylene (low-pressure polymer), lined with foamed polyethylene in the area of contact with the skin.

The essence of the tire is illustrated by drawings, where:

figure 1 shows the tire (General view);

figure 2 shows the carpal grip (top view);

The functional bus has an original design,

consists of 4 nodes:

1. Tutor - fits on the palmar surface of the forearm.

2. Hand grip - fits on the palmar surface of the brush and consists of:

1. palmar carpal rest;

2. emphasis for abduction of the first finger;

3. reference arc;

4. metal arc;

5. metal plates;

6. rubber threads;

7. finger cuffs;

3. Circular spring mechanisms and springs - operate in one block and connect the splint with the hand grip.

4. The stand.

Application Technique:

The functional bus (figures 1 and 2) is used as follows:

1. the splint is placed on the palmar surface of the forearm (see photo); fixation is carried out using belts (7) on the dorsum of the forearm; fixation is performed without effort or mechanical obstruction for smooth sliding of the muscular extensor apparatus of the hand and fingers. The splint is connected to the stand with the help of metal plates in the style of a Russian lock for rigid fixation of two components.

2. carpal grip (figure 2) is laid on the palmar surface of the brush, on the palmar carpal rest 16; fixing is carried out using a belt 7 on the back surface of the brush. The advantage of this tire is the ability to wear wrist grip on both the right and left hand. To this end, there is emphasis for the abduction of the first finger of the right 14 and left 15 of the brush. A metal arc 10 is fixed to the supporting arc 12 of the wrist grip, to the base of which 4 rubber threads 11 are well fixed, which run along special grooves in the metal arc 10. At the ends of the rubber threads there are cuffs for fingers 9 made of leather or skin-like material, C 2 to 5 fingers are placed in rubber cuffs for fingers, which can be fixed both at the level of proximal and distal interphalangeal joints.

3. Circular mechanisms 4 and springs 3 (Fig. 1) are the connecting link between the splint and the hand grip. Removable springs for compactness of the device and convenience, and also for the use of this tire without wrist grip. In the case of using the tire without wrist grip, the end of the spring is fixed directly to the metal plates - 1 (6), which are located in the middle third of the splint, while the splint should be on a removable stand.

On the lateral sides of the wrist grip there are metal plates - 2 (13), which have grooves of sufficient depth where the springs 3 fit from the circular mechanism 4. The springs 3 move along the grooves of the metal plates smoothly, without resistance and with minimal friction,

The advantage of this tire is the ability to adjust the range of motion in the wrist joint. To do this, using the circular mechanism, you can adjust the angle of extension of the hand from 20 to 75 ° 0 without blocking movements in the wrist joint, and you can also fix the angle of extension of the brush (from 20 to 75 °) with blocking movements in the wrist joint for the purpose of functioning of the innervated muscle group deep branch of the radial nerve. Thus, by adjusting the angle in a circular mechanism, it is possible to dose the load on the paralyzed muscles of the hand and fingers.

The load dosing parameters are determined individually for each patient, taking into account the stage of the disease, the period after the injury, the electromyographic data, and the ultrasound scan data of the extensor muscle apparatus.

Of no small importance is the damage to the deep branch of the radial nerve, in which there is a complete extension of the hand with the presence of elements of radiation deviation and the absence of extension of the fingers, including the first finger.

To dose the load only on paralyzed muscles in this category of patients without involving healthy and well-innervated muscles remains a problem in medical practice to the present. time. The tire we proposed allows us to dose the load on individual muscle groups innervated only by the deep branch of the radial nerve, using the complete blocking of movement in a circular mechanism.

Thus, the load on the functioning and well innervated muscles (radial extensors of the hand) is excluded and the load is given on the affected muscles (common extensor of the fingers, long and short extensors of the first finger).

The amount of load on paralyzed muscles innervated by a deep branch can also be set by adjusting the angle of blocking movements in a circular mechanism (blocking the circular mechanism from 20 degrees of extension is the minimum load on paralyzed muscles, up to 75 degrees - full load).

4. The last detail of the proposed tire is the stand (figure 1) - it is removable, and the development of movements can be carried out both on the stand and without it; It has two supports - proximal 17 and distal 8. Its main function is to create optimal conditions when undergoing rehabilitation and functional biofeedback procedures. The height of its front part is 10 cm. The height of its rear part is 4 cm (in order to avoid friction of the elbow joint on the edge of the table). The difference in height increases the load on the muscle extensor apparatus of the hand and fingers, which will require great attention from the patient during the course of rehabilitation.

We give an example of the use of the proposed device: patient K., 39 years old, A / C No. 6107, took a course of functional biocontrol on a functional bus (Fig. 1) for 3 weeks at the laboratory of the biomechanics of CITO, and this bus was also used at home for rehabilitation from the moment of injury to the full restoration of hand function.

The applicability of the tire is confirmed by the fact of its successful clinical use in the Department of Microsurgery and Hand Injury of FSU CITO named after N.N. Priorova.

The inventive object allows to eliminate the disadvantages of the prototype and can dose the load both on the group of paralyzed extensor muscles of the extensors of the hand and fingers, and on individual muscles, excluding the functioning of other muscles innervated by the radial nerve.

Claims (1)

Functional tire for the rehabilitation of patients with radial nerve damage, containing a forearm splint with straps, carpal grip, characterized in that it is equipped with a splint stand and a circular mechanism with removable springs connecting the forearm splint with carpal grip, carpal grip has palm wrist rest , 4 rubber threads, an emphasis for the removal of the first finger of the right and left hand, located at the ends of the rubber threads of the cuff for 2-5 fingers, metal plates with grooves for springs of a circular mechanism, as well as a supporting arc and a metal arc, the latter being fixed to the supporting arc, and the metal arc has a base for attaching rubber threads and a furrow for the passage of rubber threads.

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