RU2448672C2 - Method of treating incomplete dislocation of hip and adductor syndrome in children - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to orthopaedics. Hip adductor-pronation is corrected with using an exoskeletonisation device, for this purpose each hip is abducted and, if required, rotated entoectad at angles sufficient for correction of a pathological position of each hip. It is followed by fixing in the corrected position with enabled hip motions in three planes within a range of motions preset by the exoskeletonisation device. In case of one-sided or preferentially one-sided pathological process, there is required a various degree of abduction of each hip with specifying a greater degree of abduction on a side of the more manifested pathological process.

EFFECT: improved centration of the femoral head in the cotyloid cavity and increased motor possibilities in the patients.

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Description

The invention relates to medicine, in particular to orthopedic neurology and rehabilitation medicine, and can be used to treat patients suffering from spastic or paralytic subluxation of the thigh or having a pathological adductor or adductor-pronational installation of the thigh due to spasticity or dystonia of the adductors of the thigh in pathology of the central nervous system , first of all, with cerebral palsy (cerebral palsy).

As you know, with a number of diseases of the central nervous system in children, especially in cerebral palsy, an imbalance in the forces of the muscles serving the hip joint is formed. Muscular imbalance is characterized by the predominant loss of function of abductors (piriform, middle and minor gluteus muscles), arch support (piriform, obturator muscles, square muscle of the thigh, posterior bundles of the middle gluteus, tailor, etc.) and extensors of the thigh (gluteus maximus, muscles of the hamstring group) . Under the conditions of pathological tension of their antagonists (adductors, anterior gluteal maxilla, gluteus maximus, etc.), abductors, arch supports and extensors of the thigh almost completely lose the role of a lever, which is accompanied by a displacement of the femoral head in the acetabulum outward, upward and posteriorly, leading to incomplete covering the femoral head with the roof of the acetabulum and the development of subluxation.

A known method of surgical treatment of the internal rotational component of the adductor syndrome in children with cerebral palsy in the form of spastic diplegia by violating the integrity of the middle and small gluteal muscles at the site of attachment to the greater trochanter of the femur, tenomyotomy of the adductors of the hips, extrathia neurotomy of the obturator nerve (RF patent No. 2284776) however, this method is invasive, accompanied by surgical trauma and risk of infection, and also requires postoperative rehabilitation.

A known method of surgical treatment of adductor syndrome (I.S. Perkhurova et al., "Regulation of posture and walking with cerebral palsy and some correction methods", Moscow, 1996, p. 160), in which myotomy of adductors and neurectomy of the motor branches are performed anterior portion of the obturator nerve, followed by immobilization of the lower extremities with a plaster cast to the groin for two weeks at the maximum abduction position. The method is invasive and for a long time excludes the possibility of active participation of the patient in the rehabilitation process, in addition, it is associated with operational risk.

There is a method of correcting the spasticity of hip adductors, according to which type A botulinum toxin preparations are introduced into the adductor muscles of the thigh. (Kislyakova EA, Maslova NN, Alimova IL “Botulinum toxin type“ A ”in the comprehensive rehabilitation of children and adolescents with cerebral palsy.” Bulletin of Siberian Medicine, No. 3, 2008, p. 97-104).

The disadvantage of this method is the risk of complications associated with the injection of the drug botulinum toxin, relapse of muscle hypertonicity, partial reversible drug denervation of the adductor muscles, which turns off part of the muscle fibers from the process of rehabilitation treatment for the duration of the drug botulinum toxin.

A device is known for developing a pathological musculoskeletal system of a patient and a method for the rehabilitation of hip joints with cerebral palsy carried out with it (Auth. Certificate. USSR No. 1801447, 1993, class A61H 1/02). The method consists in the fact that in the supine position the feet and legs of the patient are fixed with the lower extremities abducted by a predetermined angle due to the extension of the latches on the support. The disadvantage of this method of rehabilitation is the possibility of influencing the state of the hip joints only in the supine position.

Known orthopedic simulator "Lotus" and a method for correcting pathological changes in the musculoskeletal system of a patient with its help (RF Patent No. 2307640). The method consists in placing the patient in the simulator in the "sitting in Turkish" position with the hip fixed in the abduction position. The simulator contains a vertical support connected to the base, mounted on the base of the seat, table and supplementary tubes for fixing the knee joints. As a result, the effectiveness of the impact on the hip joints in a sitting position is increased due to rigid fixation. The disadvantage of this method is to achieve a corrected position of the thigh only in a sitting position.

A known method of treating motor disorders by eliminating pathological settings of segments of the lower extremities with cerebral palsy using stage gypsum treatment (A.V. Pchelyakov. Odessa State Medical University, "Orthopedic treatment of motor disorders with spastic cerebral palsy", Visnik Morsko-medicine, No. 1 (13 ) (very birch), 2001 p.).

The method consists in the phased elimination of pathological settings in the lower extremities, including the adductor or adductor-pronational installation of the thigh with spasticity or dystonia of the adductor muscles and internal rotators of the thighs by means of long-term fixation of segments of the lower extremities in a corrected position using circular plaster casts. Before stage gypsum is applied, one or another type A botulinum toxin preparation is injected into spastic muscles.

The disadvantage of this method is the long (4-5 weeks or more) immobilization of segments of the lower extremities, significantly limiting the motor activity of the patient and excluding his full participation in the process of rehabilitation and rehabilitation treatment.

This method is chosen by us as a prototype.

The objective of the present invention is to improve the centering of the femoral head in the acetabulum and increase the motor capabilities of patients with cerebral palsy.

The problem is solved by phased correction of the pathological adductor or adductor-pronational installation of the hips with spasticity or dystonia of the adductor muscles and internal rotators of the hips, while the correction of the adductor-pronational installation of the hips is carried out using an exoskeleton device, for which each hip is manually removed and, if necessary, rotate outwards at angles sufficient to correct the pathological position of each thigh, fix in a corrected position with the ability to perform an asset movements in the hip joint in three planes within the range of motion specified by an exoskeleton device, and in case of a unilateral pathological process, a different degree of abduction of each hip is carried out, while a greater degree of abduction is established on the side of a more pronounced pathological process. After reaching a certain corrected position at each stage, the patient should perform a special set of exercises every day 1-2 times a day aimed at better adaptation to the corrected position of the thigh at this stage and development close to the physiologically optimal voluntary motility of the muscles serving the hip joint. The set of exercises is developed taking into account the initial motor capabilities of the patient and is performed passively, passively-actively and actively.

The technical result of the method is:

- reduction or correction of pathological muscle tone, primarily hip adductors (spasticity, spasticorigidity or dystonia), and a decrease in the imbalance of the muscles that serve the hip joint;

- improved centering of the femoral head in the acetabulum with the existing imbalance of muscle traction due to violations of muscle tone;

- the development of a balanced balanced voluntary motility of the hip muscles with the existing neuromotor deficit while maintaining the possibility of active movements with prolonged use of a special orthopedic device.

In the description of the proposed method, the following model is introduced:

- the names of the planes and directions of motion of the body segments used in the description of the invention are oriented to a patient conditionally in a vertical position (posture - standing) while maintaining angles close to 180 ° between the longitudinal axes of the trunk and thigh from the ventral side, between the longitudinal axes of the thigh and lower leg from the dorsal side and an angle close to 90 ° between the longitudinal axes of the lower leg and foot from the back of the foot (Fig. 1, a, b).

The method is as follows:

The patient’s thigh is diverted to a conditional acute angle (Fig. 2) sufficient to eliminate the pathological adduction unit (Fig. 2) in the frontal plane between a line parallel to the median longitudinal axis of the body and drawn through the projection of the center of rotation of the femoral head on the frontal plane and the longitudinal axis of the femur in the frontal plane and fixed in corrected position using a special orthopedic exoskeleton device (Fig. 3). The hip is fixed in such a way that the resulting reflex tension (stretch reflex) of the hip adductors is not accompanied by a painful reaction of the patient. Another criterion for choosing the optimal angle of hip abstraction is the need to ensure that the patient can maintain a standing position and perform step movements, on the one hand, without crossing the lower extremities due to insufficient hip abduction, and on the other hand, without deterioration of statokinetic stability due to excessive hip abduction.

The patient’s hip abduction is performed by adjusting the structural elements of various exoskeleton devices, for example, such as the device described in Eurasian patent No. 013306, (B1 2010.04.30 Bulletin No. 2) or S.W.A.S.H. Camp Scandinavia, Helsingborg, Sweden.

The thigh of the patient is rotated in a horizontal plane in the opposite direction to the pathological pronational installation (supination) in order to optimally correct this installation, but with a slight pronation of the hip installation for better centering of the femoral head in the acetabulum. This circumstance (preservation of an insignificant pronational installation) acquires special significance in case of paralytic subluxation of the hip or instability of the hip joint.

The first stage of correction - adaptive - lasts 2-3 months. During this period, the patient should daily, 1-2 times a day, regardless of the initial motor capabilities (walking independently, with support for one arm, with support on canes or with high support), perform the following set of exercises in a corrective exoskeleton device:

Complex 1

1. Starting position (hereinafter - I.p.): sitting on a chair, feet - on the floor. Alternately lifting the legs bent at the knee joints is performed (passively, passively-active, active).

2. I.p .: sitting on a chair, feet - on the floor. Alternately lifting the legs bent at the knee joints is performed, followed by fixing in the upper position (passively, passively-active, active).

3. I.p .: sitting on a chair, feet - on the floor, in front of the patient - support (chair or Swedish wall). The patient gets up, straightening his legs, pulls the pelvis forward, fixes the position, and then returns to I.p. (passively, passively-active, active) - repeat several times.

The purpose of the adaptive stage is direct adaptation to the corrected position of the thigh, preparation for independent walking in a corrective exoskeletal device, stabilization of the hip joint during support, improvement of the function of the muscles serving the hip joint (iliopsoas, rectus quadriceps, sacrospinous, quadratus muscles of the lower back, large and middle gluteus), as well as an indirect effect on the function of distally located antigravity muscles of the lower limb, previously in this triceps muscle of the leg.

At the subsequent stages of correction (the duration of each subsequent stage is individual and, on average, is 3 months), after setting up the corrective device, the patient is prescribed complex 2, depending on the patient's motor capabilities at the beginning of the stage. For patients who are not independently moving or moving with high support or with support for two hands, the following set of exercises is prescribed in addition to the described complex for the adaptive stage of correction (performed in an exoskeleton device):

Complex 2

1. I.p .: standing with support for two hands or with support on a chair or a Swedish wall. The patient transfers body weight to one leg (without taking his feet off the floor) and returns to I.p., after which he transfers body weight to his other leg (without taking his feet off the floor) and returns to I.p. - repeat several times (passively-active, active).

2. I.p .: standing with support for two hands or with support on a chair or a Swedish wall. Alternately raising the legs bent at the knee joints (passively active, active) is performed.

3. I.p .: standing with support for two hands or with support on a chair or a Swedish wall. Walking in place with knees raised high (passively active, active).

4. I.p .: standing with support for two hands or with support on a chair or a Swedish wall. Alternating legs to the side are performed (passively-active, active).

5. I.p .: standing with support for two hands or with support on a chair or a Swedish wall. Alternating extension of the straight legs in the hip joints with fixation of the body, i.e. holding the longitudinal axis of the body in a vertical position (passively active, active).

6. I.p .: standing with support for two hands or with support on a chair or a Swedish wall. Circular movements are performed with the pelvis in one direction, and then in the other direction, while the feet and shoulder girdle of the patient are fixed (passively-active, active) - repeat several times.

7. I. p.: Standing with support for two hands or with support on a chair or a Swedish wall. Movements of the pelvis back and forth are performed, the feet and shoulder girdle of the patient are fixed (passively-active, active).

For patients traveling with support for one arm, the following complex 3 is prescribed, which must be performed in an exoskeleton device, in addition to the complexes described above.

Complex 3

I.p .: standing with support for the left hand (for a chair or a Swedish wall). Alternately raising the legs bent at the knee joints is performed (active). I.p .: standing with support for the left hand (for a chair or a Swedish wall). Walking in place with knees high (active)

1. I.p .: standing with support for the right hand (for a chair or a Swedish wall). Alternately raising the legs bent at the knee joints is performed (active).

2. I.p .: standing with support for the right hand (for a chair or a Swedish wall). Walking in place with knees high (active).

3. I.p .: standing with support for two hands (for a chair or a Swedish wall). Walking on the stepper is performed (passively-active, active), then walking with support for two hands is performed, then walking with support for one hand is performed.

For independently, without the support of moving patients, the following complex of three exercises is prescribed, which must be performed in an exoskeleton device, in addition to all the complexes described above.

Complex 4

I.p .: standing alone (without support). The patient maintains balance without assistance (during the exercise, the patient must be insured).

1. I.p .: standing on their own (without support). Without assistance, body weight is transferred from one leg to the other without taking the feet off the floor (you must insure yourself when performing the exercise).

2. Walking on your own at a slow pace (it is necessary to insure yourself when performing the patient’s exercise).

3. Walking on your own at a fast pace (you must insure yourself when doing the patient’s exercise).

The essence of the invention lies in the fact that they achieve a phased non-violent correction of the pathological adductor or adductor-pronational installation of each thigh, practically without interference, using one of the special exoskeleton orthopedic devices and maintain the corrected position of the thigh for a long time necessary to reduce the pathological hypertonicity of the adductors and internal thigh rotators, while maintaining the possibility of active movements in the hip joint in three planes bones, within the established range of motion; at the same time, at each stage of correction, a specially developed set of exercises is performed depending on the initial motor capabilities. When expanding the patient’s motor abilities during a correction stage, the next set of exercises is developed into a set of exercises for the next stage, designed for a higher status of voluntary patient motility.

Forced abduction of the thigh is unacceptable, since this can contribute to increased adductor spasm and increased pressure on the femoral head of the edge of the acetabulum, which is fraught with the development of aseptic necrosis of the head. If the optimal correction of the adducting installation of the thigh is impossible due to the pronounced contraction of the adductors and the pain response of the patient, then the necessary degree of abduction of the thigh is achieved gradually, at subsequent stages of correction, as the severity of the pathological hypertonus of the adductor muscles decreases as a result of maintaining a long corrected position of the thigh and reducing the severity myotatic reflex.

In a unilateral pathological process (for example, spastic subluxation of only the right or only the left thigh), the thigh is preferentially removed from the pathological process. A prerequisite for the possibility of correction of the adductive or adduction-pronational installation of the thigh by the described method is the absence of fixed deformations of the hips and muscular-articular contractures of the hip joints.

Visual control of the correction of the pathological installation of the thigh by the described method is carried out when the patient performs various static poses (sitting, standing, in a 4-support stance) and during locomotion, namely when performing step movements. The purpose of the control is to make sure that the optimal combination of the hip abduction angle and a sufficient degree of correction of the pathological pronational hip installation are selected (selected individually, taking into account the above criteria). At the same time, the corrective device is selected and adjusted in such a way that its structural elements do not interfere with the pose - standing and 4-post, as well as locomotor act. Subsequently, the visual control of the effectiveness and optimality of correction of the pathological installation of the thigh is carried out at least once every 3 months with the aim of a possible timely increase in the angle of abduction of the hip with a decrease in pathological hypertonicity of the adductors and correction of the device settings as the child grows further.

The degree of tension of the adductors of the femur when reaching the corrected position is controlled manually, feeling the tendons of the adductors near their attachment to the bone protrusions, while the patient should sit with his legs down (Fig. 4). They also find out if the patient is experiencing any pain that is directly related to the correction.

X-ray control of co-optation of the femoral head and acetabulum is carried out regularly, 1-2 times a year, in order to assess the dynamics of the pathological process and timely correction of the degree of abduction and external rotation of the femur. At night, the corrective device is removed and the lower extremities are laid down without any adjustments using the unloading splints on the ankle joints and knee splints to give the corrected position of the axis of the lower limb with fixation of the ankle joint at an angle of 90 ° (between the longitudinal axis of the lower leg and the longitudinal axis of the foot from the side rear of the foot) and at the same time holding the knee joint at an angle close to 180 ° (between the longitudinal axes of the thigh and lower leg from the dorsal side). At the same time, over the splints in the ankle joints, a deflecting splint is installed, such as the Vilnius splint, to give the abductor position of the lower limb during night sleep.

The invention is new, since it is fundamentally non-invasive from surgical methods for correcting adductor spasm, and it differs from conservative therapy in maintaining the ability to perform active movements in the three joints of the lower extremities in a standing, sitting and locomotion position, does not limit the patient's vital activity and does not interfere with his active participation in the process of rehabilitation and rehabilitation treatment.

Indications for the use of the method are spastic or paralytic subluxation of the thigh, lateral position of the femoral head with dysplastic type of development of the roofs of the acetabulum, antisype, instability of the hip joint, adductor pronation installation of the hip.

Contraindications to the use of the method are fixed deformities of the hips and muscular-articular contractures of the hip joints, as well as pronounced involuntary movements (hyperkinesis).

Examples of clinical implementation of the method:

Example 1. Patient boy P., 8 years old.

Diagnosis: cerebral palsy, spastic diplegia with a primary lesion of the right limbs, spastic subluxation of the right thigh

Objectively: in the supine position, the tone of the adductors of both thighs is increased, passive abduction of the right thigh is limited. Sits alone with legs down. When sitting, the pectoralis major muscles are tense, total kyphosis is noted. Hips are given. Do not stand alone, do not walk. It stands with support for one arm in a pose of triple bending, the hips are brought and rotated inward. He walks with support for one arm, with the torso tilted forward, frontal swaying of the torso, leading and rotating the hips inward, relying on the anterior inner sections of the feet.

On the R-gram of the hip joints in a direct projection: the acetabuli are flattened, the plaque is valga on both sides, more on the right, pronounced antetorsia on the right. The head of the right thigh is laterally shifted, the outer third of the head is not covered by the acetabulum roof, the Shanton line on the right is interrupted (10 mm).

The child underwent correction of the adductory-pronational installation of both hips using an exoskeleton device (“Hip orthosis for the correction of the pathological installation of the thigh.” Eurasian patent No. 013306, B1 2010.04.30 Bulletin No. 2), while the angle of the right thigh abduction exceeds the angle of the left thigh abduction . With manual control of the abduction of both thighs in the sitting posture, the adductors tendons are contoured, but the child does not complain of pain. In the standing posture and when performing step movements, the selected abduction angles provide an almost parallel position of the thighs (the right thigh is allotted more than the left), the adductor the pronational setting of both the right and left thighs is fully adjusted. In the 4-support rack, the bar-distractors of the corrective device do not interfere with the reciprocal movements of the limbs.

The child was recommended to wear the device - constantly during wakefulness, for nighttime laying of the lower extremities with the help of unloading splints on the ankle joints and knee splints with abduction of the lower extremities with the help of an overhead splint installed on top of the splints in the distal third of the shins such as the Wilensky TAP CITO bus. For the period of the adaptive stage of correction, the child was assigned complex 1.

A follow-up examination of the child after 3 months required the correction of the angle of abduction of both hips and additional adjustment of the elements of the corrective orthopedic device. In neurological status, a decrease in pathological hypertonicity of the adductor muscles of the hips was noted. Passive abduction of the right thigh increased slightly. The subsequent complicated stages of exercises are assigned to the subsequent stages of correction for the child: complex 2, complex 3, complex 4.

1 year after the start of treatment for the child, an improvement in the pattern of step movements without a device, a decrease in the severity of the adductory-pronational installation of both thighs in a standing pose and when performing step movements was noted. The child learned to stand on his own in a corrective device. Makes several independent steps in the corrective device.

During the year, the degree of abduction of the hips was corrected twice more.

A control x-ray of the hip joints in direct projection, performed 1 year after the start of treatment of the child, revealed a decrease in the antetorsia of the right thigh, an increase in the degree of coverage of the head of the right thigh. A recommendation is given to continue treatment.

Example 2. The patient is a boy Sh., 4 years 10 months

Diagnosis: spinal dysraphism, myelodysplasia, condition after removal of lumbar intradural lipoma, dissociated lower flaccid paraparesis, dysfunction of the pelvic organs, paralytic subluxation of the right thigh, left subluxation of the left hip, instability of both knee joints, adducto-equinovarus deduction, deformity of the left foot, left foot deformity right foot.

Objectively: not worth it yourself. He walks fast in orthopedic shoes on his own, unstable, with pronounced frontal swaying of the body, rotating his legs inward, more left, during the period of transfer there is no flexion in the left knee joint. In the supine position, the active extension of the hips is performed with the involvement of auxiliary muscles. Frontal instability of the knee joints. The stiffness of the ankle joints, the left foot is deformed (adduct-equinovarus), is not corrected passively, the right foot in the adduct-equinovarus installation is passively displayed in the middle position, passive back flexion of the foot to an angle of 90 °. Active back flexion of the feet is absent. Hypotrophy, hypotension of the lumbar muscle, gluteus, thigh and lower leg muscles.

On the R-gram of the hip joints in a direct projection: the acetabulums are beveled, the thigh heads are reduced in size, the right one is lateral, covered by the roof of the acetabulum by 2/3, the left one is laterally and high, partially extending beyond the limbus, is covered by the roof of the acetabulum on 1/4.

The child was corrected for the position of both thighs using an exoskelerating device from SWASH from Camp Scandinavia (Sweden), and the minimal pronation installation of the left thigh was preserved at the first stages of correction. The child was recommended to wear a corrective device constantly during wakefulness, at night - fixation of the knee and ankle joints with the help of tutors and abduction of the hips with the help of a discharge tire such as the Vilensky tire.

Against the background of the constant use of the device that corrects the position of the hips and orthopedic shoes, the child performed complex 1, 2, 3 for 1 year.

During the year, the hips abduction angles and the degree of passive supination were corrected 4 times. After 9 months from the start of treatment, the child was prescribed a set of exercises 1, 2, 3 and complex 4 was added.

A follow-up examination after 1 year revealed a qualitative change in the walking pattern. The frontal swaying of the torso decreased, and I learned to stand on my own. There were minimal active movements in the toes of the left foot, active back flexion of the right foot, the severity of angiotrophic disorders in the distal parts of the lower extremities decreased, trophism and tone of the muscles of the thighs improved.

A direct projection x-ray of the hip joints, performed 1 year after the start of treatment of the child, showed a tendency to improve the shape of the acetabulum, more on the right, better position of the heads of both thigh bones, left coverage increased (1/3 of the femoral head). Recommendations are given to continue treatment with the possibility of applying the method of dynamic proprioceptive correction.

Example 3. The patient is a girl K., 13 years old

Diagnosis: cerebral palsy, spastic-hyperkinetic form, severe adductor syndrome, flexion settings of the knee joints, pronounced equinovarus installation of the feet.

Objectively: do not stand alone, do not walk. Uses a wheelchair. With support for two hands, he performs stepping movements in a position of pronounced triple bending, bringing the hips, an unstable cross of the lower extremities at the level of the middle third of the legs, internal rotation of the lower extremities and resting on the anterior parts of the feet. Choreic hyperkinesis, more pronounced in the muscles of the face, neck and upper limbs, affects the pose and movements in general. There is dystonia of the adductors of the hips, occasionally - pronounced tension of the adductor muscles, significantly limiting the passive abduction of the hips.

On the R-gram of the hip joints in a direct projection: the acetabuli are flattened, the lateral position of the heads of both thigh bones, antetorsia, plaque valga bilateralis, the initial phenomena of dysplastic coxarthrosis on both sides.

Since involuntary movements were moderate, the teenager was corrected for the position of the hips of the claimed method. For the period of adaptation to the corrected position of the hips, complex 1 was assigned. Further, as the motor abilities increased, the complex of exercises was supplemented sequentially with compasses 2 and 3, and 10 months after the start, complex 4 was added.

Correction of the lead angles and the degree of external rotation of the hips during the year of observation was carried out 3 times.

Examination of the adolescent 1 year after the start of treatment showed that the patient was trained to control involuntary movements in the upper limbs through the use of postures facilitating active movements (for example, grasping the shoulders with hands). It stands on its own for a long time and walks independently in the device correcting the position of the hips and apparatuses on the ankle joints with a hinge, holding the shoulders brought to the body with the help of the hands. It can walk independently without apparatuses on the ankle joints, while leaning on a full foot, but it does not differentiate the phases of the support period (there is no "roll"). When walking in the apparatus on the ankle joint with a hinge, elements of the differentiation of the phases of the support period appeared. When walking without a corrective device, a cross of the lower extremities is not noted, but the leading installation of the hips is preserved. I completely refused to use a wheelchair. She studied self-care.

A control x-ray of the hip joints in direct projection, performed 1 year after the start of treatment with the patented method: the severity of antetorsia on both sides decreased, the centering of the head of the right thigh improved slightly, the position of the head of the left thigh did not change. The patient is recommended to continue treatment.

During 2008-2009, we observed 67 independently moving children aged 3 to 15 years, suffering from unilateral or bilateral spastic subluxation of the hip or instability of the hip joints against cerebral palsy in the form of moderate spastic diplegia. With these children, a phased non-violent correction of the adductor or adductor-pronational installation of the hips was performed using the patented method using a special exoskeleton device (the Vilensky bus was used at night).

During the control radiography of the hip joints, performed after the 1st year of using the device in the recommended mode, 43 patients showed a positive dynamics in the form of a decrease in antetorsia, an improvement in the centering and coverage of the femoral head, in other children, radiological dynamics were not observed. Negative dynamics of the position of the femoral head in the cavity was not revealed in any of the patients, despite the ongoing axial load during verticalization.

The invention can be used in specialized medical institutions for rehabilitation treatment and increase the motor capabilities of patients with cerebral palsy and other diseases of the central nervous system, accompanied by a pathological adductor or adductor-pronational installation, or suffering from comorbid subluxation of the thigh.

Claims (1)

A method of treating hip subluxation and adductor syndrome in children by phasing correction of a pathological adductor or adductor-pronational installation of the hips with spasticity or dystonia of the adductors and internal rotators of the hips, characterized in that the corrected position is achieved in the exoskeleton device, for which the hip is removed by adjusting the constructive elements of an exoskeleton device are fixed in a corrected position in the device with the ability to perform active movements th in the hip joint in three planes within the range of motion specified by the exoskeletal device, and with a unilateral pathological process, a different degree of abduction of each thigh is performed, with a large degree of abduction installed on the side of the most pronounced pathological process and rotated outwards at angles sufficient for correction of the pathological position of each thigh, after reaching the corrected position with the patient in the exoskeleton device 1-2 times a day with the help The methodologist performs a set of exercises aimed at improving adaptation to the corrected position of the thigh and improving the motility of the muscles serving the hip joint, then the first adaptive stage of correction is performed in an exoskeleton device, which lasts 2-3 months, during which a set of exercises is performed with the patient, including: alternately raising the legs bent at the knee joints, then raising the legs bent at the knee joints, followed by fixing in the upper position, and then, in a standing position, straightening e legs with the pelvis pulled forward, then with a patient who does not move independently or moves with high support or with support for two hands, a set of exercises is carried out, including: transferring body weight first to one, then to the other leg, then alternately raising legs bent in the knee joints, walking in place with the knees raised high, alternating legs to the side, alternating extension of the straight legs in the hip joints with fixation of the trunk, circular movements of the pelvis in one and then the other direction, movement back and forth with the pelvis, with the patient moving with support for one arm, an additional set of exercises is carried out, including: alternately raising the legs bent at the knee joints, walking in place with the knees raised high, walking on the stepper, standing with support for two hands , walking with support for two hands, walking with support for one arm, with an independently moving patient additionally carry out a set of exercises, including: maintaining balance without assistance, transferring body weight from one leg to another without tryva feet from the floor, independent walking at a slow pace, independent walking at a fast pace.

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