RU2547608C2 - Method for functional recovery of lower extremity joints - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: kinesitherapy is performed with the use of a training device having a plane with a sit support making it possible to fix a pelvis therein at the level of a gluteal fold with using a belt. The training device comprises pivots configured so that to align their rotational axis to those of hip, knee and ankle joints. The manipulation involves aligning the above rotation axis of the pivots of the training device of the joints; a screw device with a spring gage is mounted on a foot, a joint tension is preset in the joint at 25-40 kg. In the given regiment, the patient applies a force to the lower limb muscles and moves first with one, and then with the other foot. The joint motions represents bending and extension, adduction and abduction, circular rotation inwards and outwards within 10-15°. The session length is 25-35 minutes, 2-3 times a week; the therapeutic course is 15-25 procedures.

EFFECT: method provides the optimum motor load on the joints on a basis of the graduated tensile stress, faster tissue regeneration, faster functional recovery of the joint motion, reduced time for rehabilitation and maintaining the joint in the working condition for a long period of time, reducing or eliminating the drug-induced load on the body.

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Description

The present invention relates to medicine, namely to orthopedics, traumatology, sports and rehabilitation medicine, and can be used for rehabilitation of patients after fractures, treatment of deforming arthrosis, training athletes.

Various methods for restoring the function of the joints of the lower extremities are widely known (physiotherapy exercises, massages, manual therapy, various simulators and devices with control of the angle, time, parameters of movement parameters (www.mediumplus.ru/product/diagnostic/biodex).

These traditional non-drug methods of treatment do not provide an effective cure and only relieve pain symptoms for a short time.

Known effects on the knee joint with the help of physical exercises and additional inertial shocks during sharp inhibition of the flexion and extensor movements of the lower leg (RF patent No. 2069965 (Mikhailov NM, 02/25/1992) "Method for the treatment of arthrosis of the knee joint"). However, this method can lead to loosening of the joints of the lower extremities, trauma to the cartilage and menisci.

For the closest analogue, RF patent No. 2281746 was adopted "Method for the treatment of joints of the lower extremities." The method consists in kinesitherapy: performing flexion and extension of the lower extremities in the joints, walking in weighted shoes, the weight of which for adults is 10 kg, and for children from 8 years old - 3-5 kg, after relieving pain in the joints they add weight to the trunk the patient through a heavy belt or vest, the weight of which for an adult is from 20 kg, for a child from 8 years old - 3-5 kg, while in the first session up to 1000 steps are performed, and in subsequent sessions their number is increased by 200 steps each session, and the course of treatment is n e less than 20 sessions.

Disadvantages: traction is inefficient, because it "works" only with relaxed muscles. When flexing, the muscles tighten, and at this moment there is no tension, which reduces the effect of exposure. The method for the patient is uncomfortable, which is important, especially for children.

The patient experiences a load on the spine, no movement around the sagittal and vertical axes is provided. Limited movement in the joints during treatment sessions also reduces the effect of exposure. Dosing of the load is very arbitrary.

Tasks: improving the efficiency of recovery or restoration of the musculoskeletal function of the joints, reducing the time of medical and social rehabilitation, creating favorable conditions for the patient when taking procedures, improving the quality of life of patients, increasing the range of motion in the joints.

The technical result is achieved by ensuring optimal motor load on the joints, based on the effect of dosed tensile stress, which accelerates tissue regeneration, which ensures faster restoration of the joints. The elimination of impaired motor function of the limbs when using the simulator allows you to improve the quality of life, reduce the time of medical and social rehabilitation, improve the joints, maintain them in working condition for a long time or a lifetime, reduce or eliminate the drug load on the body.

The essence of the method is that the pelvis is fixed on the simulator with the help of the sciatic emphasis at the level of the gluteal fold and with a belt to the plane of the simulator. The foot is also fixed with a screw through a dynamometer mounted to the fixed foot, the tensile stress in the joints is set with a force of 25-40 kg, the axis of rotation of the hip, knee and ankle joints is combined with the axis of rotation of the hinges of the simulator, and the patient in the specified mode by the efforts of the muscles lower extremities and (or) the muscles of the hands attached to the handle of the simulator, performs flexion-extension of the lower extremities for 25-35 minutes, 2-3 times a week, a course of 15-25 procedures.

The method was tested for 2 years for 56 patients with deforming arthrosis, 10 postoperative patients for fractures of the lower extremities and 18 athletes. The tasks set are solved in full: 92.3% of the total number of patients received positive results in accordance with the tasks.

The method is as follows. The patient is placed in a reclining position on a flat surface (table, couch). In this case, the patient lies with the condition that the axes of rotation of the hip, knee and ankle joints are combined with the axis of rotation of the joints of the simulator. The pelvis and foot are fixed with straps (shown in photo 1). Then, a dynamometer is connected to the fixed foot, with the help of which an individual load is established - tensile tension of the limb in the range from 25 to 40 kg, depending on the patient’s gender, age, degree of physical fitness, severity of impaired limb function (s). The upper body of the patient is raised to a half-sitting position - a comfortable, stress-free posture. Preparation for the procedure is completed. The patient in a quiet mode using the efforts of the muscles of the limb for 25-35 minutes produces a flexion-extension of one, then the other leg in the same order (photo 2). On the simulators there is usually a handle with which you can help to produce the same manipulation by the effort of the muscles of the hands. The course of treatment is 15-25 procedures to ensure relaxation - recovery. The procedures are performed intermittently in 2-3 days, i.e. for a week the patient receives 2-3 medical procedures. During the manipulation of tension, flexion, the patient should not have pain or discomfort. The longitudinal tension of the limb (distraction) and the amplitude of movement as the patient adapts to the procedures and improves the condition of the joints gradually increase.

In order to eliminate discomfort and fatigue, the load is sparing: after 10-15 movements, the patient takes a break of 10-15 seconds. In addition to movements in the joints along the frontal axis (flexion, extension), the method involves movements in the joints around the sagittal axis (adduction, abduction) and in the vertical - circular rotation inside and out within 10-15 °. After taking the procedure, the patient should rest in a supine position for 5-10 minutes. The course of treatment, as a rule, is 15-25 procedures. All patients showed gradual positive dynamics in the condition, prolonged remission after treatment or complete absence of complaints, increased range of motion and restoration of support ability.

Example. Patient N., 76 years old. About 2 years old suffers from multiple arthrosis of the hip, knee and ankle joints. Concomitant diseases: general moderate atherosclerosis, aortocardiosclerosis. Upon admission to the clinic complaints of pain in the right knee joint, ankle joints with limited mobility and gait changes.

Objectively: the contours of the joints are smoothed, with palpation - pain in the medial condyle of the tibia, especially on the right. Soreness in the hip joint when pressing in the area of the greater trochanter. On the radiograph - narrowing of the medial halves of the joint spaces and marginal bone growths in the femoral condyles, tibia, articular surfaces of the patella. In the area of the ankle joints there are also signs of deforming arthrosis.

On radiographs of the hip joints there is sclerosis of the locking plates and a narrowing of the joint spaces. The patient completed 25 treatment sessions. The patient was placed in a half-sitting position. Combined the axis of rotation of the hinges of the simulator with the axis of rotation of the hip, knee and ankle joints. The pelvis and the foot of the right leg were fixed with soft straps. Using a dynamometer through a fixed foot created a tensile stress in the leg of 25 kg. Using the efforts of the leg muscles, the patient rhythmically performed flexion-extension of the right lower limb for 10-15 movements with breaks of 5-10 seconds for 25 minutes. After this, the fixing belts were removed, the patient was at rest for 25 minutes. After 3 days, then after 2 days the procedure was repeated. A total of 25 procedures were performed.

As a result of the training procedures, an increase in the joint space, a reduction in the marginal bone growths in the femoral condyles, tibia, and patella surfaces are clearly visible on x-ray photographs. The awl-like growths in the ankle joints were somewhat smoothed out. In addition, the skin temperature in the knee area returned to normal. Conducted another 2 courses of treatment with an interval of 1 month.

Upon re-examination (after 1.5 years), the patient did not deteriorate.

Example 2. Athlete K., 23 g. Complaints of pain that appeared after an injury in the right lower limb in the ankle and knee joints for 0.5 years: at first only with exertion (long-distance running), then at rest. The cessation of sports is accompanied by a decrease in the functional abilities of organs and systems of the whole organism in connection with the destruction of conditioned reflex connections developed by many years of systematic training. State of depression, psychological training. On palpation revealed in the ankle and knee joints - pain at the level of the joint space, limited mobility.

A course of restorative and preventive development of deforming arthrosis was prescribed procedures according to the method described above for 3 weeks, 30 minutes by the proposed method. The initial voltage of 40 kg. The regimen of procedures was carried out by the athlete with the help of handles. After the procedures, rest is prescribed for 10 minutes at rest.

A control examination at the end of the course of treatment revealed: the athlete does not show complaints, pain syndromes are eliminated, the functional activity of the right lower limb is restored. The athlete returned to professional sports.

Claims (1)

A method for restoring the function of joints of the lower extremities, including kinesitherapy using a simulator, characterized in that they use a simulator having a plane with an ischial focus that allows you to fix the pelvis on it at the level of the gluteal fold using a belt, the simulator also contains hinges made with the possibility of combining their axes rotation with the axis of rotation of the hip, knee and ankle joints, while the simulator combines the specified rotation axis of the hinges of the simulator and joints, feet fixed to the simulator with a belt, a screw device with a dynamometer is installed on the foot and tensile tension in the joints is set with an effort of 25-40 kg, then the patient in the specified mode uses the muscles of the lower limb to move with one leg, then the other leg, use flexion as the joint movements - extension, reduction-abduction, circular rotation of the inside and outside within 10-15 °, the session is carried out 25-35 minutes, 2-3 times a week, a course of 15-25 procedures.

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