RU2559425C1 - Method of treating congenital clubfoot in infants - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves putting a corrective splint on, using a foot support with foot retention elements and a distraction apparatus. The corrective splint is configured as a removable sleeve with holding elements within a lower leg and a thigh with flexed knees. The foot support for foot retention represents a hard soled shoe. It is connected to a threaded holed semi-ring by elastic elements. The semi-ring is fixed in a lower leg segment of the sleeve by means of an adjustable rod. The following redressment procedure is performed under the supervision of epithesis and under the control of muscular sensation with stretching soft tissues and ligaments of the foot.

EFFECT: method promotes recovering the normal pre-walking support ability of the extremity, enables correcting the cyllosis over a relatively short period of time and ensuring the good complication-free functional effect.

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Description

The invention relates to orthopedics, in particular to children's orthopedics, and can be used to effectively eliminate foot deformity.

Clubfoot is a complex congenital combined deformation of the foot, manifested by plantar flexion of the foot in the ankle joint (equinus), lowering of the outer edge of the foot (supination), adduction of the forefoot (adduction), torsion of the lower leg bones and contracture of the joints of the foot.

Congenital clubfoot is one of the most common malformations in children. According to statistics, 3 out of 1000 live births have this deformation.

Treatment of congenital clubfoot is a complex and not completely resolved problem of modern orthopedics. The conservative treatment of congenital clubfoot has been known for more than 2000 years, since the time of Hippocrates, his tactics and methods have gone through a long evolution. Current principles of conservative treatment are based on J.H. Kite (1932), Ignazio Ponseti (1950), V.A. Sturm (1956), V.Ya. Vilensky (1973), M.V. Volkova (1983) and many other authors consist in a gradual, phased correction of clubfoot components, starting with the deformation of the forefoot and ending with its equinus with fixation of the limb with plaster casts.

Currently, in the practice of modern orthopedics (see http://ponseti.ru/classification_kosolaposti), mainly methods of conservative treatment of young children with congenital clubfoot are used, for example, gradual casting according to Ponseti.

The disadvantages of this method are necrosis of the skin and soft tissues due to the lack of control over soft tissues under a circular plaster cast. The use of plaster dressings excludes the possibility of conducting therapeutic exercises, massage, baths, physiotherapy for a long period of time, and also noticeably worsens the tone and trophism of the leg and foot muscles. These methods were associated with a significant lengthening of the treatment period and fairly frequent complications of the skin and soft tissues. Caring for a child in a plaster cast requires patience and great attention from parents.

A device for treating clubfoot in preschool children (see RU No. 36206, IPC A61B 17/66, publ. 10.03.2004), containing proximal and distal supports mounted on the bones of the lower leg and indirectly connected by connecting elements to each other and horizontal support, connected with a vertical support and installed on the forefoot of the foot by means of a spreading rod, while the distal support is connected with a vertical support by two hinges, and with a horizontal support by two threaded rods, in addition, tikalnaya and horizontal supports may be moved relative to each other and the distal support. The principle of the device is to eliminate the components of the deformation of the foot by dosed tightening the nuts after the operation.

The disadvantages of the analogue are the complexity of the design of the device, which complicates the hygienic and therapeutic care of the fixed limb of the patient. In this case, the possibility of movement of the fixed foot is completely excluded, which will inevitably lead to malnutrition, atrophy of the entire muscle group of the fixed lower leg and foot, and the deformation will be eliminated in strictly defined planes. In addition, supports are placed directly on the bones of the lower leg and foot, which can cause a risk of infection. It should be noted that installation of the device will require anesthesia, postoperative child care, dressings, which is possible only in conditions of long-term inpatient treatment and observation.

There is a method of preventing foot-rocking in the treatment of congenital clubfoot (see RU No. 2185116, IPC A61B 17/56, publ. 07/20/2002), based on the use of an external fixation device, the supports of which are superimposed on the bones of the lower leg and foot, while detorsion knitting needles with stops carried through the ankles, heel and metatarsal bones. Torsia is eliminated by dosing traction, while fixing the spokes on the traction nodes of the ring supports, to the normal position of the cuboid, talus, metatarsal and heel bones.

The elimination of the clubfoot components is achieved by surgical intervention, which requires preoperative preparation of the patient, hours-long operation, long-term postoperative inpatient treatment and observation of the operated patient, causing general stress to the sick child. The use of many spokes through the bones of the leg and foot, of course, causes a risk of infection in the body, damage during surgery of blood vessels, nerves. In addition, the fixation of the foot of the child contributes to atrophy of the muscles of the leg. As a result, the treatment is accompanied with complex care and further treatment (distraction in the apparatus) for the operated child.

A device for treating congenital clubfoot in young children (see RU No. 107476, IPC A61F 5/00, publ. 08/20/2011), containing footsteps with elements of fixation of the foot, which are made in the form of a pair of leather orthopedic shoes with tongue and open the toe, equipped with three fixing straps attached on the medial side of the shoes and buckles on the lateral side, both foots are made in the form of metal plates commensurate with the sole of the shoes, attached on the heel side each to its own metal strap for setting the strip and between podstopnikom angles from 30 ° to 70 ° for a possible change in the position in a horizontal plane for retraction stops at 30-70 °.

The disadvantages of the known device are the complexity of the design of the device, expressed in bulkiness, which makes it difficult to care for a sick child. Elimination of deformation can only be achieved in certain planes. During fixation, certain movements of both lower extremities are excluded, which can lead to malnutrition, muscle atrophy.

The problem to which the invention is directed is expressed in increasing the effectiveness of the treatment of congenital clubfoot in young children.

The technical effect obtained when solving the problem is expressed in obtaining a method of treating congenital clubfoot in young children, which provides positive results without complications and technical difficulties in a short time.

To solve this problem, a method of treating congenital clubfoot in young children, including the application of a corrective splint, the use of a footstep with elements of fixation of the foot and distraction apparatus, is characterized in that the corrective splint is made in the form of a removable sleeve with fasteners in the lower leg and thigh with a fold in the knee joint, the footrest for fixing the foot is made in the form of a boot with a solid sole, while it is connected with a half ring with threaded holes by means of elastic elements s, and the half-ring is fixed in the segment of the lower leg of the sleeve using an adjustable rod, the subsequent reduction is carried out under the supervision of correcting deformation when controlling the muscular feeling, stretching the soft tissues and ligaments of the foot.

A comparative analysis of the features of the claimed solution with the signs of the closest analogues indicates the conformity of the claimed solution to the criterion of "novelty."

The features of the characterizing part of the claims provide correction of foot deformation and obtaining a functional result without complications and technical difficulties in a short time.

The device used in the invention is intended for multi-plane, dynamic, constant traction of the foot in the correction position with congenital clubfoot.

The device is illustrated by a drawing, where its general view is schematically shown, and consists of a removable sleeve 2 made of thermoplastic material, for example, polyvik up to 3 mm thick, fixed with two fasteners 1, for example, velcro-type textile fasteners, in the region of the shank segments and hips. The sleeve 2 fixes the hip and lower leg in the position of flexion in the knee joint at 90 °, because when the knee joint is bent, the points of attachment of the calf muscle come closer, and the foot, freed from muscle traction, is easier to correct.

In the lower part of the shank segment of the sleeve by screwing, an adjustable rod 3 is fastened up to 8-10 cm long with an external threaded thread along the entire length and a nut. The rod is installed in a half-ring 4 (for example, from the Ilizarov apparatus) with a diameter of the inner surface of the arc up to 100-120 mm, on which threaded holes for the rod are made, for regulating the mounting along the length, width and height depending on the degree of deformation of the foot.

To fix the foot, a boot 5 with a hard sole is used. Shoes can be leather and must strictly correspond to the size of the feet, because should not be inside free space.

A multi-plane traction is applied behind the boot by an elastic element 6, for example, a rubber band, while the components of the deformation of the foot (equinus, adduction, supination, torsion) are taken into account. The diameter and tension of the elastic element are selected depending on the severity of the deformation of the foot and the age of the child.

The use of the claimed device is based on the features of the anatomical development of the conduction nerve pathways in children in the first months of life and the use of constant multi-plane traction, functionally affecting certain muscle groups. It is recommended to begin treatment of clubfoot as early as possible, from the moment of birth. The sooner treatment is started, the better and faster the correction of a deformed foot.

A method of treating congenital clubfoot in children is as follows.

At the initial stage, the sleeve is made of thermoplastic material (polyvic). For example, a cast (plaster) is taken for this, starting from the lower third of the lower leg to the upper third of the thigh. Next, in the lower part of the shin segment of the sleeve mounted adjustable rod with a half ring and fasteners.

The next step, the assembled sleeve with a half ring and a rod and shoes with a solid sole are put on the child and fixed to the limb with fasteners. For the boot, a multi-plane traction is applied with an elastic element, taking into account the components of the deformation of the foot. The amount, direction, points and traction force of the traction can be different depending on the degree of deformation.

Subsequent redressing is carried out under observation in the direction of correcting deformation when controlling muscular sensation, stretching the soft tissues and ligaments of the foot. Passive corrective gymnastics is carried out without pain and violence. This device not only allows you to keep the foot in the position of the achieved correction, but also constantly works to eliminate deformation. Periodically, the child’s parents can independently remove the device for monitoring and caring for the condition of the skin of the limb and the child receiving warm baths and physiotherapy.

The above device is applied for a period of 1 to 2 months. As the child grows, the sleeve changes, the strength and direction of traction are regulated.

The effectiveness of the use of the inventive device was tested in the treatment of children (boys) aged 5 days to 2 weeks with a diagnosis of "severe degree of bilateral clubfoot."

As a result of treatment, the complete elimination of deformation was achieved in a period of 3-4 months, which confirms the high efficiency of the device. Subsequently, the retention of the foot was carried out in an orthopedic splint.

Thus, the simplified and easy-to-use design of the device used according to the technical solution contributes to the restoration of normal limb supportability by the start of the child’s walk and allows painless correction of the foot deformity in a short time and a good functional result without complications.

The invention can be used in an outpatient service, while the manufacture of the device does not require significant material costs.

Claims (1)

A method of treating congenital clubfoot in young children, including the application of a corrective splint, the use of a footstep with elements of fixation of the foot and the distraction apparatus, characterized in that the corrective splint is performed as a removable sleeve with fasteners in the lower leg and thigh with a bend in the knee joint, an armrest for fixing the foot, they are made in the form of a boot with a solid sole, connecting it with a half ring with threaded holes by means of elastic elements, and the half ring is fixed in a segment those shins of the sleeve with the help of an adjustable rod, the subsequent reduction is carried out under observation in the direction of correction of deformation when controlling the muscular feeling, stretching the soft tissues and ligaments of the foot.

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