RU2732314C1 - Brace for treating keel-shaped chest deformity in girls/teens - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medical equipment. Orthosis comprises front thoracic plate, posterior dorsal plate connected by two lateral adjusting movable plates, left and right, shoulder belts. Front chest plate contains rows of adjusting holes, to which by means of screws there fixed are side adjusting movable plates, with the possibility of position change. Longitudinal compression platform is installed on the front thoracic plate, by means of the plank, with the possibility of changing its position along the length of the anterior thoracic plate. Front thoracic plate and the back dorsal plate are connected by two adjustable shoulder belts equipped with locks. Shoulder belts are installed with the possibility of changing their position along the length of the front chest plate. One side adjusting movable plate is connected with rear back plate by means of hinge and detachably. Other lateral adjusting movable plate is connected with the rear back plate by means of a hinge. Plates are covered with a hypoallergenic coating.

EFFECT: invention provides eliminating the bulge in the chest, taking into account the patient's individual characteristics, and reducing the risk of unfavourable results and improving the comfort of use for the patient and the doctor.

9 cl, 18 dwg

Description

The field of technology.

The invention relates to medical technology, and relates to devices intended for the correction of the sternocostal hump and fixation of the sternocostal complex in the non-surgical treatment of keeled chest deformities (pectus carinatum). The orthosis can also be used to treat other deformities such as Lushko's rib or kyphosis.

State of the art

KDGK is a congenital deformity of the chest, in the form of protrusion of the anterior wall, caused by dysplasia of the costal cartilage. The sternocostal complex at the junction of the costal arches with the sternum is deformed.

Treatment, in most cases, has cosmetic purposes, although in some, severe cases, there are no cosmetic indications for treatment, due to the effect of deformation on the functioning of internal organs. In the future, the development of CDGC can lead to deformation of the lungs, bronchi, heart, coronary vessels, lead to a violation of biomechanics and deformities of the spinal column.

Known methods of surgical and non-surgical treatment of CDC. The main goal of treatment is to correct the shape of the chest, eliminate protrusion by correcting and fixing the sternocostal complex in a given position.

A known method of treating congenital keeled chest deformity in children (source [1]: patent RU 2701696), including a skin incision in the deformation area, chondrotomy of deformed ribs and fixation of the sternocostal complex with a metal plate. A known method of treating congenital asymmetric keeled chest deformity (source [2]: patent RU 2386409) is a parasternal rib hump in children, including a transverse skin incision in the defect area, chondrotomy of deformed ribs and fixation of the sternocostal complex with metal plates,

However, the methods of treatment [1; 2] are traumatic surgical treatment that require surgical intervention and carry risks associated with the intervention. The use of orthopedic fixation is increasingly used as an alternative to CDC surgery. For treatment, many patients prefer the use of external orthoses designed for direct mechanical action on the protruding region of the chest. Non-surgical methods (without surgical treatment) are popular for the treatment of CDGC of a compliant chest, since they do not create risks for the patient inherent in surgical treatment (trauma, risk of infection, the need to restore wounds after treatment).

It is also known to combine surgical treatment with orthotics. A device for treating chest deformities and a method for treating CDC with its use is known from the prior art (source [3]: patent RU 2067854). The device contains a corset made of thermoplastic material and formed according to the patient's figure. An opening is made in the front half of the corset, which exceeds the size of the chest deformation; above the opening, there are transverse plates mounted on threaded rods. Threaded holes are made in the plates through which threaded stays with compression pads (stops) are installed. The device is used in the surgical treatment of CDC in the following way. A support corset is formed on the patient, consisting of the front and back parts. On the front of the corset, a hole is cut out that exceeds the size of the chest deformation. On the sides, the holes reinforce the corners. At the corners, several transverse plates with threaded holes are attached parallel to each other using threaded rods. Compression platforms are made of the required shape and size, and they are fixed on threaded rods. Surgically, the sternum is mobilized and stitched with thick mylar threads. The threads are tied to the transverse plates. Compression pads are installed along the line of resected ribs, which are attached using threaded rods and perform local modeling compression on the chest. In the postoperative period, the back part of the corset is applied, both halves of the corset are connected together with a Velcro tape. The patient is allowed to walk and active functional rehabilitation begins. Carrying out asymmetric distraction by uneven movement of the transverse plates and using asymmetric compression with compression pads on the protruding parts of the chest, deformity correction is achieved, any excessive hypercorrection is eliminated, and the correct shape of the chest is formed.

The disadvantages of this design and the method of its use [3] should include the need for surgical intervention to mobilize the sternum. In addition, the design of the device contains a bulky corset covering a significant part of the body, hindering natural air exchange, moisture exchange, heat exchange and restricting movement, for example, limiting the ability to tilt and turn the torso.

From non-invasive methods it is known to use a device for correcting the keeled deformity of the sternum and ribs of a child and a method for treating CDC with its use (source [4]: patent RU 178272). The device contains a chest support and a back support made of plates. The chest support and backrest are made of solid material, interconnected by two rigid support holders. The support holders are connected to the shoulder straps. The stop holders have a means for adjusting the length. The chest support is made of two interconnected chest plates having means for adjusting the relative position of the chest plates, made with the possibility of regulating the lateral displacement of the chest plate in case of an asymmetric deformation of the sternum and ribs of the child. The dorsal support is made of two interconnected dorsal plates having a means for adjusting the relative position of the dorsal plates, made with the possibility of regulating the lateral displacement and the distance between the dorsal plates, regardless of the symmetric or asymmetric deformation of the sternum and ribs of the child. The means for adjusting the mutual arrangement of the stop plates is made in the form of an adjusting screw, which can be fixed in the threaded groove of one plate and presses the second plate against it through one of several holes located in it. The plates have a protective cover made of filled fabric. Rigid stop holders are mainly made of metal. The method for treating CDC with the described device is as follows. The device is fixed on the body, until the plates are in close contact with the body. It is recommended to wear the proposed device just below the nipple line. The chest rest pressure plate should be between the nipples. Tighten the adjustment means (straps) of the support holders on both sides evenly, providing a compressive (pressing) force on the protruding part of the sternum. It is recommended to wear the proposed device for the first days for several hours a day. The child will achieve optimal results if the proposed device is worn continuously (23 hours a day, 7 days a week) for an average of 6-12 months.

The described device and method [4] of its use have disadvantages. The chest support of the device has insufficient width in width, does not have a means (platform) for distributing the compressive force along the length of the chest, as a result of which it does not provide a uniform distribution of the compressing force over the selected surface of the chest. The holders of the stops are rigid and are located in the region of the anterior lateral surface of the chest (armpits) and put pressure on the ribs and arms, creating additional (unnecessary) lateral force on the chest, not directed to the reduction of the protruding sternocostal complex. The geometric shape of the chest rest, plates, is not suitable for the treatment of CDGC in patients with large mammary glands (girls and women), since it does not take into account the need to evenly distribute the load on the soft tissues of the mammary glands. The use of the device [4], for patients with a significant volume of soft tissues in the area of the mammary glands, can lead to impaired blood flow, injury or tissue necrosis. The device and method of its application do not provide the selection of the optimal value of the compressing force necessary and sufficient for the treatment of deformity, but not traumatic. The device does not provide for control of the magnitude of the compressive force during treatment, this, in case of excessively high effort, is fraught with complications in the form of tissue trauma, and, in the case of excessively small effort, the absence of positive treatment results expressed in a decrease in the size of the protrusion of the sternocostal complex. The connection of the shoulder straps, in the area of the sternum support, is fixed, the ends of the shoulder straps are fixed on the support holders, which does not allow changing their position relative to the chest support. This does not allow them to advantageously change their position for the patient. The shoulder straps do not contain quick couplings, which complicates the process of mounting and dismounting the device. The support holders are made of metal plates, they are placed between the arms and the body and they cause discomfort, interfere with the implementation of hand movements. The chest and back supports contain a protective cover, but they do not have soft (damping) pads that reduce local pressure on the skin and do not provide a comfortable fit to the body. The design of the device and the way it is used do not provide a compressive force of more than 10 kg, for example, a force of 20 kg or 25 kg. The method and device do not allow to provide a reliably determined and sufficient compressive force necessary to correct the deformity and fix the sternal protrusion in the achieved position with minimal tissue trauma. Measurement of intrathoracic pressure is not provided before use and during use of the device, which can lead to complications, cause a negative effect on internal organs. The device does not allow metered and controlled changes in the compressive force. Using only the belt tightening to adjust the tension does not provide a uniform and controlled tension.

Known device for dynamic compression of the chest (source [5]: patent application PCT / BR2014 / 000379) and a method of using it. The device contains a chest support and two backrests fixed on transverse rods, front and back. The front and rear transverse rods are connected by pins with the possibility of mutual displacement to adjust the compression force. The transverse rods function as guides on which stops with pressure pads are installed. The device is installed on the chest, and the nuts of the threaded pins are tightened to apply a compressive force, which leads to the convergence of the sternum and dorsal supports.

The device [5] does not contain elements that ensure the holding of the device at the same level on the chest, for example, shoulder straps; during treatment, the device is able to move downward, which can lead to a change in the place of application of the compressive force. The device does not allow its use for the treatment of patients with enlarged mammary glands, since the geometric shape of the chest rest is flat. The chest support does not provide an even distribution of the pressing force along the midline of the sternum, since it does not contain elements of distributing forces along the sternum. The design of the device and the method of its use do not provide for the creation of a compressive force of more than 10 kg, for example, in 20 kg or 25 kg, do not allow to provide a reliably determined and sufficient compressive force necessary to correct the deformation and fix the thoracic protrusion in the achieved position with minimal trauma to soft tissues. Measurement of intrathoracic pressure is not provided before use and during use of the device, which can lead to complications, cause a negative effect on internal organs. The device does not allow metered and controlled changes in the compressive force, the use of belts to adjust the tightening force does not provide a uniform and controlled force.

Thus, today there is a problem that the known arsenal of technical means is not able to meet the individual needs of the patient and the attending physician. During the period of treatment, the chest grows in children and it is necessary to regularly monitor and regulate the compression. The known methods and devices for the non-invasive treatment of CDGC have such disadvantages as the absence of a procedure for determining and controlling the magnitude of the compressive force, the lack of the necessary technical means to determine and control the magnitude of the compressive force. The orthosis should take into account the individual characteristics, the degree of deformity, chest rigidity and bulging, anatomy, and the patient's age. The known methods and devices are not suitable for use in a group of patients with enlarged mammary glands. In pediatric gynecology and mammology, pressure on the area of the mammary glands during their growth is not recommended, as this can lead to a change in the course of the mammary gland ducts and abnormal growth of the mammary glands. Patients may experience breast asymmetry as a result of wearing rigid breast orthoses made of hard plastic, hard rubber or plaster. Correction of CDGC without regard to gender is complicated by the need to correct cosmetic defects of the mammary gland after correction with a compression orthosis. The known methods and devices can lead to local trauma to soft tissues, and do not provide a uniform distribution of the compressing force over the selected local surface of the chest, taking into account the distribution of force along the length and width of the protrusion, with the ability to provide a force of up to 25 kg. The known methods involve the use of devices with rigid plates, stops, they do not have elastic stops capable of numerous elastic deformations while maintaining the magnitude of the compressive force. The elasticity of the abutment plates is a necessary element to ensure a comfortable stay of the patient in the device, since the chest is mobile during inhalation and exhalation, and rigid plates and stops limit its natural mobility. The known methods and devices do not take into account the geometric dimensions of the chest and the height of the protruding part of the chest. The level of the compression force of the orthosis should not exceed certain values, because a high compression load causes the likelihood of pain from the sternum, leads to compression of the skin, maceration and necrosis.

Therefore, there is still a need to improve the non-surgical treatment of CDCA and the devices used, making their use more comfortable for both the physician and the patient, less risky, and less painful.

The essence of the technical solution.

The task is to locally correct the deformity of the chest, eliminate the protrusion of the sternum and ribs, prevent the further development of deformity, taking into account the individual characteristics of the patient, and reduce the risk of adverse results and increase the comfort of use for the patient and the doctor.

The technical result consists in eliminating the bulging in the chest, taking into account the individual characteristics of the patient, and reducing the risk of adverse results and increasing the comfort of use for the patient and the doctor.

The technical result is achieved by the fact that the orthosis for the treatment of keeled chest deformity contains a front chest plate, a back dorsal plate, connected by two lateral adjusting movable plates, left and right, shoulder straps. The front chest plate contains rows of adjusting holes, to which the lateral adjusting movable plates are fixed by means of screws, with the possibility of changing the position, on the front chest plate, by means of the bar, a longitudinal compression platform is installed, with the possibility of changing its position along the length of the front chest plate, to the right or to the left , the front chest plate and the back dorsal plates are connected by two adjustable shoulder straps equipped with quick-release locks, the shoulder straps are installed so that their position can be changed along the length of the front chest plate, one side adjusting movable plate is hinged and detachable to the rear back plate by means of a loop, the other lateral adjusting movable plate connected to the rear back plate by means of a hinged and detachable lock, front chest plate, rear back plate, side adjusting movable plates, longitudinal compression platform equipped with a soft hypoallergenic coating.

In accordance with another aspect of the present invention, it is provided that the front chest plate, the rear back plate, the side adjusting movable plates, the longitudinal compression plate are resilient.

It is envisaged that the front chest plate, back back plate, side adjusting movable plates, longitudinal compression platform are made of elastic stainless steel alloy 12x18n10t.

It is envisaged that the anterior chest plate is made of an individual anatomical shape.

It is envisaged that the anterior chest plate is made with protrusions designed to accommodate the mammary glands.

It is provided that the front chest plate contains a force sensor and a control unit with a display that reflects the value of the force in the metric system up to 25 kg.

It is provided that the anterior chest plate contains a control unit equipped with a non-volatile memory and a means of wireless packet data transmission about the amount of compressive force required for remote control by the attending physician.

It is envisaged that the adjusting holes are made with a step that provides, when the adjusting plate is moved, to change the value of the compression force by 1 kg.

It is envisaged that the longitudinal compression platform is 50 by 80 mm.

It is provided that the front chest plate is equipped with layers of elastic material silicone rubber.

The given and additional possible embodiments of the invention, and their advantages, as an example, without limiting the possibility of implementing other options, are illustrated by graphic materials:

Fig. 1 - Scheme, general view of the orthosis for patients with small mammary glands;

Fig. 2 - Scheme, general view of the orthosis for patients with enlarged mammary glands;

Fig. 3 is a schematic, general view of an orthosis equipped with a force sensor control unit for patients with small mammary glands;

Fig. 4 is a schematic, general view of an orthosis equipped with a force sensor control unit for patients with enlarged mammary glands;

Fig. 5 - Scheme, anterior chest plate, for patients with enlarged mammary glands;

Fig. 6 - Scheme, back dorsal plate;

Fig. 7 - Diagram, shoulder strap, lock.

Fig. 8 is a diagram of a compression platform;

Fig. 9 - Scheme, loop;

Fig. 10 - Photo of a general view of the orthosis for girls, shoulder straps removed.

Fig. 11 - Photo of the chest of a patient with CDC; there is an extension of the sternum forward relative to the normal position of this part of the chest;

Fig - Photo, measurement of intrathoracic pressure;

Fig - Photo, measurement of the lateral size of the chest using a special two-horned ruler;

Fig. 14 - Photo, compression test;

Fig - Photo, measurement of the anterior-posterior size of the chest using a two-horned ruler, in a free state;

Fig. 16 - Photo, measurement of the anterior-posterior size of the chest using a two-sided ruler, after pressing on the protrusion area until complete correction of the defect;

Fig. 17 - Scheme, measurements of the size of the chest, in a free state; where A is the width of the chest; B - the maximum thickness of the chest in a free state; D-distance from the apex of the deformity to the midline of the sternum;

Fig. 18 - Scheme, measurements of the size of the chest, after pressing on the protrusion area until complete correction of the defect; where C is the contour line of the cross-section of the chest in the deformation area; F - the thickness of the chest, after pressing on the protrusion area until the defect is completely corrected; E is the degree of deformation (difference between B and F).

The drawings indicate:

1 - anterior chest plate;

2 - back dorsal plate;

3 - left side adjustable movable plate;

4 - right lateral adjustable movable plate;

5 - shoulder strap;

6 - adjusting holes;

7 - screw;

8 - bar;

9 - compression platform;

10 - shoulder strap lock;

11 - loop;

12 - side plate lock;

13 - cover;

14 - anatomical protrusions for the placement of the mammary glands;

15 - force sensor;

16 - control unit with display;

17 - press machine (Press machine);

18 - two-horned ruler;

A is the width of the chest;

B - the maximum thickness of the chest in a free state;

D is the distance from the apex of the deformity to the midline of the sternum;

C - the contour line of the cross-section of the chest in the area of deformation;

F is the thickness of the chest, after pressing on the protrusion area until the defect is completely corrected;

E is the degree of deformation (difference between B and F).

Exercise device

The orthosis for the treatment of keeled chest deformity comprises an anterior chest plate 1, a posterior dorsal plate 2, connected by two lateral adjusting movable plates, left 3 and right 4, shoulder straps 5. The front chest plate 1 is elastic, i.e. able to deform elastically in a wide range of values. The front chest plate 1 is made in the form of a curved strip. The back dorsal plate 2 is made in the form of a strip curved around the circumference. This allows for dynamic loading. The front chest plate 1 contains rows of adjusting holes 6, to which the side adjusting movable plates 3 and 4 are fixed by means of screws 7, with the possibility of changing the position on the front chest plate 1. Each side adjusting movable plates 3 and 4 are fixed on the front chest plate 1 by two screws 7, located one above the other, this eliminates the possibility of uncontrolled displacement of plates 3 and 4. On the anterior chest plate 1, by means of a strap 8 and screws, a longitudinal compression platform 9 is installed, with the possibility of changing its position along the length of the anterior chest plate 1, to the right or to the left. The longitudinal compression platform 9 is longer in length than in width, this allows it to be positioned between the mammary glands and to distribute the compressive load over the surface and along the deformation area. The front chest plate 1 and the back dorsal plate 2 are connected by two adjustable shoulder straps 5 equipped with quick-release locks 10. Shoulder straps 5 allow you to keep the orthosis at a given height. The shoulder straps 5 are installed with the possibility of changing their position along the length of the front chest plate 1, this allows you to adjust the position of the shoulder straps 5 individually for the patient. One lateral adjusting movable plate (for example, left 3) is connected to the rear back plate 2 pivotally and detachably by means of a loop 11. This allows mutual rotation of the front chest plate 1 and the rear back plate 2, which is necessary when installing the orthosis. This allows mutual displacement of the anterior chest plate 1 and the posterior dorsal plate 2, thereby achieving a dynamic compression load. Another lateral adjusting movable plate (for example, right 4) is hingedly detachable to the rear back plate 2 by means of a lock 12. This provides the ability to separate the parts for installing the orthosis and the possibility of mutual displacement of the front chest plate 1 and the rear back plate 2 to achieve a dynamic compressive load. The anterior chest plate 1, the posterior dorsal plate 2, the side adjusting movable plates 3 and 4, and the longitudinal compression platform 9 are equipped with a soft hypoallergenic coating 13 necessary to reduce the contact pressure on the skin and soft tissues.

To reduce the negative effects of compression of the protruding part of the chest, the front chest plate 1, the back back plate 2, the side adjusting movable plates 3 and 4, the longitudinal compression platform 9 must be made elastic. This allows, during natural movements of the chest, to provide mobility and the necessary compression, without critical compression of soft tissues.

In a particular case, the front chest plate 1, the rear back plate 2, the side adjusting movable plates 3 and 4, the longitudinal compression platform 9 can be made elastic from an alloy of stainless steel 12x18n10t, which has the necessary elastic properties for a given thickness of the parts.

An orthosis for patients with enlarged mammary glands, (as shown in the example in Figs. 2, 4, 10), the anterior chest plate 1 is made of an individual anatomical shape (Fig. 5) with protrusions 14 designed to accommodate the mammary glands. This design eliminates the risks of a negative effect of the orthosis on the development of the mammary glands and allows using the cut for a long time without the need to replace it, with an increase in the size of the mammary glands during treatment.

The orthosis in one of the embodiments (as shown in the example in Figs. 3, 4) on the front chest plate contains at least one force sensor 15 and a control unit with a display 16 reflecting the value of the force in the metric system up to 25 kg. In this case, it is preferable to have three force sensors 15 to control the magnitude of the compression force. This design allows the doctor and the patient to constantly have information about the magnitude of the compressive force and to provide the optimal values of the force required to eliminate deformation.

The control unit 16 can be equipped with a non-volatile memory and a means of wireless packet data transmission about the amount of compressive force required for remote control by the attending physician. For example, by installing an electronic subscriber module used in mobile communications, in particular GSM networks, and a transmitter with independent autonomous power supply. This design allows the physician, in a constant mode, being remote, to have information about the magnitude of the compressive force and to control the course of treatment, the duration of wearing the cut, the time and duration of removal, the amount of the compressive force required to eliminate deformation.

The adjusting holes 6 can be made with a step providing, when moving the adjusting plate, to change the value of the compression force by 1 kg or 0.5 kg. This design allows you to set the required amount of compressing force depending on the stages of treatment, for example 6 kg, 10 kg, etc.

The longitudinal compression platform 9 in most cases for girls has a size of 50 by 80 mm. This design is suitable for most patients.

The front chest plate 1 is equipped with layers of elastic material silicone rubber, which makes it possible to additionally adjust the value of the generated compressive force by changing the number of layers (respectively, the thickness), before tightening the side plates 3 and 4 and fixing them on the front chest plate 1 with screws 7.

Using the orthosis

The orthosis is made according to the individual parameters of the patient, taking into account the magnitude of the deformity, anatomical features of the body structure, age, gender. The anterior chest plate 1 corresponds to the geometric shape of the protruding part of the chest. The orthosis is used in patients aged 4 to 30 years who have sufficient elasticity of the chest in the area of deformation, and they are able to heal in this way quite quickly - within a period from 3 months to 18 months. The orthosis allows you to correct deformities of the symmetrical and asymmetrical type in girls (girls) and boys (boys).

The value of the resistance force of the deformed portion of the sternum to compression (intrathoracic pressure) is measured using a press machine 17 (Press machine. Mustafa Yuksel, Turkey 2012). Correction with an orthosis is permissible when the deformed portion of the sternum resists compression up to 25 kg. Determine the magnitude of the compressing force sufficient to affect the deformed region of the chest in order to correct the shape and eliminate the protrusion. Measure the lateral size of the chest A - the width of the chest, and the anteroposterior size of the chest B - the maximum thickness of the chest in a free state, the distance from the apex of the deformity to the midline of the sternum D in a standing position using a two-sided ruler 18 ((Marcello M F. Argentina , 2006) in a free state, standing. (Fig. 17; 18). Conduct a compression test, for this in the position of the patient standing against the wall, hand compress the deformed region of the chest, assess the rigidity of the sternum, painless reduction of the protrusion indicates the possibility of treatment The anterior-posterior size of the chest is measured using a special two-horned ruler (Marcello M F. Argentina, 2006) in a deformed state.The thickness of the chest is determined after pressing the bulge until the defect is completely corrected F and the degree of deformity E, as a difference between B and F. Press on the deformity area, sternum, with the hand until the defect is completely corrected (corrected deformity by reducing the protrusion of the sternocostal complex) and measure the anterior-posterior size F of the chest using a two-horned ruler 18. The difference between these two dimensions B and F is the degree of deformity E, according to which the CDCA is classified. Determine the amount of compression force sufficient to affect the deformed area of the chest in order to correct the shape and eliminate protrusion, pressing the protruding part using a press machine 17.

At the first stage of treatment, a compression force of the orthosis is created in the range of 6 to 8 kg, the orthosis is installed for a period of 10 to 15 days. The used design of the orthosis allows you to set the required amount of the compressing force depending on the stages of the treatment of CDHC. For this, the back dorsal plate 2 is placed on the back, the front chest plate 1 is placed over the deformed region of the chest (over the protrusion). For patients with enlarged mammary glands (as shown in the example in Figs. 2, 4, 10), an anterior chest plate 1 of an individual anatomical shape (Fig. 5) is used with projections 14 designed to accommodate the mammary glands. This design eliminates the risks of a negative effect of the orthosis on the development of the mammary glands and allows using the cut for a long time without the need to replace it, with an increase in the size of the mammary glands during treatment. Plates 1 and 2 are connected by two lateral adjusting movable plates, 3 and 4. The cut is fixed in height with shoulder straps 5. The lateral adjusting movable plates 3 and 4 are installed by means of screws 7 on the front chest plate 1 using adjusting holes 6. Changing the position of the side plates 3 and 4 leads to a change in the distance between the posterior dorsal plate 2 and the anterior chest plate 1 and an increase or decrease in the amount of the compressing force, depending on which adjustment holes 6 the side plates 3 and 4 are fixed in. The longitudinal compression platform is moved on the anterior chest plate 1 9, to the left or to the right, by an amount D from the center line, placing it over the deformation region (above the protruding part), the position is fixed by means of the bar 8 and screws. The longitudinal compression platform 9 is longer in length than in width, this allows it to be positioned between the mammary glands and to distribute the compressive load over the surface and along the deformation area. Shoulder straps 5, fasten using quick-release buckles 10. Shoulder straps 5 allow you to keep the orthosis at a given height. The shoulder straps 5 are installed with the possibility of changing their position along the length of the front chest plate 1, this allows you to adjust the position of the shoulder straps 5 individually for the patient. The lateral adjusting movable plate 4 is connected to the rear back plate 2 by means of a lock 12. This allows the parts for installing the orthosis to be disconnected and the possibility of mutual displacement of the front chest plate 1 and the rear back plate 2 to achieve a dynamic compressive load.

After a period of 10 to 15 days of wearing the cut, it is removed and the resistance of the sternum, the value of the intrathoracic pressure is determined by palpation, and the presence of pain under the orthosis is assessed. The intrathoracic pressure after the first stage of treatment should be in the range of 10 to 15 kg, and there is an increase in chest rigidity. In this case, the pain should be absent, if there is pain, treatment is suspended. With positive dynamics (increased chest rigidity), they move on to the second stage of treatment. If there is no effect after the first stage of fixation with a cut, fixation with an orthosis with a compressive force in the range from 6 to 8 kg is extended for another period from 10 to 15 days. At the first stage of treatment, the patient must wear a brace for at least 22 hours a day.

At the second stage of treatment, a sufficient compressive force of the orthosis is created in the range from 8 to 10 kg, the orthosis is installed for a period of 15 to 20 days. In patients over the age of 18, the amount of sufficient compressive force can reach values up to 25 kg, with a high degree of stiffness of the sternum. In the process of the second stage of treatment, the patient is assigned therapeutic gymnastics and exercise therapy. Constant monitoring of the condition of the skin under the orthosis is carried out, since at this stage of treatment, skin compression and maceration may occur. After a period from 15 to 20 days of wearing the cut, it is removed and the resistance of the sternum, the value of the intrathoracic pressure is determined by palpation, and the presence of pain under the orthosis is assessed. In this case, the pain should be absent, if there is pain, treatment is suspended. In case of positive dynamics (decrease in the elasticity of the chest), they proceed to the third stage of treatment. If there is no effect after the second stage of fixation with a cut, fixation with an orthosis with a compressive force in the range from 8 to 10 kg is extended for another period from 15 to 20 days. At the end of the second stage, the cosmetic appearance of the chest should be not satisfactory with a probability of 90%. However, this often results in a protrusion of the costal arch and compensatory kyphosis. At the second stage of treatment, the patient must wear a brace for at least 22 hours a day.

In the third stage of treatment, the compression orthosis should touch the chest without compression and should provide compressive force only during inhalation. In the third stage, the orthosis is worn for a period of 8 to 12 months under the periodic supervision of a doctor. During this long period, in children and adolescents, the chest grows in side and width, the growth of mammary glands in girls. During the third stage, every 20 to 30 days of treatment, it is necessary to gradually release the compressive force by adjusting the size of the orthosis from the side, rearranging the side plates 3 and 4 in the adjustment holes 6 on the anterior chest plate 1.

During the entire period of treatment, under the anterior compression platform 9 of the orthosis, if necessary, or add additional pillows, layers, for example, of silicone rubber. At the third stage of treatment, arching of the costal arches and compensatory kyphosis are most often observed. In order to correct this phenomenon, a soft compressive bandage is applied to the area of rib curvature and compensatory kyphosis is corrected using a soft posture corrector.

The duration of wearing the orthosis according to the scheme is selected individually and depends on the degree of deformity, type and age of the patient. In the first and second stages of treatment, the patient must wear a brace for at least 22 hours a day. The patient can remove it every 5 hours, 4 times a day, for 30 to 45 minutes. At this time, the patient can eat, take a hygienic shower, change clothes. During the removal of the orthosis, it is necessary to treat the skin at the site of the skin orthosis with baby powder, to carry out a light local massage of the skin to improve blood circulation.

After a period of 7 to 8 months from the start of treatment, at the third stage, the wearing time of the orthosis can be reduced by 1 hour every month, and from 10 to 11 months it is necessary to extend the wearing time again, gradually increasing to 22 hours a day.

Throughout the entire treatment process, the patient is prescribed physical therapy on an outpatient basis, spinal massage and a hard orthopedic mattress.

The duration of the complex treatment is up to 18 months.

If the required compressive force (intrathoracic pressure) is more than 25 kg, and a high degree of stiffness of the chest bone (the presence of increased resistance (rigidity) of the chest is more often observed in patients over the age of 18 years), or if the result of orthosis treatment is unsatisfactory, it is recommended to correct the CDC using a minimally invasive method according to Abramson in the presence of a symmetric type and minimally invasive method according to Sandwich-I, II with an asymmetric type of CDHC (Park.HJ) or correction of CDHC by an open method according to Ravich.

Peculiarities of treatment of symmetric and asymmetric type CDGCs using a compression orthosis in girls.

CDCA in girls occurs with the same frequency as in boys, but treatment is different, especially during puberty and post-puberty. The mammary glands in girls develop from the age of 12 and care must be taken when wearing a compression orthosis. In pediatric gynecology and mammology, pressure on the area of the mammary glands during their growth is not recommended, as this can lead to a change in the course of the mammary gland ducts and abnormal growth of the mammary glands. The result is an asymmetry of the mammary glands in girls. Patients often deal with breast asymmetry resulting from wearing breast braces made of plastic, rubber or plaster. Ultimately, the correction of CDHC is complicated by the need to correct cosmetic defects of the breast after correction with a compression orthosis. Thus, the correction of KDGK in girls has its own characteristics.

First, you need to pay attention to the age, physique, development, size of the mammary glands and the expected dynamics of increasing their size.

Secondly, the type of deformity, the position of the mammary glands (lateral, medial, upper standing, asymmetry of the mammary glands) are important;

Thirdly, the presence of concomitant diseases, such as curvature of the spine (scoliosis, kyphosis, lordosis), deformities of the ribs, pathology of the hip joint, anomalies and pathology of the intrathoracic organs, etc., matters.

For girls, before installing the orthosis, a template of the chest circumference is formed from the side of the mammary glands. The anterior chest plate 1 of the orthosis is formed according to the template, taking into account the forecast of an increase in the size of the mammary glands in a period of 18 months for the patient of this patient. The anterior chest plate 1 is installed so that there is no contact with the plate with the mammary glands. When wearing the orthosis, attention should be paid to the contact between the skin of the mammary glands and the inside of the orthosis to be sure that there is no compression of soft tissues. The compression platform 9 of the orthosis is installed between the mammary glands on the protruding part of the chest, so that. For girls, they also measure the size of the chest, measure the amount of sufficient compressive force (intrathoracic pressure) and conduct a compression test. During the compression test, the deformed area is depressed so that it must be corrected, and the appearance of the mammary glands must also be satisfactory. If the indicators of intrathoracic pressure are not high and the angle of rotation of the sternum is small, then treatment is performed using an orthosis as described above. At the same time, at the first stage of treatment, wearing the orthosis is carried out with a compressive force of 5 to 6 kg for 10 to 14 days. During the treatment, the deformed area is visually and palpably checked and the results of the correction are noted. Treatment in the second and third stages is carried out using an orthosis, as described above.

With CDGC with medium and large mammary glands in girls, a narrow compression platform 9 (60 × 80 mm) should be selected so as not to squeeze the edges of the mammary glands and to easily control the compression of the central part of the deformed part of the breastbone. Treatment also includes the first, second and third stages, as described above. When breast compression appears during treatment, the anterior breast plate 1 is removed and a sufficient level of soft rubber cushion (1-2-3-4 layers) is gradually added under the anterior breast plate 1 layer by layer until a sufficient compressive force of the orthosis is achieved and the contact of the plate 1 is eliminated with the mammary glands. The second stage of treatment lasts from 20 to 60 days, and if the result is good, the third stage of correction is started. In the third step, the intrathoracic pressure, resistance and stiffness of the sternum are re-measured. The presence of pain is assessed, the effectiveness of the correction and its effect on the cosmetic appearance of the mammary glands, their growth and symmetry are assessed. At the third stage, the value of the compressive force is in the range from 1 to 3 kg. During this treatment, it is necessary to adjust the circumference of the orthosis using the lateral adjustment holes 6, and / or adding additional pads to the anterior chest plate 1. In the process of the second and third stages of treatment, the patient is prescribed therapeutic exercises and exercise therapy. At the third stage, the correction of compensatory kyphosis begins with the help of a soft posture corrector. A positive result of treatment is considered when correcting the deformity of the sternum and maintaining the normal shape and symmetry of the mammary glands. The duration of wearing the orthosis, as well as the duration of each stage, is variable and individual, depending on the degree of deformity, its type and the patient's age.

The positive result of the correction of CDHC in girls, taking into account the preservation of the normal structure of the mammary gland, is 90-94%.

Claims (9)

1. An orthosis for the treatment of keeled chest deformity, comprising a front chest plate, a back dorsal plate, connected by two lateral adjusting movable plates, left and right, shoulder straps, characterized in that the front chest plate contains rows of adjusting holes, to which are fixed by means of screws lateral adjusting movable plates, with the possibility of changing the position, on the front chest plate, by means of the bar, a longitudinal compression platform is installed, with the possibility of changing its position along the length of the front chest plate, to the right or left, the front chest plate and the rear back plate are connected by two adjustable shoulder straps equipped with locks, shoulder straps are installed with the possibility of changing their position along the length of the front chest plate, one lateral adjusting movable plate is hingedly and detachably connected to the rear dorsal plate by means of a loop, the other lateral adjustment The forefoot movable plate is hingedly detachable with a lock to the rear dorsal plate, the front chest plate, the back dorsal plate, lateral adjusting movable plates, the longitudinal compression platform are equipped with a hypoallergenic coating. 2. The orthosis according to claim 1, characterized in that the front chest plate, back dorsal plate, lateral adjusting movable plates, longitudinal compression platform are made elastic. 3. The orthosis according to claim 1, characterized in that the front chest plate, back dorsal plate, lateral adjusting movable plates, longitudinal compression platform are made of elastic stainless steel alloy 12x18n10t. 4. The orthosis according to claim 1, characterized in that the anterior chest plate is made of an individual anatomical shape. 5. The orthosis of claim. 1, characterized in that the front chest plate is made with protrusions designed to accommodate the mammary glands. 6. The orthosis of claim. 1, characterized in that the front chest plate contains a force sensor and a control unit with a display that reflects the amount of force in the metric system up to 25 kg. 7. The orthosis according to claim. 1, characterized in that the front chest plate contains a control unit equipped with non-volatile memory and means of wireless packet data transmission about the amount of compressive force required for remote control by the attending physician. 8. The orthosis according to claim 1, characterized in that the longitudinal compression platform is 50 by 80 mm. 9. The orthosis according to claim 1, characterized in that the front chest plate is equipped with layers of elastic material - silicone rubber.

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