RU2801292C2 - Device for the rehabilitation of the spine and joints with multiplanar deformity - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: device for influencing the spinous processes of the vertebrae contains a body with a fixed handle, a straight movable bar located in the body, and a mechanism for moving the bar. A fixed handle is fixed to the upper surface of the body. One wedge is fixed with screws to the opposite end part of the body, at the other end of the bar, there is a removable handle fixed with a screw to another wedge made integral with the handle. The said wedges have a plane for closing, and on the opposite surfaces of the said wedges there are holes corresponding to the anatomy of the spinous processes with marginal thickenings and edges. The mechanism for moving the bar contains the first and second plates, each of which is mounted on the movable bar by means of a corresponding slot in the plate, two springs mounted on the movable bar, the first of which is compressed between the plates, and the second is compressed between the housing wall and the second plate, a movable handle in the form of a two-arm lever pivotally mounted on the body with the possibility of approaching one of the lever arms to the fixed handle of the body, and a button to disable the fixation of the movable bar. The first plate is initially skewed by the first spring when one end of the first plate rests against the protrusion on the body and its other end contacts the pressing element of the button, and the second plate is not initially skewed when its one end is fixed in the housing groove and its other end contacts the second arm of the lever. On the bar there is a scale in mm to control the amount of expansion of the wedges. At one end of the bar, a limiter for the movement of the bar is made.

EFFECT: invention provides more effective impact on the spinous processes of the vertebrae, reduction of tissue trauma due to the parallel distribution of impact forces by the wedges, and increased ease of use of the device.

1 cl, 1 ex, 2 dwg

Description

The invention relates to medicine, medical equipment for the rehabilitation of the spine with congenital or acquired multiplanar deformity, adjacent and/or combined.

The prior art known methods of healing the spine and joints: EN 2545447, publ. 03/27/2015 using a device for improving the spine and joints RU 137194 publ. 02/10/2014; RU 2644267, publ. 08/24/2016.

Known methods and devices, with all the positive properties, are limited in their capabilities and have a number of disadvantages:

- There is no stable fixation of the expansion of the intervertebral, interarticular, intertransverse, intercostal spaces.

- The expansion of the wedges occurs at an angle, which leads to displacement of the nucleus pulposus.

- In the process of exposure, a large load is created on the hands, due to the need to keep the handles of the device in a compressed state.

The objective of the present invention is to create a device for influencing the spinous processes of vertebrae with multiplanar deformations with the elimination of the above disadvantages of known devices.

The technical results are a more effective impact on the spinous processes of the vertebrae, a decrease in tissue trauma due to the parallel distribution of the impact forces by the wedges, and an increase in the usability of the device.

This problem is solved with the achievement of the indicated technical results by the fact that a device is proposed for influencing the spinous processes of the vertebrae, containing a body with a fixed handle, a straight movable bar located in the body, a mechanism for moving the bar, a fixed handle is fixed to the upper surface of the body, to the opposite end part of the body, one wedge is fixed with screws, at the other end of the bar, a removable handle with another wedge is fixed with a screw, made integral with the handle, while the mentioned wedges have a plane for closing, and on the opposite surfaces of the said wedges holes are selected corresponding to the anatomy of the spinous processes with marginal thickenings and edges , the mechanism for moving the bar contains the first and second plates, each of which is mounted on the movable bar by means of a corresponding slot in the plate, two springs mounted on the movable bar, the first of which is compressed between the plates, and the second is compressed between the housing wall and the second plate, a movable handle in the form of a two-arm lever pivotally mounted on the body with the possibility of approaching one of the lever arms to the fixed handle of the body and a button to disable the fixation of the movable bar, the first plate being initially skewed by the first spring when one end of the first plate abuts against the protrusion on the body and its other end contacts with a pressing element of the button, and the second plate is not initially skewed when its one end is fixed in the groove of the body and its other end is in contact with the second arm of the lever, while a scale in mm is made on the bar to control the amount of expansion of the wedges, and a limiter is made at one end of the bar plank movements.

The claimed device is illustrated by drawings in Fig. 1 and 2:

Fig. 1.

1 - The body of the device with mechanical movement of the bar (3).

2 - Fixing screws to the body of the device for wedges and for the fixed handle.

3 - Mobile bar in the device.

4 - Fixed handle of the device;

5 - Button for disabling the fixation of the bar (3) and for moving it and setting it in the desired position.

6 - Bar movement limiter (3).

7 - Monolithic wedge on the handle (12).

8 - Wedge fixed to the body of the device (1).

9 - Thumb screw for fixing the handle (12) on the bar (3).

10 - Scale in mm on the bar (3) to control the spreading of the wedges.

11 - Level on the handle (12) for controlled action in the frontal plane.

12 - Removable handle on the bar (3) with a solid wedge (7).

13 - Hole in the wedge on the handle (12), corresponding to the anatomical dimensions of the spinous processes and a mirror-like hole in the wedge (8) (indicated by a dotted line).

14 - Edge mirrored to edge (15) for congruent insertion into the vertebral segment.

15 - Edge for introduction in a closed state with an edge (14) between the spinous or transverse processes.

16 - Marginal thickenings of the wedge (7) for influencing the spinous processes displaced contralaterally relative to each other.

17 - Marginal thickenings of the wedge (8) for influencing the spinous processes displaced contralaterally relative to each other.

18 - Movable handle for compression with a fixed handle (4); in this case, the force displacement of the bar (3) with the handle (12) fixed on it occurs and a parallel expansion occurs between the wedges.

Fig. 2.

3 - Mobile bar in the device.

5 - Button for disabling the fixation of the bar (3) and for moving and setting it in the desired position.

18 - Movable handle for compression with a fixed handle (4); in this case, the bar (3) with the handle (12) fixed on it is displaced and the space between the wedges expands.

29 - Stopping steel plate with a slot in it for the bar (3), initially not skewed, preloaded with a spring (32) and allows the bar (3) to move freely.

30 - Stopping steel plate with a slot in it for the lath, initially skewed by the spring (31).

31 - Spring that warps the locking plate (30).

32 - Spring keeping the stop plate (29) not warped.

33 - Working end, movable around the axis (34) of the handle (18).

34 - Axis of the working end of the movable handle 18.

The device for improving the spine is designed to affect the spinous processes of the vertebrae. The device is equipped with a housing with a mechanism for moving the bar (3), which has a movement limiter (6) at one end, and a wing screw for attaching a removable handle with a monolithic wedge (7) at the other end. On the handle (12) there is a level for controlled action in the frontal plane. The bar (10) has a scale in mm to control the spreading of the wedges (7 and 8). In the wedge of the handle (12) there is a hole corresponding to the anatomical dimensions of the spinous processes. The same hole is mirrored in the wedge (8), fixed with screws to the body. A fixed handle (4) is fixed on the upper surface of the body with screws.

The mechanism for moving the bar (3) is embedded in the body of the device (1) and consists of two locking steel plates with a slot, dressed on the bar and preloaded with springs resting against the body. One of the steel plates (30) is locking and initially skewed by the spring (31), due to one-sided fixation in the housing groove. The slotted steel plate (29) is pressed by the spring (32), is initially not warped and allows the bar (3) to move freely. When compressing the handles (18) and the fixed one (4), the working end (33) of the handle (18), rotating around the axis (34), squeezes out, warping the steel plate with a slot (29) and moves it together with the bar (3). At the same time, the slotted steel plate (30) does not interfere with the movement of the bar (3) towards the handle. When the handle (18) is released, the mechanism returns to its original position: the steel plate with a slot (30) warps and wedges the bar (3) to move towards the handle. And the slotted steel plate (29) returns to its original position without interfering with the movement of the bar in any direction. When the button (5) is pressed, the steel plate (30) is leveled and releases the bar (3) for movement.

The impact of the device on the spinous processes makes it possible to exclude the holding of the handles in a constantly compressed state in time, keeping the extended wedges in the joints. In the proposed device, after spreading the wedges, we hold only the device, since the position of the wedges before pressing the button (5) is fixed.

When the pelvic bones are skewed, which occurs with multiplanar spinal deformities, the disposition of the sacrococcygeal joint occurs, which also leads to disorders of the genitourinary system. The sacrum, consisting of vertebrae connected by syndesmoses, is subject to deformations that cannot be removed by hand. The device is installed with wedges in a closed state and pressed into the segmental gaps (syndesmoses) in the sacrum. The rudiments of the spinous processes (in the form of tubercles) serve as landmarks. By squeezing the handles (18 and 4), we gradually increase the intervertebral, sacral spaces with derotation. This effect is carried out gradually, with pauses in time. Further, holding the device with the wedges inserted into the joint, we swing and derotate in the frontal plane. This is similar to working with a screwdriver inserted into the slot of a screw. Having passed all the intervertebral fissures of the sacrum, we center the position of the coccyx.

After that, we install the wedge (8) in a closed state with the wedge (7), for example, in the segment S1, L5 between the base of the sacrum and the spinous process L5 and make a smooth and dosed expansion. In the presence of rotations in adjacent vertebral bodies, we place closed wedges (7 and 8) in the interspinous space and, contralateral to the rotations, unfold and move the wedges apart (emphasizing pressure with marginal thickenings 16 and 17) until the spinous processes align in the sagittal plane. The device makes it possible, by placing a wedge (8), for example, in segment S1, L5 and pressing the lock button (5), to move the bar (3) with a fixed wedge (7) on the handle (12) and act in the cranial direction on the spinous processes above located vertebrae, restoring the intervertebral spaces. Manipulations are carried out with reference to the level (11), scale (14).

To influence the spinous processes during retrolisthesis, as one of the components of multiplanar deformity, we use wedges with holes for the end parts of the spinous processes. The force impact is carried out along the longitudinal axis of the spinous process by compressing the handles (18) and (4) with a cranial accent.

To eliminate rotational twisting of the vertebral bodies, closed wedges of the device are inserted into the damaged joint. We deploy the device contralateral to the twist, after which we perform a gradual dosed dilution of the wedges with retention in time, allowing the ligaments, tendons and muscles to rebuild.

The device is possible, when installed across the sternum, to displace the heads of the ribs laterally to the physiological position, acting on the sternocostal joints. When installing the device along the sternum, we eliminate the compression of the syndesmosis of the sternum and cartilaginous connections with the ribs.

Sequence of the impact of the device on damaged joints of the spine.

After the anamnesis and palpation examination, the patient is placed on the bench. The device is acted upon through a soft tissue (for example, a terry towel). The force impact on the spinous processes is carried out with wedges with holes for the end parts of the processes. The impact is carried out along the longitudinal axis of the spinous process in the cranial direction during retrolisthesis and in the frontal plane when the rotation of the spinal motion segment is eliminated.

To eliminate rotational twists of the vertebral bodies, closed wedges of the device are inserted into the damaged joint of the spine to the desired depth. We deploy the device contralateral to the twist, after which we perform a gradual dosed dilution of the wedges with retention in time, allowing the ligaments, tendons and muscles to rebuild.

When the pelvic bones are skewed, the disposition of the sacrococcygeal joint occurs, which also leads to disorders of the genitourinary system. The sacrum, consisting of vertebrae connected by syndesmoses, is subject to deformations that cannot be removed by hand. The device is installed with wedges in a closed state and is pressed into the segmental space of the sacrum. The rudiments of the spinous processes (in the form of tubercles) serve as landmarks. By squeezing the handles (18 and 4), we gradually increase the intervertebral, sacral spaces. This effect is carried out gradually, with pauses in time and very carefully. Further, holding the device with the wedges inserted into the joint, we swing and derotate in the frontal plane. This is similar to working with a screwdriver inserted into the slot of a screw. Having passed all the intervertebral fissures of the sacrum, we center the position of the coccyx.

The device is possible, when installed across the sternum, to displace the heads of the ribs laterally to the physiological position, acting on the sternocostal joints. When installing the device along the sternum, we eliminate the compression of the syndesmosis of the sternum and cartilaginous connections with the ribs.

The impact of the device on the spinous processes makes it possible to exclude the holding of the handles in a constantly compressed state in time, keeping the extended wedges in the joints. In the proposed device, after spreading the wedges, we hold only the device, since the position of the wedges before pressing the button (5) is fixed.

The mechanism that creates the power movement of the steel bar (3) operates only in one direction when the handles (4) and (18) are compressed. A handle (12) with wedges is installed at the end of the movable steel bar (3). The handle (12) is fixed to the steel bar (3) with a wing screw (9). To return the steel bar (3) to its original position, it is necessary to press the button (5) with a hold, which makes it possible to move the steel bar (3) in any direction for installation and subsequent actions on other damaged joints. Expansion sufficiency control when eliminating articular compressions is determined by the scale in mm on the bar (3). The impact in the frontal plane is controlled by the level (11). The mechanism of unilateral movements of the steel bar (3) only in one direction by the handles (12) with wedges depends on the impact point.

We give an example of the implementation of a method for improving the spine and joints with multiplanar deformity in patient M., 56 years old. After carrying out clinical and laboratory, X-ray studies, MRI and establishing the diagnosis of multiplanar deformity, we place the patient on a bench on the stomach with an elastic roller under the shins to relax the back muscles.

To influence the spinous processes, wedges with holes are used for the end parts of the spinous processes. The force impact is carried out along the longitudinal axis of the spinous process by compressing the handles (27) and (4) with a cranial accent. When the pelvic bones are skewed, the disposition of the sacrococcygeal and pubic joints occurs, which also leads to disorders of the genitourinary system. The sacrum, consisting of vertebrae connected by syndesmoses, is subject to deformations that cannot be removed by hand. The device is installed with wedges in a closed state and pressed into the segmental gaps (syndesmoses) in the sacrum. The rudiments of the spinous processes (in the form of tubercles) serve as landmarks. By squeezing the handles (18 and 4), we gradually increase the intervertebral, sacral spaces with derotation. The impact is carried out gradually, with pauses in time. Further, while holding the device with the wedges inserted into the joint, rocking and derotation are performed in the frontal plane. Reminds me of working with a screwdriver inserted into the slot of a screw. Having passed all the intervertebral fissures of the sacrum, we center the position of the coccyx.

After that, we install the wedge (8) in a closed state with the wedge (7) in the segment S1, L5 between the base of the sacrum and the spinous process of L5 and make a smooth and dosed separation. In the presence of rotations in adjacent vertebral bodies, we place closed wedges (7 and 8) in the interspinous space and, contralateral to the rotations, unfold and move the wedges apart (emphasizing pressure with marginal thickenings 16 and 17) until the spinous processes align in the sagittal plane. The device makes it possible, by placing a wedge (8), for example, in segment S1, L5 and pressing the lock button (5), to move the bar (3) with a fixed wedge (7) on the handle (12) and act in the cranial direction on the spinous processes of the superior vertebrae , restoring intervertebral spaces. Manipulations are carried out with reference to the level (11), scale (14).

To eliminate rotational twisting of the vertebral bodies, the closed wedges of the device are inserted into the damaged joint. We deploy the device contralateral to the twist, after which we perform a gradual dosed dilution of the wedges with retention in time, allowing the ligaments, tendons and muscles to rebuild.

The holding of the device, the stability of the installation and the impact have been significantly improved: due to the fixed handle (4) and the handle (12) of the device. The clamping force is more stable and more controllable.

Possibility of using one wedge, which is easier to insert than a wedge of two wedges. One wedge is gradually inserted into the affected segment, the second wedge is placed 1, 2, 3… segments higher than the injured (taking into account the length of the bar 3) with subsequent movement from the injured segment in the cranial direction.

The wedge device facilitates insertion, insertion, insertion into the interarticular spaces and allows displacement in a predominantly cranial direction.

The device is used both in an independent method of recovery or in the preparatory stage for surgical treatment.

Claims (1)

A device for influencing the spinous processes of the vertebrae, comprising a body with a fixed handle, a straight movable bar located in the body, a mechanism for moving the bar, a fixed handle is fixed to the upper surface of the body, one wedge is fixed to the opposite end part of the body, one wedge is fixed to the other end of the bar is fixed with a screw a removable handle with another wedge made integrally with the handle, while said wedges have a plane for closing, and on opposite surfaces of said wedges there are holes corresponding to the anatomy of the spinous processes with marginal thickenings and edges, the mechanism for moving the bar contains the first and second plates, each of of which is mounted on a movable bar by means of a corresponding slot in the plate, two springs mounted on a movable bar, the first of which is compressed between the plates, and the second is compressed between the housing wall and the second plate, a movable handle in the form of a two-arm lever, pivotally mounted on the housing with the possibility of approaching one of the arms of the lever to the fixed handle of the body, and a button to disable the fixation of the movable bar, and the first plate is initially warped by the first spring when one end of the first plate rests against the protrusion on the body and its other end contacts the pressing element of the button, and the second plate is initially not warped when fixing its one end in the groove of the body and contacting its other end with the second arm of the lever, at the same time, a scale in mm is made on the bar to control the amount of expansion of the wedges, and at one end of the bar there is a limiter for the movement of the bar.

Images