RU58911U1 - MODULAR ORTHOPEDIC APPARATUS - Google Patents

Abstract

The invention relates to medicine, namely to devices for treating patients with the consequences of damage to the central nervous system and with damage to the musculoskeletal system and can be used in neurology, neurosurgery, traumatology, orthopedics, in particular, for the treatment and rehabilitation of patients with cerebral palsy, patients with spinal injury, scoliosis, etc.

A modular orthopedic device is proposed, where a rigid orthosis on the lumbar spine is used as one of the modules, containing flat seating areas made at an angle to the vertical in the area of the hip joints, on which hinges are placed, connecting this orthosis with tires rigidly fixed to the side of the sleeves hips.

By using the structure thus obtained, the movement of the lower extremities is ensured while walking in an arc (from the inside to the outside), which ensures optimal movement of the femoral head in the acetabulum. As a result, under the influence of vertical loads, the formation of anatomically correct ratios in the hip joint occurs.

As other modules, the apparatus may contain a rigid crimping sleeve on the lower leg connected to the thigh sleeve with a flat hinge and / or an orthosis for the shoulder girdle and chest part of the body, made in the form of a rigid arch connected in its lower part with an orthosis for the lumbar spine.

As studies have shown, the use of the apparatus allows you to restore or improve the function of the lower extremities, get the opportunity to move independently, correct bone-articular deformities, prevent secondary deformations, and form the correct stereotypes of movement.

Description

The utility model relates to medicine, namely to devices for treating patients with the consequences of damage to the central nervous system and with damage to the musculoskeletal system and can be used in neurology, neurosurgery, traumatology, orthopedics, in particular for the treatment and rehabilitation of patients with cerebral palsy , patients with spinal cord injury, possibly complicated spinal cord injury, scoliosis, patients with consequences of traumatic brain injury and acute cerebrovascular accident.

The problem of treatment of the above diseases is extremely urgent due to the presence of a large number of patients suffering from such diseases. Moreover, there is a growth trend in patients with these diseases.

Currently, various devices are known for restoring the musculoskeletal functions of various departments of the musculoskeletal system of a person. Almost all known orthopedic devices for the treatment of pathologies of the lower extremities are the so-called “external skeleton” that protects the function of the muscles and capsule-ligamentous apparatus of the joints of the limbs. Thus, US Pat. No. 5,658,242 describes a device for facilitating the musculoskeletal functions of the lower extremities, comprising a lumbar support element (band) connected through an elastic-elastic connection with the ankle support bandages and support bandages for the thigh. The specified bandages are connected

between each other by rigid rods, which have an articulated joint in their middle part at the level of the knee joint.

The specified device provides load relief from the muscles of the legs when walking and contributes to some restoration of the musculoskeletal functions of the legs of a user who has suffered an injury or disease of the lower extremities. However, the use of a rigid “external skeleton” leads to weakening and hypotrophy of the muscles of the lower extremities.

In the treatment of the musculoskeletal system of the upper limbs, well-known devices can be used to treat various parts of the upper limbs, for example, “Unloading bandage on the upper limb”, “Elbow bandage”, “Bandage on the wrist”, “Splint of the first finger”, “Wrist holder "(Catalog of orthopedic products, SPC" Spark ", Moscow, 1998, pp. 12, 13, 33).

However, these devices are difficult to use at the same time, since each of them is suitable for autonomous use only in the treatment of specific pathologies of the upper extremities.

To eliminate the consequences of injuries and operations of the lumbar spine, a device made in the form of a corrective corset for the lumbar spine equipped with longitudinal metal inserts is widely used (Catalog of orthopedic products, SPC Ogonyok, Moscow, 1998, p. 29). Such a device for certain diseases provides fixation of the lumbar spine in a physiologically favorable position. However, these devices do not provide for the possibility of their joint use in the event of such a need for medical reasons.

A device for the treatment of patients with impaired posture and motor activity (RF patent 2054907, 01/31/1992), which is a suit of complementary supporting-static and dynamic elements. The supporting-static elements of this costume are a combination of shoulder, pelvic, knee, foot, elbow, wrist and

finger supports and are interconnected by dynamic elements - elastic rods that provide the creation of a dosage load, correcting the patient’s posture. Each rod is connected to two supports by fixing one end to one of the static supporting element through a tension regulator and rigidly fixing the other end to another static supporting element. Due to this connection, the location of the elastic rods with respect to the user's body is carried out in pre-selected directions, namely, along the front, side and rear surfaces of the patient's body. The specified location of the elastic rods cannot be changed depending on the pathology of the user. If it becomes necessary to change the user's corrected position, the use of another similar device is required, taking into account the correction of the user's pathology. Thus, the specified device is functionally limited.

A device for the treatment of patients with damage to the musculoskeletal system, including the consequences of damage to the central nervous system (RU 2131232, 1998). This device is a suit of complementary elements and contains:

- a declinator for the upper body of the user, which is a supporting and staging bandage (OPB) for the upper shoulder girdle and chest part of the body, made in the form of a pelot, the height of which is not less than the distance from the seventh cervical vertebra to the lower edge of the user's shoulder blades, and the width is not less than the distance between the vertical lines bounding the medial parts of the blades;

- OPB for the shoulders, made in the form of pelots, having the shape of triangles corresponding to the anthropometric dimensions of the shoulders and shoulder joints of the user;

- OPB for the lower back, made in the form of a belt having a device for interlocking with other supporting-staging elements;

- OPB for the lower extremities, representing kneecaps and kneecaps,

- bandages on the front of each foot,

- bandages for each ankle joint and each calcaneal region.

OPB for the shoulder girdle and the thoracic part of the body re-sets the muscles of the thoracic spine, performs the function of the supporting-staging element and participates in the creation of a single flexible frame by connecting with the bandages for the shoulders. This reclinator works as a corrective device of the reflex-load type and is a key staging element for the formation of a single flexible frame.

The shoulder straps are used for attaching fixing elements to them and forming a flexible frame for the user's trunk and lower extremities; OPB for the lower back performs the function of a supporting-staging element, to which flexible rods are attached, participates in the formation of a single flexible framework for the trunk and lower extremities.

OPB for the lower extremities are designed to attach corrective-rotating elements to them and participate in the formation of a single flexible frame for the trunk and lower limbs of the user. Kneecaps are used to provide correction of the position of the knee joint relative to the hip joint, kneecaps are used to provide additional correction of the foot and ankle joint. At the same time, knee and knee pads are not used.

Bandages for the anterior part of the feet, bandages for the ankle joints and each calcaneal region are supporting and staging elements for the formation of a single flexible frame in the ankle and foot area.

All parts of this device are interconnected by fixing longitudinal elements (fasteners) forming a flexible frame for the user's trunk and limbs, as well as elastic rods that perform the function of corrective-rotating elements, the degree of elasticity of which shape, size and installation location can be changed in accordance with physiological and muscle synergies of the user.

The specified device allows you to weaken or temporarily eliminate the influence of the cervical symmetric tonic and labyrinth tonic reflexes of the patient by creating conditions for a more complete dilution of his shoulders and fixing them in this position, which is achieved through the use of a supporting staging bandage for the upper shoulder girdle and chest torso - reclinator.

However, this device provides a therapeutic effect only when applying the entire costume as a whole. Moreover, in order to have a therapeutic effect on any specific section of the musculoskeletal system of the user, it is required to use the entire device as a whole, and the use of only a fragment of it in the form of a supporting staging band corresponding to the affected section does not provide a therapeutic effect, since it does not provide the necessary to correct the tension force of the corrective-rotational elements.

All of the above devices for treating patients with the consequences of damage to the central nervous system and damage to the musculoskeletal system can be considered as power circuits that create a more or less pronounced load on all elements of the spinal column without real compensation for the possible deforming effect.

The closest in technical essence and the achieved effect is the apparatus (RU 2165752, 2001) for the treatment of patients with the consequences of damage to the central nervous system. The device consists of separate

modules made with the possibility of independent use. The device includes the following elements:

- OPB for the shoulder girdle and the thoracic torso - a reclinator made in the form of a curved tape, the first ends of which are interconnected, and the second ends are fixed on this tape with the formation of two straps for placement on the shoulders of the user.

- Corrective corset, adapted to correct the spine without load.

- Corrective device for the lower extremities, containing at least one first part, which is a complex bandage of the thigh and lower leg, having two flexible strips for fixing respectively above the knee joint and under the knee joint, at least one second part, which is a corrective device for ankle joint and toes, having first and second flexible strips for placement on the ankle and foot, respectively, and at least one third part, which is a single we stiff-plantar element.

- The device may additionally include a module containing a comprehensive bandage of the shoulder and forearm, having two flexible strips for fixing respectively above the elbow joint and under the elbow joint, and a corrective element for the palm and thumb.

The modules included in the device can be used independently or as a single device. In the latter case, they are interconnected by fixing longitudinal elements (fasteners), forming a flexible frame for the user's trunk and limbs, as well as elastic rods.

The disadvantage of the claimed device is not sufficiently effective treatment-corrective effect for the correction of osteoarticular

deformations of the lower extremities, in particular, in connection with non-optimal movement of the patient's hips when using the device.

The technical problem solved by the authors was the creation of a modular orthopedic apparatus, in which, along with the healing effect on the spine and lower extremities, the optimal movement of the femoral head in the acetabulum would be ensured while other skeleton bones were placed in a physiologically optimal position.

The technical result consisted in the introduction of a modular orthopedic device as one of the modules of a rigid orthosis to the lumbar spine, containing in the area of the hip joints flat landing sites made at an angle to the vertical, on which hinges are placed, connecting this orthosis with tires, rigidly fixed on the side of the hips.

Relief of a rigid orthosis on the body is achieved by accurate taking of casts and staging additional inserts (pelots) in the area of the ilium. (Strong fixation of the module on the patient is necessary, since it is the connecting part between the upper and lower modules of the device.)

By using the structure thus obtained, the movement of the lower extremities is ensured while walking in an arc (from the inside to the outside), which ensures optimal movement of the femoral head in the acetabulum. As a result, under the influence of vertical loads, the formation of anatomically correct ratios in the hip joint occurs.

For optimal treatment of the consequences of diseases such as cerebral palsy, as one of the modules, the apparatus may contain a rigid crimp sleeve on the shin connected to the thigh sleeve with a flat hinge and / or an orthosis for the shoulder girdle and chest part,

made in the form of a rigid arc, rigidly connected in its lower part with an orthosis for the lumbar spine.

In a complete set, the apparatus has 4 modules: an orthosis for the shoulder girdle and the chest part (module 1); orthosis on the lumbar spine (module 2); thigh crimp sleeve (module 3); shin sleeve (module 4).

Modules are made of polyethylene 2-4 mm thick, depending on the growth and weight of the patient and the severity of the pathologies.

The angles in the landing sites and the tire connecting the 2nd and 3rd modules can also vary slightly depending on the degree of deformation of the hip joint and muscle tone of the lower extremities. The thigh and lower leg sleeves can open either front or back, depending on the pathology.

All elements included in the device usually contain additional metal flip loops and Velcro tapes (Velcro) for their optimal fastening on the patient's body.

A general view of the inventive modular apparatus is shown in figure 1. The following notation is used:

1 - an orthosis for the shoulder girdle and chest part (OPT) (module 1);

2 - orthosis on the lumbar spine (AKP) (module 2);

3 - nuts for attaching module 1 to module 2;

4 - landing pad;

5 - hinge;

6 - tire;

7 - crimp sleeve on the thigh (OGB) (module 3);

8 - nuts of fastening of the tire on the module 3;

9 - crimp sleeve on the lower leg (OGG) (module 4);

10 - flat joint.

11 - fasteners.

The device is prescribed for spastic and flaccid paralysis and paresis of the lower extremities, leading to changes in the musculoskeletal system. It can be used both in the complete assembly, in particular, in the presence of paralysis and paresis (when the spine and lower extremities are subject to deformities), as well as in separate fragments. For example, the 1st and 2nd modules are used for violations of posture and curvature of the spine; 2nd and 3rd - with dysplasia of the hip joints, etc. Work with the apparatus as follows. Separate the orthosis for the shoulder girdle and the chest 1 and the orthosis on the lumbar spine 2 by unscrewing the fixing nuts 3. Lay the apparatus on the horizontal plane with its back.

Bend both OGB 7 in the hip joint at an angle of 90 degrees, then widely open UGB 2 and place the baby's pelvis in it. Adjust the position of the pelvis in such a way as to achieve a snug fit of the module to the pelvis of the patient. Fasten the Velcro tape of the 2nd module. Bend OGB 7 in the hip joint and, slightly opening, place the thigh and lower leg in the sleeve 7 and 9. In this case, the knee joint should coincide with the axis of rotation of the knee joint. Fasten Velcro tape on modules 3 and 4. Install the UCP 1 and fix it with nuts 3.

The device is used during rehabilitation classes and daily life. Its use is recommended while mastering walking skills and constantly while the patient is moving in an upright position. For combined disorders of the musculoskeletal system, as well as for static-kinematic dysfunctions, the use of the entire device is recommended.

In case of isolated spinal deformities (scoliotic disease of 1-2 degrees, round back, dysplasia of the lumbar vertebrae), it is possible to use a combination of only the 1st and 2nd modules as a back holder.

With isolated deformations of the hip joints (congenital dysplasia, operated dislocations and subluxations) and impaired muscle tone of the hip joint, it is possible to use the 2nd and 3rd modules, as an improved hip orthosis.

The practical applicability of the drug is illustrated by the following examples.

Example 1. Child: Masha P., 5 years old. Upon admission to the Center, the diagnosis of cerebral palsy. Spastic diplegia. Orthopedic disorders. S-shaped scoliosis of the second degree. Hip dysplasia is larger on the right. Shortening the right leg by 0.5 cm. Walks with support or walkers. At the step - cross-leg at the level of the middle third of the leg. Passive abduction in the hip joint: left - 35 °, right - 27 ° ÷ 29 ° from the central axial.

The wearing of an orthopedic four-module device was fully included in the comprehensive rehabilitation. The device was used every time a girl stood or walked during rehabilitation classes. Also, classes were conducted in the apparatus to develop the correct stereotypes of movement. After three months of using the device while walking, the girl began to put her feet correctly. Cross-legs during walking are less common. By the end of the rehabilitation period, the passive abduction in the hip joint on the left and on the right began to be 35–37 ° from the central axial.

Example 2. The child. Pavel. N. 2.5 years. Upon admission to the Center, the diagnosis: Congenital bilateral dysplasia of the hip joints. Treated conservatively in the first year of life. I started walking on my own at 1 year 2 months. At 1 year and 8 months, parents noticed impaired gait (heaved his knees inward). The radiograph shows signs of decentralization of the femoral heads. The roof of the acetabulum is not fully formed. It was not possible to use nightly distributing tires due to the strong psycho-emotional stress of the child.

It was equipped with an individually made, hip orthosis, which included the 2nd and 3rd modules of a 4-module apparatus.

During the day, the child was in the orthosis almost constantly (with short breaks): he walked, sat, rode a bicycle, played.

After 4 months of use, a control x-ray showed satisfactory centering of the heads of the hip bones in the verto-hollow depressions. The gait of the child returned to normal. Stepping movements have become correct.

Example 3. The study involved 20 patients aged from 1.5 years to 13 years. Of these, with a diagnosis of hip dysplasia; 3 persons. Cerebral palsy, spastic diplegia, hip dysplasia - 1; person; spastic diplegia - 2 people.

Table 1 shows the results of using a four-module orthopedic apparatus for 3 treatment courses of 20 procedures for 2-3 hours in each.

Table 1 Indicators Only 20 people - one hundred% Boys - 9 people - one hundred% Girls 11 people - one hundred% Gait improvement 17 pax - 85% 7 pax - 77.7% 10 pax - 90.9% Learning new motor skills 18 pax - 90% 8 pax - 88.9% 10 pax - 90.9%

As studies have shown, the use of the device allows you to restore or improve the function of the lower extremities, to get the opportunity to move independently, correct bone-articular deformities, prevent secondary deformations, and form correct stereotypes of movement.

Claims (4)

1. A modular orthopedic apparatus for treating patients with the consequences of damage to the central nervous system and with injuries of the musculoskeletal system, containing orthopedic modules for various parts of the body, made with the possibility of their independent use, including an orthopedic module based on thigh sleeves for correction of lower limbs, and also devices for their mounting on the body, characterized in that the orthopedic module for the lower extremities includes a rigid orthosis on the lumbar onochnika comprising the hips flat landing pads formed at an angle to the vertical, which are placed on the hinges connecting the brace with the tire fixedly secured laterally on the cartridges thighs. 2. The modular orthopedic apparatus according to claim 1, characterized in that as devices for attaching modules to the body, it contains metal flip loops and Velcro tapes. 3. The modular orthopedic apparatus according to claim 1, characterized in that as the orthopedic module it contains a rigid crimp sleeve on the lower leg connected to the thigh sleeve with a flat hinge. 4. The modular orthopedic apparatus according to claim 1, characterized in that as the orthopedic module it contains an orthosis for the shoulder girdle and chest part of the body, made in the form of a rigid arch, rigidly connected in its lower part to the orthosis of the lumbar spine.