RU59973U1 - SIMULATOR ORTHOPEDIC - Google Patents

Abstract

The utility model relates to medicine, namely to devices for the rehabilitation and treatment of 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 of patients with cerebral palsy , patients with spinal injury, scoliosis, patients with consequences of traumatic brain injury and acute cerebrovascular accident. It is proposed in an orthopedic simulator with fixation of the spine, hips and feet, for fixing the hips use a sliding node in the form of a pedestal. The simulator can be used to treat patients in a standing position or in a sitting position. When training in a standing position, the sliding unit contains detachable sleeves and a device for their orientation and fixing in space. When training in a sitting position, the sliding unit is made in the form of a seat with a backrest containing width-adjustable linings on the side surfaces of the seat. Using this unit allows you to change the angle of abduction in the hip joints to 45 degrees from the central axial. As shown by tests, the simulator allows the formation of anatomically correct supporting surfaces of large and medium joints and the spine, improving the patient's orientation in space, learning the correct motor stereotypes, treatment and prevention of osteoporosis. It can be used for rehabilitation after surgical treatment of the musculoskeletal system of a person. The simulator is easy to disassemble and easy to manufacture.

Description

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

Currently, 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. These bandages are interconnected 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.

Known devices for the treatment of the lower extremities of patients with paralysis:

“Inclined plane with knees - patient” system, which consists in rigid fixation of the feet and joints of the patient to the inclined plane, and at the same time verticalization of the spine. ("Physiotherapy" edited by M. Weiss, A. Zembatoi Lane from Polish. M., 1986, p. 8.), as well as the system of straightening the limbs and torso of the patient, posture correction, fixation of the hip, knee, ankle joints, fixation and rotation of the feet outside, using a complex of elastic rods, semi-rigid and rigid joints attached to the patient’s body, the so-called “Gravistat” medical suits (RF patent N 2131232, class A 61 H 5/02, 1998) and the medical suit “Adele "(USSR patent N 2054907, class A 61 H 5/00, 1992).

Such devices are worn on the patient, they regulate the tension of elastic rods until the new position of the body and limbs is reconstructed, which is close to physiological and they are worn up to 12 hours a day for 15-30 days.

The disadvantages of treating a patient with the "Inclined plane with knees - patient" system are that attaching the patient to an inclined plane limits his freedom of action and does not allow him to develop motor skills. Therefore, the use of such a system is practically impossible for the rehabilitation of children with infantile cerebral palsy and in patients with radiculitis.

The use of various elastic rods and rigid stabilizers in medical suits such as "Adele" and Travistat, is ineffective because they lack the effect of extension (traction) of the spine along the length and the effect of creating the necessary extension (over extension) in the thoracolumbar region, which is a condition for decompression of the spinal column. The presence of front longitudinal rods on the lower extremities reduces the effect of straightening the lower extremities and fixation of the knee and hip joints

in a straightened position. The transverse thrust in the thoracic region, the presence of rigid stabilizers and the longitudinal direction of the action of all the rods in the suits "Adele" and Travistat "create the possibility of deformation of the joints and intervertebral discs. Costumes themselves are difficult to use for young children with cerebral palsy.

Closest to the claimed solution according to the technical essence and the achieved effect is a device containing an elastic support element fixed on the patient’s back in the form of a λ-shaped elastic tire with pneumatic valves into which air is pumped under pressure (RF patent No. 2170566, class A 61 N 3/00, 2001), additional locking elements in the form of cuffs, fixed on the sides of the cover into which the support element is placed, and elastic traction in the form of rubber bands with clamps, fixed in the region of the shoulder, hip, knee and ankle GOVERNMENTAL joints with locking brake.

The device can be used both in a standing position and in a sitting position, but its use is ineffective for correcting the bones of the pelvic-femoral belt in young children with cerebral palsy.

The problem solved by the authors was the creation of a simpler and more universal simulator for the correction of disorders of the musculoskeletal system of the lower extremities and the patient's body.

The technical result is achieved due to the fact that in the device with the fixation of the spine, hips and feet, for fixing the hips using a sliding node in the form of a pedestal. Adjusting pads can be installed on the lateral surfaces, which allows you to change the angle of abduction in the hip joints up to 45 degrees from the central axial.

The simulator can be used to treat patients in a standing position or in a sitting position.

Figure 1 shows a diagram of a simulator for implementation in a standing position.

Figure 2 shows a diagram of a simulator for implementation in a sitting position.

Figure 3 shows a diagram of a sliding node simulator.

The following notation was used:

1 - the bottom of the simulator;

2 - element for fixing the foot;

3 - vertical removable stand;

4 - side amplifiers;

5 - removable back;

6 - sliding node;

7 - pads;

8 - a seat with a back;

9 - Velcro fixing tapes.

The device consists of a bottom 1 with an element fixing the feet 2; vertical removable rack 3 with side amplifiers 4, height-adjustable removable backrest 5, and height-adjustable sliding unit, fixing the hips 6, on the side surface of which are placed the adjusting pads 7. The backrest and the sliding unit can be made in the form of a seat with a back 8. For fixing elements 2, made in the form of plastic feet, on the bottom 1 grooves are made in which feet are inserted. The sliding unit 6 consists of split sleeves 10, mounted on a movable crosspiece 11 with the possibility of movement along the arc and fixing the sleeves 10 in a predetermined position.

The bottom 1, on which removable feet of thermoplastic are installed, can be made to move around the room with legs or roller wheels with clamps.

The simulator works as follows.

When training in a standing position. At the bottom 1, a vertical removable stand 3 with side amplifiers 4 is installed. On which the backrest 5 and plastic feet are attached - element 2 (they are placed in the grooves located on the bottom of the simulator closer to the common back).

The modules are adjusted as follows: the backrest 5 is positioned so that the pelvis and the shoulder girdle of the patient rest on it; the sliding node 6 in height is located so that the patient’s legs are fixed in the thigh and knee area without touching the patient’s crotch, the angle of its breeding is regulated by the central wing nut in front; elements 2 are moved apart at a distance at which an optimal angle of hips is reached, with a perfect match

axes of the thigh and lower leg. All adjustments are made by loosening-tightening the wing nuts and moving the component elements along the grooves.

Installation of the patient, as a rule, in order to avoid injuries, installation is performed by two people. One person holds the patient by the shoulder girdle, being behind the simulator. The second fixes it in front with Velcro 9 tapes in the following order: fixation of the feet; fixation of the hips on the sliding node 6; fixation in the pelvic region with the lower velcro tape located on the back 5; fixation directly under the axillary hollow with the upper Velcro tape located on the back 5. After this, the patient is finally controlled and adjusted in space:

In the sagittal plane (side view), it is necessary that the following points are projected onto a straight line running perpendicular to the area of the support; center of the external auditory meatus; center of the shoulder joint; the center of the hip joint (large trochanter); the center of the knee joint; a point located at a distance equal to the width of the 1st and 2nd fingers of the patient anterior to the transition from the lower leg to the back surface; the angle of flexion in the knee joint is 3-5 degrees.

In the frontal plane (front view) it is necessary: to place exactly the pelvis in three planes, focusing on the location of the anterior iliac spines; control the location of the thigh and lower leg on the same axis; position the feet at the same distance from the center, parallel to each other.

Different heights of the ilium are adjusted due to rigid polyethylene linings under the patient's feet, the rest of the body settings are regulated by soft isolon pads under the pelvis and under the patient's knee hollows.

In the sitting position: the sliding unit 6 and the backrest 5 are replaced with a seat 8, which is installed in the upper vertical grooves of the rack 3.

Also, the elements 2 are rearranged in the grooves of the bottom 1, located at a greater distance from the rack 3.

The height of the seat and the width of the spread of the feet are adjusted so that in the sitting position the bending angles of the hip and knee joints are equal to 90 degrees; the spine was maximally straightened; abduction in the hip

the feet 2 are rearranged in the grooves 3 of the bottom 1, located at a greater distance from the rack 4.

The height of the seat and the width of the spread of the feet are adjusted so that in the sitting position the bending angles of the hip and knee joints are equal to 90 degrees; the spine was maximally straightened; abduction in the hip joints of 45 degrees from the central axial (if the condition of the patient’s musculoskeletal and ligamentous apparatus of the patient allows; the pelvis is placed exactly in three planes. Isolon pads are used for adjustments.

In a standing position, the optimal fixation time of the patient is 3 hours per day. This time is gained in several approaches and is due to the maximum effect of restoration of the osteoarticular apparatus. In the sitting position, the fixation time and the number of approaches can be increased.

The simulator provides the opportunity for the patient to sit and stand in strictly defined treatment positions that allow for the correction of the articular relationships of the human musculoskeletal system.

In a standing position, the patient is fixed strictly along the anatomical axial in three planes (frontal, sagittal and horizontal). Gradual dilution of the legs in the hip joints is allowed, depending on the condition of the patient. The maximum dilution angle is 45 degrees from the central axial (total angle of 90 degrees), which plays a big role for the correct formation of the hip joints, and as a result for mastering the correct stereotypes of movement. By changing the module that extends the legs into a special seat, and fixing the feet on other platforms, you can put the patient in the correct physiological position.

Its most effective application in the conservative correction of skeletal deformities, such as:

- subluxation of the hip joint,

- hip dysplasia,

- valgus or varus deformity of the knee joint,

- curvature of the spine

- distortions of the pelvic bones

- foot deformities.

When using it, it becomes possible to fix the middle and large joints of the lower extremities at certain angles, due to which the maximum therapeutic effect on the formation and restoration of bone tissue is achieved, as well as provide abduction in the hip joints up to 45 degrees from the central axial (in foreign analogues, this angle is 30-40 degrees maximum).

The practical applicability of the simulator is illustrated by examples.

Example 1. Alexandra U., 2 years old, was admitted to the Center in February 2005. Diagnosis: Right-sided hemiparesis. Dysplasia of the right hip joint. Shortening of the right leg by 0.9 cm. On examination: muscle flexion contracture of the right knee joint (passive extension within 170 degrees), muscle adducing contracture of the right hip joint (passive abduction 30 degrees from the central axial joint), walks with support for the left arm.

In the treatment complex, a simulator was used for 1.5-2.5 hours a day daily, for three months.

After treatment: Shortening of the right limb was 0.2-0.3 cm, passive extension of the right knee joint 180 degrees, passive abduction of the right hip joint 35-37 degrees. I mastered the skill of independent walking.

Example 2. The effectiveness of using an orthopedic simulator for after three courses of treatment (one treatment course includes 20 procedures) is shown in Table 2) for 50 sick children with the following pathologies.

Table 1
Characteristics of treated children. Diagnosis Age Number of persons Cerebral palsy, spastic diplegia from 1 year to 14 years 35 Perinatal encephalopathy from 4 months to 1 year 10

Postnatal damage to the central and peripheral nervous systems from 7 months to 14 years 3 Hereditary symptoms 1.5 years and 5 years 2

Table 2.
The results of using the inventive simulator Options Only 50 people one hundred% Boys 29 pax - one hundred% Girls 21 people - one hundred% Increased passive dilution of the hip joint 45 pax - 90% 26 pax - 89.6% 19 people - 90.4% Gait improvement 39 pax - 78% 20 pax - 68.9% 19 people - 90.4% Posture improvement 36 pax - 72% 19 people - 65.5% 17 pax - 80.9% Reducing contractures in the joints of the lower extremities 47 people - 94% 26 pax - 89.6% 21 people - one hundred%

As shown by tests, the simulator allows the formation of anatomically correct supporting surfaces of the joints and spine, improving the patient's orientation in space, learning the correct motor stereotypes, treatment and prevention of osteoporosis. It can be used for rehabilitation after surgical treatment of the musculoskeletal system of a person. The simulator is easy to disassemble and easy to manufacture.

Claims (4)

1. Orthopedic simulator, which includes devices for fixing the spine, hips and feet, characterized in that for fixing the hips using a sliding node made in the form of a pedestal. 2. The simulator according to claim 1, characterized in that the sliding assembly comprises width-adjustable linings on the side surfaces of the pedestal. 3. The simulator according to claim 1, characterized in that for fixing the spine it contains a vertical removable stand and a removable back. 4. The simulator according to claim 2, characterized in that the removable back and pedestal are made in the form of a seat with a back.