SU1147380A1 - Apparatus for recovery of mobility of radial elbow joints - Google Patents

Abstract

1. APPARATUS FOR MOBILITY RECOVERY radioulnar joint, comprising a divergent arc with spokes and spitsederzhatel E, threaded rods, binders arc, the drive unit with the worm gear, characterized in that in order to provide compression in fractures and bone perelomovyvihah forearms with simultaneous development rotational movements in the zone of each joint, unidirectional arcs are combined into blocks, extreme arcs from opposite sides of the blocks have the ability to rotate and guides are attached to them you and the brackets with grooves in the plane of the axes of the blocks in which the bars are installed are connected to the blocks, the slots on one side of the blocks are made along the arc of an ellipse, the small axis of which is equal to the distance between the axes of the axes, the larger axis exceeds it by 8-10 mm, and on the other hand, in a circular arc. 2. An apparatus according to claim 1, characterized in that the worm gearbox is mounted on one of the arcs of each block and is provided with a drum (L with punched tape associated with guide screws and brackets.

Description

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The invention relates to medical technology, more specifically to traumatology and orthopedics.

A known apparatus for restoring mobility in the radiate-right joints, contains arcs associated with threaded rods and strips with holes, in which the needle holders with knitting needles are installed with stop pads installed in the notches of the brackets 1.

The disadvantage of this apparatus is that it does not ensure the development of rotational movements of the forearm in the treatment of fractures and fractures of the bones of the forearm.

Also known is an apparatus for restoring mobility in radioulnar joints containing multidirectional arcs with knitting needles and spokes-holders, threaded rods, connecting arcs, and a drive unit with a worm gearbox 2.

However, this device does not provide compression for fractures and fractures of the bones of the forearm with the simultaneous development of rotational movements in the zone of each joint.

The aim of the invention is to provide compression for fractures and fractures of the bones of the forearm with the simultaneous development of rotational movements in the zone of each joint.

The goal is achieved by the fact that in the apparatus for restoring the mobility of the arthro-articular joints, containing multidirectional arcs with knitting needles and spokes-holders, threaded rods connecting arcs, a drive unit with a worm gear, unidirectional arcs are combined into blocks, the outer arcs from opposite sides of the blocks have the possibility of rotation and on them are fixed guide screws and brackets with grooves in the plane of the axes of the blocks in which rods are mounted associated with the blocks, the grooves on one side of the blocks being made along the arc of an ellipse, the small axis of which is equal to the distance between the axes of the shaft, the larger axis exceeds it by 8-10 mm, and on the other hand, along the arc of a circle.

In addition, a worm gearbox is installed on one of the arcs of each block and is equipped with a perforated drum associated with guide screws and brackets.

FIG. 1 shows an apparatus for restoring mobility in radial-flat joints in a perspective view; in fig. 2 - the same, frontal projection; in fig. 3 - the same, horizontal projection; in fig. 4 is a view A of FIG. 2; in fig. 5 is a view B in FIG. 2; in fig. 6 - apparatus on the bones of the forearm, middle physiological position, side view; in fig. 7 - the same view from the distal end; in fig. 8 - the same, front view; on

FIG. 9 - apparatus on the bone of the forearm, position of pronation, view from the distal end; in fig. 10 - the same, front view; in fig. 11 - apparatus on the bone of the forearm, supination position, view from the distal end; in fig. 12 - the same, front view. The device consists of multidirectional arcs, united in two multidirectional relative to each other block 1 and 2, interconnected from the end sides

0 by two hinge nodes 3, rotated 180 ° relative to each other in parallel planes, each of which is movable in two mutually perpendicular planes, and a drive unit 4. Each block 1 and 2 includes unidirectional arcs that consist of supporting arcs 5, axial arc 6, threaded rods 7, the cutter 8 and the spokes 9 with protruding threads 10 in the middle part. Support 5 and axial 6 arcs have seven

There are 0 holes 11 for threaded rods 7 and radial grooves 12 for the cutter holders 8. On the axial arc 6 there are guide rollers 13, four of which are located along the outer edge of the arc 6, and two - along the inner edge.

Each hinge assembly 3 consists of an extreme arc 14 of each block 1 and 2, which is movably connected to an axial arc 6 by means of rollers 13 so that they have a common axis of rotation.

0 At the extreme arc) 4, there are two guiding screws 1b for mounting punched tape 16 on them, and brackets 17 are fixed at its ends. Brackets 17, located at one end of block 2, are made with grooves 18, in which rods 19 are mounted, placed in The slits of the strips 20 fixed to the support arc 1 of block 2. At the same time, the grooves 18 are made along the arc of an ellipse, whose small axis is equal to the distance between the axes of the rods 19, and the larger one exceeds the minor axis by 8-10 mm. The brackets 17, mounted on the extreme arc 14 of block 1, are made with grooves 21 having the shape of an arc of a circle. In these slots 21, rods 19 are mounted, placed in the slots of the strips 20, mounted on the support

5 arc block 1. The grooves 18 and 21 are located in the plane of the axes of blocks 1 and 2.

The drive unit 4 consists of a handle 22, a worm gear 23, on the output shaft of which a drum 24 is mounted with pins 25 spaced evenly along its generatrix, and punched tape 16, rebased through the drum 24 and fastened with its ends to the bracket 17. Drive unit 4 is attached to the axial arc 6 with a screw 26. The slats 20 are fixed to the support arcs of the blocks 1, 2 with screws 26 and slats with a slit 27 located along the axis of the blocks and across the slats 20. The technique of the osteosynthesis operation is as follows. . To eliminate coarse cuts, avenues of fragments and ease of applying the device before the operation, the forearm is fixed in one of the known repositioning devices or in a special attachment to the orthopedic table. To accurately determine the levels of the spokes 9, they are first clinically determined, radiopaque marks are noted, and then radiographs are taken with a line that has radiopaque divisions, which are set at the bone level. Radiographs clarify the level of the spokes 9 and measure the distance from the radiopaque landmarks to the refined levels. The distances obtained are measured on the patient's limbs, according to the reference points. Especially, the level of spokes 9 near the heads of each bone must be determined. They are conducted at a distance from the end of the bone, equal to the distance from the axial arc 6 of the apparatus to the middle of the grooves 18, 21 of the brackets 17. The remaining needles 9 are held in such a way that the arcs 5, 6 of one block 1 fixed on them have the opportunity to enter between arcs 5, 6 of another block 2. A needle 9 with protruding thread 10 in the middle part is held perpendicularly in the frontal plane of the fragment and screwed into the bone so that the threaded part 10 forgives both cortical layers. Each bone is superimposed with a pre-assembled block 1, 2, consisting of three supporting arches 5 and one axial 6 at a fracture, and one no. 5 and one axial arc 6, in the absence of a fracture. Spokes 9 held near the ends of each bone in nat In this case, the axial arc 6 of each block 1, 2 is fixed on the spoke 9, which is held near the head of the corresponding bone. The needles 9, carried out near the site of the fracture, produce exact reposition, and in case of oblique and helical fractures, counter-lateral compression is also performed. The movement of the ends of fragments in the frontal plane is realized with the help of a pull for the corresponding end of the spoke 9, which is not shown, and in the sagittal due to the arc-like bend of the spokes 9, which are formed when the spokes 8 are moved with the needle 9 in the radial grooves 12, the support arc 5, and its subsequent tension on both sides of the spicate givateli. At the end of the reposition, compression is performed between the fragments (in case of transverse fracture) using threaded rods 3 located between the middle supporting arches 5. Then both blocks 1, 2 are connected using joint nodes 3 and the drive unit 4 is installed on one of the axial arcs 6. The punched tape 16 is placed with the middle part of the drum 24 of the reducer 23, the guide screws 15 and its ends are fixed to the brackets 17. When the bone breaks, the head of the dislocated bone in the reposition attachment is prefixed to osteosynthesis. By distraction, the offset in length is removed, and manual dismounting of the dislocated head is performed. The apparatus then overlaps. Rods 19 prevent head relaxation. After the operation to reduce the edema, the patient spins the handle 22, the rotation of which is transmitted through the reducer 23 to the drum 24 with pins 25. The latter, when rotated, pulls the punched tape 16, which is fixed at the end of the bracket 17 of the extreme arc 14 and does not have it, causing the latter to rotate along the rollers 13 of the axial arc 6. The rotation of the extreme arc 14 of block 2 through brackets 17 ptanga 19 n of the bar 20 is transmitted to OD1Yuy from the supporting arcs 5 of block 1, the axial arc 6 of which rotates along its extreme arc 14 when the rollers 13 are driven 14. Simultaneously happened A turn of the block 1 relative to the block 2, guided by HJTanrami 19, moving in the grooves 18, 21 of the brackets 17. The lines connecting the centers of rotation of the hinge assemblies 3, which are located at the intersection points of the axes of rotation of the extreme arcs 14 with the lines, connect the middle The arcuate grooves 18, 21 of the brackets 17 are the axis of rotation of the apparatus and coincide with the rotational axis of the forearm. Embedding the handle 22 is metered, alternately in one and the other side, which causes the forearm to lean in the direction of supination, then pronation. When the maximum volume of passive pro-prolation movements in the apparatus is reached, the tape tape 16 is removed and active rotational movements are developed. The apparatus is produced when the non-refractory fusion is determined clinically and radiologically and the rotational movements of the forearm are restored. Thus, the proposed apparatus allows the treatment of fractures and fractures of the forearm and their consequences to combine reliable fixation of fragments with the early development of rotational movements and, in addition, to reduce the invasiveness of the operation by achieving a stable fixation with a minimum number of needles. The biomechanical substantiation of the principle of operation of the apparatus for transosseous osteosynthesis of the bones of the forearm and restoring the mobility of the radial-ulcer joints is as follows. The forearm is formed by two bones, one of the main functions of which is the rotate. Each of the two bones of the forearm performs a different role in accordance with the anatomical structure and the relationship with the adjacent segment} and: the ulna communicates with the shoulders, and the beam - the rotational movements of the forearm.

The kinematics of movements of the radial bone relative to the ulnar is determined not only by the shape of the articular surfaces of the radioulnar joints, but also by a number of other factors. The upper and lower radioulnar joints are cylindrical and are built in full accordance with each other. The axis of the lower joint is a continuation of the axis of the upper joint and forms a rotational axis of the forearm, which passes through the center of the head and neck of the radial bone along the intercostal space, the head of the ulna and ends at the apex of the styloid process.

Their investigation of rotational movements of the forearm has established that during rotation the head of the radial bone, surrounded by a strong ring-shaped link, remains in place, rotated around its axis, while the articular bone of the radial bone slides eoKpyf of the stationary head of the stationary bone while rotating Finger relative to the latter with the axis of rotation perpendicular to the ulna and making translational motion along it in a volume of 8-10 mm. When this occurs, the elongation of the forearm occurs in the supination position and its shortening in the pronation position. The arc of turning one axis relative to another in the distal radioulnar articulation takes the form of an ellipse, and in the proximal one it takes the shape of a circle.

The correspondence of the kinematics of rotational movements of the radial bone relative to the elbow with the kinematics of the movement of one unit of the device proposed relative to another is represented in FIG. b-12.

Rotation in the distal radioulnar articulation of the radial bone around the ulnar head, and in proximal rotation of the radial bone in its place, is directed in the device by the extreme arcs 14 of blocks 1, 2, rolling along 13 ocesibix guide rollers of arcs, and through brackets 17, the bars 19 are transmitted the support arc 5 of each block 1, 2. At the same time, the block rotates relative to the other along with the fixed bones by moving the shthang 19 along the arc-shaped grooves 18, 21 of the brackets 17, which in the distal section are arcs of the ellipse, is small Referring which is equal to the distance between the centers schtang 19 and bolschoy is the sum of this distance and the magnitude of the radius of movement along the ulna (8 10 mm) and proximally - arcs of a circle that corresponds to a turn of one bone with respect to the other.

The proposed apparatus makes it possible to improve the functional results of the treatment of fractures of the bones of the forearm and their consequences, and to reduce the time taken to restore the patient’s ability to work.

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Claims (2)

1. APPARATUS FOR RESTORING THE MOBILITY OF BEAM-JOINT JOINTS, comprising multidirectional arcs with knitting needles and spoke holders, threaded rods connecting arcs, a drive unit with a worm gear, characterized in that, in order to provide compression during fractures and fractures, one has to move to one another the area of each joint, unidirectional arcs are combined into blocks, the extreme arcs on the opposite sides of the blocks are rotatable and guide screws and brackets with grooves in the plane of the axes of the blocks in which the rods are connected associated with the blocks, and the grooves on one side of the blocks are made along an ellipse arc, the small axis of which is equal to the distance between the axes of the rods, the major axis exceeds it by 8-10 mm, and on the other sides — along an arc of a circle. 2. The apparatus by π. 1, characterized in that the worm gear is mounted on one of the arches of each block and is equipped with a drum with a punched tape connected with guide screws and brackets. SS