WO2011075003A1 - Способ коррекции патологических установок сегментов нижних конечностей и устройство для его осуществления - Google Patents
Способ коррекции патологических установок сегментов нижних конечностей и устройство для его осуществления Download PDFInfo
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- WO2011075003A1 WO2011075003A1 PCT/RU2010/000746 RU2010000746W WO2011075003A1 WO 2011075003 A1 WO2011075003 A1 WO 2011075003A1 RU 2010000746 W RU2010000746 W RU 2010000746W WO 2011075003 A1 WO2011075003 A1 WO 2011075003A1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F5/00—Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
- A61F5/01—Orthopaedic devices, e.g. splints, casts or braces
- A61F5/02—Orthopaedic corsets
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F5/00—Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
- A61F5/01—Orthopaedic devices, e.g. splints, casts or braces
- A61F5/0102—Orthopaedic devices, e.g. splints, casts or braces specially adapted for correcting deformities of the limbs or for supporting them; Ortheses, e.g. with articulations
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F5/00—Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
- A61F5/01—Orthopaedic devices, e.g. splints, casts or braces
- A61F5/0102—Orthopaedic devices, e.g. splints, casts or braces specially adapted for correcting deformities of the limbs or for supporting them; Ortheses, e.g. with articulations
- A61F5/0123—Orthopaedic devices, e.g. splints, casts or braces specially adapted for correcting deformities of the limbs or for supporting them; Ortheses, e.g. with articulations for the knees
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F5/00—Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
- A61F5/01—Orthopaedic devices, e.g. splints, casts or braces
- A61F5/0102—Orthopaedic devices, e.g. splints, casts or braces specially adapted for correcting deformities of the limbs or for supporting them; Ortheses, e.g. with articulations
- A61F5/0127—Orthopaedic devices, e.g. splints, casts or braces specially adapted for correcting deformities of the limbs or for supporting them; Ortheses, e.g. with articulations for the feet
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F5/00—Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
- A61F5/01—Orthopaedic devices, e.g. splints, casts or braces
- A61F5/0193—Apparatus specially adapted for treating hip dislocation; Abduction splints
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F5/00—Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
- A61F5/01—Orthopaedic devices, e.g. splints, casts or braces
- A61F5/04—Devices for stretching or reducing fractured limbs; Devices for distractions; Splints
- A61F5/05—Devices for stretching or reducing fractured limbs; Devices for distractions; Splints for immobilising
Definitions
- the present invention relates to medicine, namely to traumatology, orthopedics and neurology, and more particularly to a method for correcting pathological settings of lower limb segments and a device for its implementation.
- segments of the lower extremities we mean different parts of the musculoskeletal system of the lower extremities of a person, such as a thigh segment, a shin segment, and a foot segment.
- the first direction is widely known, which is that this correction is carried out using phased casting of plaster casts on segments of the lower extremities to eliminate pathological settings of the thigh, lower leg, ankle, foot, and the like.
- this method has limited use and can be used, as a rule, for children, mainly young children.
- the use of this method implies a long stay of the user in a position in which there is no possibility of free movement in the correction process, which leads to the loss of some motor skills, hypotrophy of the muscles of the pelvic girdle and lower limbs.
- the second direction is that the correction is carried out using various devices, which are simulators, through exercises which reduce the pathological settings of the segments of the lower extremities.
- the orthopedic simulator Lotus is known and a method for correcting pathological changes in the patient’s musculoskeletal system with its help.
- the user is placed in the indicated simulator in the sitting position “Turkish”, with his back close to the vertical support.
- the lower legs are fixed with the help of a fixing module, the knees are fixed with the help of a table mounted on them, and the back is fixed to the vertical support.
- the user's stay in the indicated position is two to three hours a day.
- the specified method and device allows you to adjust the pathological settings of the segments of the lower extremities. However, this correction can be carried out only during many years of training and only to a small extent. Moreover, the specified method and device have limited use, since they can be used for adults and older children, but cannot be used to correct pathological settings of lower limb segments in young children, including those suffering from cerebral palsy (cerebral palsy).
- fixing the user in the specified simulator limits the user's freedom of action, and fixing the lower extremities does not allow the development of motor navigation and does not contribute to the independent movement of the user.
- the third direction is that the correction is carried out to a small extent when using various devices that contribute to the independent movement of the user, despite the presence of pathological settings of the segments of the lower extremities.
- GB 2 301 776 A discloses a method and apparatus for facilitating walking, equipped with controls.
- the known device includes an exoskeleton containing an external frame for carrying around the body and lower extremities of the user and control means for controlling the device.
- the external frame includes a pelvic section, a thigh section, a hip section, a knee section, a shin section, an ankle section, and a foot section.
- the named sections are interconnected by means of hinges and sliders and are controlled by a joystick.
- the described device is a complex structure and is designed specifically for a specific user, since the thigh and lower leg sections have a fixed length, which does not allow changing the linear size of this device if necessary.
- the specified device has limited use.
- the described device can only be used as a single design. In the event that, for medical reasons, there is no need to facilitate the movement of all departments of the lower extremities, the use of such a device is impractical.
- US Pat. No. 5,658,242 describes a method and apparatus for facilitating the musculoskeletal functions of the lower extremities, to a small extent providing the ability to correct pathological settings of lower limb segments.
- the specified device is a complex single design and contains a lumbar support bandage, ankle support bandages and support bandages for the hips.
- the said bandages are interconnected by rigid rods having a hinged joint at the level of each knee joint.
- This device is a hard exoskeleton made by individual standards of a particular user, and having large dimensions and complex design.
- the application of the indicated device and method provides load relieving from the supporting apparatus and muscles of the lower extremities, which makes it possible to independently move the user.
- these method and device also have limited use and can be used to move adults and older children, but cannot be used to correct pathological settings of lower limb segments in young children, including those suffering from cerebral palsy, since the device is suitable only for individual use due to the fact that it is performed according to the size of the body of a specific user without the possibility of correction of the device during implementation with allowance. This excludes the possibility of using this device and method for children who, over a short period of time, significantly change their body size. Moreover, the use of this device leads to weakening and hypotrophy of the muscles of the lower extremities.
- a device and method for facilitating walking are known (JP 2006 087478), which allow, to a very small extent, the correction of pathological settings of lower limb segments.
- the specified device contains an adjustable pelvic bandage, placed around the pelvic region of the user, on each side of which along the corresponding lower limb of the user are located a means of rotation of the hip joint, means of fixing the thigh in a predetermined position, means of rotation of the lower leg, means of fixing the lower leg in a predetermined position, means for correcting the position of the foot and the volume of its movement in the ankle joint, a means for placing the foot.
- the aforementioned means are interconnected by connecting elements, which are flat rods.
- the known method and device are intended to facilitate the movement of users who do not have peripheral innervation of the lower extremities.
- the pelvic bandage of the known apparatus secures the apparatus to the user's body, while the means for turning the hip joint associated with the pelvic bandage is a flat femoral hinge, allowing the movement of the thigh only in the sagittal plane.
- a first electric drive installed in the area of the femoral hinge.
- the means for fixing the thigh in a predetermined position is a flat bar mounted on the thigh of the user with two thigh cuffs and rigidly connected with the femoral hinge and with the means of rotation of the lower leg made in the form of a flat hinge (knee hinge).
- a second electric drive which provides rotation of the knee hinge and, accordingly, rotation of the lower leg in the sagittal plane.
- the means for fixing the tibia in a predetermined position is made similar to the means for fixing the thigh and also is a flat rod fixed to the lower leg of the user with the cuff of the lower leg and rigidly connected to the knee joint.
- the means for correcting the position of the foot and the volume of its movement in the ankle joint is made in the form of a flat hinge (ankle hinge) and provides movement of the tibia back and forth in the sagittal plane.
- a means for placing the foot made in the form of a lightweight shoe, is rigidly connected.
- the described device is a single exoskeleton design, providing for the simultaneous use of all structural and functional units.
- the corresponding electric drives of the thigh and knee joint sections control the actuators, the action of which is aimed at facilitating the walking process of a user who does not have peripheral innervation of the lower extremities.
- the known device has limited use and cannot be used by users with high and subluxation of the thigh, since the pelvic brace in the known device provides only the installation of the apparatus on the user's body, but does not allow the centering of the femoral head in the acetabulum. The inability to center the femoral head, in turn, does not allow you to set an adequate load on the entire surface of the lower limb of the user.
- the known device does not provide for adaptation to the anatomical features of the user, since there is no possibility of changing the configuration of the flat connecting rods, taking into account, for example, the shape of the lower leg or thigh.
- the described device has a complex design, including articulated joints containing moving and rotating parts located in the immediate vicinity of the user's body, which practically excludes the use of this device for children, including young children.
- the basis of the invention is the task of creating a method for correcting pathological settings of segments of the lower extremities and a device for its implementation, specific methods of the method and simplified structural design of the device which would allow simultaneously or in a given combination to correct the position of the segments of the lower extremities in horizontal and / or frontal, and / or sagittal planes with the possibility of movement around the corrected biomechanical axes of rotation of the hip, knee and ankle joints, as well as expand the possibilities of correction of pathological settings of segments of the lower extremities and provide the possibility of using the invention for adults and children of various ages, including young children, to provide the possibility of free movement of the user in the process of correction and simultaneous phased elimination of various individual or combined pathological settings segments of the lower extremities.
- This problem is solved by creating a method for correcting pathological settings of segments of the lower extremities, including correcting pathological settings of segments of at least one lower limb using an orthopedic device, in which, according to the invention, stage-by-stage correction of the position of the longitudinal axes of these segments in horizontal and / or the frontal and / or sagittal planes by simultaneous dosed elimination of the imbalance of forces the muscles serving the corresponding joints, and reducing the pathological settings of these segments, as well as the subsequent fixation of the segments in a corrected position at each stage using an orthopedic device, which is at least one module of a modular exoskeleton, made with the possibility of individual settings, approximating each stage of correction, the position of the longitudinal axis of each pathologically established segment to the physiologically correct position, while fixing
- the segments in the corrected position at each stage are carried out with the possibility of movements in the respective joints around the corrected rotation axes of these joints within the volume defined by the specified modular exoskeleton, and the stereotype of the user's movements in the respective
- the technical result consists in improving the supportability of the lower extremities and correcting the pathological posture and motor stereotype of young children, adolescents and adults suffering from spastic or flaccid paresis of the lower extremities of various origins, diseases of the musculoskeletal system, including metabolic nature, or any other diseases and conditions leading to separate or in combination pathological settings of lower limb segments.
- the proposed method can be used to correct pathological settings of individual segments of the lower extremities, which makes it possible to use not the entire exoskeleton as a whole, but only its individual modules. It is advisable to gradually reduce the pathological settings of the segments in the form of bringing the hip in the corresponding hip joint, while the correction of these settings is carried out by simultaneous dosed stretching of the adductors of the hip and dosed correction of the position of the femoral head in the acetabulum of the corresponding hip joint by abducting the thigh in the frontal plane, as well as subsequent fixation corrected position using the first exoskeleton module, providing possible st of the movements in the corresponding hip joint in a horizontal, frontal and sagittal planes within the scope of which is set by means of said first module.
- Using the proposed method improves the supportability of the lower extremities and the correction of the pathological posture and motor stereotype of young children, adolescents and adults suffering from spastic or flaccid paresis of the lower extremities of various origins, diseases of the musculoskeletal system, including metabolic nature, or any other diseases and conditions leading to separate or in combination pathological settings of lower limb segments.
- a device for correcting pathological settings of segments of the lower extremities containing an adjustable pelvic band placed around the pelvic region of the user, at least one means of fixing the thigh in a predetermined position, at least one means of rotation of the lower leg, at least one means of fixing the lower leg in a given position, at least one means of correcting the position of the foot and the volume of its movement in the ankle joint, at least one means for accommodating feet, and a group of connecting elements, in which, according to the invention, the specified adjustable pelvic bandage is made with the possibility of centering the head of at least one thigh, the specified means of fixing the thigh in a predetermined position is made with the possibility of installation rotation in a horizontal plane, the specified means of rotation the lower leg is configured to correct the position of the axis of rotation of the knee joint in the frontal and horizontal planes, the specified means of fixing the lower leg in a given position EHO pivotable foot in a horizontal plane, each connecting element in said group of connecting elements comprises
- the technical result of the claimed invention is the possibility of correcting the position of the positions of the axes of rotation of the hip, knee and ankle joints in the horizontal, frontal and sagittal planes.
- the patented device can be used for functional correction of pathological settings of the thigh, lower leg and foot, such as internal rotation of the axis of the lower limb, internal rotation of the thigh, adduction of the thigh, varus or valgus installation of the lower leg, varus or valgus installation of the foot, equinus position of the foot, sagging of the forefoot, adduction or abduction of the foot in various clinical forms of cerebral palsy, with partial damage to the spinal cord, as well as damage to peripheral nerves and other diseases in adults and children, leading to pathological settings of segments of the lower extremities.
- pathological settings of the thigh, lower leg and foot such as internal rotation of the axis of the lower limb, internal rotation of the thigh, adduction of the thigh, varus or valgus installation of the lower leg, varus or valgus installation of the foot, equinus position of the foot, sagging of the forefoot, ad
- the design of the proposed device is quite simple and contains lightweight structural units, which is especially important when using the device for young children.
- Connecting elements in the form of cylindrical rods allow you to change the length of the device as a whole, as well as carry out rotation and free linear movements of its parts. This allows you to accurately adapt the device for a specific user, which is especially important for children during the period of active growth.
- said adjustable pelvic bandage comprises a support plate on which a base oriented along the pelvic bandage is fixed, on each of the two opposite sides of which there is a means for centering the femoral head, including a flange having a hemispherical recess, a removable cover rigidly connected to the specified flange and having reverse hemispherical recess, and a spherical hinge, rigidly fixed in these recesses with the possibility of installation free rotation and having a first squo hydrochloric channel in which is freely rotatably fixed to a first end of said first rod.
- a patented device provides centering of the femoral head in the acetabulum with simultaneous correction of the longitudinal axis of the lower limb.
- the claimed design means of centering the femoral head allows the abduction of the thigh both in a static position ("sitting", "standing"), and with locomotion.
- the said means of centering the femoral head is configured so that a different degree of hip abduction is provided for different positions of the user's body (“sitting”, “standing”) and in the process of locomotion. This setting is achieved. due to the possibility of installation free rotation of the spherical joint in the frontal and horizontal planes and its fixation in a predetermined position corresponding to the pathology of a particular user.
- the specified means of fixing the thigh in a predetermined position was made of the first and second parts installed with the possibility of free rotation of one relative to the other in the sagittal plane and with the possibility of installation rotation in the horizontal plane, while the device had an adjustable thigh cuff, on which the rotation in the sagittal plane is fixed to the first part of the indicated means of fixing the thigh in a predetermined position, having a second through channel, in which a first end of said second rod, and a second end channel is located in a second part of said thigh fixation device in a predetermined position, in which the second end of said first rod is freely linearly movable.
- said means of fixing the thigh in a predetermined position contains an axis connecting said adjustable thigh cuff of the thigh with said first and second parts of the means for fixing the thigh in a predetermined position, while the ends of this axis are rotatably fixed on said adjustable thigh cuff and on said the second part of the means of fixing the thigh in a predetermined position.
- the indicated means of rotation of the lower leg was made of two parts installed with the possibility of installation rotation relative to one another in the frontal and horizontal planes, while in the first part of this means of rotation of the lower leg a fourth through channel is made, in which the second fixed channel is mounted with the possibility of linear installation the end of the specified second rod, and in the second part of the indicated means of rotation of the lower leg a slot is made in which a knee hinge mounted on the axis is made to limit flexion and extension of the tibia in the sagittal plane and having a slot in which is rigidly fixed first end of said third rod.
- said knee joint comprises a needle bearing whose axis is mounted at its opposite ends with its ends the specified second part of the means of rotation of the lower leg, and in the area of the specified slot of the second part, an emphasis is made restricting the rotation of the specified knee joint in the sagittal plane.
- the indicated means of rotation of the lower leg contained an axis, one end of which is rigidly fixed in the specified first part of the means of rotation of the knee joint, and the second end of the specified axis is installed in the specified second part of the means of rotation of the lower leg with the possibility of rotation of the specified second part relative to its first part.
- the described means of rotation of the lower leg i.e., correcting the position of the axis of rotation of the knee joint
- said shin fixation means in a predetermined position comprises an adjustable shin cuff and a base having fifth and sixth through channels in which the second end of said third rod and the first end of said fourth rod are fixed linearly, respectively, wherein said base has an axis on which, with the possibility of rotation in the sagittal plane, said adjustable cuff of the lower leg is fixed.
- the implementation of the means for fixing the lower leg with one adjustable cuff, which is placed in the middle part of the lower leg, is advisable when the length of the lower leg is small and when the volume of the lower leg varies slightly along its length. In this case, the cuff is firmly held on the lower leg and does not cause inconvenience when using the device.
- the said means of fixing the lower leg in a predetermined position contain the first and second adjustable cuffs of the lower leg and the first and second bases, each of which has a seventh and eighth through channels, while the device contains an intermediate rod, and in said seventh through channel of said first base, the second end of said third rod is rigidly fixed, in said eight through channel of said first base with the possibility installation linear movement, the first end of the specified intermediate rod is fixed, in the specified seventh and eighth through channels of the specified second base with the possibility of installation linear movement, the second end of the specified intermediate rod and the first end of the specified fourth rod are fixed, respectively, while each specified base has an axis on which with the possibility of rotation in the sagittal plane, the corresponding specified adjustable cuff of the lower leg is fixed.
- said intermediate rod is made curved in the shape of the calf of the user.
- An embodiment of the apparatus with two lower leg cuffs, the first of which is located in the upper part of the lower leg under the knee, and the second in the lower part, closer to the ankle joint, provides more reliable functioning of the lower leg fixation device, eliminating distortions and poor fit to the lower leg.
- said means for correcting the position of the foot and the volume of its movement in the ankle joint contain an ankle hinge having a hollow body in which a tip is installed, at the first end of which the second end of the specified fourth rod is rigidly fixed, and the second end of the specified tip is fixed in the specified hollow body on the axis of the specified ankle joint with the possibility of rotation in the sagittal plane.
- the device contains a connecting plate, one end mounted on the specified axis of the specified ankle joint with the possibility of rotation in the sagittal plane, and the other end is rigidly connected with the specified means for placing the foot.
- the specified connecting plate in its configuration corresponds to the anatomical features of the user's foot.
- At least one elastic element is configured to limit the rotation of the foot in the sagittal plane.
- said means for placing the foot comprise a shoe and at least one fastener for fixing the foot.
- the means for correcting the position of the foot and the range of motion in the ankle joint, made as described above, provides the ability to correct the pathological installation of the foot, is reliable and convenient to use.
- the presence of elastic elements provides a smooth movement of the ankle joint, which facilitates the operation of the apparatus.
- the device contains a means of extension of the knee joint, fixed in the area of the respective ends of the specified second and third rods.
- said knee extension means comprises at least one spring, one end fixed to said second part of the tibia rotation means, and the second end fixed to said first end of the third bar.
- said knee extension means comprises at least one mover mounted in the area of the respective ends of said second and third rods.
- the device contains a mover mounted on the specified adjustable pelvic brace in the installation area of the specified means of centering the femoral head.
- said adjustable pelvic brace comprises a base, near each of the opposite ends of which there is a corresponding seat, comprising a first annular gear surface, on which there is a corresponding means for centering the femoral head, which is mounted on the corresponding seat with the possibility of installation rotation and contains a housing, on the surface of which, facing the base, a second ring-shaped gear surface is made, and a beveled washer mounted between the specified base and the specified housing with the possibility of installation rotation and having at its ends a third and fourth ring-shaped gear surfaces made with the possibility of engagement with the specified first and second ring-shaped gear surfaces, respectively.
- the device prefferably has at least one adjustable thigh hip cuff that is rotatable in the sagittal plane and on which it can be rotated in the horizontal plane secures the appropriate means of fixing the thigh in a predetermined position, while the ninth through channel oriented along the base is made inside the specified body of the center of the femoral head, in which the fastening means of the first end of the first connecting rod are fixed, made with the possibility of free rotation and linear installation of the specified the first end of the first connecting rod, the specified second end of which is installed in the said tool fix thigh populations in a given position.
- said fastening means of said first end of the first rod comprise first and second bushings with corresponding flanges, mounted for free rotation in said ninth through channel of said body of means for centering the femoral head from opposite sides, while the outer surface of said first end of the first rod and the inner surfaces of these first and second bushings are threaded and form a threaded connection to provide installation linear movement the specified first end of the first bar.
- said beveled washer is capable of discrete installation rotation, while on a corresponding indicated mounting location around said first annular gear surface there is a scale, the division of which corresponds to the step of discrete installation rotation of said beveled washer.
- the bevel angle of said beveled washer is from 3 to 30 °.
- said means for centering the femoral head comprise a first flat spring installed between said surfaces of said bases and beveled washers, respectively, inside said first and third annular gear surfaces.
- said means for centering the femoral head comprise a second flat spring mounted between said said housing surfaces and the beveled washer, respectively, inside said second and fourth annular gear surfaces.
- said means of fixing the thigh in a predetermined position comprise a hollow body and an attachment point of said means of fixing the thigh in a predetermined position to said adjustable hip cuff, wherein said node is fixed on one side of this hollow body partially inside of it with the possibility of rotation of the hip in a static position and when moving, and on the opposite side of the aforementioned hollow body with the possibility of linear displacements, the specified second end of the first rod.
- said attachment point of the hip fixation device in a predetermined position comprises an insert fixed in the indicated hollow body of the hip fixation device in a predetermined position and having a shank protruding from this hollow housing, in which a ball bearing having a stator and a rotor rotatably mounted in the sagittal and horizontal planes.
- the device comprises at least one attachment point of a first end of said second rod, mounted rotatably in a horizontal plane and having a tenth through channel in which said first end of the second rod is rotatably and positioned linearly.
- said tibia rotation means comprises a step housing, in the first step of which a second end of said second rod is fixed, capable of installation rotation in the frontal and horizontal planes, and in the second stage a knee hinge is mounted, which is capable of limited rotation in the sagittal plane, however, there is a mounting unit for the first end of the said third rod associated with the specified knee joint.
- the specified knee hinge contains a base, a cover made with the possibility of discrete installation rotation and fixation in a predetermined position, a spring, one end fixed in the specified second stage of the step housing, and the other end fixed in the indicated hinge knee hinge, and the axis, one end fixed in the specified second stage of the stepped housing, and the other end fixed in the indicated hinge knee joint. It is desirable that between the specified base of the knee hinge and the specified second stage of the stepped housing was installed liner made with the possibility of restricting the rotation of the specified knee hinge.
- said insert has a C-shape and is made of an elastic material.
- the indicated attachment point of the first end of the third rod contains a clamp fixed to the indicated base of the knee joint, and a latch configured to engage with the specified cover of the knee joint.
- the device contains a clamping element, covering the specified clamp and retainer.
- said tibia rotation means comprises a gear pair configured for limited rotation in the sagittal plane and including first and second gears, each of which has a ring gear and an axis of rotation, first and second side plates, which are mounted at the ends of the gear pair and in which are fixed to the first and second axis of rotation passing through the specified first and second gears, and front and rear stops mounted on one of these side plates, while the specified second to the end of the second rod is fixed in the specified first gear, and the specified first end of the third rod is fixed in the specified second gear.
- said means of fixing the lower leg in a predetermined position comprise a first adjustable lower leg cuff, on which the first base is rotatably mounted in the sagittal plane, and a second adjustable lower leg cuff, on which the second base is rotatably mounted in the sagittal plane, while the device comprises a first intermediate bar connecting said first and second adjustable lower leg cuffs.
- said means for correcting the position of the foot and the volume of its movement in the ankle joint contain an external ankle joint having a hollow body in which a tip is mounted, at one end of which a second end of the specified fourth rod is fixed, and a second end of the specified tip is fixed on the axis of the external ankle the hinge with the possibility of rotation in the sagittal plane, while the device contains a curved a connecting plate, fixed at one end on the specified axis of the external ankle joint with the possibility of rotation in the sagittal plane, and at the other end fixed on the specified means for placing the foot.
- At least one resilient member configured to limit the rotation of the foot in the sagittal plane is installed in the indicated hollow body of the means for correcting the position of the foot and the volume of its movement in the ankle joint.
- the said means for correcting the position of the foot and the volume of its movement in the ankle joint contain an external ankle joint having an axis and a body in which the second end of the specified fourth rod is fixed, while the device contains a curved connecting plate spring-loaded to the specified body, fixed at one end on the specified axis of the external ankle joint with the possibility of rotation in the sagittal plane, and the other end mounted on the specified tool for placing the foot.
- the device contains at least one second intermediate bar
- said means for correcting the position of the foot and the volume of its movement in the ankle joint contains at least one internal ankle joint
- said first and second adjustable cuffs of the lower leg with the first and second clamps are installed on the inner side of the lower leg with the possibility of rotation in the sagittal plane, in the first of which the first end of the specified second intermediate is fixed with the possibility of linear installation movements exact rod, the second end of which is passed through said second collar and is connected to said inner ankle joint.
- said inner ankle hinge has a hollow body in which a tip is mounted, at one end of which said second end of the second intermediate rod is fixed, and a second end of the tip is fixed on the axis of said inner ankle hinge with the possibility of rotation in the sagittal plane, while the device comprises curved connecting plate, one end fixed to the axis of the specified internal ankle joint with the possibility of rotation in the sagittal plane, and the other end mounted on the specified tool for placing the foot.
- the specified internal ankle hinge has a housing in which the specified second end of the second intermediate rod is fixed, while the device contains a curved connecting plate spring-loaded to the specified body, one end fixed to the axis of the specified internal ankle hinge with the possibility of rotation in the sagittal plane, and the other end mounted on the specified means for placing the foot.
- each said first rod is made in the form of a cylindrical rod of complex spatial shape and has a first rectilinear section oriented along the axis of rotation of said first rod, a second rectilinear section oriented essentially along the user's thigh, and a third curved section smoothly connecting the first straight section and the second straight section.
- a patented device for correcting pathological settings of segments of the lower extremities is unique in comparison with other devices of the same purpose, as it provides high efficiency results due to the possibility of correcting the position of the longitudinal axes of the segments of the lower extremities and the positions of the axes of rotation of the hip, knee and ankle joints.
- the patented device can be adapted for a specific user, which facilitates the use of such a device.
- the absence of rotating and rubbing parts in contact with the user's body is also its undoubted advantage.
- the use of the proposed device improves the supportability of the lower extremities and the correction of the pathological posture and motor stereotype of young children, adolescents and adults suffering from spastic or flaccid paresis of the lower extremities of various origins, diseases of the musculoskeletal system, including metabolic nature, or any other diseases and conditions leading to separate or in combination pathological installations of segments of the lower extremities.
- the proposed method is intended for the phased elimination of various pathological settings of the segments of one or two lower limbs (thigh, lower leg, foot), individually or in combination.
- These pathological settings may include, for example, adduction of the thigh (s); internal rotation of the thigh (thighs); internal rotation of the entire lower limb (lower limbs); flexion of the lower leg or recurrence of the lower leg (legs); varus or valgus installation of the lower leg (lower legs); equinus position or sagging of the foot (stop); varus or valgus installation of the foot (stop); reduction or abduction of the foot (stop) and other pathological settings, which may be the result of various combinations of the above settings.
- the proposed method for the correction of pathological settings of the segments of the lower extremities includes the correction of pathological settings of the segments of one or two lower limbs using an orthopedic device.
- This device is a biomechanical rotational corrective apparatus for the lower extremities, which we call a modular exoskeleton.
- the modular exoskeleton is made with the possibility of individual customization for a specific user and with the possibility of reconfiguration during its use.
- a modular exoskeleton has first, second, and third modules, as well as other means that can be independently used or in a given combination, depending on the type of pathological settings of the user's lower extremities.
- the proposed device will be described below when describing a specific variant of the proposed exoskeleton.
- a phased correction of the position of the longitudinal axes of those segments is carried out one or two lower limbs, which have separate or combined pathological settings.
- This correction is carried out in the horizontal and / or frontal and / or sagittal planes. Depending on the presence of pathological settings in the user, correction can be carried out individually in each plane, in various combinations of planes, or in all planes simultaneously.
- the specified correction is carried out by simultaneously performing a metered elimination of the imbalance of muscle forces serving the corresponding joints and reducing the pathological settings of these segments and then fixing these segments in a corrected position at each stage of correction using the specified orthopedic device, which is at least one module of the specified modular exoskeleton, made with the possibility of individual settings, approximating at each stage of correction Assumption longitudinal axis of each segment pathologically set to a physiologically correct position.
- the fixation of these segments in the corrected position at each stage is carried out with the possibility of movements in the respective joints around the corrected biomechanical axes of rotation of the respective joints within the volume specified by the specified modular exoskeleton. As a result, the stereotype of the user's movements in the corresponding joints is brought closer to the physiologically correct stereotype of the movements.
- the position of these planes in the implementation of the proposed method is determined when the user is in the standing position.
- Fixation of these segments in the corrected position at each stage of correction using the appropriate modules is carried out when the user is in the "lying” position. After fixing the corresponding modules, the user is transferred to the “standing” position, in which he has the ability to move around and painlessly carry out any actions associated with movement in various joints, including corrected ones.
- the number of correction steps is individual for each user and depends on the severity of the pathological settings of the lower limb segments, the initial muscle tone of the user, the user's tolerance to physical activity and the rate of physiological growth.
- the proposed method was used in continuous use when awake for a long time (for example, one year or more).
- the pathological settings of the segments in the form of bringing the hip in the corresponding hip joint are phased.
- the correction of these settings is carried out by simultaneously dosing the adductors of the thigh and dosing the position of the femoral head in the acetabulum of the corresponding hip joint by adjusting the hip in the frontal plane and then fixing the corrected position using the first exoskeleton module, which allows movements in the corresponding hip joint in horizontal, frontal and sagittal planes within the volume a, which is set by the specified first module.
- the position of the femoral head in the acetabulum of the corresponding hip joint is brought closer to the physiologically correct position, while at each stage, the metered extension of the femoral adductors, the metered abduction of the femur and the metered change in the position of the femoral head in the acetabulum of the corresponding hip joint are carried out within the limits excluding user pain.
- a number of correction steps is selected that, without pain in the user, gradually achieves physiologically the correct position of the longitudinal axis of the corresponding lower limb when the user is in the "standing" position.
- the pathological settings of the segments in the form of bringing the hips in the corresponding hip joints of the two lower limbs are gradually reduced, the correction of which is carried out independently for each hip joint without mutual influence.
- a different degree of dosed extension of adductors of each thigh, dosed lead of each thigh and dosed change of position of the head of each thigh in the acetabulum of the corresponding hip joint is provided.
- the pathological settings of the segments in the form of internal rotation of the lower limb are gradually reduced.
- the correction of these settings is carried out by simultaneous dosed elimination of the imbalance of muscle forces serving the corresponding hip joints and the external rotation of the lower limb in the corresponding hip joint.
- the corrected position is fixed using the first and second exoskeleton modules, which makes it possible to carry out movements in the corresponding hip and knee joints within the volume defined by the indicated first and second modules.
- the dosed external rotation of the corresponding thigh and lower leg in the corresponding hip joint and the dosed elimination of the imbalance of the forces of the muscles serving the corresponding hip joint are carried out within the limits excluding the pain sensations of the user.
- the pathological settings of the segments are gradually reduced in the form of internal rotation of two lower limbs, the correction of which is carried out independently for each lower limb without mutual influence. Moreover, depending on the degree of pathological settings, they provide a different degree of dosed external rotation of the corresponding lower limb in the corresponding hip joint and dosed elimination of the imbalance of muscle forces serving the corresponding hip joint.
- pathological settings of segments in the form of shin recurrence in the corresponding knee joint are reduced, and these settings are corrected by dosing the extension of the shin in the corresponding knee joint in the sagittal plane during support during locomotion and fixation corrected position using the second module of the exoskeleton, providing the possibility of flexion and extension of the lower leg in the knee joint in the sag the ottal plane within the volume specified by the specified second module.
- the pathological settings of the segments in the form of flexion of the lower leg in the knee joint are gradually reduced.
- the correction of these settings is carried out by simultaneous dosed elimination of the imbalance of the forces that serve the knee joint and the limb flexion in the corresponding knee joint in the sagittal plane during support during locomotion and subsequent fixation of the corrected position using the spring-loaded second exoskeleton module, which allows bending and extension shins in the knee joint within the volume specified by the specified second module.
- step by step reduce the pathological settings of the segments in the form of flexion of the lower leg in the corresponding knee joint of the two lower extremities. Moreover, this correction is carried out using two spring-loaded second exoskeleton modules independently for each knee joint without mutual influence. Moreover, depending on the degree of pathological settings provide a different degree of dosed elimination of imbalance the forces of the muscles serving the corresponding knee joint and the dosed restriction of flexion of the lower leg in the corresponding knee joint.
- the dosed elimination of the imbalance of the forces of the muscles serving the corresponding knee joint and the dosed restriction of flexion of the lower leg in the corresponding knee joint are carried out within the limits excluding pain sensations in the user. Moreover, they choose such a number of stages of the specified correction, which without pain in the user gradually ensures that the physiologically correct position of the longitudinal axis of the corresponding lower limb is achieved when the user is in the "standing" position.
- step by step reduce the pathological settings of the segments in the form of varus or hallux valgus installation in the knee joint.
- the correction of these settings is carried out by simultaneous dosed elimination of the imbalance of the forces of the muscles serving the knee joint, and correction of the position of the lower leg in the frontal plane.
- the corrected position is fixed using the second exoskeleton module, which provides the possibility of flexion and extension of the lower leg in the knee joint in the sagittal plane within the volume specified by the specified second module.
- the pathological settings of the segments in the form of a varus or hallux valgus of the lower legs are gradually reduced, the correction of which is carried out independently for each lower leg without mutual influence.
- they provide a different degree of dosed elimination of the imbalance of muscle forces serving the corresponding knee joint and dosed straightening of the corresponding lower leg.
- the dosed elimination of the imbalance of the forces of the muscles serving the corresponding knee joint and the dosed correction of the position of the lower leg in the frontal plane are carried out within the limits excluding the pain sensations of the user. Moreover, they choose such a number of stages of the specified correction, which without pain in the user gradually ensures the achievement of physiologically correct the position of the longitudinal axis of the corresponding lower limb when the user is in the "standing" position.
- the pathological settings of the segments in the form of adduction or abduction of the foot in the ankle joint are gradually reduced.
- the correction of these settings is carried out by simultaneous dosed elimination of the imbalance of the forces of the muscles serving the ankle joint, and the corresponding abduction or reduction of the foot in the horizontal plane.
- the corrected position of the foot is fixed using the third exoskeleton module, which enables plantar and dorsal flexion of the foot in the ankle joint in the sagittal plane within the volume specified by the specified third module.
- the pathological settings of the segments in the form of adduction or abduction of the foot in the corresponding ankle joint of the two lower extremities which are carried out independently for each foot without mutual influence, are gradually reduced. Moreover, depending on the degree of pathological settings, they provide a different degree of dosed elimination of the imbalance of muscle forces serving the corresponding ankle joint, and dosed removal of the corresponding foot.
- the dosed elimination of the imbalance of the forces of the muscles serving the corresponding ankle joint, and the dosed abduction and reduction of the corresponding foot are carried out within the limits excluding the pain sensations of the user. Moreover, they choose such a number of stages of the specified correction, which without pain in the user gradually ensures that the physiologically correct position of the longitudinal axis of the corresponding lower limb is achieved when the user is in the "standing" position.
- the pathological settings of the segments in the form of a varus or valus installation of the foot in the ankle joint are gradually reduced.
- the correction of these settings is carried out by simultaneous dosed elimination of the imbalance of the muscles of the leg and changing the position of the foot in the ankle joint in the frontal plane to coincidence of the longitudinal axis of at least the calcaneus of the foot with the physiologically correct position of the longitudinal axis of the corresponding lower limb.
- fixation of the corrected position of the foot is carried out using the third module of the exoskeleton and individual corrective inserts that are installed on the inner or outer surface of the tool to place the foot of the exoskeleton, which allows the plantar and dorsal flexion of the foot in the ankle joint in the sagittal plane within the volume specified through the specified third module.
- the pathological settings of the segments in the form of varus or shafts of the foot of the foot of two lower limbs are gradually reduced, the correction of which is carried out independently for each foot. Moreover, depending on the degree of pathological settings, they provide a different degree of change in the position of the foot in the corresponding ankle joint.
- a metered change in the position of the foot in the ankle joint is carried out within the limits excluding pain in the user. Moreover, they choose such a number of stages of the specified correction, which without pain in the user gradually ensures that the physiologically correct position of the longitudinal axis of the corresponding lower limb is achieved when the user is in the "standing" position.
- the pathological settings of the segments in the form of an equine position or sagging of the foot in the ankle joint are gradually reduced.
- the correction of these settings is carried out by simultaneous dosed stretching of the triceps muscle of the corresponding lower leg and limiting plantar flexion of the foot in the sagittal plane.
- the corrected position of the foot is fixed using the third exoskeleton module, which enables the back flexion of the foot in the ankle joint in the sagittal plane within the volume specified by the specified third module.
- step by step reduce the pathological settings of the segments in the form of an equine position or sagging of the foot in the corresponding ankle the joint of two lower limbs, which are carried out independently for each foot without mutual influence. Moreover, depending on the degree of pathological settings, they provide a different degree of dosed stretching of the triceps muscle of the corresponding lower leg and limitations of the plantar flexion of the foot.
- the metered stretching of the triceps muscle of the corresponding tibia and the restriction of the plantar flexion of the foot are carried out within the limits excluding pain in the user. Moreover, they choose such a number of stages of the specified correction, which without pain in the user gradually ensures that the physiologically correct position of the longitudinal axis of the corresponding lower limb is achieved when the user is in the "standing" position.
- various active exercises of a dynamic nature can be carried out to reduce the tone of the corresponding muscles.
- various effects on the user for example, manual effects, hardware effects, physiotherapeutic effects, drug effects.
- these effects can be used individually or in combination.
- botulinum toxin type “A” preparations As a medical effect, it is possible to use, for example, the following drugs: botulinum toxin type “A” preparations, muscle relaxants, and local anesthetic therapy drugs.
- a physiotherapeutic effect for example, electrical stimulation of muscles can be used, including functional electrical stimulation of muscles in walking (artificial correction of movements), oscillatory therapy, cryotherapy, cryocontrast.
- the use of the proposed method ensures the physiologically correct position of the longitudinal axes of the segments of the left and / or right lower limb while maintaining the possibility of active movements in large joints, which is a prerequisite for the development of active motor skills in the process of long-term correction and eliminates the negative impact of prolonged immobilization on musculoskeletal and central nervous system of the user.
- FIG. 1 schematically depicts a device for correcting pathological settings of segments of the lower extremities, a General view, according to the invention
- FIG. 2 an adjustable pelvic bandage according to the invention
- FIG. 3 - means for centering the femoral head, a cross section according to the invention
- FIG. 4 is the same as in FIG. 3 is a plan view according to the invention.
- FIG. 5 - means for fixing the thigh in a predetermined position, a longitudinal section according to the invention
- FIG. 6 is a section along line I-I in FIG. 5;
- FIG. 7 - means of rotation of the lower leg, a longitudinal section according to the invention
- FIG. 8 is a section along line II-II in FIG. 7;
- FIG. 9 is a plan view of FIG. 7 with cuts and tears, according to the invention.
- FIG. 10 - means for fixing the lower leg in a given position, a longitudinal section with tears, according to the invention;
- FIG. 11 is a section along the line III - III in FIG. 10, with breakouts;
- FIG. 12 - means of fixing the foot relative to the ankle joint and correcting the volume of its movement, a longitudinal section, with tears, according to the invention
- FIG. 13 is a section along the line IV - IV in FIG. 12;
- FIG. 14 - means of extension of the knee joint according to the invention
- FIG. 15 is an embodiment of a device for correcting pathological settings of segments of the lower extremities, in this configuration comprising an adjustable pelvic brace, means for centering the femoral head and means for fixing the thigh in a given position, general view, according to the invention;
- FIG. 16 is a fragment of an adjustable pelvic brace with means for centering the femoral head, according to the invention.
- FIG. 17 is a section along line V-V in FIG. 16;
- FIG. 18 is a fragment D in FIG. 17 is an enlarged scale according to the invention.
- FIG. 19 - means for fixing the thigh in a predetermined position, a longitudinal section according to the invention
- FIG. 20 is a section along line IV-IV in FIG. 19;
- FIG. 21 - means of rotation of the lower leg, a longitudinal section according to the invention
- FIG. 22 is a view along arrow E in FIG. 21;
- FIG. 23 - means for fixing the lower leg in a predetermined position, general view, according to the invention
- FIG. 24 is a section along the line VII - VII in FIG. 23;
- FIG. 25 is a tool for rotating the lower leg, a longitudinal section, in another embodiment, according to the invention.
- FIG. 26 - means of fixing the foot relative to the ankle joint and correcting the volume of its movement, a longitudinal section with tears, according to the invention
- FIG. 27 is a section along line VIII-VIII in FIG. 26;
- FIG. 28 is a view along arrow F in FIG. 27;
- FIG. 29 - means of fixing the foot relative to the ankle joint and correcting the volume of its movement, in longitudinal section in another embodiment, according to the invention
- FIG. 30 (a, b) is the same as in FIG. 15, in the configuration containing the means for turning the lower leg, the means for fixing the lower leg in a predetermined position, the means for fixing the foot relative to the ankle joint and correcting its volume movement and means for placing the foot, front and rear views, respectively, according to the invention;
- FIG. 31 - the attachment point of the second intermediate rod, with a gap, according to the invention.
- the proposed device for correcting pathological settings of segments of the lower extremities is a biomechanical rotational corrective apparatus for the lower extremities, called a modular exoskeleton.
- the exoskeleton contains an adjustable pelvic bandage 1 (Fig. 1), placed around the pelvic region of the user and configured to center the head of at least one thigh in the acetabulum of the hip joint.
- the possibility of centering the femoral head in the acetabulum is provided by at least one means 2 of the femoral head centration, made with the possibility of fixing the position of the thigh in a predetermined position and mounted on the pelvic brace 1.
- the exoskeleton also contains at least one means 3 of fixing the thigh in a predetermined position, at least one means 4 of rotation of the lower leg, configured to correct the position of the axis of its rotation in the frontal and horizontal planes, at least one means 5 of fixing the lower leg in a predetermined position, configured to rotate the foot in the horizontal plane, at least one means 6 for correcting the position of the foot and the volume of its movement in the ankle joint and at least one means 7 for placing experiment
- each connecting element is a connecting cylindrical rod 8, 9, 10, 11, made with the possibility of installation linear movement, and / or rotation, and / or free linear movement. More detailed possibilities of linear movement (free or installation) and rotation of each rod 8, 9, 10, 11 will be reflected in the corresponding section relating to the detailed description of each of the above means 2 - 6.
- Common to all rods 8, 9, 10 , 11 is the implementation of each in the form of a cylindrical rod, which allows rotation, free or installation linear movement.
- Patented exoskeleton provides, if necessary, the possibility of correcting pathological settings of all segments of the lower extremities, and in this case includes all of the above tools 2-6, placed on each lower limb and interconnected by respective rods 8, 9, 10, 11.
- Adjustable pelvic brace 1 contains a support plate 12 (Fig. 1, 2), on which is fixed the base 13, oriented along the pelvic brace 1 and having a complex shape, taking into account the anatomical features of the user.
- the base 13 is a horizontally elongated plate with rounded corners, in the upper part of which there is a symmetrically made narrowing.
- a corresponding femoral head centering means 2 is installed on each of the opposite sides of the base 13 of the adjustable pelvic brace 1, a corresponding femoral head centering means 2 is installed.
- the pelvic bandage 1 has an emphasis 11 for placement on the front wall of the abdomen.
- the emphasis 11 is made of elastic material and has a removable closed cover b, in which the corresponding means for centering the femoral head 2 are placed.
- cover b is depicted partially removed from the pelvic brace 1.
- the base 13 has a dumbbell shape and is made of light metal selected from the group: titanium, titanium alloys, aluminum alloys, magnesium alloys, and the base plate 12 is made of durable plastic, for example polypropylene.
- Each first rod 8 is made in the form of a cylindrical rod of complex spatial shape and has two rectilinear sections 8 ⁇ and 82, the first of which is oriented along the axis of rotation of the rod 8, and the second is oriented essentially along the thigh of the user, and the third curved section 8z, smoothly connecting the first and the second straight sections 81 and 82.
- the length of the straight sections 8 ⁇ and 82 of the first rod 8 corresponds to the anthropometric parameters of the user and has at least three sizes defining the total length of the first rod 8.
- Each means 2 of the centering of the femoral head (Fig. 3, 4) includes a flange 14, having a hemispherical recess, a removable clamp 15, rigidly attached to the flange 14, for example, by means of a bolt connection, and having a reverse hemispherical recess, and a spherical hinge 16, rigidly fixed in these recesses with the possibility of installation free rotation to create a certain position of the first rod 8 in the horizontal and frontal planes.
- the first end of the first rod 8 is freely rotatable.
- a through axial hole is made in the hinge 16, in which the first end of the first rod 8 is fixed with a gap, fixed by any known method, for example, by means of a washer, flared in the hole, or washer, fixed by screw connection or in another known manner.
- a conical selection is made.
- the flat angle a at the top of the conical sample is from 20 ° to 60 °, which provides a wide range of mounting positions of the hinge 16.
- the specified angle is chosen taking into account the specific pathology of a particular user.
- the arrow Ki shows the possibility of installation rotations of the hinge 16 in the frontal plane
- the arrow Kg shows the possibility of installation rotations of the hinge 16 in the horizontal plane, as well as the possibility of rotation of the first rod 8 relative to the hinge 16 when using the apparatus.
- Means 3 of fixing the thigh in a predetermined position is made of two parts 17, 18 (Fig. 5, 6) installed with the possibility of free rotation of one relative to the other in the sagittal plane and with the possibility of installation rotation in the horizontal plane.
- the device comprises an adjustable thigh cuff 19, on which the first part 17 is mounted with the possibility of rotation in the sagittal plane means 3 of fixing the thigh in a predetermined position, having a first through channel in which the first end of the second rod 9 is rotatably and positioned linearly, and a second through channel is made in the second part 18, in which the second end of the first rods 8.
- metal washers 20 are provided that are rigidly fixed on opposite sides of the cuff 19 by rivets 19 ⁇ .
- the means 3 of fixing the thigh in a predetermined position contains an axis 21 connecting the adjustable thigh cuff 19 with the first and second parts 17, 18 of the means 3 of fixing the thigh.
- the ends of the axis 21 are mounted for free rotation on an adjustable thigh cuff 19 and on the second part 18 of the means 3 for fixing the thigh in a predetermined position, for example, by means of a bolt 211 fixed on the axis 21.
- the cuff 19 and the bolt 211 washers 22 are installed, made, for example, of fluoroplastic.
- a sleeve 23 is installed in it, made of a polymeric material, for example, polypropylene or fluoroplastic.
- this part 17 is performed by the national team. After installing the second rod 9, the first part 17 is fastened, for example, with bolts 24.
- the shin rotation means 4 is made of two parts 25, 26 (Figs. 7, 8, 9) installed with the possibility of installation rotation of one relative to the other in the frontal and horizontal planes.
- the third through channel is made, in which the second end of the second rod 9 is fixed with the possibility of linear installation, and the slot 27 is made in the second part 26 of the tibia rotation means 4, in which the knee joint 29 is installed on the axis 28, which is made with the possibility of limited flexion and extension of the lower leg in the sagittal plane.
- a socket is made in which the named end of the third rod 10 is rigidly fixed, for example, by means of a rivet 10 ⁇ .
- a bearing for example, a needle bearing 30, the axis of which serves as the axis 28 of the knee joint 29.
- this part 25 is made integral, and the fastening is carried out by two bolts 32, rigidly fixing the second end of the second rod 9.
- a cylindrical protrusion serving as an axis 33 with respect to which the installation rotation of the second part 26 of the tibia rotation means 4 is carried out in the frontal and horizontal planes. Fixation of the axis 33 after its installation in a predetermined position is carried out using a bolt 331.
- the described means of rotation of the lower leg 4 allows you to adjust the position of the lower leg in the horizontal and frontal planes and at the same time carry out the specified flexion-extension of the lower leg in the sagittal plane during locomotion (movement).
- the device 5 for fixing the lower leg in a predetermined position contains an adjustable cuff 34 (Fig. 10, 11) of the lower leg and the base 35 having a fourth and fifth through channels in which the second end of the third rod 10 and the first are fixed linearly movable the end of the fourth bar 11, respectively.
- the base 35 has an axis 36 on which an adjustable lower leg cuff 34 is mounted rotatably in the sagittal plane.
- this base 35 is made integral, and the parts of the base 35 are fastened by bolting.
- the shin fixer 5 in a predetermined position comprises two similarly made adjustable cuffs 34 ⁇ (see Fig. 1) and 34g lower leg, each of which is installed on the corresponding base 351 and 35g.
- the apparatus contains an intermediate rod 37 (Fig. 1).
- each base 351, 352 has an axis 36 (Fig. 11), on which the corresponding adjustable cuff 34 ⁇ , 342 (Fig. 1) of the lower leg is rotatably mounted in the sagittal plane.
- All the cuffs mentioned above - the adjustable thigh cuff 19 and the adjustable cuffs 34, 34 ⁇ , 34g of the lower leg are made of durable plastic, for example, foamed polyethylene, polyurethane, sevelen or other similar materials and have fasteners 192 and 34z, respectively, for example, type of fastener Velcro.
- FIG. 1 shows an embodiment of the patented device, in which the means 5 for fixing the lower leg in a predetermined position are made with two cuffs 34 ⁇ , 342 mounted on the lower leg of the user as described above.
- the intermediate rod 37 can be made straight, as shown in FIG. 1, or a curved shaped tibia of the user.
- An embodiment of the apparatus with two cuffs 341, 342 of the lower leg, the first of which is located in the upper part under the knee, and the second in the lower part, provides more reliable operation of the means 5 for fixing the lower leg in a predetermined position, eliminates distortions and poor fit.
- the means 6 for correcting the position of the foot and the volume of its movement in the ankle joint contains an ankle joint 38 (Fig. 12, 13) having a hollow body 39 in which the tip 40 is mounted.
- the second end is rigidly fixed to one end of the tip 40 the fourth rod 11, for example, using rivets H i, and the second end of the tip 40 is fixed in the hollow body 39 on the axis 41 of the ankle joint 38 with the possibility of rotation in the sagittal plane.
- the housing 39 consists of two parts 39 ⁇ , 392, interconnected by bolts 39z, 394.
- At least one elastic element 42 is installed (in the described embodiment there are two elastic elements 42) installed in the hollow body 39 and made with the possibility of limiting the rotation of the foot in the sagittal plane.
- One or two elastic elements 42 create more favorable conditions for the operation of the proposed device and are made, for example, of rubber or rubber.
- the device comprises a connecting plate 43, one end fixed to the axis of the ankle joint 38 (Fig. 12) with the possibility of rotation in the sagittal plane, and the other end is rigidly connected to the means 7 (Fig. 1) for placing the foot, which contains the shoe 44 and fasteners 45 for fixing the foot.
- the shoe 44 of the foot placement means 7 corresponds to the length of the user's foot and can be made with or without the forefoot. If necessary, shoe 44 of one size can be replaced with shoe 44 of a different size.
- the apparatus may contain a means 46 (Fig. 1, 14) of the extension of the knee joint, fixed in the area of the respective ends of the second and third rods 9, 10.
- the knee extension means 46 comprises at least one spring 461 (Fig. 14), one end fixed to the second part of the tibia rotation means 4 (Fig. 1), and the second end fixed to the first end the third bar 10.
- the knee extension tool 46 may include at least one mover (not shown) installed in the area of the respective ends of the second and third rods 9, 10.
- the device may contain a mover (not shown in the drawing), mounted on an adjustable pelvic brace 1 of the thigh in the installation area of the means 2 of the center of the femoral head.
- a distinctive feature of the patented apparatus is the ability to correct pathological settings of different segments of the lower extremities.
- the apparatus contains an adjustable pelvic brace 1 made with the possibility of centering the femoral head in the acetabulum, and at least one means 3 of fixing the thigh in a predetermined position, which are interconnected by a first rod 8 made with the possibility of rotation and free linear movement.
- the named structural units form the first module A, made with the possibility of installation rotation in the horizontal plane and rotation of the hip in a static position and during movement (locomotion).
- the apparatus includes at least one means 3 of fixing the thigh in a predetermined position, at least one means 4 of rotation of the lower leg and at least one means 5 of fixing the lower leg in a predetermined position, which connected between a second and third rods 9, 10, respectively.
- the second rod 9 is made with the possibility of rotation and installation linear displacement
- the third rod 10 is made with the possibility of installation linear displacement.
- the above-mentioned means 3, 4, 5 form a second module B, configured to change the position of the lower leg in the horizontal and frontal planes.
- module A in combination with module B.
- the apparatus includes at least one means 5 for fixing the lower leg in a predetermined position and at least one means 6 for correcting the position of the foot and the volume of its movement in the ankle joint, which are connected between a fourth rod 11, made with the possibility of installation linear movement.
- the above funds 5, 6 form the third module C, made with the possibility of external and internal rotation of the lower leg and foot in the horizontal plane
- first, second and third modules A, B and C are made with the possibility of independent use or in a predetermined combination, depending on the type of pathological settings of the lower limbs of the user.
- a device of the required size is selected for a specific user. They mainly use apparatuses of three sizes, while it is possible to adjust individual modules in length by changing the length of individual rods 8 - 11, 37. In addition, it is possible to create an individual apparatus made for a specific user.
- the proposed modular exoskeleton having the first, second and third modules A, B, C and all means 2, 3, 4, 5, 6, 7 installed on the two lower limbs of the user.
- cuffs 341, 34g of the lower leg and shoe 44 are put on, their position is fixed by means of fasteners 34z and fasteners 45, and the lengths of the rods 10, 11, 37 are selected.
- the lengths of the rods 10, 11, 37 are chosen so that the axis 28 of the knee hinge 29 was projected slightly higher (approximately 2 cm) in the joint space of the knee joint.
- an adjustable pelvic bandage 1 is put on the user's pelvic region (Fig. 1), ensuring that it fits snugly against the user's body.
- the user's hips are inserted into the hip cuffs 19, which are fixed in the lower third of the thigh by means of fasteners 192 so that the cuffs 19 do not fall under the knee joints, after which the length of the rod 9 is set.
- the means for centering the femoral head, the means for 4 rotation of the lower leg and the means for correcting the position of the foot and the volume of its movement in the ankle joint are set to that position of the corresponding means 2 , 4, 6, so that the correction of the position of the axes of rotation of the hip, knee and ankle joints in the horizontal and frontal planes is achieved.
- the spherical hinges 16 (Fig. 3, 4) are installed in the middle position, in which the axis of the first rod 8 is parallel to the longitudinal axis of the base 13.
- the optimal axis direction of the corresponding first rod 8 is selected and the position of the corresponding spherical hinge 16 is fixed by bolting. This position of the spherical hinge 16 and the associated first rod 8 corresponds to the prescribed hip correction and does not cause pain for the user.
- the proposed modular exoskeleton can be configured individually for each hip joint of a particular user without mutual influence, which distinguishes it from known structures of a similar purpose.
- the tightening of the bolt 331 of the second part 26 of the tibia rotation means 4 which fixes the position of the second part 26 on the axis 33, is loosened and held in the selected position by the third bar 10 together with the calf of the user and fix the position of the tibia by tightening the bolt 331.
- the proposed modular exoskeleton can be used with other devices to solve the problem of correction of pathological settings of the lower extremities, especially in children.
- the proposed modular exoskeleton can be used in combination with a device for the treatment of injuries of the musculoskeletal system, known from RF patent N ° 2241500, with the Gravistat ® device or with other similar devices, which, along with the correction of pathological settings of lower limb segments, can be performed correction of pathological settings of segments of the upper limbs and / or body of the user individually or in combination. This distinguishes the proposed method and device from the known.
- the specified embodiment of the present invention will be considered in relation to the correction of pathological settings of the segments of the two lower extremities.
- the proposed modular exoskeleton contains an adjustable pelvic brace 47 (Fig. 15), placed around the pelvic region of the user and having a base 48, at each of the opposite ends of which there is a means 49 for centering the femoral head, made with the possibility of fixing the position of the thigh in the acetabulum in the hollow.
- the device contains two adjustable thigh cuffs 50, each of which is adapted to be placed around the corresponding distal part of the thigh of the user and is made with the possibility of rotation in the sagittal plane.
- Each thigh cuff 50 has a corresponding means 51 for fixing the hips in a predetermined position, each of which is installed with the possibility of installation rotation in the horizontal plane, and the first two rods 52.
- Each first rod 52 is fixed by the first end to the fastening means of the first end of the first rod (in the drawing not shown) installed in the corresponding means 49 of the centering of the femoral head, and the second end is connected to the means 51 of fixing the thigh in a predetermined position, made with the possibility of installation orot in the horizontal plane.
- Each first rod 52 is made in the form of a rod of complex spatial shape and has a first rectilinear section 53, which is oriented along the axis of rotation of the first rod 52, a second rectilinear section 54, which is oriented essentially along the user's thigh, and a third curved section 55, smoothly connecting the first and the second straight sections 53, 54.
- the length of the straight sections 53, 54 of the first rod 52 corresponds to the anthropometric parameters of the user and has at least three sizes defining the total length of each first rod 52, however, in the described embodiment of the apparatus there is an additional possibility of regulating the length of the first rod 52, which will be said below.
- seats 56 are made (FIGS. 16, 17), on each of which a first annular gear surface is made, and means 49 for centering the head of the corresponding thigh is fixed with installation free rotation.
- Each means 49 for centering the head of the corresponding thigh includes a housing 57, a beveled washer 58, and means 59 for fastening the first end of the first rod.
- a second annular gear surface is made on the surface of the housing 57 facing the base 48.
- the bevel angle of the beveled washer 58 is from 3 to 30 °.
- a beveled washer 58 is installed between the base 48 in the area of the seat 56 and the housing 57 with the possibility of installation rotation.
- the means 59 for fastening the first end of the first rod 52 is made with the possibility of free rotation and installation linear movement of the first end of the first rod 52.
- the third and fourth annular gear surfaces corresponding to the first and second annular gear surfaces are made, respectively.
- a beveled washer 58 is mounted between the base 48 and the housing 57 with the possibility of engaging the third and fourth annular gear surfaces of the washer 58 with the first and second gear surfaces, respectively, and with the possibility of installation rotation in the plane of the base 48.
- FIG. 18 On an enlarged scale in FIG. 18 shows the engagement of the respective gear surfaces mentioned above.
- Each means for centering the femoral head 49 comprises a first flat spring 60 mounted between the facing surfaces of the base 48 facing one another and the beveled washer 58 inside the first and third annular gear surfaces, respectively.
- a second flat spring 61 installed between facing one another of the surfaces of the housing 57 and the beveled washer 58 inside the second and fourth annular gear surfaces, respectively.
- the first and second flat springs 60, 61 having a cross-shaped lobe configuration, as well as the boundaries of said gear surfaces, are shown in dashed lines.
- the housing 57, the beveled washer 58 and the first and second flat springs 60, 61 are fixed to the base 48 by means of a bolt 62, one end of which is installed in the sleeve 63, located in the base 48 and partially in the beveled washer 58.
- a head 64 is made, the shape of which is adapted for convenient rotation of the bolt 62.
- the means 49 of the centering of the femoral head, made as described above, is quite compact and slightly protrudes above the base 48, which does not create inconvenience to the user when wearing the patented apparatus.
- Each beveled washer 58 is made with the possibility of discrete installation rotation, and on the surface of the base 48 around the first ring-shaped gear surface, a scale 65 is made, the division of which corresponds to the step of the discrete installation rotation of the beveled washer 58. To visualize the installation position of the beveled washer 58, a protrusion 66 is made on it .
- an eighth through channel oriented along the base 48 is formed inside the housing 57 of the femoral head centering means 49.
- a means 59 for fastening the first end of the first rod 52 which is capable of free rotation and linear installation movement of the first rod 52.
- the means of fastening the first end of the first rod 52 comprises first and second bushings 67, 68 with corresponding flanges 69, 70, mounted with the possibility of linear movement in the eighth through channel of the housing 57 from opposite sides with the possibility of free rotation relative to this housing 57.
- Each sleeve 67, 68 has a thread made on its inner surface, and the thread on the first sleeve 67 is directed in the opposite direction relative to the thread on the second sleeve 68.
- Inside the bushings 67, 68 is placed The first end of the first rod 52 is provided, on the outer surface of which a thread is made.
- the first end of the first rod 52 in conjunction with the bushings 67, 68 forms a threaded connection that provides linear linear movement of the first rod 52.
- the first end of the first rod 52 linearly moves in one direction or another, which allows you to adapt the first bar 52 for a specific user.
- FIG. 16 shows several positions of the first rectangular portion 53 of the first rod 52 inside the bushings 67, 68, illustrating the possibility of linear alignment.
- each means 51 of fixing the thigh in a predetermined position is fixed on an adjustable cuff 50 and is configured to rotate in a horizontal plane.
- each means for fixing the thigh 51 includes a hollow body 71 (Fig. 19, 20) and a mounting unit 72, which is fixed on one side of the body 71 partially inside it and is fixed on the axis 73 on an adjustable cuff 50 of the thigh with the possibility of rotation of the thigh in a static position and when moving.
- On the opposite side of the hollow body 71 is placed the second end of the first rod 52, mounted with the possibility of linear movement.
- a bolt 74 is fixed at the end of the housing 71 with bolts 74, through which the second end of the first rod 52 is passed.
- bushings 76, 77 are made made of an elastic material, for example, fluoroplastic.
- the attachment assembly 72 includes an insert 78 fixed in a hollow housing 71 and having a shank 79 protruding from the housing, in which a ball bearing is installed, having a stator 80 fixed in the shank 79, and a rotor 81 in the form of a spherical belt, rigidly fixed on the axis 73 and made with the ability to rotate in the sagittal and horizontal planes.
- the insert 78 is made of prefabricated and consists of two parts interconnected, for example, rivet 82.
- Means 51 of fixing the thigh in a predetermined position is used in the patented apparatus in the case of its use for a user having pathological settings of the thigh.
- the apparatus In the event that it is additionally required to correct the position of the lower leg and / or foot of the user, the apparatus must additionally be equipped with means for turning the lower leg and / or means for fixing the lower leg in a predetermined position, and / or means for correcting the position of the foot and the volume of its movement in the ankle joint.
- a second rod 83 is provided to connect the means 51 of fixing the thigh in a predetermined position with the means following it along the length of the lower limb of the user, for example, with tibia rotation means.
- FIG. 19 20 shows the assembly 84 of the fastening of the first end of the second rod 83.
- the second rod 83 is absent and, therefore, the specified mount 84.
- FIG. 19, 20 one embodiment of the indicated structural embodiment of the apparatus is presented, namely, the embodiment with the presence of said assembly 84 for fastening the first end of the second rod 83.
- the mounting housing 84 ⁇ of the assembly 84 consists of two parts interconnected by a bolt 85.
- metal washers 86 are provided that are rigidly fixed on opposite sides of the cuff 50 by rivets 82.
- the ends of the axis 73 are freely rotatable on the adjustable thigh cuff 50 and on the inserts 78 of the hip fixation means 51 in a predetermined position, for example , by means of a bolt 87, fixing the axis 73.
- washers 88 are made between them, made For example, of Teflon.
- the modular exoskeleton contains at least one tibia rotator 89 (FIGS. 21, 22) configured to correct the position of the axis of rotation of the knee joint in the frontal and horizontal planes, at least one tibia fixator in a predetermined position (shown in 23, 24 and will be described below) configured to rotate the foot in the horizontal plane of at least one second barbell 83 and at least one third barbell 90 connecting the tibia rotation means 89 to the hip fixation means 51 adannom position and with means for fixing the tibia, respectively.
- tibia rotator 89 shown in 23, 24 and will be described below
- the tibia rotation means 89 comprises a stepped body 91, in the second stage of which a knee hinge 92 is mounted, capable of limited rotation in the sagittal plane relative to the axis 93 of the knee hinge 92.
- the axis 93 is fixed at its ends in a stepped body 91 and knee hinge 92.
- the second end of the second rod 83 is fixed in the first stage of the stepped housing 91 and is made with the possibility of installation rotation in the front and horizontal th planes.
- the first end of the third rod 90 is installed in the node 94 of the fastening of the first end of the third rod 90 associated with the knee joint 92.
- the tibia rotation means 89 in the described embodiment comprises a liner 95 mounted between the base 96 of the knee hinge 92 and the second stage of the stepped body 91 and made of an elastic material, for example, rubber.
- the insert 95 has a C - shaped shape.
- the knee hinge 92 comprises a base 96 adjacent to the liner 95, a cover 97 that is capable of discrete installation rotation and fixation in a predetermined position, and a spring 98, fixed with the first end 981 in the second stage of the step housing 91, and secured with the second end 982 in the cover 97 knee joint 92 and configured to limit the rotation of the knee joint 92.
- the second end of the second rod 83 is fixed in the first stage of the stepped housing 91 by means of a clamp 99 mounted on an axis 100, which is rotatably mounted in the protrusion 101 of the stepped housing 91.
- the protrusion 101 of the stepped housing 91 is made integral and fastened with a fastener, for example, a bolt 102.
- the cover 97 is connected to the base 96 by means of fasteners, in this case, by means of bolts 102.
- the axis 93 of the knee joint 92 is located in a sleeve 103 made, for example, of fluoroplastic.
- the assembly 94 of the fastening of the first end of the third rod 90 includes a clamp 104, mounted on the base 96 of the knee joint 92, and a latch 105, made with the possibility of engagement with a cover 97 of the knee hinge 92.
- a group of discretely arranged grooves 106 is made, which are designed to interact with the latch 105 and provide discrete installation movement of the cover 97 of the knee hinge 92 to achieve a predetermined position.
- the latch 105 is a valve (latch).
- a clamping element 107 is provided, covering the clamp 104 and the latch 105, which in the described embodiment is a cuff made, for example, of rubber.
- the shin pivoting means 89 (FIG. 25) comprises a gear pair made with the possibility of limited rotation in the sagittal plane and including the first and second gears 108, 109, each of which has a gear ring 108 ⁇ , 109 ⁇ and an axis of rotation 111, rotation 111 and the first and second side plates 112, respectively, (in the drawing, one plate 112 is not shown), which are installed at the ends of the gear pair.
- the side plates 112 protect the gears 108, 109 from getting clothes, foreign objects or upper limbs of the user, which is especially true when using the device for children.
- front and rear stops 113, 114 are mounted, fixed to one of the side plates 112 and preventing excessive extension and bending of the tibia rotation means 89, respectively.
- the side plates 112 have a specific structural purpose, namely, with their help, gears 108, 109 are fastened into a single unit by means of axes PO 111 passing through the first and second gears 108, 109 and fixed to the corresponding side plates 112 with bolts 115.
- the second end of the second rod 83 and the first end of the third rod 90 are mounted in the same way: the second end of the second rod 83 is fixed in the first gear 108 with the possibility of installation rotation in the frontal and horizontal planes by means of a collar 116 mounted on an axis 117.
- the first end of the third rod 90 is fixed in the second gear 109 with the possibility of installation rotation in the frontal and horizontal planes by means of a clamp 118, installed oh on the axis (not shown in the drawing).
- Lengths of the second rod 83 and the third rod 90 are fixed by means of fasteners, for example, bolts 119, 120.
- the described embodiments of the means of rotation of the lower leg 89 allow you to adjust the position of the lower leg in the horizontal and frontal planes and at the same time carry out the specified flexion-extension of the lower leg when walking.
- the apparatus comprises means 121 for fixing the lower leg in a predetermined position, shown in FIG. 23 ⁇ 24.
- the means for fixing the lower leg in a predetermined position comprises an adjustable lower leg cuff 122 (Fig. 24) and a base 123 having the tenth and eleventh through channels in which the second end of the third rod 90 and the first end of the fourth are fixed linearly movable. rods 124, respectively.
- the base 123 is mounted on the axis 125 for rotation in the sagittal plane, and the axis 125 is mounted on an adjustable cuff 122 of the lower leg.
- the base 123 is made integral, and the components of the base 123 are fastened together by a bolt connection consisting of three bolts 126 (Fig. 23).
- the axis 125 is made stepwise and mounted on the cuff 122 of the lower leg with its large base.
- metal washers 127 were installed on both sides of the sleeve 122. The washers 127 were fastened to the sleeve 122 with rivets 128.
- the means 130 for correcting the position of the foot and the volume of its movement in the ankle joint comprise an external ankle joint 131 having an axis 132 and a hollow body 133 in which a tip 134. is mounted. At one end of the tip 134, the second end of the fourth rod 124 is fixed, and the second end of the tip 134 is fixed on the axis 132 of the outer ankle joint 131 with the possibility of rotation in the sagittal plane.
- the modular exoskeleton contains a curved connecting plate 135, one end fixed to the axis 132 of the external ankle joint 131 with the possibility of rotation in the sagittal plane, and the other end fixed to the means for placing the foot (not shown).
- the hollow body 133 of the means 130 for correcting the position of the foot and the volume of its movement in the ankle joint is made integral and fastened using fasteners, for example, bolts 136.
- At least one elastic element 137 is installed in the hollow body 133, which is configured to limit the rotation of the foot in the sagittal plane.
- two elastic elements 137 are installed in the hollow body 133, filling the internal volume of the hollow body 133 and configured to limit the rotation of the foot in the sagittal plane.
- the elastic elements 137 create more favorable conditions for the operation of the apparatus and are made, for example, of rubber or rubber.
- the modular exoskeleton contains a curved connecting plate 135, spring-loaded to the housing 133 by means of springs 138, inside each of which a pin 139 is installed, located on the supporting platform 140, interacting with the connecting plate 135 at its periphery.
- One end of the connecting plate 135 is fixed on the axis 132 of the outer ankle joint 131 with the possibility of rotation in the sagittal plane, and the other end is fixed on the means for placing the foot (not shown).
- the apparatus contains two adjustable lower leg cuffs 122 ⁇ and 1222, and the means for fixing the lower leg in a predetermined position consists of two similarly made parts 1211 and 1212 located in the upper and the lower parts of the lower leg and interconnected by an intermediate bar 141 (Fig. 30 (a, b)), which eliminates distortions and poor fit.
- FIG. 30 (a, b) an embodiment of the proposed apparatus shown in FIG. 30 (a, b) will be described below.
- Each part 1211 and 12b of the shin fixation means 121 in a predetermined position is made as described above (Figs. 23, 24).
- the apparatus contains at least one second intermediate rod 142 (Fig. 30 (a, b)) mounted on the inner side of the lower leg of the user and mounted on the adjustable lower leg cuffs 122 ⁇ and 1222.
- the second intermediate rod 142 is fastened by means of two clamps 143 (first and second) (Fig. 31), each of which is mounted on an axis 144, mounted for rotation in the sagittal plane on the corresponding cuff of the lower leg, for example, on the cuff 122 ⁇ , as shown in FIG. 31.
- the first end of the second intermediate rod 142 with the possibility of linear adjusting movements is fixed in the first clamp 143, and the second end of the rod 142 is passed through the second clamp 143 and connected with the inner ankle joint 145 of the means 130 for fixing the foot relative to the ankle joint and correcting the volume of its movement.
- the inner ankle joint 145 is made similarly to the above-described embodiments of the outer ankle joint 131 (FIGS. 26-29) and therefore is not shown in detail in the accompanying drawings.
- the inner ankle joint 145 has a hollow body in which a tip is mounted, at one end of which the specified second end of the second intermediate rod is fixed, and the second end of the tip is fixed to the axis of the specified inner ankle joint 145 with the possibility of rotation in the sagittal plane, while the device contains a curved connecting plate, one end fixed to the axis of the specified inner ankle joint 145 with the possibility of rotation in the sagittal plane ty, and the other end is fixed on the specified tool for placing the foot.
- the inner ankle joint 145 has a housing in which the specified second end of the second intermediate rod is fixed, the device comprising a curved connecting plate spring-loaded to the specified body, one end fixed to the axis of the specified inner ankle joint 145 with a possibility of rotation in sagittal plane, and the other end mounted on the specified tool for placing the foot.
- FIG. 30 shows an embodiment of the patented modular exoskeleton in a complete set, including a hip brace 47 with means 49 for centering the femoral head; means 51 of fixing the thigh in a predetermined position; shin turning means 89; means 121 for fixing the lower leg in a predetermined position; means 130 for correcting the position of the foot and the volume of its movement in the ankle joint and means 146 for placing the foot.
- the hip bandage 47 with the means 49 for centering the femoral head and the means 51 for fixing the hips in a predetermined position form the first module A.
- the means 51 for fixing the hips in a predetermined position, the means 89 for rotating the tibia and the means for fixing the lower legs in a predetermined position form the second module B.
- 121 fixation of the tibia in a predetermined position and means 130 for correcting the position of the foot and the volume of its movement in the ankle joint form the third module C.
- the first, second, third, fourth rods 52, 83, 90, 124 and the first and second intermediate rods 141, 142 serve as connecting elements and, essentially, each of them represents a cylindrical rod made with the possibility of linear installation movement and / or rotation , and / or free linear movement, as mentioned above.
- a distinctive feature of the patented device is its modularity, that is, the ability to correct pathological settings of different segments of the lower extremities using separate modules A, B, C, or a combination thereof, or the entire modular exoskeleton as a whole.
- the proposed device includes a first module A containing an adjustable pelvic brace 47 with means 49 for centering the femoral head in the acetabulum, and means 49 for fixing the thigh in a predetermined position, which are interconnected by the first rod 52, made with the possibility of rotation and free linear movement.
- the proposed device includes a second module B containing means 51 for fixing the thigh in a predetermined position, means 89 for rotating the lower leg and means 121 for fixing the lower leg in a predetermined position, which are connected by a second and third rods 83 , 90, respectively.
- the second rod 83 is rotatable and installation linear displaceable
- the third rod 90 is rotatably mounted.
- the above-mentioned means 51, 89, 121 that is, the second module B
- the proposed device includes a third module C, comprising means 121 for fixing the lower leg in a predetermined position and means 130 for correcting the position of the foot and the volume of its movement in the ankle joint, which are interconnected by a fourth barbell 124 made with possibility of installation linear movement.
- the above-mentioned means 121 and 130 (that is, the third module C) provide the ability to change the position of the lower leg and foot in the horizontal plane.
- a device of the appropriate size for a particular user is selected. Basically, apparatuses of three sizes are used, while it is possible to control individual modules in length by setting the length of individual connecting rods.
- an adjustable pelvic brace 47 is put on the user's pelvic region (Fig. 15), ensuring that it fits snugly against the user's body.
- the user’s hips are inserted into the thigh cuffs 50, which are fixed in the lower third of the thigh so that these cuffs 50 do not fall under the knee joints, after which the length of the second rod 83 is set.
- the means for centering the femoral head 49, the means for turning the tibia 89 and the means 130 for correcting the position of the foot and the volume of its movement in the ankle joint are set to the corresponding position means 49, 89, 130, so that the correction of the position of the axes of rotation of the hip, knee and ankle joints in the horizontal and frontal planes is achieved.
- the means for centering the femoral head 49 (FIGS. 16, 17, 18) are set to the middle position at which the axis of the first bar 52 is parallel to the longitudinal axis of the base 48.
- the optimal axis direction of the corresponding first rod 52 is selected and the position of the corresponding femoral head centering means 49 is fixed by bolting. This position of the centering means 49 of the femoral head and the first bar 52 associated with it corresponds to the prescribed hip correction and does not cause pain to the user.
- the proposed modular exoskeleton can be individually configured for each hip joint of a particular user, which distinguishes it from the known designs for a similar purpose.
- the tightening of the bolts 102 (Fig. 21, 22) on the base 96 is loosened, the user's foot is rotated together with the means 146 for placing the foot in the desired direction by rotating the first end of the fourth rod 124 in the eleventh through channel, hold and fix the foot in a corrected position by tightening the bolts 102 on the base 96.
- the patented modular exoskeleton has a simple compact design, it can be used in combination with other devices that can solve the problem of correction of pathological settings, including lower limbs, especially in children.
- the proposed exoskeleton consists of separate modules A, B, C (the components of these modules are described above), which, if necessary, can be used individually, in different combinations, or all together.
- the patented modular exoskeleton provides for the possibility of correcting pathological settings of all segments of the lower extremities, and in this case includes the above elements and means 47, 49, 51, 89, 121, 130, 146, interconnected by the corresponding rods 52, 83, 90, 124, 141, 142, and also provides for the possibility of correcting pathological settings of individual segments of the lower extremities or pathological settings in combination of segments of the lower extremities, and in these cases includes the individual elements listed above and means, interconnected by corresponding bars .
- cerebral palsy hereinafter cerebral palsy
- spastic diplegia with a predominant lesion of the right extremities, severe form, adductor-pronational installation of the hips, pathological flexion and valus installation of the lower legs, more to the right, abduction-equinoplanowalus installation of the feet.
- the user does not stand on his own, does not walk. It walks with support for one arm or with support on two Canadian canes, in a pose of triple bending, with internal rotation of the hips, with support on the front-inner sections of the feet.
- an unstable cross of the lower extremities is noted at the level of the lower third of the thigh. Marked valus installation of the right tibia in the "standing" position and with locomotion, the valus installation of the left tibia is less pronounced. In the "standing" position and with locomotion, pathological abduction of the feet is noted, more than the right foot
- the user performed a phased correction of the longitudinal axes of the right and left lower extremities using the proposed method and device for one year.
- Patent exoskeleton module C contained the external and internal ankle joints for each lower limb, providing improved stabilization of the corrected position of each foot.
- cryocontrast contrast alternation of cold and thermal effects on the so-called motor points of spastic muscles
- stimulation of their antagonists to improve contractility were used in the framework of the patented method apparatus Sotrech-3, a complex of medical gymnastics for better adaptation of the user with an individual selection of medical and the training load at each stage of using the apparatus, the method of kinesiological taping (Dr. Kenzo Kase, Founder) of muscles, the lack of function of which determined the nature of the pathological settings of the thigh, lower leg and foot of each lower limb.
- the exoskeleton module A for the correction of the adductor-pronation installation of each thigh was adjusted in stages, and the abduction and external rotation were dosed at each stage for each hip without mutual influence, depending on the severity of the initial pathological installation at each stage of correction.
- Module B of the exoskeleton together with the tibia of the user was rotated in stages in the horizontal and frontal planes. Then, they were fixed in a corrected position simultaneously with the position of module C, achieving correction of the valgus installation and internal rotation of the lower leg and the associated valgus position of the foot of each lower limb without mutual influence, additionally changing the position of module C with respect to the position of module B in each lower limb for correction of pathological abduction of the feet.
- the range of motion of the ankle joints for each lower limb was set with the restriction of plantar flexion of the feet, but without limitation of the rear flexion, almost the same for the left and right lower limbs.
- a control examination after one year showed: the user without a corrective exoskeleton stands and walks with support on two Canadian canes, the severity of the shafts of the shin installation, mainly the left shin, has decreased. The user relies on a full stop. Eliminated abnormal abduction of both feet. The severity of adductors of both thighs decreased, and the volume of passive hip abduction increased. It is recommended to continue the application of the proposed method and the use of the proposed device ..
- Diagnosis cerebral palsy, spastic diplegia of moderate severity with a predominant lesion of the left limbs, secondary myodystrophic syndrome, adductor-pronational installation of the hips, internal rotation of the two lower extremities, hallux valgus installation of the left lower leg, pronounced equino-valgus deformity of the left foot.
- the user was corrected for the physiological axis of the lower limb using the patented method and device.
- Module C of the patented exoskeleton contained the external and internal joints of the ankle joint for the left lower limb in order to better stabilize the corrected position of the left foot, since the initial pathological equino-flat-valgus position of the left foot was significantly expressed.
- the corrective settings of the exoskeleton are similar to those described above in Example 1.
- the number of tuning steps is five during the year.
- the mode of application of the exoskeleton is constant wearing while awake.
- the adductory-pronational installation of the left and right thighs was eliminated without interference, achieving a more significant abduction of the left thigh, since the initially pathological reduction of the thigh was more pronounced on the left.
- the pronational installation of the hips was not completely corrected with the aim of better centering the head of the left and right thighs in the corresponding acetabulum.
- the adductor installation of the hips is completely eliminated (in the apparatus), the internal rotation of the lower extremities is preserved, but less pronounced.
- Diagnosis consequences of a closed craniocerebral trauma, brain contusion, left-sided dissociated hemiparesis with a primary lesion of the lower limb, impaired posture in the frontal plane, flexion of the left forearm, adductor-pronational installation of the left thigh, recurrence of the left lower leg, adducto-equinovarus installation of the left foot with reduction of the anterior region, anatomical shortening of the left lower limb 7 mm.
- Module C for the user contained an external hinge of the ankle joint, since the adduct-equinovarus installation of the left foot was effortlessly passively brought to the physiologically correct position.
- Module C of the apparatus contained corrective contributions to reduce the severity of the varus installation of the left foot and the adductor installation of the forefoot of the left foot (medial arch-forming and higher lateral piercing, as well as lateral finger piercing).
- the muscle tone of the left lower extremity was initially impaired by the type of spasticity with a predominance in the adductors of the thigh, the hamstring group (that is, in the flexors of the lower leg), as well as in the triceps muscle of the lower leg.
- Dosed elimination of muscle imbalance was carried out at the first stage - with the help of botulinum toxin preparations (the introduction of dysport in the adductor muscles of the thigh, in the soleus muscle and both calf muscles, mainly in the medial gastrocnemius), 00746
- muscle tone correction was carried out using physiological factors (cryocontrast).
- an individual therapeutic gymnastics complex was selected for the user to adapt to the corrected position of the segments of the left lower limb.
- Diagnosis long-term consequences of a spinal cord injury with partial damage to the spinal cord at the level of lumbar enlargement, lower flaccid paraparesis, pelvic organ dysfunction (enuresis, encopresis). Lumbar hyperlordosis, instability of the hip and knee joints, recurrence of both lower legs, sagging of the forefoot of two lower limbs.
- each module B contained the external hinge of the ankle joint.
- the knee joint of each module B was supplemented with a spring-loaded mechanism.
- Kenzo Kase Founder
- the user was assigned a set of exercises to improve voluntary motility of the lower extremities and adapt to the apparatus.
- five stages of the proposed method were carried out, for which five exoskeleton settings were made, including once, due to the significant growth dynamics of the user.
- the device takes several independent steps.
- Diagnosis cerebral palsy, spastic diplegia with a predominant lesion of the right limb, pathological torsion of the torso to the right, adductor-pronational installation of the hips of the two lower extremities, flexion-valgus installation of the legs two lower limbs, abducto-equinoplanangalus installation of the feet of two lower limbs.
- Myofascial pain syndrome cerebral palsy, spastic diplegia with a predominant lesion of the right limb, pathological torsion of the torso to the right, adductor-pronational installation of the hips of the two lower extremities, flexion-valgus installation of the legs two lower limbs, abducto-equinoplanangalus installation of the feet of two lower limbs.
- the user was prescribed treatment using the patented method and device in a continuous wear while awake for a year.
- module B for each lower limb contained two cuffs.
- Module C for the right and left lower limbs contained both ankle joints (external and internal) in order to better stabilize the feet in a corrected position.
- cryocontrast technique In order to eliminate muscle imbalance and myofascial pain, cryocontrast technique, relaxing massage, application of external anesthetics (versatis), oscillatory and high-tone therapy (Hivamat and Hi-top devices, respectively) were used.
- the legs and feet of the user was prescribed a set of therapeutic exercises. Part of the exercises was performed in the exoskeleton, and part - just before putting on the exoskeleton.
- the kinesitherapeutic load was increased.
- the proposed method and device can be used in the rehabilitation of pathological installations resulting from damage to the musculoskeletal system or damage to the central nervous system.
- the proposed method and device can be used to correct pathological settings of lower limb segments in patients with cerebral palsy, patients with spinal cord injuries, possibly complicated spinal cord injuries, patients with consequences of craniocerebral trauma and acute cerebrovascular accident.
- the proposed method can be used in the treatment of children with various pathological settings of the segments of the lower extremities with an imbalance of muscle strength, failure of the articular-ligamentous apparatus and the presence of pathological torsion in the absence of fixed muscle-joint contractures and pronounced deformities of the bones of the lower extremities.
Abstract
Description
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Priority Applications (8)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
KR1020127018350A KR101496683B1 (ko) | 2009-12-15 | 2010-12-10 | 하지 부위 변형의 개선 방법 및 이의 실행을 위한 장치 |
CA2784672A CA2784672C (en) | 2009-12-15 | 2010-12-10 | Method for correcting pathological configurations of segments of the lower extremities and device for realizing same |
CN201080057465.0A CN102711678B (zh) | 2009-12-15 | 2010-12-10 | 下肢各节段病理畸形矫正方法及其实现装置 |
UAA201207902A UA103710C2 (ru) | 2009-12-15 | 2010-12-10 | Способ коррекции патологических установок сегментов нижних конечностей и устройство для его осуществления |
US13/515,855 US9101451B2 (en) | 2009-12-15 | 2010-12-10 | Method for correcting pathological configurations of segments of the lower extremities and device for realizing same |
AU2010332387A AU2010332387B2 (en) | 2009-12-15 | 2010-12-10 | Method for correcting pathological configurations of segments of the lower extremities and device for realizing same |
EP10837956.1A EP2514392A4 (en) | 2009-12-15 | 2010-12-10 | METHOD FOR CORRECTING PATHOLOGICAL POSITIONS OF SEGMENTS OF LOWER LIMBS AND DEVICE FOR IMPLEMENTING THE SAME |
IL220396A IL220396A (en) | 2009-12-15 | 2012-06-14 | Device for repairing pathological configurations of limb segments |
Applications Claiming Priority (6)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
EA201000171 | 2009-12-15 | ||
EA201000171A EA018702B1 (ru) | 2009-12-15 | 2009-12-15 | Аппарат биомеханический ротационно-корригирующий для нижних конечностей |
EA201001788 | 2010-11-12 | ||
EA201001788A EA017956B1 (ru) | 2010-11-12 | 2010-11-12 | Аппарат биомеханический ротационно-корригирующий для нижних конечностей |
EA201100041A EA016657B1 (ru) | 2010-11-26 | 2010-11-26 | Способ коррекции патологических установок сегментов нижних конечностей |
EA201100041 | 2010-11-26 |
Publications (1)
Publication Number | Publication Date |
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WO2011075003A1 true WO2011075003A1 (ru) | 2011-06-23 |
Family
ID=44167527
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/RU2010/000746 WO2011075003A1 (ru) | 2009-12-15 | 2010-12-10 | Способ коррекции патологических установок сегментов нижних конечностей и устройство для его осуществления |
Country Status (8)
Country | Link |
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US (1) | US9101451B2 (ru) |
EP (1) | EP2514392A4 (ru) |
KR (1) | KR101496683B1 (ru) |
CN (1) | CN102711678B (ru) |
AU (1) | AU2010332387B2 (ru) |
CA (1) | CA2784672C (ru) |
IL (1) | IL220396A (ru) |
WO (1) | WO2011075003A1 (ru) |
Cited By (2)
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- 2010-12-10 CA CA2784672A patent/CA2784672C/en not_active Expired - Fee Related
- 2010-12-10 KR KR1020127018350A patent/KR101496683B1/ko not_active IP Right Cessation
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Cited By (3)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
CN102441252A (zh) * | 2011-08-22 | 2012-05-09 | 国家康复辅具研究中心 | 下肢运动模式塑型训练装置及其使用方法 |
CN108714890A (zh) * | 2018-06-28 | 2018-10-30 | 吉林大学 | 一种刚柔耦合仿生外骨骼膝关节助力装置 |
CN108714890B (zh) * | 2018-06-28 | 2023-08-15 | 吉林大学 | 一种刚柔耦合仿生外骨骼膝关节助力装置 |
Also Published As
Publication number | Publication date |
---|---|
KR101496683B1 (ko) | 2015-03-04 |
EP2514392A4 (en) | 2014-10-29 |
KR20120104351A (ko) | 2012-09-20 |
AU2010332387B2 (en) | 2014-01-16 |
US9101451B2 (en) | 2015-08-11 |
CA2784672C (en) | 2016-02-02 |
EP2514392A1 (en) | 2012-10-24 |
CN102711678A (zh) | 2012-10-03 |
AU2010332387A1 (en) | 2012-07-26 |
US20120259259A1 (en) | 2012-10-11 |
CA2784672A1 (en) | 2011-06-23 |
IL220396A (en) | 2016-03-31 |
CN102711678B (zh) | 2015-06-10 |
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