RU2708841C1 - Whole leg-length orthopedic device - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine. Full-length orthopaedic apparatus for correction of locomotor functions of lower extremities in patients with flaccid, spastic paralyzes, paresis of muscles of lower extremities of different severity, prevalence consists of corset for body, thigh sleeves, shin and foot, elements of sleeves fixation on extremity, knee and ankle hinge joints, hip joint assembly and dynamic bend attachment. Dynamic knee fixation is made in the form of cup-like element with softening inner gel-like layer and with elastic tie-rods installed on sleeves of hip and shin. Corset on the side surface is made with a horizontal plate bent along the circumference, which has holes for attachment to it, external vertical teeth and two parallel horizontal grooves. Hip joint assembly consists of upper and lower frames, intermediate link, screw with head, flange bushing-axis with internal threaded hole for screw, axis, parallel rotary rods, connected to each other by movable adjustable tie rod, which can be moved along rods, changing rotation value lower extremity. One ends of the rods are connected to the lower part of the lower frame by means of fasteners, and other ends have an end plug rigidly installed in the slot made on the side upper end of the hip sleeve. Upper end of the upper frame is made in the form of a plate bent in a circle, with internal vertical teeth and holes, in which screws are installed, for connection of the upper end of the upper frame with the corset plate. Screws enter the corset plate horizontal slots. Lower end of upper frame has hole for part of flange bushing-axis with smaller diameter. Upper end of intermediate link has stepped hole, starting from side far from human body, there is a first section with smooth surface for screw head, second section with thread for body of screw, third section with smooth surface for part of flange bushing-axis with smaller diameter and the fourth one - with smooth surface for flange bushing-axis. There is a slot for the lower end of the upper frame, which crosses the third section of the stepped hole from top to bottom. Lower end of the intermediate link has lugs on each side with holes for said axis. Distance between said lugs is arranged to accommodate upper part of lower frame. Lower end of intermediate link has thrust platform. Upper end of lower frame is installed on said axis and has thrust screw with spring installed on thrust screw between lower frame and thrust pad, contacting thrust site of lower end of intermediate link and providing movement of lower frame relative to top frame. Sleeves of foot, shin, hip and corset are made of composite material with areas of different stiffness, wherein front surfaces of sleeves are softer than rear surfaces, and foot shell in front area is made flat with reinforcing layers of fabric based on synthetic fibers, laid in the form of spring. Femoral sleeve along upper contour is reinforced with additional layers of reinforcing materials. Frames of knee and ankle hinges are rigidly installed in slots made in lower lateral butt ends of hip sleeve and shin and upper lateral ends of sleeves of shin and foot.

EFFECT: invention provides correction of locomotor functions of lower extremities in patients with sluggish, spastic paralysis of various severity, prevalence, paresis of muscles of lower extremities, has corrective controlled action in sagittal, frontal and horizontal planes in symbiosis with expansion of indications for use, provision of energy recovery, improved reliability of scales, reduced weight, improved strength and reliability of fasteners and apparatus as a whole, improved conditions of use and unloading of extremity, fabrication of sleeves from composite material with sections of various stiffness.

1 cl, 4 ex, 5 dwg

Description

The invention relates to medical equipment, namely to orthosis and orthosis.

The orthopedic apparatus for the whole leg is intended for children and adults for the purpose of rehabilitation, orthopedic correction of the musculoskeletal functions of the lower extremities in patients with various severity, prevalence of flaccid, spastic paralysis, paresis of the muscles of the lower extremities of various etiologies.

Known apparatus for the whole leg of AN8-12 [1], consisting of thigh, lower leg and foot sleeves having a metal insole, formed by metal frames with leather elements mounted on them, interconnected by metal knee and ankle hinge assemblies having connecting tires, and sleeve fasteners.

However, this device has several disadvantages - increased weight, low hygiene, poor cosmeticity due to the large size, lack of movement in the horizontal plane and a number of others, which interferes with its use, limits the indications for use, especially with spastic paralysis of the lower extremities, in particular with consequences of cerebral palsy (cerebral palsy).

A device is known for the whole leg [2] with sleeves of the thigh, lower leg and foot made of composite material, while the thigh and lower leg sleeves are connected by knee hinge assemblies, the sleeves of the lower leg and foot are connected by ankle hinge assemblies, and the thigh sleeve is connected at the top by means of a hip joint knot having the upper tire is at the top, and the lower tire is at the bottom, with the device securing the device to the trunk, the knee and ankle hinge assemblies having upper and lower ends of the tires, and the thigh and lower leg sleeves have fastening elements. This device is intended for orthosis of adult patients with flaccid paralysis.

The disadvantages of this apparatus are the inability to adjust the location of the axes of the hip joint node, as well as the inability to affect the limb abduction in the apparatus in the frontal plane, which is necessary for spastic paralysis of the lower extremities, especially in childhood, when the thigh segment has a pathological tendency to bring with simultaneous by inward rotation, as shown in FIG. 1. In addition, the fastening element on the torso in the known apparatus is made in the form of a leather belt with a horizontal rectangular metal plate mounted on it, which is not sufficient for reliable centering of the underlying nodes and elements of the apparatus relative to the torso which is the base. While walking, the belt bends, shifts on the body, which leads to a planar change in the direction of movement of the apparatus, the displacement of the axes of the hinge nodes, the deterioration of the effectiveness of its impact in the rehabilitation process. In addition, this mount does not allow the use of the known apparatus in patients with simultaneous damage to the lower limbs and spine, which is often found in patients with the consequences of cerebral palsy. In the known apparatus, the thigh and lower leg sleeves are made stiff and in order to be able to insert the corresponding segment of the limb painlessly into them, it is necessary to cut them from the front in the projection onto the horizontal plane by almost 40-45% of the sleeve perimeter. At the same time, the fastenings of the sleeves in front compress the protruding sections of the leg segments, which leads to edema, the appearance of vascular lesions, constriction of soft tissues, etc. The elimination of this effect by means of valves leads to additional technological operations, an increase in the manufacturing time, and an increase in the cost of the apparatus. The rigid structure of the apparatus does not provide for the normal rotation of limb movements typical of walking, which are highly desirable for spastic lesions. In addition, the implementation of the foot sleeve in the form of a rigid box prevents movements in the metatarsophalangeal joints of the foot, which leads to atrophy, the occurrence of secondary deformations, the absence of the use of efforts aimed at recovering energy and ensuring the stressed repulsion of the foot in the phase of the back push.

The presence of the ends of the tires of the hinge assemblies with dimensions of 120-150 mm in the known apparatus leads to its weighting. In addition, the external fastening of the tires of the hinge assemblies to the corresponding sleeves of the thigh, lower leg and foot, the presence of riveted joints requires drilling of the sleeves, which leads to a violation of the strength in the field of drilling. This is especially undesirable for composite material. In addition, with a rivet connection, protrusions appear on the inner surface of the sleeves adjacent to the surface of the limb segment, which can lead to injury. In the known apparatus, the ends of the tires riveted from above create a poor cosmetic appearance of the apparatus. Another disadvantage of the known apparatus is the lack of impact on the knee joint in the front to prevent it from bending into the support phase and thereby increase the under-stability. This excludes the use of the known apparatus in the presence of flexor units in the knee joint in a patient. In the known apparatus, the pronounced, in the form of a thin-walled hard edge of the cylinder, the upper contour of the thigh liner does not provide physiologically acceptable discharge to the tuber pad and the entire landing contour, which prevents the necessary limb unloading, leads to pain, bruises, "piston" leg movements in the device, violation of the comfortable operation of the device to patients.

The objective of the invention is the creation of an orthopedic apparatus for the whole leg for the correction of musculoskeletal functions of the lower extremities in patients with varying severity, prevalence of flaccid, spastic paralysis, paresis of the muscles of the lower extremities with a corrective adjustable effect in the sagittal, frontal and horizontal planes in symbiosis with an expansion of indications to the destination, ensuring energy recovery, increasing the anti-skid resistance, reducing weight, improving the strength and reliability of cr nizhnyh elements and the apparatus as a whole, improving the conditions for use and unloading of the limbs, the manufacture of sleeves from composite material with sections of different stiffness.

The task is achieved due to the fact that the apparatus is equipped with a dynamic knee mount made in the form of a cup-shaped element with a softening gel-like layer and with elastic hooks mounted on the thigh and lower leg sleeves, and the corset on the side surface is made with a horizontal plate bent around a circle, which has holes for attachment to it, external vertical teeth and two parallel horizontal grooves, and the hip joint assembly consists of upper and lower tires, intermediate a vein, a screw with a head, a flange sleeve-axis with an internal threaded hole for a screw, an axis, parallel rotational rods, interconnected by a movable adjustable coupler, which can be moved along the rods, changing the rotation value of the lower limb, while one ends of the rods are connected to the lower part of the lower tire using fasteners, and the other ends have an end cap rigidly mounted in a groove made on the lateral upper end of the thigh sleeve, the upper end of the upper tire is made in the form of a plate and bent around a circle with internal vertical teeth and holes in which the screws are installed to connect the upper end of the upper tire to the corset plate, and the screws fit into the horizontal grooves of the corset plate, the lower end of the upper tire has an opening for a part of the flange sleeve-axis with a smaller diameter, the upper end of the intermediate link has a stepped hole, starting from the side farthest from the human body there is a first section with a smooth surface for the screw head, a second section with a thread for the screw body, the third a section with a smooth surface for a part of a flange sleeve-axis with a smaller diameter, and a fourth with a smooth surface for a flange sleeve-axis, in addition there is a slot for the lower end of the upper tire, crossing from top to bottom the third section of the stepped hole, the lower end of the intermediate link has sides ears with holes for said axis, while the distance between the ears is made to accommodate the upper part of the lower tire, in addition, the lower end of the intermediate link has a thrust pad, the upper end of the lower the tire is mounted on the aforementioned axis and has a stop screw with a spring mounted on the stop screw between the lower tire and the stop pad, and in contact with the stop pad of the lower end of the intermediate link, and providing movement of the lower tire relative to the upper tire, while the sleeve of the foot, lower leg, thigh and the corset is made of composite material with sections of different stiffness, and the front surfaces of the sleeves are softer than the rear surfaces, and the sleeve of the foot in the region of the front section is made flat with reinforcing with synthetic fiber based fabric laid in the form of a spring, while the thigh sleeve along the upper contour is reinforced with additional layers of reinforcing materials, and the tires of the knee and ankle joints are rigidly installed in the grooves made in the lower lateral ends of the thigh and lower leg liners and upper lateral ends liners of the lower leg and foot.

In FIG. 1 shows a biomechanical diagram of the installation of the lower extremities. The figure shows that with a pathological installation, the lower limb under the influence of the moment of forces M ₁ arising due to the imbalance of the affected muscles of the limb rotates inward, which is typical for spastic paralysis, for example, for days (Fig. 1a). In addition, there is a reduction of the affected limb at an angle β. Due to this, the knee hinge is close to the central vertical axis of the human body, the heel of the foot rises up, the front equinus appears, the foot is moved away from the central vertical axis, and the toe moves inward.

When installing the lower limb without pathology, the limb has a physiological reduction at an angle α (Fig. 1b), which is less than the angle β. Therefore, the proposed orthopedic apparatus with a designed and constructed hip joint unit is intended primarily for adjusting the pathological installation of the lower extremities (s) of a spastic nature in order to reduce limb rotation inward and excessive adduction ..

In FIG. 2, an orthopedic apparatus is presented, which consists of a corset 1, on which the apparatus is attached, thigh sleeves 2 with a groove 30, shin sleeves 3, foot sleeves 4, hip hinge assembly 5, knee hinge assemblies 6, ankle hinge assemblies 7, as well as fastening elements apparatus on the lower limb of the patient 8 and the dynamic fastening of the knee 9, made in the form of a cup-shaped element with a softening inner gel-like layer and elastic hooks mounted on the liners of the thigh and lower leg, spring front section of the foot sleeve 39 of composite.

In FIG. 3 presents a diagram of the hip department of the apparatus, which consists of:

10 - tires of the hip hinge assembly;

11 - lower tire of the hip hinge assembly, which consists of two parallel end faces with fixing screws 29 and a movable adjustable tie 28;

12 - upper end of the tire of the hip joint assembly;

13 - the lower end of the tire of the hip joint assembly;

14 - the upper end of the lower tire of the hip joint assembly;

15 - the lower end of the lower tire of the hip joint assembly;

16 - vertical teeth on the upper end of the tire of the hip joint assembly;

17 - platforms for reinforcing fasteners;

18 - screws attaching the upper end of the tire to the hip joint assembly;

19 - horizontal plate curved in a circle;

20 - holes for mounting a horizontal plate bent around the circumference to the corset;

21 - vertical teeth on a horizontal plate bent around the circumference of the apparatus fastening element to the corset;

22 - grooves for moving the upper end of the tire of the hip joint assembly relative to a horizontal plate bent around a circle and a corset in a horizontal plane at an angle y;

23 - a screw with a head for moving the lower end of the tire in the sagittal plane at an angle Δ;

24 - axis, for moving the upper end of the lower tire in the frontal plane at an angle β ₁ ;

25 - thrust screw;

26 - springs;

27 - fasteners of the upper ends of the rods of the lower tire;

28 - mobile adjustable coupler;

29 - fixing screws mounted on a metal platform.

40 - flange sleeve-axis.

From the one shown in FIG. Figure 3 of the hip section of the apparatus with the hip joint assembly shows that the upper end of the tire 12 of the hip joint assembly is made in the form of a plate curved in a circle with a radius R with vertical teeth 16 and holes in which screws 18 are installed to connect the upper end of the upper tire to the plate 19, which is also made curved in a circle with a radius R] and has vertical teeth 21. The teeth 21 are engaged with the vertical teeth of the upper end of the tire 16. On the plate 19 there are horizontal grooves 22 in which includes screws 18 fixing the upper ends of the bus to the plate. For fastening the plate to the corset 1 there are holes 20 into which fastening elements, for example, screws, are inserted using screws, the plate of the fastening element is connected to the lower region of the corset and is securely fixed to it. Such a connection of the hip joint assembly by means of a horizontal plate and tire with the corset does not allow the hip joint assembly and the orthopedic apparatus to be displaced as a whole. Due to the gearing of the fastening plate 19 and the upper end of the tire of the hip joint assembly of the hinge 12, as well as the horizontal grooves 22 along which the upper end of the tire can be moved due to the screws 18, discrete movement of the upper end of the tire in the horizontal direction by an angle γ is fixed in required provisions. In this case, outward rotation of all underlying elements of the apparatus with a limb installed in it occurs, which prevents the pathological installation of inward rotation, characteristic of spastic paralysis, in particular with cerebral palsy.

In order to move the lower limb in the sagittal plane, in the hip hinge assembly there is a screw with a head 23 installed in the flange sleeve-axis 40.

To fix the required position of the abduction in the frontal plane, there is an emphasis 25 on the lower tire, at the end of which a spring 26 is located. The spring 26 acts as a shock absorber when the patient moves in the device.

In order to ensure rotation in the apparatus during the support phase, as occurs in the lower limb when walking normally, the lower tire 11 is made in the form of two rods. The rods of the lower tire are interconnected by a mobile adjustable coupler 28, which can be moved along the rods, changing the amount of rotation of the lower limb. The position of the connecting screed 28 is recommended by an orthopedic surgeon. The length of the rods depends on the size of the patient, but should be from 100 to 180 mm. In the event that the dimensions of the rods go beyond the specified limits, the design does not create the necessary effect in the treatment. The lower end of the lower tire 15 is inserted into the slit-like groove 30 (Fig. 2) located in the upper part of the thigh sleeve and fixed in it by a binder of composite material. Additionally, the lower end of the tire 15 is fixed with screws 29 mounted on a metal platform.

Thus, using the designed hip joint assembly in the proposed device, discrete movement of the patient’s legs in the horizontal direction and smooth in the frontal plane is ensured, while the pathological installation of rotation inside the lower limb is reduced, which expands the scope of the invention.

The proposed apparatus has a corset, which eliminates its displacement when walking and creates a reliable base for centering the underlying elements of the apparatus and their effective predetermined effect on the limb. In addition, with the consequences of spastic paralysis, in particular with cerebral palsy, quite often spinal pathologies are observed in patients and the corset is one of the most important conservative means of rehabilitation. The corset is made of composite material, which significantly reduces the weight of the device as a whole.

Sleeves of the apparatus (thigh, lower leg and foot) are made of composite material, which has different stiffness. Due to the different laying of carbon fabric and fabric from high-strength yarn during the manufacturing of the composite material for the sleeves, as well as a different ratio of the binder, the sleeves in the rear areas have high strength properties and increased stiffness, and are elastic in the area of the cut of the sleeves (in front). This makes it possible to painlessly insert the corresponding segment of the limb into the device’s sleeves, opening the sleeves rather than cutting them in front, and at the same time, evenly distributing the load on the front sections of the limb and trunk without local clamping and the need to manufacture additional valves that increase the manufacturing time, the cost of the apparatus and the complexity of dressing. The use of such material leads to a comfortable wearing of the apparatus, and will prevent the appearance of vascular lesions. In addition to the convenience of dressing, the technology for producing a composite material of various stiffness leads to material savings, since it does not require cutting sleeves in front.

In the thigh sleeve, the upper contour is made with blades and reinforced with additional reinforcing layers, which allows unloading on the tuber pad and the entire upper landing contour of the thigh sleeve, providing unloading of the entire limb to the necessary degree and improving comfort of use, reducing pain, the appearance of “piston” movements scuffs.

Due to the fact that the lower end of the lower tire of the hip joint has two parallel rods with a movable adjusting screed, and in the lower leg sleeve the reinforcing layers are laid starting from the upper side surfaces with the intersection along the back surface in the middle of the lower leg sleeve with transition to the lower side surfaces, dosed rotational movements in the hip and foot joints are metered, which is characteristic of movement when walking and standing normally. Thus, the biomechanical characteristics of walking are improved, stereotypes of walking are not violated, the muscular system of the lower limb is not inhibited or atrophied.

On the edges of the side surfaces of the sleeves, slit-like grooves of 20-40 mm are made, laid out by reinforcing layers, and the lower end of the lower tire of the hip joint assembly and the upper and lower ends of the tire of the knee joint assembly and the upper ends of the ankle joint assembly are 25 ± 5 mm long, installed in slit-like grooves and filled with a binder of composite material. Thus, the installation of the ends of the tires and the rods of the hip joint assembly in the sleeves creates a strong and reliable design that does not require rivet fasteners, which due to the presence of holes in the tires and, especially, in the sleeves significantly reduce the strength characteristics of the apparatus. With this installation, the size of the ends of the lower tires is reduced by 3-7 times, which significantly reduces the weight of the device. At the same time, the absence of protruding ends of the tires improves the cosmetic appearance of the device, prevents damage to clothing, which is possible when it comes into contact with protruding tires.

The thigh and lower leg attachment elements in the proposed apparatus have an additional dynamic knee fastening in front of the knee hinge assemblies, made in the form of a cup-shaped element with an internal softening gel-like layer and adjustable elastic hooks connected to the thigh and lower leg sleeves 9. This additional fastening, due to the adjustable elastic the impact on the patient’s knee located in the apparatus prevents its bending into the phase of support on the heel and the entire foot, thereby improving the brace resistance of the apparatus. This increases the safety of use, which is especially important in the presence of a bending installation, in this case, a constant corrective effect on the bending installation is carried out. The patient’s knee is also protected from bruises.

Sleeves of the lower leg and foot are connected by ankle hinge nodes made of titanium alloy. The metal ankle joint shown in FIG. 4 consists of upper and lower connecting elements in the form of tires for fastening to the legs of the lower leg 31 and foot 33, as well as the base 32. In FIG. 5 shows a diagram of the base of the ankle hinge assembly. The upper tire 31 is attached to the base 32 using screws 37, and the lower tire 33 is attached to the base 32 using a hinge screw 36 and has a stop 38 at the end. An elastic element is built into the base, which consists of a cone spring 35, a pusher 34.

This design of the elastic element makes it possible to facilitate the rotation of the foot by the angle Q (Fig. 4).

The axes of the ankle joints should be aligned and aligned with the positive marking centers. It is allowed to position the axis of the ankle joints slightly higher if the installation of the lower tires is difficult, but not higher than the top of the ankle. When rotating the lower leg, it is possible to apply a construction scheme with a rotation of the axes of the ankle hinge to 15 degrees. When adjusting the apparatus, the lower tires should be installed vertically, taking into account the equinus angle of the foot in the child and depending on the appointment of the orthopedic surgeon.

The foot sleeve in the proposed apparatus in the anterior region is made flat with reinforcing layers laid in the form of a spring (Fig. 2, pos. 39), which provides movement in the metatarsophalangeal joints when walking and allows energy recovery in the back shock phase, and also prevents atrophy of the forefoot and the occurrence of secondary deformities.

The orthopedic apparatus for the whole leg provides fixation of the lower extremities, its unloading, orthopedic correction of deformation and pathological settings, support ability, under-resistance, the ability of patients to perform locomotion with the normalization of biomechanical characteristics, sitting, standing, and dosed rotational movements.

The device can be made as one-sided (on the right or left leg), and with bilateral damage.

The device can be used in the general complex of rehabilitation measures.

The mode of use of the device is determined by the attending orthopedic surgeon.

The process of manufacturing the apparatus on the whole leg begins after a thorough examination of the patient by an orthopedic surgeon, who gives recommendations on the configuration of the apparatus, which are recorded in the order form.

Then the POI master takes measurements from the affected limb and writes the data to the order form.

Sleeves of the orthopedic apparatus are made of composite material. As a reinforcing material, both carbon fabric and carbon tape are used. In the locations of fasteners for the purpose of hardening, an additional fabric lining from high-strength Rusar thread is used. In accordance with the technology developed at the enterprise, the first stage in the manufacture of the apparatus is the removal of gypsum negative from the patient’s feet, and then the production of gypsum positive. On the positive, with the help of a felt-tip pen and taking into account the size of the patient, the necessary marks are made for the installation of the hip, knee and ankle joints. This procedure is carried out under the supervision of an orthopedic surgeon. From a sheet of foamed polyethylene, blanks are cut under the insert of the apparatus. Then the sleeve is made. For these purposes, a polyurethane composition is used as a binder, and a synthetic knitted sleeve made of textured polyester yarn or a combined yarn (a combination of textured polyester yarn with Rusar high-strength yarn) is used as a reinforcing layer to strengthen the rear walls of the sleeves using a tape or carbon fiber fabric. Reinforcing layers on the positive stack in a certain order. After that, semi-finished products are selected according to the order form. In accordance with the markings on the positive, the knee and ankle joint units are attached (the hip unit is attached after the manufacture of the corset), as well as fasteners.

Simultaneously with the apparatus, a corset is made on the whole leg according to the individual size of the patient. The corset is made of composite material using a polyurethane binder and carbon fabric as a reinforcing material.

Fasteners are attached to the corset and the horizontal plate is bent around the circumference (if the device is on one lower limb). Fasteners are made using rotational tape, Contact fastener tape and a metal frame.

The apparatus and corset are finished using leather yuft. After this, the patient is called for a fitting.

The device is tried on by the POI master in the presence of an orthopedic surgeon.

In the process of fitting, the location of the axes of the hip, ankle, and knee tires relative to the joints of the limb is checked and installed in the required position. Checks the height of the apparatus, its volumetric dimensions and ease of use of the patient. If necessary, the POI master conducts a local shaping of the sleeves, preheating the sections of the sleeves with an electric gun. A bowl-shaped element is superimposed on the knee joint, and the places of its attachment to the thigh and lower leg sleeves are noted. The apparatus on the whole leg and the corset are worn on the patient in a prone position and fixed on it. With the help of a doctor and a POI master, the patient in the device takes a standing position and conducts test wear: the patient is recommended to walk in the device in the presence of an orthopedic doctor and a POI master. After fitting, all parts of the apparatus are fixed. The dynamic fastening of the knee in the form of a cup-shaped element with a softening inner gel-like layer with elastic chokes is fixed in the holes of the thigh and shin liners.

Before giving the finished device to the patient, the orthopedic surgeon checks his appearance, the smoothness of movement in the hinged nodes, the compliance of the sizes with the sizes indicated on the order form. Then the patient is called. The device is worn on the patient and check the ease of use. The doctor teaches the patient (or accompanying patient) the rules for using the device and draws up its issuance in accordance with the requirements established by the manufacturer.

Here are the results of clinical trials of the proposed orthopedic apparatus for the whole leg.

For this purpose, 4 patients were selected (N. 5 years old; R. 5.5 years old; K. 7 years old; A. 12 years old) with a diagnosis of cerebral palsy (cerebral palsy).

Patient N. (5 years old) has spastic diplegia with a predominant lesion of the right limb, bilateral spastic subluxation of the thigh, hallux valgus installation of the legs, abducto-flat valgus installation of the feet.

The patient walks with support for the left hand in a pose of triple bending, significantly rotating the hips inward, resting on the medial sections of the feet, abduction of the feet. Frontal swaying of the body during walking is noted. Hypotrophy of the legs is noted.

Before using the proposed apparatus for the whole leg for two years, the patient, in addition to the splint-leather apparatus for the whole leg, also used the Vilensky splint with installation on the ankle joints.

Patented orthopedic apparatus for the whole leg, on the recommendation of an orthopedic surgeon, the patient wore 6 months, after which a medical examination was performed. Walking in the apparatus showed a decrease in the severity of the leading installation of the hips and abduction of the feet. The torso forward is maintained, the hallux valgus setting has decreased. In the apparatus, the patient stands alone for 10-15 minutes and walks for 20-30 minutes. Centering of the head of the right thigh improved. The doctor’s recommendation is to continue using this device for the entire leg for another 6 months. Over the past 6 months, the device has been set up. A secondary examination of the doctor showed that the patient can walk independently in the apparatus. The torso forward is preserved, but it has become much smaller, the hallux valgus setting has decreased. The orthopedic surgeon believes that the use of the device significantly improves the patient's condition and that it is necessary to continue the use of this device.

Patient R. (5.5 years old) has spastic diplegia, a dysplastic type of development of the acetabulum, adductor syndrome, flexion-pronation installation of the hips, adductive-equinoscopic valgus feet.

An orthopedic surgeon recommended that the proposed apparatus be worn over the entire leg while awake. The device was used for 5 months. Inspection of the doctor showed that the pattern of independent walking has significantly improved, since the patient has a slight forward bend, internal rotation of the legs has decreased, the support of the hind legs has improved, the number of frontal swaying of the body during walking has decreased.

It is recommended to continue wearing the device during wakefulness for 1 year.

Patient K. (7 years old) has a bilateral adductopronal installation of the hips, hallux valgus installation of the legs, abducto-flat-valgus installation of the feet. Secondary myodystrophic syndrome. The patient walks with support for one (mainly left) arm in a pose of triple flexion, significantly rotating the hips inward, relying on the medial sections of the feet, abduction of the feet, more than the right. Hypotrophy of the legs is noted.

An orthopedic surgeon recommended wearing the patented apparatus on the whole leg during wakefulness for 3 months.

After wearing the apparatus for 3 months, the valgus setting of the legs decreased slightly. In the apparatus, the patient takes steps with support. The internal rotation of the thighs decreased, the torso forward leaned slightly. Orthopedic surgeon's recommendation: use of the device for 1 year. Examination of the patient after prolonged use of the device showed significant improvements in the patient's condition: adduction of the hips was significantly reduced, pronation setting was reduced. In the process of walking the patient with support, the body does not lean forward. The orthopedic surgeon recommended that the use of the device be continued on the whole leg.

Patient A. (12 years old), sluggish lower paraparesis, abducto-flat-valgus installation of the feet, flexion installation in the knee joint, rotation inside the right lower limb.

An orthopedic surgeon recommended the use of a patented apparatus for the whole leg during wakefulness for 5 months.

After examining the patient, the orthopedic surgeon gave a positive assessment of the effect of the apparatus on the lower extremities and recommended that the use of the apparatus continue for 1 year. A control examination of the patient after a year confirmed a further improvement in the patient's condition compared with his condition before using the proposed apparatus on the whole leg. An improvement in the statokinetic stability of the child, a decrease in the frontal sway of the torso during walking, and an internal rotation of the legs decreased. The knee flexion was significantly reduced. The orthopedic surgeon praised the use of the proposed device and recommended its wearing in the future.

The present invention - the apparatus for the whole leg differs from the prototype in the following:

- the apparatus uses a hip joint assembly of an original design, which allows movement not only in the sagittal plane, but also adjustable impact on the movement of the patient’s legs, both in the horizontal and in the frontal planes, which expands the scope of the invention and prevents the pathological rotational installation inside and limb reduction characteristic of spastic paralysis;

- thigh and lower leg sleeves in the rear areas, due to additional laying of the carbon tape, have high strength properties and increased rigidity, and in the area of the sleeve section (in front) the rigidity is lower, which makes it possible to insert the corresponding limb segment painlessly into the sleeve of the apparatus, revealing the sleeve rather than cutting them further in the front, which leads to material savings; uniform, rather than local, effect on segments of the lower limb;

- a metal ankle hinge assembly design with an elastic element is proposed, which allows to prevent sagging of the foot of the patient in the transfer phase and to provide various technological approaches to their use, depending on the characteristics of the patient;

- the foot sleeve in the anterior region is made flat with reinforcing layers laid in the form of a spring, which provides movement in the metatarsophalangeal joints when walking and allows energy recovery during the back push phase, prevents atrophy of the forefoot and the occurrence of secondary deformations;

- the apparatus is equipped with a corset made of composite material, which eliminates its displacement when walking and creates a reliable base for centering the underlying elements of the apparatus and their effective predetermined effect on the limb;

- the use of a corset made of composite material is one of the most important conservative means of rehabilitation, in the case when patients have a spinal pathology at the same time as consequences of spastic paralysis, in particular with cerebral palsy;

- the proposed installation of the lower ends of the tires and rods in the sleeves creates a strong and reliable design that does not require rivet fasteners. With this installation, the size of the ends of the lower tires is reduced by 3-7 times, which significantly reduces the weight of the device and improves the cosmetic appearance of the device.

- the apparatus has a dynamic front knee mount made in the form of a cup-shaped element with an internal softening layer, which improves the brace resistance of the apparatus, increases the safety of use, provides a corrective effect, and also prevents the patient’s knee from bruises;

- the upper contour in the thigh sleeve is reinforced with additional reinforcing layers, which allows unloading on the tuber pad and the entire upper landing contour of the thigh sleeve, providing unloading of the entire limb to the necessary degree and improving comfort of use, reducing pain, the appearance of "piston" movements, scuffs;

- the implementation of one of the tires in the form of rods in the hip hinge assembly, as well as a special installation of the armature of the lower leg, provide rotational movements similar to movements when walking normally;

- the implementation of the front of the sleeve of the foot in the form of a spring provides energy recovery, promotes repulsion in the phase of the back push;

- the application of the invention will have a socio-economic effect by reducing the patient’s stay in medical, rehabilitation centers and increasing the patient’s vital activity.

1. Catalog of the enterprise FSUE “Moscow PrOP”

2. RF patent №2127569

Claims (1)

Orthopedic apparatus for the whole leg for the correction of musculoskeletal functions of the lower extremities in patients with varying severity, prevalence of flaccid, spastic paralysis, paresis of the muscles of the lower extremities, consisting of a corset for the trunk, thigh sleeves, lower leg and foot, sleeve attachment elements on the limbs, knee and ankle hinge nodes, hip hinge node, characterized in that the apparatus is equipped with a dynamic knee mount made in the form of a cup-shaped element with softening internal gel with a thin layer and with elastic hooks mounted on the thigh and lower leg sleeves, and the corset on the lateral surface is made with a horizontal plate curved in a circle that has holes for attachment to it, external vertical teeth and two parallel horizontal grooves, and the hip joint assembly consists of from the upper and lower tires, the intermediate link, the screw with the head, the flange sleeve-axis with an internal threaded hole for the screw, the axis, parallel to the rotation rods, interconnected by a mobile adjuster an adjustable screed that can be moved along the rods, changing the rotation value of the lower limb, while some ends of the rods are connected to the lower part of the lower tire by means of fasteners, while the other ends have an end cap rigidly mounted in a groove made on the lateral upper end of the thigh sleeve , the upper end of the upper tire is made in the form of a plate curved around the circumference, with internal vertical teeth and holes in which the screws are installed, for connecting the upper end of the upper tire to the corset plate, with than the screws fit into the horizontal grooves of the corset plate, the lower end of the upper tire has an opening for a part of the flange sleeve-axis with a smaller diameter, the upper end of the intermediate link has a step hole, starting from the side farthest from the human body, there is a first section with a smooth surface for the head the screw, the second section with a thread for the body of the screw, the third section with a smooth surface for part of the flange sleeve-axis with a smaller diameter and the fourth with a smooth surface for the flange sleeve-axis, in addition there is a gap l for the lower end of the upper tire, crossing from top to bottom the third section of the stepped hole, the lower end of the intermediate link has ears on the sides with holes for the mentioned axis, while the distance between the ears is made to accommodate the upper part of the lower tire, in addition, the lower end of the intermediate link has thrust pad, the upper end of the lower tire is mounted on said axis and has a thrust screw with a spring mounted on the thrust screw between the lower tire and the thrust pad in contact with the thrust pad the lower end of the intermediate link and providing movement of the lower tire relative to the upper tire, while the sleeve of the foot, lower leg, thigh and corset are made of composite material with sections of different stiffness, the front surfaces of the sleeves being softer than the rear surfaces and the sleeve of the foot in the front made flat with reinforcing layers of fabric based on synthetic fibers laid in the form of a spring, while the thigh sleeve along the upper contour is reinforced with additional layers of reinforcing materials, and the tires of the knee and ankle joints are rigidly installed in the grooves made in the lower lateral ends of the thigh and lower leg sleeves and the upper lateral ends of the lower leg and foot sleeves.

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