JP6714252B2 - Upper arm prosthesis socket and upper arm prosthesis - Google Patents

Description

The present invention relates to a socket for an upper arm prosthesis and an upper arm prosthesis used by an upper arm amputee. More specifically, the present invention relates to a contact-type socket that comes into contact with a stump and an upper arm prosthesis provided with this socket.

Prostheses are essential in daily life for patients who have amputated part of their limbs. Generally, the artificial limb is composed of a socket for directly enclosing and supporting the cut end, a joint corresponding to a joint, a hand tool corresponding to a hand or foot, and a foot portion. In the case of an upper arm prosthesis used by an upper arm amputee, a suspension member (harness) for suspending the prosthesis is used to support and fix the stump.

However, a brachial prosthesis that is supported and fixed using a harness has a problem that neck pain and joint pain occur on the opposite shoulder (see Non-Patent Document 1). In addition, since the weight of the upper limb reduced by the upper arm amputation is not complemented in the artificial hand of this method, there is a risk that the trunk is inclined and shoulder joint pain and low back pain develop.

In order to improve these secondary obstacles, a brachial prosthesis in which a stump is supported and fixed by a liner is conventionally prescribed. In the case of a liner type upper arm prosthesis, a liner made of silicone resin or the like is directly attached to the stump, and a lock pin is used instead of a harness for the suspension mechanism. By using this liner type upper arm prosthesis, it is possible to eliminate the discomfort of the harness.

Further, conventionally, there has also been proposed a double-structured prosthetic foot socket part in which an inner socket formed of a tapered substantially cylindrical body having a slit is inserted into an outer socket formed of a tapered substantially cylindrical body for use (Patent Document 1). reference). In the socket part for artificial legs described in Patent Document 1, slits are provided over the entire length of the tapered substantially cylindrical body that constitutes the inner socket, whereby the tapered substantially cylindrical body can be expanded and contracted in diameter. ..

JP, 2011-143227, A

Witso E et al., "Improved comfort and function of arm prosthesis after implantation of a humerus-T prosthesis in transhumeral amputees," Prosthet. Orthot. Int, No. 30, pp. 270-278, 2006

The socket is a part that supports and fixes the cut end and transmits the movement of the stump to the hand tool or foot, and it is necessary to match the socket and the stump for wearing and using the artificial limb. .. Therefore, when making a socket, an artificial limb orthologist directly wraps a bandage-shaped plaster called plaster cast on the stump of the patient to make a model, and the socket is produced using the negative model produced thereby.

However, when the artificial hand is attached, the stump is suspended or extended due to the weight of the artificial hand, and therefore the shape of the stump portion is different from that at the time of casting. Specifically, at the time of casting, no force is applied to the stump other than the weight of the stump itself, but when actually using the prosthetic hand, the stump should not be touched by the prosthetic hand such as an elbow joint or a hand. The stump extends downward due to the weight of the other members constituting the. Therefore, the conventional upper arm prosthesis has a problem that the socket loosens during wearing and is easy to come off, and there are secondary obstacles such as skin disorders such as redness and blisters around the socket when it rotates. There is a problem that it will occur.

On the other hand, taking into account the shape change of the stump, when making a socket by drawing the stump by pulling or suspending it to make a socket, it is difficult to mount when the stump is not suspended or extended. become. Such difficulty in fitting the socket causes skin damage at the stump and neck pain and shoulder joint pain that occur near the shoulder (proximal portion).

Further, in the socket portion described in Patent Document 1, a slit is provided in the inner socket in order to improve the fitting property, but since the actual shape of the stump changes from moment to moment, it is described in Patent Document 1 When the structure is such that the ring-shaped members are combined like the socket part, the pressure may be locally applied and blood flow may be disturbed. Further, the socket portion described in Patent Document 1 is for a prosthesis, and the method of applying force and the state at the time of mounting are different from those of the artificial hand. Therefore, the structure of the socket portion described in Patent Document 1 is directly applied to the artificial hand. Even so, it is difficult to obtain a stable wearing state.

For this reason, when using an artificial hand as an auxiliary hand when performing two-handed movements such as writing and changing clothes, which are necessary for daily life, secondary obstacles such as skin disorders, neck pain, and shoulder joint pain may occur. Therefore, it is required to develop a socket that avoids the problem, is easy to mount, is hard to pull out, and has good mountability and compatibility.

Therefore, it is an object of the present invention to provide a socket for an upper arm prosthesis and an upper arm prosthesis that are easy to mount, are hard to come off, and can prevent secondary disorders.

The prosthetic hand socket according to the present invention is a socket for an upper arm prosthetic hand that is connected to an upper arm stump, and an inner socket in which a stump is inserted and contacts the stump directly or via a liner or an insert , There is an outer socket that covers the entire inner socket and a part or all of the shoulder, and a slit is formed in a spiral shape along the circumference of the inner socket.
The inner socket can be formed of, for example, fiber reinforced plastic.
Further, the inner socket is adapted to change in diameter and/or length in accordance with the shape of the stump or following the change in shape of the stump with time.
Further, the slit of the inner socket can be formed with a spiral angle of 60 to 80°, for example.
On the other hand, the inner socket and the outer socket may be connected via a resin belt.

A prosthesis according to the present invention is an upper arm prosthesis provided with the socket described above.

According to the present invention, a double structure of an inner socket and an outer socket is formed, and a spiral slit is formed in the inner socket, so that it is easy to mount and difficult to remove, and it is possible to prevent a secondary obstacle. An upper arm prosthetic arm and an upper arm prosthesis can be realized.

1A and 1B are perspective views schematically showing the configuration of a prosthetic hand socket according to a first embodiment of the present invention, where A is a state when an inner socket is attached, and B is a state where an outer socket is attached. .. It is a figure which shows the state at the time of extension of the inner socket 1. A and B are figures which show the other structural example of an inner socket, A is a front view, B is a side view. It is a figure which compared the extension degree of the inner socket 1 shown in FIG. 1A, and the inner socket 11 shown in FIG. 6A to 6D are views showing another configuration example of the outer socket, where A is a front view, B is a rear view, C is a right side view, and D is a left side view. It is a perspective view which shows typically the structure of the artificial hand of the 2nd Embodiment of this invention.

Hereinafter, a mode for carrying out the present invention will be described in detail with reference to the accompanying drawings. The present invention is not limited to the embodiments described below.

(First embodiment)
First, the prosthetic hand socket according to the first embodiment of the present invention will be described. The prosthetic hand socket of the present embodiment is a socket for a prosthetic arm that is connected to the stump of an upper arm amputee, supports and fixes the stump of the brachial arm, and transmits the movement of the body to a hand tool or the like.

[overall structure]
1A and 1B are perspective views schematically showing the configuration of the prosthetic hand socket of the present embodiment. FIG. 1A shows a state when the inner socket is attached, and FIG. 1B shows a state where the outer socket is attached. As shown in FIGS. 1A and 1B, the prosthetic hand socket of this embodiment has a double structure of an inner socket 1 into which a stump portion is inserted and an outer socket 2 that covers the inner socket 1. The inner socket 1 and the outer socket 2 are connected by a resin belt or the like.

[Inner socket 1]
FIG. 2 is a view showing a state when the inner socket 1 is extended. The inner socket 1 comes into contact with the stump directly or through a liner or insert, and is produced by drawing the stump and suspending or extending it. In addition, a spiral slit 1a is formed on the side surface of the inner socket 1 so that the diameter and/or the length of the inner socket 1 can be changed according to the shape of the stump or change over time. Has become. Specifically, as shown in FIG. 1A, the slits 1a are in contact with each other at the time of shortening, but the interval of the slits 1a becomes wider at the time of extension shown in FIG. 2 to follow the shape of the stump or the shape change with time. ..

The slit 1a of the inner socket 1 is preferably formed with a spiral angle of 60 to 80 from the viewpoint of improving extensibility. Similarly, from the viewpoint of improving extensibility, it is preferable that the slits 1a have a pitch of about 1 to 3 cm and a width of 5 mm or less. The spiral angle, pitch, width, etc. of the slits 1a formed in the inner socket 1 are not limited to the ranges described above, and can be appropriately selected according to the shape and length of the stump.

3A and 3B are diagrams showing another configuration example of the inner socket, FIG. 3A is a front view, and FIG. 3B is a side view. Further, FIG. 4 is a diagram comparing the degree of extension of the inner socket 1 shown in FIG. 1A and the inner socket 11 shown in FIG. The inner socket 11 shown in FIG. 3 has a larger spiral angle than that of the inner socket 1 shown in FIG. 1, and further has a narrower pitch to increase the number of slits 11a. When these inner sockets 1 and 11 were stretched and compared, as shown in FIG. 4, it was confirmed that the inner socket 11 having a larger spiral angle was superior in stretchability.

The material of the inner socket 1 is not particularly limited, and may be formed of a conventionally used material such as a thermoplastic resin, a thermosetting resin, and various reinforced plastics to which fibers and reinforcing materials are added. .. Among these materials, a fiber reinforced plastic composed of a woven fabric (cloth) formed of carbon fiber, glass fiber, nylon fiber and the like and a matrix resin such as an acrylic resin or a urethane resin is preferable from the viewpoint of strength.

The slit 1a of the inner socket 1 may be formed by first forming a slit-less one, and then forming a spiral cut into it. The slit 1a may be formed. A connecting member such as a lock pin may be attached to the tip of the inner socket 1, 11 on the elbow joint side in order to fix the liner or insert to the socket.

[Outer socket 2]
The outer socket 2 covers the entire inner socket 1, protects the stump and the inner socket, and maintains the shape of the inner socket 1 that has expanded and contracted following the stump to connect the elbow joint and the hand tool. belongs to. The outer socket 2 is manufactured by suspending or extending the stump with the inner socket 1 mounted, and taking a mold.

The material of the outer socket 2 is also not particularly limited, and can be formed of a conventionally used material such as a thermoplastic resin, a thermosetting resin, various reinforced plastics to which fibers and reinforcing materials are added. .. The outer socket 2 may be formed of the same material as the inner socket 1 described above, but may be formed of a different material.

However, while the stump shape is changing, the outer socket 2 is preferably formed of a thermoplastic resin having a relatively low melting point from the viewpoint of ease of adjustment after molding. On the other hand, after the stump shape is stabilized, the outer socket 2 is composed of a woven fabric (cloth) formed of carbon fiber, glass fiber, nylon fiber, etc. and a matrix resin such as acrylic resin or urethane resin from the viewpoint of strength. It is preferable to form the fiber reinforced plastic.

The outer socket 2 is shaped so as to cover the shoulder of the patient, which limits rotation of the socket with respect to the stump. The outer socket 2 is not limited to the shape shown in FIG. 1B, and may have a shape that covers a part of the shoulder. 5A to 5D are views showing another configuration example of the outer socket, FIG. 5A is a front view, FIG. 5B is a rear view, FIG. 5C is a right side view, and FIG. 5D is a left side view. As shown in FIGS. 5A to 5D, the outer socket 21 is in contact only with the humeral head, the foramen process, and the back surface under the scapular spine, and the side surface portion is open.

Patients with concomitant injury and contralateral shoulder or neck trauma need to reduce pain from wearing a prosthesis as much as possible, but this shape of the outer socket limits socket rotation. It is also possible to reduce the occurrence of skin disorders such as friction and rash between the skin of the stump and the socket.

A connecting member for connecting an elbow joint or the like may be attached to the tip of the outer socket 2 on the elbow joint side. The socket of this embodiment and the elbow joint are connected by this connecting member.

[Resin belt 3]
The resin belt 3 connects the inner socket 1 and the outer socket 2, and is attached to, for example, an outer surface of a portion (distal portion) of the inner socket 1 near the elbow joint. Further, the outer socket 2 is provided with a hole for inserting the resin belt 3 and a fixing member for fixing the resin belt 3. Then, after mounting the outer socket 2 on the inner socket 1, the resin belt 3 is passed through the hole and is fixed by a fixing member to connect the inner socket 1 and the outer socket 2.

As described in detail above, in the prosthetic hand socket of the present embodiment, the inner socket has a spiral shape in which spiral slits are formed (spiral socket), so that the socket itself extends and follows the shape change of the stump. It is possible. This makes it possible to prevent secondary disorders such as skin disorders, neck pain, and shoulder pain that occur when it is difficult to fit the socket.

The prosthetic hand socket of the present embodiment has a double structure of an inner socket and an outer socket, so that it can be easily attached and detached and is hard to be detached when attached. Further, since the prosthetic hand socket of the present embodiment is of a contact type, the harness can be simplified, and neck pain and shoulder pain on the opposite side due to the harness can be reduced. In the case of a long stump, a harness may not be needed.

The inner socket of the artificial hand socket according to the present embodiment has a length that is shortened and expanded according to the stump shape, and the inner diameter is shortened and expanded, so that the mounting is easy and difficult to pull out, and it corresponds to various stump shapes. It is possible. Further, since this inner socket is unlikely to be locally pressed, it has an effect of preventing secondary damage.

Normally, the stump shape of a person with a brachial amputee is an inverted conical shape in which the diameter increases as it approaches the proximal side. Since the diameter is small, a gap is formed in the conventional socket, and secondary damage such as skin damage is likely to occur due to loosening or friction. On the other hand, in the prosthetic hand socket of the present embodiment, since the inner socket is deformed according to the shape of the stump, even in a patient in which it is difficult to apply the conventional socket such as a patient of bicep muscle resection, a skin disorder or the like occurs. It does not occur and can be used in good condition.

In addition, in the case of a patient just after the injury, the circumference of the stump changes daily, so it is difficult to fit the socket, and conventionally, prosthetic wearing training tends not to proceed due to neck pain, shoulder joint pain, skin disorders. However, by using the socket of the present embodiment, it becomes possible to accelerate the artificial limb attachment training. Early prosthetic wear training may also improve phantom pain, a refractory complication in amputees.

(Second embodiment)
Next, a prosthetic hand according to the second embodiment of the present invention will be described. FIG. 6 is a perspective view schematically showing the configuration of the artificial hand of this embodiment. The prosthetic hand of the present embodiment is an upper arm prosthetic hand connected to the upper arm cutting portion, and as shown in FIG. 6, the forearm support portion 30 and the hand tool 40 are connected to the socket 10 via the elbow joint 20. ..

The artificial hand of this embodiment uses the socket of the above-described first embodiment for the socket 10. That is, the socket 10 has a double structure of an inner socket having a spiral slit and an outer socket covering the inner socket. Known members can be used for the elbow joint 20, the forearm support portion 30, and the hand tool 40.

The prosthesis of this embodiment uses a double-structured socket including an inner socket having a spiral slit and an outer socket covering the slit, so that the prosthesis is easy to mount and is difficult to remove, and prevents secondary obstacles. It is also possible to do so. Further, the artificial arm of the present embodiment can be favorably applied not only to a normal upper arm amputator but also to a patient who has resected the upper arm muscle.

The patient wearing the prosthetic hand of the present embodiment is trained under the guidance of an occupational therapist or a physical therapist to hold the paper in writing motion as an assistant to the two-handed motion of daily life, or when changing clothes. It is possible to keep your clothes down, and to take out your wallet when you take out money from your wallet. As described above, by using the prosthetic hand of the present embodiment, it becomes easier to use the prosthetic hand than before, and it is possible to contribute to the improvement of activities of daily living such as writing and changing clothes and the improvement of QOL (quality of life). ..

The artificial hand of the present embodiment can also be used as a myoelectric artificial hand. The "myoelectric prosthetic hand" attaches an electrode to the remaining part of the arm, detects a potential change (myoelectric potential) generated when the muscle is moved, and operates the prosthetic hand. Generally, a suction socket is used for the myoelectric prosthesis in a case of an upper arm amputation, and a harness is required for a short stump. Further, in the conventional myoelectric prosthetic hand, an electrode is attached to the upper arm of the patient to detect the myoelectric potential of the biceps brachii or the triceps brachii.

On the other hand, the artificial hand of the present embodiment uses the socket having a double structure of the inner socket and the outer socket that covers the inner socket, and therefore, due to its structure, detects the myoelectric potential of the biceps brachii or the triceps brachii. Difficult to do. Therefore, when the prosthetic hand of the present embodiment is used as a myoelectric prosthetic hand, electrodes are arranged inside the outer socket and the myoelectric potential around the shoulder of the deltoid muscle, the pectoralis major muscle, and the subspinal muscle is used. The prosthetic hand of the present embodiment can satisfactorily detect the myoelectric potential around the shoulder, and can obtain an operating performance equivalent to or higher than that of the conventional myoelectric prosthetic hand.

Hereinafter, the effects of the present invention will be specifically described with reference to examples.

(First embodiment)
The socket of the first embodiment described above was applied to the decorative artificial arm of a patient with right upper arm amputation (male in his 40s). In this patient, the wound at the stump was scarred, and neck pain and left shoulder pain associated with cervical spondylosis were also observed. Then, when the socket for artificial hands was changed to the socket of the first embodiment of the present invention, the neck pain and the left shoulder pain were reduced and the skin disorder was also improved in this patient. As a result, this patient was able to work.

(Second embodiment)
The socket of the first embodiment described above was applied to the working prosthesis of a patient (male in his twenties) having an upper right arm amputation. This patient had complete paralysis of the right upper limb due to a right brachial plexus injury. This patient was able to attach and detach the socket of the first embodiment of the present invention without any problems, and even after the attachment, the occurrence of skin disorders such as blistering at the stump and pigmentation due to circulatory disorder was observed. There wasn't.

Further, in this patient, the stump was in the process of maturation, and the stump circumference changed by 1 cm or more in 3 weeks. In such a case, the existing prosthetic socket needs to be remanufactured, but the socket of the first embodiment of the present invention can be used as it is without remanufacturing.

(Third embodiment)
The socket of the first embodiment described above was applied to the myoelectric prosthetic hand of a patient (male in his thirties) with left upper arm amputation. This patient had a short stump and had neck pain and right shoulder pain. In the case of this patient, a harness is required when the conventional socket is used, but by using the socket of the first embodiment of the present invention, the harness is not required and the load on the right shoulder can be reduced. As a result, the patient had improved neck pain and right shoulder pain.

Further, when two pairs of electrodes were attached to the inner side of the outer socket and the myoelectric potentials of the deltoid muscle, the pectoralis major muscle, the subspinal muscle, etc. were detected, good detection was possible.

(Fourth embodiment)
The socket according to the first embodiment described above was applied to the decorative artificial hand of a patient with left upper arm amputation (male 70s). Since this patient had a cut due to a malignant soft tissue tumor in the upper arm, the muscle that remained in the proximal socket (biceps) was usually excised. Since the circumference of the proximal portion of this patient is small, the conventional prosthetic socket causes loosening and friction, which is considered to cause skin disorders.

Therefore, the socket of the first embodiment of the present invention was applied to the present patient from the beginning as a socket for a prosthetic hand. As a result, this patient was able to use the prosthesis in good condition for a long period of time without the occurrence of skin trouble. It is considered that this is because the socket according to the first embodiment of the present invention can be deformed following the shape of the stump, so that loosening and friction were difficult to occur.

From the above results, it was confirmed that by using the socket of the present invention, it is possible to realize an upper arm prosthesis that is easy to attach, is hard to pull out, and can prevent secondary damage.

1,11 inner socket, 1a,11a slit, 2,21 outer socket, 3 resin belt, 10 socket, 20 elbow joint, 30 forearm support, 40 hand tool

Claims (6)

A socket for an upper arm prosthesis connected to an upper arm stump,
An inner socket into which the stump is inserted and which contacts the stump directly or through a liner or insert ,
While covering the entire inner socket , an outer socket that covers a part or all of the shoulder ,
Have
The inner socket is a prosthetic arm socket in which slits are spirally formed along the circumference . The upper arm prosthetic socket according to claim 1, wherein the inner socket is made of fiber reinforced plastic. 3. The upper arm prosthetic socket according to claim 1, wherein the inner socket has a diameter and/or a length that changes according to the shape of the stump or following a change in shape of the stump with time. .. The upper arm prosthetic socket according to claim 1, wherein the slit of the inner socket is formed at a spiral angle of 60 to 80°. The upper arm prosthetic socket according to claim 1, wherein the inner socket and the outer socket are connected via a resin belt. An upper arm prosthesis provided with the socket according to any one of claims 1 to 5.

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