RU178811U1 - MODULE FOR EXTERNAL FIXING DEVICE FOR THE DEVELOPMENT OF MOVEMENTS IN THE HIP JOINT - Google Patents

Abstract

The technical solution relates to medical equipment, to the field of traumatology and orthopedics, to devices for the development of movements in the hip joint in the early postoperative period. The module contains a guide unit 1, a reponent assembly in the form of two mechanisms for adjusting position 2 and 3, fastening elements to the femoral and pelvic supports of the external fixation apparatus in the form of clamps 4 and 5. The guide assembly rotates, contains a single-plane axial hinge 6, two guides 7, a movable carriage 8, the first link 9, with the possibility of gate relative to the second link 10. The guide mounted on the second link hinge axis and equipped with arc-shaped grooves 13, 14. The center line of each arcuate groove is part of a circle, the center "O" which, in the frontal plane, potentially corresponds to the center of rotation of the hip joint. The carriage in the frontal plane moves along arched grooves around the center "O". The position adjustment mechanisms allow the guide assembly 1 to be moved relative to the hip joint. An isolated rotation of the AVF femoral support relative to the pelvic support is achieved in two planes, while the center of rotation in the frontal plane is outside the guide assembly. 11 s.p. f-ly, 13 ill.

Description

The technical solution relates to medical equipment, to the field of traumatology and orthopedics, to devices for treating patients with defects of the proximal femur (POBK). The technical solution is a module (node), fixed to the supports of the external fixation apparatus, used in conjunction with the external fixation apparatus, to develop movements in the hip joint in the early postoperative period.

Defects in POBK lead to a pronounced dysfunction of the hip joint and limb as a whole. The problem of treating this pathology in children and adolescents is recognized to the end is not solved. Known reconstructive interventions are characterized by technical complexity and aggressiveness, and in some cases their outcome remains unpredictable. After surgical treatment, the hip joint is immobilized. Moreover, after surgery, there is a high risk of developing joint stiffness, contractures, limited range of motion, mobility in the hip joint. The improvement of methods and the development of devices and devices for the rehabilitation of children and adolescents with PHD defects is an urgent task. In medical technology, the arsenal of technical means fixed to the supports of the external fixation apparatus, used together with the external fixation apparatus, designed to develop movements in the hip joint in the early postoperative period, is limited. The presented technical solution extends this arsenal. To avoid the negative effects of prolonged fixation, immobilization, hip joint early active development of movements in the joint after surgery is necessary. In this case, it is necessary to maintain the position of the components of the hip joint achieved during surgery (hereinafter also referred to as the “joint”). It is necessary to develop movements in the joint when it is still fixed in the external fixation apparatus, this is important for maintaining the mobility of the limb. In the treatment of pathologies and joint injuries with external fixation devices, it is possible to develop a joint during the fixation period in the device, while unloading the joint and performing movements are possible. The existing designs of external fixation apparatuses, in particular, the Ilizarov apparatus, allows the joint to be developed in the sagittal plane by assembling and installing the hinge assembly at the level of the center of rotation of the hip joint, one end of which is fixed to the pelvic support and the other to the femoral. The hinge in this case is single-axis, consists of two brackets connected by a bolt. In this case, the axis of rotation of the hinge should coincide with the center of rotation of the femoral head in the joint. To perform hip movements in the frontal plane, the center of rotation of the hinge must also coincide with the center of rotation of the head in the joint. But it is difficult to implement such a movement using a single-axis hinge, it is necessary that the axis of this hinge passes through the center of the joint, which means that it must be in front and / or behind the hip joint, resulting in a bulky design that is inconvenient for the patient. There is a need for a node that can be fixed to the pelvic and femoral support to the external fixation apparatus, and if necessary, to move in the hip joint, first in one plane and then in another, so that the head of the femur does not move relative to the center of rotation of the joint.

Devices of a similar purpose are known from the prior art, but they do not fully satisfy the existing requirements of a doctor and patient. Known devices for the development of movements in the hip joint ([1] - RU 2281077, [2] - SU 640740). Devices [1; 2] bulky stationary devices that are designed to develop the joint in the later stages of treatment. They do not allow to begin the development of the joint in the early postoperative period when the limb is in the external fixation apparatus (AVF), since the limb with AVF cannot be properly fixed on the lodges.

A device for the development of movements in the hip joint in children ([3] - RU 2191564) consisting of a bed and a mechanism for influencing the limb. The mechanism of influence on the limb is made in the form of a telescopic rod equipped with an arcuate supporting platform for the lower third of the lower leg and elements for adjusting the length of the rod in the form of coaxial holes on the telescopic parts of the rod and the fixing bolt, and a lever with a handle attached to the outer tube. The bed is made in the form of a hollow stand according to the standard size of the pelvis, is equipped with straps for attaching the body and a side bracket with a goniometer scale that can be moved along the scale of the lever with the handle and secured in the desired position using the fixing screw, while the rod and bed are pivotally fixed to each other .

However, this device [3] is also intended for joint development after removal of the AVF and is not suitable for use with it. Devices [1; 2; 3] provide for the development of the joint during the period when the AVF is removed. As you know, the earlier the development of movements in the joint begins, the less likely the occurrence of contractures, i.e. to develop a joint is necessary even while the patient is in the AVF. Thus, the best option is when the AVF is equipped with a device that allows you to develop movements in the joint without violating the stable position of its parts relative to each other. It is convenient to make such a device in the form of a module that can be installed on the AVF and removed from the AVF if necessary.

A known apparatus for the treatment of diseases of the hip joint ([4] - RU 2183434) containing the pelvic and femoral supports connected by threaded rods, a correction unit mounted on one of the supports, and intraosseous rods. The correction unit is made in the form of guide bushings with channels for intraosseous rods, while each sleeve has a threaded leg pivotally connected to it,

However, this device [4] rigidly fixes the femur relative to the pelvic, the design of the correction unit does not allow to develop movements in the hip joint with a stable position of its components.

An external skeletal fixation device is known ([5] US 20090024128). The device reduces the load on the patient’s joint, has a simple structure, includes two load-bearing beams, on which bone retainers in the form of screws are installed by means of fixing elements, bone screws of one beam are installed in the femur, bone screws of the other beam are installed in the pelvic bone. The ends of the beams are connected by a hinge assembly consisting of three, fixed axial joints.

However, the design of the hinge assembly of the device [5] does not allow the development of abduction / adduction in the hip joint. The device is an external fixation device, not intended, and not adapted, for use in combination with known circular AVFs.

Known apparatus for the hip joint AN6-05 ([6] - Internet site "www.cito-pro.ru" of the enterprise FSUE "CITO" - "Home - Product Catalog - Prostheses and orthoses - Apparatuses - Universal apparatuses - Apparatus for the hip joint AN6 -05. Access mode: http://www.cito-pro.ru/index.php?option=com_content&view=article&id=232:app-uni&catid=45:apparat&Iternid=66). The device [6] contains the pelvic element, the femoral element (langeta), connected movably by a hinge assembly located at the level of the hip joint. It has profiled polypropylene linings with a triplex lining, connected to a capsule of Tricor fabric by a metal tire with a multi-position hinge. It is indicated after fractures and operations in the area of the bones of the pelvis and hip joint. Provides external fixation of the bones of the pelvis and hip joint with a dosed range of motion in the sagittal plane, if necessary, for the phased development of contractures of the hip joint.

The design of the hinge assembly of the device [6] does not allow the development of abduction / adduction in the hip joint. The device [6] is fixed on the patient’s body, taking over the load through soft tissues, while the rigidity of the femoral head fixation in the acetabulum may be insufficient and dislocation is possible during joint development. The device [6] is not applicable with AVF and is not structurally adapted for use in combination with circular AVFs.

A known apparatus for restoring mobility of the hip joint ([7] - SU 1630803). The apparatus [7] contains the pelvic and femoral nodes (pelvic support and femoral support with knitting needles), a connecting unit (articulated or guiding assembly), distractors, elements for fixing the articulated assembly to the pelvic and femoral support, mechanisms for repositioning the articulated assembly (reponent or mechanism for adjusting the position of the guide assembly) relative to the pelvic and femoral support. The connecting node has the ability to rotate relative to the joint, has three degrees of freedom. The arc of the pelvic node is pivotally connected by at least three distractors to the connecting node. The connecting unit consists of a housing, made in the form of a part of a sphere in which a separator with balls is installed, and is connected with the reponent assembly, which in turn is connected to the arc. The apparatus [7] provides the simultaneous development of all types of movements in the hip joint, without restricting the rotation in the joint to any one plane. For this, the arc of the pelvic node is pivotally connected by distractors to the connecting node with the possibility of rotational movement relative to the hip joint

This analogue [7] is massive, has a complex structure, and does not allow the development of movements in the hip joint to be isolated first in the frontal plane, then in the sagittal joint. This is due to the fact that the guide assembly has a spherical surface, i.e. the head in the acetabulum during fixation in this device [7] has three degrees of freedom, which does not allow to develop a lead / lead separately from flexion / extension. In addition, for the installation of the hinge unit, it is necessary to accurately carry the knitting needle into the head, which complicates its use. The device [7] is used independently, is not applicable and is not structurally adapted for use in combination with circular AVFs. The analogue [7] does not provide the goals that are set today in the treatment period — the implementation of isolated abduction / adduction, the implementation of isolated flexion / extension in the hip joint, during the stabilization period of the applied AVF. The design is metal-intensive, expensive to manufacture. The analogue [7] does not provide the ability to use a guide unit (articulated or connecting node) separately from the pelvic and femoral supports, together with various designs of the AVF.

The task to which the technical solution is directed is to ensure the development of the hip joint, in the early stages after surgery, alternately isolated in two planes, the frontal and sagittal, provided that the external fixation apparatus is stabilized on the pelvic bone and thigh, which stabilize the components of the hip joint - the position of the femoral head relative to the acetabulum.

EFFECT: using a technical solution, an isolated rotation of the AVF femoral support relative to the pelvic support in two planes is achieved, while the center of rotation in the frontal plane is outside the guide assembly.

The technical result is achieved by the fact that the module to the external fixation apparatus for developing movements in the hip joint (hereinafter referred to as the “module”) contains a guide assembly, a reponent assembly, fastening elements to the femoral and pelvic supports of the external fixation apparatus. Rotating guide unit (the first link has the ability to rotate relative to the second link). The guide assembly is connected to a reponent assembly made in the form of two position adjustment mechanisms. The fastening elements to the femoral and pelvic supports contain two clamps. Each of the clamps is associated with its own position adjustment mechanism. The guide assembly includes a single-plane axial hinge, two guides, a carriage mounted, with the possibility of movement, on the guides. A single-plane axial hinge consists of two links connected by a cylindrical axis. The first link is connected to the first position adjustment mechanism. The second link is associated with the second position adjustment mechanism. Two guides equipped with arcuate grooves are rigidly symmetrically mounted on the second link of the axial hinge. The center line of each arcuate groove is part of a circle whose center, in the frontal plane, potentially corresponds to the center of rotation of the hip joint. Between the guides is a carriage mounted for movement along arched grooves. The carriage is connected to a second position adjustment mechanism. Each position adjustment mechanism comprises a threaded rod. One end of the threaded rod is connected to the clamp by means of a ball joint, with the possibility of dosed longitudinal movement in a ball joint. The other end of the threaded rod is connected to the guide assembly.

The above essence ensures the achievement of the claimed technical result, provides the possibility of isolated development of the hip joint in the frontal and sagittal plane, with the supports of the external fixation apparatus installed on the limb.

In this case, when implementing the technical solution, it is preferable that each clamp consists of an arm equipped with a ball joint, a clamp bolt with a nut, and the ball joint contains a ball and a stopper. The single-plane axial hinge contains a locking screw installed in the first link and a visual mark of the location of the center of rotation of the hip joint, providing ease of use. The guides are preferably marked with a scale for visual control of the position of the carriage, as well as a limiter for the movement of the carriage in the form of a figured washer with a screw, which also provides ease of use. The mechanism for adjusting the position of the guide assembly preferably includes a threaded rod, one end of the threaded rod is connected to the clamp by a ball joint and nuts, the other end of the threaded rod contains an eye, with internal thread, the eye is mounted in the housing of the position adjustment mechanism with the possibility of movement by means of a rod, the rod contains a head Full construction. In this case, the threaded rod contains a clamping nut and a washer with a mustache, providing visual control of movement. It is envisaged that the housing of the position adjustment mechanism is equipped with a visual position control scale. The housing of the first position adjustment mechanism is parallel to the housing of the second position adjustment mechanism, the housing is connected to the guide assembly by rods, the guides are interconnected by screws with spacer sleeves. Preferably, the module parts are made of a titanium alloy, and the surfaces comprise a protective anode oxide film. The module can be made of aluminum alloy, which provides low cost and light weight, as well as stainless steel. The friction surfaces of the guide assembly have a roughness Ra from 0.20 to 0.6 μm.

The essence of the technical solution is illustrated by graphic materials which depict:

FIG. 1 - module (stainless steel), general view;

FIG. 2 - module (stainless steel), front view;

FIG. 3 - module, embodiment (aluminum alloy), general view;

FIG. 4 - module, embodiment (aluminum alloy), front view;

FIG. 5 - module, embodiment (aluminum alloy), side view;

FIG. 6 - module, embodiment (aluminum alloy), a common view with spaced parts;

FIG. 7 - module, embodiment (titanium alloy), front view;

FIG. 8 - module, embodiment (titanium alloy), general view;

FIG. 9 - module, embodiment (titanium alloy), a common view with spaced parts;

FIG. 10 - module, embodiment (titanium alloy), mounted on AVF supports, general view, arrows indicate the directions of possible movement of the guide assembly;

FIG. 11 - module, embodiment (titanium alloy), mounted on AVF supports, front view, arrows show the directions of possible movement of the guide assembly;

FIG. 12 - module, mounted on the supports of the AVF, front view, a series of 3 types is shown during abduction of the hip;

FIG. 13 - module, mounted on the supports of the AVF, side view, a series of 3 types is shown when the hip is bent.

In the figures, the numbers indicate:

1 - guide assembly;

2 - the first position adjustment mechanism;

3 - second position adjustment mechanism;

4 - the first clamp (for attaching to the pelvic support AVF);

5 - second clamp (for attachment to the femoral support of the AVF);

6 - axial hinge (single-plane);

7 - a guide;

8 - carriage;

9 - the first link of a single-plane axial hinge;

10 - the second link of a single-plane axial hinge;

11 - a cylindrical axis;

12 - the body of the first position adjustment mechanism;

13, 14 - arcuate groove;

15 - set screw;

16 - clamping screw;

17 - the housing of the second position adjustment mechanism;

18 - threaded rod;

19 - the first end of the threaded rod;

20 - clamp bracket;

21 - ball joint;

22 - a nut;

23 - the second end of the threaded rod;

24 - an ear of a threaded rod;

25 - thrust;

26 - thrust head;

27 - a clamping bolt;

28 - a nut of a clamping bolt;

29 - ball;

30 - stopper;

31 - locking screw;

32 - visual mark;

33 - a scale of guides;

34 - limiter;

35 - curly washer;

36 - screw;

37 - clamping nut;

38 - washer with a mustache;

39 - housing scale 12, 17;

40 - a core;

41 - pin;

42 - screw;

43 - spacer sleeve;

44 - the puck.

Implementation of a technical solution.

The module contains a guide unit 1 (Fig. 1; 2; 3; 5; 7; 8; 10; 11, shown in dashed line in Fig. 1) made in the form of two mechanisms for adjusting position 2 and 3 of the reponent assembly (Fig. 1; 2; 3; 5; 7; 8; 10; 11, in Fig. 1 are marked with a dashed line), the fastening elements to the AVF supports are made in the form of clamps 4 and 5 (Fig. 1; 2; 3; 5; 7; 8; 10; 11).

The guide unit 1 is made rotatable, contains a single-plane axial hinge 6 (Fig. 1; 2; 3; 5; 7; 8; 10; 11, in Fig. 1 highlighted by a dashed line), two guides 7 (Fig. 1; 2; 3 ; 5; 6; 7; 8; 9) the carriage 8 (Fig. 1; 2; 3; 5; 6; 7; 8; 9) mounted on the guides 7. The carriage 8 is mounted with the possibility of movement along the guides 7. Guide unit 1 connected to position adjustment mechanisms 2 and 3. The single-plane axial hinge 6 consists of two links 9, 10 (Fig. 1; 2; 3; 5; 6; 7; 8; 9) connected by a cylindrical axis 11 (Fig. 2; 3; 5; 6; 7; 8; 9). Links 9, 10 are made in the form of rectangular bars. The first link 9 is connected to the first position adjustment mechanism 2. The second link 10 is connected to the second position adjustment mechanism 3. The clip 4 is connected to the first position adjustment mechanism 2. The clip 5 is connected to the second position adjustment mechanism 3. Depending on the manufacturing technology, manufacturing cost , at a particular production plant, convenience and application features, the module can be manufactured with some differences. The module shown in FIG. one; 2 made of stainless steel. The module shown in FIG. 3; four; 5; 6 is made of aluminum alloy. The module shown in FIG. 7; 8; 9 is made of VT6 titanium alloy with an interference - colored protective oxide film on the surface of parts, which is formed by anodic polarization in a conducting medium.

In this case, depending on the particular design, the clamp 4 can be structurally made uniform with the position adjustment mechanism 2, the clamp 5 can be structurally made uniform with the position adjustment mechanism 3, as shown in figures 1; 2; 7; 8; 9; 10; 11. Also, depending on the particular embodiment, the clamp 4 can be structurally spaced with a position adjustment mechanism 2, the clamp 5 can be structurally spaced with a position adjustment mechanism 3, as shown in figures 3; four; 5; 6; 12; 13. In this case (Fig. 3; 4; 5; 6; 12; 13.), the first position adjustment mechanism 2 contains a separate housing 12 (Fig. 3; 4; 5; 6.), the second position adjustment mechanism 3 contains a separate case 17 (Fig. 3; 4; 5; 6.).

Two guides 7 are mounted rigidly symmetrically on the second link 10 of the axial hinge 6. The guides 7 are equipped with arcuate grooves 13 and 14 (Fig. 1; 2; 3; 6; 7; 8). The center line (shown in FIG. 2 by a dashed line) of each arcuate groove 13 and 14 is a part of a circle whose center O (in FIG. 2 is marked with a dot) in the frontal plane, potentially corresponds to the center of rotation of the hip joint. Between the guides 7 there is a carriage 8, mounted for movement along the arcuate grooves 13 and 14. The carriage 8, mounted in the arcuate grooves 13,14 by means of set screws 15 (Fig. 1; 2; 3; 4; 5; 6; 7; 8 ; 9) and clamping screw 16 (Fig. 1; 2; 3; 4; 5; 6; 7; 8; 9). The carriage 8 is connected to the second position adjustment mechanism 3.

The position adjustment mechanism 2 comprises a threaded rod 18, one end 19 (Fig. 1; 2; 3; 4; 5; 6; 7; 8; 9) of the threaded rod 18 (Fig. 1; 2; 3; 4; 5; 6 ; 7; 8; 9) is connected to the bracket 20 (Fig. 1; 2; 3; 4; 5; 6; 7; 8; 9) of the clamp 4 by means of a ball joint 21 (Fig. 1; 2; 3; 4; 5; 6; 7; 8; 9), with the possibility of dosed longitudinal movement in the ball joint 21 (Fig. 1; 2; 3; 4; 5; 6; 7; 8; 9) by means of nuts 22 (Fig. 1; 2 ; 3; 4; 5; 6; 7; 8; 9). The other end 23 (Fig. 1; 2; 3; 4; 5; 6; 7; 8; 9) of the threaded rod 18 is connected with the guide node 1. As shown in figures 1; 2; 7; 8; 9; 10; 11, the end 23 of the threaded rod 18 can be connected directly to the first link 10 of the axial hinge 6 of the guide assembly 1. As shown in figures 3; four; 5; 6; 12; 13 the end 23 of the threaded rod 18 can be connected with the first link 9 of the axial hinge 6 of the guide assembly 1 through the housing 12 of the first position adjustment mechanism 2. The first link 9 (in figures 3; 4; 5; 6; 12; 13) of the axial hinge 6 rigidly connected to the housing 12 of the first position adjustment mechanism 2.

The position adjustment mechanism 3 comprises a threaded rod 18, one end 19 of the threaded rod 18 is connected to the bracket 20 of the clamp 5, by means of a ball joint 21, with the possibility of dosed longitudinal movement in the ball joint 21 by means of nuts 22. The other end 23 of the threaded rod 18 is connected with the guide assembly 1. As shown in figures 1; 2; 7; 8; 9; 10; 11, the end 23 of the threaded rod 18 can be connected directly to the carriage 8 of the guide assembly 1. As shown in figures 3; four; 5; 6; 12; 13, the end 23 of the threaded rod 18 can be connected with the carriage 8 of the guide assembly 1 indirectly through the housing 17 of the second position adjustment mechanism 2. The carriage 8 (in figures 3; 4; 5; 6; 12; 13) is connected to the housing 17 of the second position adjustment mechanism 3. As shown in figures 3; four; 5; 6; 12; 13 the end 23 of the threaded rod 18 contains an eyelet 24, with an internal thread. The ear 24 of the threaded rod 18 can be moved by means of the rod 25 in the housing 12, 17, the rod 25 contains a turnkey head 26.

Clips 4, 5 consist of a bracket 20 equipped with a ball joint 21, and a clamping bolt 27 (Fig. 1; 2; 3; 4; 6) with a nut 28 (Fig. 1; 2; 3; 4; 6). To adjust the position of the guide assembly 1 in the device shown in FIG. one; 2; 7; 8; 9, the bracket 20 is made with a longitudinal groove (not indicated in the diagrams). To adjust the position of the guide assembly 1 in the device shown in FIG. 3; four; 5; 6, the bracket 20 is made with a longitudinal groove (not shown in the diagrams) and, to increase the adjustment range, position adjustment mechanisms 2 and 3 are made with the housings 12 and 17 and are thus spatially extended outside the brackets 20 of the clamps 4, 5.

The ball joint 21 contains a ball 29 (Fig. 1; 6; 9) and a stopper 30 (Fig. 1; 2; 3; 4; 5; 6; 7; 8; 9) fixed by a nut 22 (Fig. 1; 2; 3; 4; 5; 6; 7; 8; 9). The single-plane axial hinge 6 contains locking screws 31 (Fig. 1; 2; 3; 4; 5; 6; 7; 8; 9) installed in the first link 9 and a visual mark 32 (Fig. 1; 2; 4; 7) , the location level of the center “O” of rotation of the hip joint, necessary to control the installation of the device at the required distance from the center “O” of rotation of the hip joint. On the guides 7, a scale 33 can be applied (as shown in Fig. 3; 4; 6; 7; 8; 9), which allows you to visually control the position of the carriage 8, as well as a limiter 34 (Fig. 3; 4; 6; 7; 8; 9) in the form of a figured washer 35 (Fig. 3; 4; 6; 7; 8; 9) with a screw 36 (Fig. 5; 6; 9). The threaded rod 18 may include a clamping nut 37 (as shown in Fig. 3; 4; 6) and a washer with a mustache 38 (as shown in Fig. 3; 4; 6). The housings 12, 17 of the adjustment mechanisms 2, 3 can be, as shown in FIG. 3; four; 6, equipped with a scale of 39, to control the position. Housings 12 and 17, as shown in FIG. 3; 4 are arranged parallel to each other. Housings 12, 17 as shown in FIG. 3; 4 are connected to the guide assembly 1 by rods 40 (FIG. 6), which are mounted using pins 41 (FIG. 6). To connect the guides 7, in the structure shown in FIG. 3; 4, 6 used screws 42 (Fig. 6), spacers 43 (Fig. 6). Rod 25 in the structure shown in FIG. 3; 4, 6 is installed in the housing 12, 17 using a washer 44 (FIG. 6) and a pin 41 (FIG. 6).

The module to the external fixation apparatus for the development of movements in the hip joint can be manufactured at modern manufacturing enterprises by machining known and accessible materials and using well-known equipment, in particular metal-working turning, milling, and cutting machines.

Use the module as follows.

The module is used in the treatment of patients with PHD defects. After reconstructive intervention, in the early postoperative period, when the patient is in AVF, in order to reduce the risk of joint stiffness, contractures, and ensuring mobility of the hip joint, the module is fixed to the AVF supports, the distractors connecting the AVF supports and interfere with the movement during joint development are removed. The first clamp 4 is installed on the AVF pelvic support. The threaded rods 18 are moved in the ball joints 21 using nuts 22. The second clamp 5 is mounted on the AVF femoral support. The position of the guide assembly 1 is adjusted using the first position adjustment mechanism 2, the second position adjustment mechanism 3. At the same time, in the frontal and sagittal plane, the guide unit 1 is installed (using visual mark 32) at the level of the “O” center of rotation of the hip joint. Provide the installation of visual mark 32 at a structurally specified distance (150 mm) from the center of rotation of the hip joint in the frontal plane. To do this, if necessary, after installing the device do an x-ray of the limb in the frontal and; the sagittal plane, and from it determine the distance by which the first link 9 of the axial joint 6 needs to be displaced so that its longitudinal axis (or visual mark 32) corresponds to the center of rotation of the hip joint. Having achieved the required position, they fix the position of the device, tighten the clamping bolts 27, ball joints 21, nuts 22, stop 30. This ensures that the axis of rotation of the axial joint 6 is aligned with the center of rotation of the hip joint in the frontal and sagittal planes, and the center is also aligned rotation of the carriage 8 along the guides 7 with the center of rotation of the hip joint. To develop movements in the sagittal plane (Fig. 13), loosen the locking screw 31, and begin to move the limbs back and forth, the guide assembly 1 rotates in a single-plane axial hinge 6, the second link 10 of the axial hinge 6 rotates relative to the first link 9 on the cylindrical axis 11 The femoral support rotates relative to the pelvic support, the femur rotates in the sagittal plane, rotating in the hip joint. After the development of movements in the sagittal plane is completed, the limb is lowered, the locking screw 31 is tightened. To develop movements in the frontal plane (Fig. 12), the clamping screw 16 is loosened and the limb is abducted. Moreover, in the design of FIG. 3; four; 5; 6; 7; 8; 9, to limit the range of movements, set the limiter 34 at the required level, guided by the scale 33. The carriage 8 of the guide unit 1 moves in the grooves 13, 14 of the guides 7. The carriage 8 moves in a circle around the center “O” of rotation of the joint, the femoral support rotates relative to the pelvic , the femur rotates in the frontal plane, spinning in the hip joint. After the development of movements in the frontal plane is completed, the limb is set to its original position and the clamping screw 16 is tightened. If necessary, to unload the hip joint, using nuts 22 along the threaded rods 18 give distraction. If necessary, to carry out free circular movements in the joint, weaken the ball joints 21, the clamping screw 16 and the locking screw 31. Thus, it is possible to isolatedly develop the hip joint in the frontal and sagittal planes with the supports of the external fixation apparatus mounted on the limb. After the development of the joint, the supports of the AVF are connected by distractors. The module is removed by loosening clamps 3 and 4.

The module to the external fixation apparatus for the development of movements in the hip joint will potentially be in demand in the clinical practice of trauma and orthopedic clinics, as it will facilitate the installation process of the necessary AVF design and the process of developing the hip joint. In the catalogs of manufacturers of medical equipment, there are no devices and devices with functional capabilities with which the module complements the well-known AVFs, for example, Ilizarov’s device, therefore, the module can be considered promising for commercialization. The module can be part of an expanded set of “Instruments and devices for transosseous osteosynthesis according to G.A. Ilizarov "for the pelvis.

Claims (12)

1. A module to an external fixation apparatus for developing movements in the hip joint, comprising a guide assembly, two mechanisms for adjusting the position of the guide assembly, fastening elements to the femoral and pelvic supports of the external fixation apparatus, each made in the form of a clip, the first clip is designed to be attached to the pelvic support external fixation apparatus, the second clamp is designed for fastening to the femoral support of the external fixation apparatus, the guide assembly contains a single-plane axial hinge, two guides and a carriage, new on the rails, the single-plane axial hinge consists of two links connected by a cylindrical axis and contains a locking screw installed in the first link, two rails are mounted rigidly symmetrically on the second link of the axial hinge, the guides are equipped with arcuate grooves, and the axial line of each arcuate groove is part circle, the center of which, in the frontal plane, potentially corresponds to the center of rotation of the hip joint, the carriage is mounted with the possibility of movement along the arc different grooves, the carriage is installed in arched grooves with set screws and a clamping screw, the clamps consist of a bracket equipped with a ball joint, and a clamping bolt with nut, the bracket is made with a longitudinal groove, the first mechanism for adjusting the position of the guide assembly contains a threaded rod, a housing and a threaded rod installed in the housing, the housing of the first adjustment mechanism is rigidly connected to the first link of the axial joint, one end of the threaded rod is connected to the ball joint of the bracket of the first clamp, with the possibility of dosed longitudinal movement in the ball joint by means of nuts, the other end of the threaded rod contains an eye, with an internal thread, for threaded rod, the latter contains a turnkey head, the second mechanism for adjusting the position of the guide assembly contains a threaded rod, housing and threaded rod installed in the housing, the housing of the second position adjustment mechanism is connected to the carriage, one end of the threaded rod is connected to the ball joint of the second clamp bracket, with the possibility of dosed longitudinal movements in the ball joint by means of nuts, the other end of the threaded rod contains an eye, with an internal thread, for threaded rod, the latter contains a turnkey head. 2. The module according to claim 1, characterized in that the ball joint comprises a ball and a stopper fixed by a nut. 3. The module according to claim 1, characterized in that the single-plane axial hinge contains a visual mark of the level of location of the center of rotation of the hip joint. 4. The module according to claim 1, characterized in that the guides are marked with a scale for visual monitoring of the position of the carriage, and a limiter for the movement of the carriage in the form of a curly washer with a screw is installed. 5. The module according to claim 4, characterized in that the threaded rod comprises a clamping nut and a washer with a mustache to provide visual control of the movement of the guide assembly. 6. The module according to claim 1, characterized in that the housings of the mechanisms for adjusting the position of the guide assembly are equipped with a scale for visual position control, the housing of the first mechanism for adjusting the position is parallel to the housing of the second mechanism for adjusting the position, the housing of the first mechanism for adjusting the position is connected to the first link of the axial hinge by a rod , the housing of the second position adjustment mechanism is connected to the carriage of the guide assembly by a rod. 7. The module according to claim 1, characterized in that the guides are interconnected by screws with spacer sleeves. 8. The module according to claim 1, characterized in that the module is made of a titanium alloy, the surface of the module contains a protective anode oxide film. 9. The module according to claim 1, characterized in that the module is made of aluminum alloy. 10. The module according to claim 1, characterized in that the module is made of stainless steel. 11. The module according to claim 1, characterized in that the friction surfaces of the guide assembly have a roughness Ra in the range from 0.20 to 0.6 μm. 12. The module according to claim 1, characterized in that the links are made in the form of rectangular bars.

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