A method of treating degenerative disc disease of the lumbar spine and the device for its implementation

 

(57) Abstract:

The invention relates to medicine, namely to traumatology, orthopedics and neurology, and can be used for the treatment of patients with diseases of the vertebrae, intervertebral joints and discs of the lumbar spine. The method of treatment consists in laying the patient on the back and foot cradles with the location being treated area of the spine at the interface of the cradle, fixation of the patient to the cradle locking elements, the conducting hardware traction of the spine and simulated manipulations. The new method is to conduct additional rigid fixation of the pelvic girdle in the transverse plane, the hardware mobilization slopes the foot of the bed by the hands of the doctor, the mobilization of contact manual techniques, simulation manipulation tilt foot lodgement hands of the doctor, handling manual contact techniques, hardware mobilization tilt spinal lodgement with the simultaneous testing of the quality of treatment and detekcii. On the body of the mechanism is installed rails horizontal movement of the foot lodgement with movably mounted on them by the node of the longitudinal displacement and tilt but the s lodgement with the segment guide grooves tilt and defined in their respective radial lugs of lodgement. Stops the lodgement made in the form of guides vertical movement of the cradle relative to the stops in conjunction with mounted under the bed bars. Moreover, the radii of the guide grooves of the supports and emphasises the selected providing the location of the level of the axis of tilt of the bed over him, back to the cradle is connected to a rod mechanism for vertical movement of the cradle can be rotated in the sagittal plane, and the fixation element of the pelvic girdle additionally has a pair of rods spaced from its top to the side of the foot bed in the transverse plane. 2 s and 5 C.p. f-crystals, 2 Il.

The invention relates to medicine, namely to traumatology, orthopedics and neurology, and is intended for the treatment of patients with diseases of the vertebrae, intervertebral joints and discs of the lumbar spine physiotherapy.

Widely known methods of treatment of patients with neurological manifestations of osteochondrosis of the lumbar spine manipulation on the couch manual mobilization techniques and manipulation techniques [1 - 3].

Treatment by known methods consists in placing or planting of the patient on the couch, who by the hands of a doctor on a soft cloth and indirect effect on vertebral motor segments classical methods of manual therapy.

Similar features are known methods with the essential features of the claimed invention is the hands of the physician mechanical effects on vertebral motor segments. The disadvantages of the known methods involve giving the patient a tiring postures and positions that increase the resistance of the soft tissues, leading to the risk of traumatic vertebral appendages, soft tissue injuries, the roots of the spinal cord and vascular lesions, as well as increased pain for the patient.

In addition, known methods determine unregulated and uncontrolled stretching of the whole spine and even the entire spine and large physical burden on the physician when performing actions.

The known method of instrumental treatment of the spine, consisting in fixing it given link multicell pnevmatikatos, laying the patient on the back and foot cradles with the location of the zone stretching of the spine above the junction of the cradle, the liberation of the area stretching of the spine from fixing the drain air from the respective pneumacare and subsequent stretching [4].

Similar features are well-known method is the missing element, laying the patient on the back and foot cradles with the location of the zone stretching of the spine above the junction of the cradle and traction.

The disadvantages of this method are:

failure to ensure rigid fixation of the patient and a given level of the spine to spinal and foot cradles;

the possible error in the liberation from fixing it pathologically modified area of the spine;

elimination of the possibility to monitor the status of pathologically modified area of the spine during extension.

Fixing a given level of the spine using pneumatic multiple locking element also defines the duration and intensity of the process of preparing the patient for traction, making the treatment as a whole tiring for the patient with possible bring it in to stress, and also requires the involvement of staff.

The known method of instrumental treatment of diseases of the spine using a device selected as a prototype), which consists in laying the patient on the head (hereinafter spinal and foot cradles so that the chest, head and top of the drain of the spine, being treated, was in the joint place of the cradle.

Patient record for thorax and pelvic girdle respectively to the spinal cord and foot cradles by means of the fixing elements. Perform traction of the spine on its axis by movement of the foot bed. In a traction condition of the spine imitate it manipulation, respectively, the nature of the disease by the slopes of the spinal cord and the foot of the cradle by means of mechanical actuators [5].

Similar features are known from the essential features of the proposed method are:

laying the patient on the back and foot cradles so that the chest, head and upper limb was placed on the dorsal lodgement, pelvic girdle and lower extremity - foot bed, and the part of the spine being treated, was in the joint place of the cradle;

fixation of the patient for thorax and pelvic girdle respectively to the spinal cord and foot cradles;

holding the traction of the spine on its axis by movement of the foot lodgement;

imitation manipulation, respectively, the nature of the disease slopes the foot of the bed in traction status poson the CSOs and spinal cradle by means of mechanical drive units determines the uncontrollability of conduct simulated manipulations on the border of pain by the patient before and beyond the functional mobility patalogichesky the modified area of the spine. The implementation of the simulation manipulation when misalignment of the axis of rotation of the vertebral motor segment about the axis of inclination of the foot lodgement in the transverse plane leads to the shift of the segments relative to each other, that is not the physiological biomechanics of the spine, causing increased pain patient, aggravation and aggravation of the disease. The negative effects of such misalignment increases with the treatment of patients with increasing obesity of their physique, and also due to insufficiently rigid fixation of the patient to the lodgments in the transverse plane. The method does not conduct monitoring patalogichesky the modified area of the spine in the course of its traction, holding in a single complex gentle manual techniques of mobilization and manipulation techniques, as well as testing the quality of treatment. In General, the application of a known method using a known device [5] is limited to use for the treatment of mild forms of diseases of the spine and is not valid for complex shapes, for example, diseases of the third stage of degenerative disc disease of the lumbar spine on Zuccero with the fallen disc herniation.

Similar features are known device with the essential features of the claimed invention are the contents of the base, the dorsal and rolling of the foot cradles, the traction mechanism, the fixation of a given level of the spine, associated with an exhaust belts. However, in the known device the mobility of the foot bed only in the horizontal plane to allow hardware mobilization and manipulation techniques in the transverse plane. The implementation of the locking element in the form of multiple pneumogram does not provide rigid fixation of the patient and a given level of his spine, determines the possible error in the release it is pathologically modified area of the spine by bleed air from certain sections of pneumogram, excludes the possibility of testing a given level of the spine pale multicell pneumogram, the relationship of each section with an exhaust belts leads to low performance properties of the known device as a whole, reflected in the length and complexity of preparation of the patient for traction, making the treatment as a whole tiring for the patient with possible bring it in to stress, and also requires the involvement of staff.

A device for treatment of the spine (selected as a prototype), containing a base, a head (dorsal) and foot cradles with fixation elements, respectively, thorax and pelvic girdle patient guides located on the base, the carriage, the traction mechanism mounted on the base and coupled to the carriage mechanism of traction. The base and the carriage is provided with two racks connected to the cradle via a biaxial hinge, and two pairs of tilt mechanisms, kinematically connected with the cradle and arranged in mutually perpendicular planes passing through the axis of the hinges [5].

Similar features are known device with the essential features of the claimed invention are the contents of the base, rolling in the sagittal plane of the spinal lodgement with the fixation element of the pelvic girdle of the patient, guides movement of the foot bed along the axis of the spine, the traction mechanism connected to the foot bed, node tilt foot lodgement in the transverse plane and a host of inclination of the spinal lodgement in the sagittal plane. However, the known device with mechanical actuators tilt foot and spinal cradle causes the uncontrollability of conduct simulated manipulations on the border of pain patients before and beyond the functional mobility patalogichesky the modified area of the spine. The mobility of the foot of the bed by means of the hinge, which is located under the bed, determines the misalignment along the vertical axis of rotation of the vertebral motor segment with the axis of tilt of the foot lodgement in the transverse plane during simulation manipulation leads to the shift of the segments relative to each other, inappropriate physiological biomechanics of the spine, causing a strengthening of pain by the patient, the possible exacerbation and aggravation of the disease. The negative effects of such misalignment increases with the treatment of patients with increasing obesity of their physique, and also in connection with nedostatocnosti exceptionally mild forms of disease of the spine holding imitation manipulation within the functional mobility of the pathologically changed the plot and unacceptable treatment of complex forms, for example, the third stage of degenerative disc disease of the lumbar spine on Zuccero with the fallen disc herniation.

The purpose of the invention is improving the treatment of degenerative disc disease of the lumbar spine, including the treatment of the third stage of osteoarthritis on Zecheru skipped herniated disc, due to the localization of mechanical impacts on patalogichesky modified part of the spine, their controllability and desirement in complex combination of hardware, hardware-manual and manual contact techniques of mobilization and manipulation techniques.

This objective is achieved in that in the method of treating degenerative disc disease of the lumbar spine, which consists in laying the patient on a movable spinal and foot cradles with the location being treated area of the spine at the interface of the cradle, commit the patient to the lodgments for thorax and pelvic girdle, the traction of the spine and conducting simulation manipulation, according to the invention the rib cage and the pelvic girdle is fixed on the healthy levels of upper and lower motor segments adjacent to patalogichesky amended plot. Additionally rigidly fixed pelvic girdle to the foot bed of the gas zone to the side of the bed. Raise or lower the cradle to bring the axis of the vertebral motor segment patalogichesky modified area to the tilt axis of the foot lodgement in the transverse plane. On patalogichesky modified section sequentially carried out:

hardware traction, which control its status by palpation, x-rays or other methods;

hardware mobilization pruinosae slopes the foot of the bed in the transverse plane by the hands of the doctor within the pathological mobility to pain by the patient;

mobilization contact pruinosae movements of the hands of the doctor up in the sagittal plane with the impact of the spinous processes blocked vertebrae up to the pain of the patient;

hardware simulation manipulation by pushing the foot slopes of lodgement in the transverse plane by a physician hands over the threshold of pain by the patient;

manipulation inching movements of the hands of the doctor up in the sagittal plane with the impact of the spinous processes blocked vertebrae beyond the threshold of pain by the patient;

hardware mobilization tilt spinal lodgement in the sagittal plane to pain Octo device for the treatment of degenerative disc disease of the lumbar spine contains established on the basis of the mechanism of vertical movement of the cradle, on the housing are rigidly mounted guides movement of the foot lodgement with movably mounted on their site longitudinal displacement and tilt of the foot lodgement in the transverse plane, made in the form movably mounted on the guide foot lodgement of the bar, comprising a pair of stationary interconnected sleeves end supports of lodgement with the segment guides tilt lodgement with installed corresponding segment stops of lodgement with the axis of rotation located above the bed. Segmental lugs associated with foot lodgement via embedded in them guides vertical movement of the cradle relative to the lugs and the respective pins located under the bed. And spinal cord to the cradle is connected to a rod mechanism for vertical movement of the cradle with the possibility of rotation in the sagittal plane about the axis as close as possible to the place of junction of the cradle. Fixing the pelvic girdle element further comprises a pair of rods spaced apart in the transverse plane (functional mode), from the top element to the side of the foot bed. At the foot of the bed in mestecko spine for manual contact techniques of mobilization and manipulation techniques.

Almost the inventive method is carried out as follows.

The patient is placed on the spinal cord and foot cradles so that pathologically modified part of the spine located at the interface of the cradle, fix the rib cage and the pelvic girdle of a patient to the lodgments corresponding locking elements on the levels of the healthy upper and lower motor segments adjacent to the pathologically altered the plot, optionally rigidly fixed pelvic girdle to the foot of the bed in the transverse plane by a pair of belt rods, spaced to the sides of the cradle, determine the distance from the edge of the soft tissues to the axis of the vertebral motor segment on the x-ray image. Raise or lower the cradle to bring the axis of the vertebral motor segment to the axis of tilt of the foot lodgement in the transverse plane, a longitudinal record of patient exhaust straps lashing from the fixation of the thorax and pelvic girdle to the peripheral ends of the respective containers. Maintain the patient within 5-10 min to calm in terms of fixation, conduct hardware traction load up to 50 kg of the pathologically changed teaching is a function or an x-ray device, other methods, as well as the patient's feelings and keep it for 10-15 minutes to calm in terms of traction. Further pathologically modified section of the spine are consistently pursuing:

mobilization pruinosae slopes the foot of the bed by a physician hands in either side of the sagittal plane 10-15 times within functional mobility plot to pain by the patient;

mobilization impact on the spinous processes blocked vertebrae pruinosae movements phalanges of the thumbs of the hands of the doctor in the sagittal plane with a constant gain exposure to pain patient 10-15 times;

hardware simulation manipulations pushing the foot slopes of lodgement by a physician hands in either side of the sagittal plane by 3-5 times over the threshold of pain by the patient;

manipulation with effects on the spinous processes blocked vertebrae thrusting movements flanks thumbs physician in the sagittal plane over the threshold of pain the patient is 3-5 times;

disposable hardware mobilization tilt spinal lodgement in the sagittal plane down to 10-15oto pain the patient with simultaneous TEC is -20 minutes Free the patient from the locking elements and kept in containers for up to 1 h for calm after effects.

In Fig. 1 shows a device for implementing the method of treating degenerative disc disease of the lumbar spine; Fig. 2 - constructive execution of the foot cradle and its segmental bearing, left side.

The device for implementing the method of treating degenerative disc disease of the lumbar spine comprises a base 1 with the installed engine 2 vertical movement of the foot cradle and the spinal lodgement 4 mounted on the shaft 5 of the engine 2. The device contains a node of longitudinal displacement and tilt the foot of the bed, consisting of a pair of guides 6 fixedly mounted on the housing of the mechanism 2 through a bracket (not shown), a pair of segmental bearings with the guide grooves 8 and installed rollers 9, interconnected by means of sliding along the guide rails 6 a pair of bushings 10, a pair of segmental lugs 11 foot bed is installed in the corresponding guide grooves 8 segment poles 7, fixed with locking screws 12 for guiding vertical movement of the foot logements screw 16 and the drive handle 17 mechanism of longitudinal movement of the foot bed. The device also includes a tilt mechanism of the spinal lodgement in the sagittal plane, consisting of a chassis drawbar screw 18, the slide bar 19 connected with the rod 5 mechanism for vertical movement of the cradle by means of the rod 20 and the drive handle 21 of the chassis drawbar screw 18, a pair of cantilever support beams 22 foot lodgement with the support straps 23, adjustably mounted on the rod 5 by means of hinge and bracket.

Spinal and foot cradles contain the locking rib cage and pelvic girdle elements 24 and 25 with an optional locking pelvic belt in the transverse plane by a pair of belt drive rod 26, the end brackets 27 longitudinal fixation of the patient for holding the traction exhaust straps (not shown). Foot cradle comprises a pair of side brackets 28 additional fixation of the pelvic girdle in the transverse plane of the belt rods 26 has two pairs of lateral grooves 29, excluding the stop side of the lodgement of the segmental bearing 7 when it bends, edge cutout 30 for manual contact techniques of mobilization and manipulation techniques. The device also includes a vertical measuring line 31 with the elevation axis of rotation lugs 11 to bring the axis of pozvonok Device for the treatment of degenerative disc disease of the lumbar spine works as follows.

The cradle 3 and 4 lead to a horizontal position and facing each other, the edges close together by moving the node displacement and tilt the foot of the bed 3 with chassis drawbar screw 16 by rotating the handle 17. Then put the patient on the cradle 3 and 4 so that the chest, head and upper limb was placed on the spinal lodgement 4, pelvic girdle and lower extremity - foot bed 3, and pathologically modified part of the spine was at the interface of the cradle 3 and 4. Patient record for thorax and pelvic girdle respectively to the spinal cord and foot cradles 4 and 3 with the help of fixation elements 24 and 25 on the healthy levels of upper and lower motor segments adjacent to the pathologically altered the plot and additionally rigidly fixed pelvic girdle to the foot of the bed 3 by a pair of belt rods 26 of the bracket 28. A longitudinal record of patient exhaust belts connecting the spinal cord and foot cradles, with the appropriate brackets 27. Release the locking foot lodgement screws 14 and by moving the rod 5 of an appropriate mechanism to raise or lower the patient, thereby causing the axis of the vertebral motor segment to the axis of the axis of rotation of the segmental lugs 11 and taking into account the distance from the edge of the soft tissues to the axis of the vertebral motor segment, fixed pins 15 lodgement 3 screws 14. Then spend traction pathologically modified area of the spine with rotation of the handle 17 of the chassis drawbar screw 16. Then take away the cantilever support beams 22 from the support straps 23 turn to the spinal cord to the cradle 4, release the set screws 12, the locking pins 15 3 lodgement and conduct hardware mobilization of pathologically modified area of the spine bends of the cradle 3 in the transverse plane using segmental lugs 11 lodgement installed in the guide grooves 8 segment poles 7 with the rollers 9 of the node of the longitudinal displacement and tilt of lodgement. Foot lodgement 3 lead to a horizontal position and hold it in place with locking screws 12, which again is released after a manual contact methods mobilization techniques through the end of the neck 30, and conduct a simulated manipulation of the tilt bed 3 by means similar to the means of holding the hardware mobilization. Then foot lodgement 3 lead to a horizontal position and hold it in place with locking screws 12 and perform mobilization of pathologically modified area of the spine spinal tilt bed 4 in the sagittal plane down simultaneity is after the return of spinal cradle 4 to the original horizontal position are destruktiw pathologically modified area of the spine with rotation of the handle 21 of the chassis drawbar screw 18 and frees the patient from the exhaust of the traction belts, the fixation of the chest 24 and pelvic belt 25.

Example 1. Patient A. in Derbent, 34). From the anamnesis it is known that ill 1 year ago with the appearance of acute pain in the lumbar spine, radiating to the left leg hamstring. Treated stationary traditional methods of manual therapy with the results of minor improvements, after discharge, the disease worsened, the patient was hospitalized, in Makhachkala with manifestations of a complete loss to spine S1to the left and was discharged without improvement. When examined objectively revealed a forced position of the torso tilted forward up to 45oexpressed lumbar kyphosis, the complete absence of active movements in the lumbar spine in all directions. In the study of passive movements defined block in the lumbar segments of the L4-L5, L5-S1. Positive symptom voltage piriformis muscle on the left, involvement in the inflammatory process ligaments of the sacrum. In the neurological status is pronounced manifestation of the tension ninepatch roots of the spinal cord, reducing the Achilles reflex on the left, gipostesia innervation of the spine S-L5, L5-S1left sclerosis reflex records. Conclusion: compression neuropathy of the spine S1on the left, expressed painful symptoms, herniated disc.

Were treated by the claimed method in the inventive device, in the amount of 10 sessions with a one-day break between sessions. The result is restored in full motion in the lumbar spine. Movement became painless. In neurological status no pathological abnormalities. He was discharged 23.02.94, With re-examination of the patient 15.05.94, the treatment results were fully confirmed. Exacerbations from the time of discharge the patient was not.

Example 2. Patient S. (Moscow, 47 years). From the anamnesis it is known, that he fell sick 6 years ago with the appearance of acute pain in the lumbar spine, radiating to the left leg on the back of the thigh to the heel and on the back surface of the tibia, with the onset of cramps in the calf muscles of the leg. Was treated permanently in Moscow. In the pain decreased, but after 1 year deteriorated again. There were feelings of numbness and weakness in the foot, which further intensified and spread to the lower third of the tibia. There was a feeling of burning on the rear of the article results. Further there was a burning sensation and pain at the rear of the right leg with a feeling of weakness. Was admitted to the hospital 20.06.94, Objectively identified a forced position of the torso tilted forward up to 15oleft and pronounced lumbar kyphosis, limitation of active movements sideways to the left and to the right by 50%. Forward tilt is possible by 50%, the slope of the back completely impossible. In the study of passive movements in the lumbar spine is defined blocking segments L4-L5and L5-S1. Revealed a pronounced voltage of the paravertebral muscles in the lumbar spine, the voltage of the square of the back muscles, positive symptom voltage piriformis muscle on the left, pain in progeniture" all sacral ligaments on both sides. In the neurological status of the symptoms of tension digipeating roots poorly expressed, ankle reflex lowered sharply to the left, expressed gipostesia intervali root S1on the left side. When the radiograph lumbar expressed in the phenomenon of citizenbane, reducing the height of the disk L5-S1, sclerosis of the switching plates L4-L5, L3-L4. Conclusion: compression neuropathy of the spine S1on the left, moderate pain etc is oiste. The sessions were conducted one-day intervals. By the 10th day after the fifth session the patient has completely disappeared all painful symptoms in the legs. By the 12th day after the sixth session was the opportunity of active movements in paralyzed leg. He was discharged 02.07.94,

Example 3. Patient K. (43 years, Cheboksary, work). Was admitted to the hospital 10.10.94, fell Ill two years ago, when he began to experience pain in the right thigh and lower leg constantly. Was cured permanently. The pain diminished. On the 10th day of treatment after a sharp movement appeared sharp pain in lower back radiating down on shinebourne surface of the right femur, the tibia, the inner surface of the foot. The pain never stopped and the night was sharply increased when attempting movements. After treatment in hospital, Cheboksary pain diminished, remaining in the form of the constant, aching in the lower back and pulling on the rear surface of the right leg. Periodically, 5-6 times a day there was a pulse, sharp, fleeting pain, reaching from the waist on the back of the legs to the feet. The disturbance of sensation in the lumbar-sacral area is unclear, clearly expressed by the human sensitivity right buttocks inner surface of the right hip, the right half of the DRA, the posterior surface of the tibia and the outer surface of the foot to the little finger. Weakness in the foot, the inability to stand on their toes, long walk, no more than 150-200 m without rest lying, constantly worried about bloating, delayed stool and urination, periodically changing incontinence and fecal short-term. Re-treatment, in Moscow and Cheboksary - no effect.

Objectively at the time of admission to the clinic: long in one position lying cannot be a symptom of Lasaga right - positive, symptoms Neri, Dejerine, Sukkar, Turin, Matskevich, Wasserman - positive. In neurological status - restricted active movements in the fingers of the right foot at the ankle joint. The absence of the Achilles reflex on the right, lowering the knee reflex on the right. The complete lack of sensitivity in the area of innervation of the roots of S1-S2. Vertebral syndrome - torso slightly tilted forward and to the left, as a result, scoliosis of the thoracolumbar. Can't stand on their toes. Bending backward, forward, left and right is almost impossible. Passive motion unit within L4-S1. The voltage of the paravertebral muscles, the back muscles of the right hip.

On the radiograph - pany reflex records.

Computer tomography - protrude into the lumen of the channel intervertebral disc L5-S1.

Diagnosis: Compression radiculomyelopathy S1-S2right, herniated disc L5-S1.

Were treated by the claimed method on the claimed device (5 sessions).

At discharge: withstands prolonged static loads, the symptom of Lasaga right negative, active movement in the toes and the ankle joint on the right possible in full. Ankle reflex on the right is slightly reduced, the knee on the right without pathological changes. Restored the sensitivity in the area of innervation of the roots of S1-S2feels superficial touch and pressure on all areas innervated by these roots. Standing on tip-toes. The active flexion in all directions possible, load walking distances of 500 m without stopping did not cause any painful or unpleasant sensations, and fatigue. Fully recovered functions of pelvic organs. Discharged 20.10.94,

1. A method of treating degenerative disc disease of the lumbar spine, including laying the patient on a movable spinal and foot cradles with M for thorax and pelvic Poas locking elements, hardware traction, hardware simulation manipulation and destruktiw spine, characterized in that the fixation is performed on the healthy levels, respectively, the upper and lower vertebral motor segments adjacent to the pathologically altered the plot, additionally fix the pelvic girdle to the foot of the bed by a pair of rods spaced apart from the upper part of the element fixation of the pelvic girdle to the sidewalls of lodgement in the transverse plane, bring the axis of the vertebral motor segment to the axis of tilt of the foot bed, after traction has consistently performed hardware mobilization hands of the doctor pruinosae slopes the foot of the bed at the side of the sagittal plane within functional mobility plot 10 - 15 times and mobilization manual contact effects spinous processes blocked vertebrae pruinosae movements phalanges of the thumbs up with a gradual increase in the pain patient 10 to 15 times, and after a hardware simulation manipulation - manipulation manual contact effects spinous processes blocked vertebrae thrusting movements of the phalanges of the thumbs up over the threshold of pain planom spinal lodgement in the sagittal plane down to 10 - 15oto pain by the patient, and the traction is conducted for 15 to 17 minutes with a load up to 50 kg, the hardware simulation manipulations are performed by a physician hands pushing the foot slopes of lodgement in the side of the sagittal plane over the threshold of pain by the patient 3 to 5 times, and destruktiw within 15 - 20 minutes

2. Device for the treatment of degenerative disc disease of the lumbar spine, containing a base, abutting movable in the sagittal plane of the spinal cord and movable in a horizontal and transverse planes of the foot cradles with locking chest and pelvic girdle patient elements, guide horizontal movement of the foot bed, the mechanism wydarzenie and mechanisms tilting of the cradle, wherein the device contains a set on the basis of the mechanism of vertical movement of the cradle on the housing are rigidly mounted rails horizontal movement of the foot lodgement with movably mounted on them by the node horizontal displacement and tilt of lodgement in the transverse plane, made in the form of the bar, includes interconnected pillars of lodgement with the segment guide grooves Naklo the form of further movement of the cradle relative to the stops in conjunction with mounted under the lodgement rods, moreover, the radii of the guide grooves segment supports and segment selected stops providing the location of the level of the axis of tilt of the bed over him, back to the cradle is connected to the rod mechanism for vertical movement of the cradle can be rotated in the sagittal plane, and the fixation element of the pelvic girdle further comprises a pair of rods spaced from its top to the side of the foot bed in the transverse plane.

3. The device according to p. 2, characterized in that it contains a measuring range with the index level of the axis of rotation of the segment stops.

4. The device according to PP. 1 to 3, characterized in that it contains a pair of cantilever support beams of the foot bed is mounted on the rod mechanism for vertical movement of lodgement with the possibility of turning 180oin the horizontal plane containing the ends of the support bars of lodgement.

5. The device according to PP. 1 to 4, characterized in that the containers contain mechanical clamps fixing the patient's exhaust straps and foot bed - side bracket additional fixation of the patient's belt rods in the transverse plane.

6. The device according to PP. 1 to 5, characterized in that the foot bed in the methods in the guide grooves segment supports mounted rollers.

 

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SUBSTANCE: one should isolate and dissect the tendons of anterior tibial and long fibular muscles to dissect the tendon of posterior tibial muscle against the site of fixation and direct it towards plantar rear area in front of internal ankle through the tunnel in subcutaneous fiber, then one should subcutaneously direct dissected tendons of anterior tibial and long fibular muscles onto plantar rear area to suture them so to leave free the tendinous end of posterior tibial muscle which should be intraosseously fixed to median wedge bone that keeps the process of foot repulsion during walking.

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5 dwg, 1 ex

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