Robot arm apparatus

FIELD: medicine.

SUBSTANCE: group of inventions refers to medicine. A device for treating bone fractures comprises a number of levers, a number of joint elements, a mechanical device, a controller and a frame. Each of the levers extends from a proximal end to a distal end and is movable in the three-dimensional space. The proximal end of each lever is connected to the frame. Each of the joint elements is connected to the distal end of the respective lever, wherein the joint element encloses and blocks a bone fixation element attached to the respective bone fragment so that each of the levers is connected to the respective bone fragment. The mechanical device makes the lever move for advance each of the levers in relation to the frame. The controller obtains data respective to a desired final position of the bone fragments in relation to each other and controls the mechanical device to advance the levers in relation to each other for achieving the desired final position of the bone fragments in relation to each other. The frame comprises a long element with a number of levers attached thereto. The long element is configured rotatable to rotate a number of levers in relation to the frame. A method of treating the bone fractures involves: attaching a first bone fragment to a first bone fixation element and a second bone element to a second bone fixation element; connecting a distal end of the first lever with the first bone fixation element and a distal end of the second lever with the second bone fixation element; each of the first and second levers extends between the distal end and proximal end connected to the frame; the frame comprises a long element with a number of levers attached thereto; the long element is configured rotatable to rotate the first and second levers in relation to the frame; obtaining the data corresponding to the desired final position of the first and second bone fragments in relation to each other; and controlling the mechanical device to advance the first and second levers in relation to each other to achieve the desired final position of the bone fragments.

EFFECT: inventions enables calculating and controlling the force, direction and rate of the process.

23 cl, 13 dwg

 

The technical field

The present invention relates to a device for treating fractures and, in particular, relates to a device for the reposition and/or retention of fragments of bone.

The level of technology

The fractures can be difficult to treat due to the displacement of bone fragments. Bone is associated with the muscles, tendons and ligaments, which often shift and have the bone at an angle, causing a shift from fragments of bone. Thus, the position of the bone fragments must be restored to achieve reposition. Recovery may require extension and correction of shifts and angular displacements by effort. For example, the surgeon or other medical professional can physically pull the foot or leg of the patient to set a bone. After reaching a must reposition the bone fragments should be kept in position until such time as will not be applied fixation means to prevent secondary displacement. However, it may be difficult to obtain and maintain the necessary force and direction of its application, which are required for correction of the bone. Existing methods do not allow to calculate or control the force, direction and speed of the process.

The invention

The present invention relates to a device for treatment arrangement is s bones, which contains a lot of controls, each of which departs from the proximal end to the distal end and capable of moving in three-dimensional space, and the proximal end of each arm connected to the frame; many elements of the joint, and each joint is connected to the distal end of the corresponding lever, where the element coupling capacity with the ability to lock the bone fixation element attached to the corresponding chip of bone in such a way that each of the levers is connected with the corresponding chip of bone; a mechanical device causing movement of the levers to move each of the arms relative to the frame; a controller receiving the data, corresponding to the desired final position of the bone fragments relative to each other, and managing mechanical device for movement of the levers relative to each other to achieve the desired final position of the bone fragments relative to each other; and a frame comprising a longitudinal member to which is attached a lot of controls, wherein the longitudinal element is made to rotate in order to rotate many of the levers relative to the frame. Each of the levers includes a first shoulder and a second shoulder, interconnected with the possibility of rotation that is rotatable around a first axis, moreover, the proximal end of each of the levers is connected for rotation with the specified frame so that each of the levers can rotate around the second axis.

Preferably the levers are movable along the longitudinal element along the third axis.

The device according to the invention may contain the first area of the carpal joint between the distal end of the first lever and the first element of the joint, and the first area of the carpal joint allows the first articulation element to rotate relative to the distal end of the second arm of the first lever. The first section of the wrist joint includes a first plate attached to the proximal end of the first articulation element and the first pin passing through the first arm, and the first pin is attached rotatably to the first plate to allow the first articulation element and the first plate to rotate around it.

A mechanical device preferably includes a set of first hydraulic cylinders, each of the first hydraulic cylinder attached to the proximal surface of the first plate in order to rotate the first plate around the first pin, where the first hydraulic cylinders are located essentially at an equal distance of each other along the perimeter of the first plate. Each of the first hydraulic cylinder is connected to the first lever through a first tension element, which, upon retraction of the first hydraulic cylinder moves the first lever in the desired position.

Each of the levers may contain the encoder that delivers to the controller information, which is consistent with the position of the respective bone fragment.

Preferably at least one of the elements of the joints made with the possibility of connection with the bearing structure adapted to support the plot of the end portion of the bone.

Also we propose a method for the treatment of bone fractures, including:

fixing a first bone fragment to the first bone fixation element and the second bone fragment to a second bone fixation element;

the connection of the distal end of the first arm with the first bone fixation element and the distal end of the second arm with the second bone fixation element, each of the first and second levers is held between the distal end and a proximal end connected to the frame, while the frame includes a longitudinal element that is attached to many of the levers, wherein the longitudinal element is made to rotate in order to rotate the first and second arms relative to the frame;

receiving data corresponding to the desired final position of the first and second bone fragments relative to each other; and

control of mechanical device to move the first and second arms relative to each other to achieve the desired final position of the bone fragments.

Preferably the method includes moving the first and second levers in a longitudinal direction along the frame and defining a position of each of the bone fragments on the basis of data received from the encoding device attached to each of the first and second levers.

The method may also include the visualization of the bone fragments by using the display device to determine the desired spatial disposition of the bone fragments.

In the method according to the invention, the data corresponding to the desired final position of the first and second bone fragments relative to each other, are entered by the user in the controller that controls the first and second levers to obtain the desired spatial location.

Preferably, the data corresponding to the desired final position of the first and second bone fragments relative to each other, are entered by the user by manipulation of control knobs, directing the movement of the first and second bone fragments relative to each other as they move controller, which controls the PE is the first and the second levers, moving the first and second bone fragments, as specified by the user, to obtain the desired spatial location.

The method may include the location of the end portion of the first and second bone fragments through the supporting structure, which supports the plot of the end portion, and the supporting structure are designed to move with the third lever, which is attached to the supporting structure.

Preferably the first and second arms include first and second wrist joint, respectively, and first and second elements of articulation, respectively, adapted to be coupled with the ability to lock with the corresponding first or second bone fixation element, and the first area of the carpal joint is attached to the distal end of the first lever, connecting with the possibility of rotation of the first element of articulation with the distal end of the first lever and the second section of the wrist hinge is attached to the distal end of the second lever, connecting with the possibility of rotation of the second element of the articulation with the distal end of the second lever.

The first arm may include a first plate attached rotatably to the proximal end of the first element of the joint with the purpose of rotating around a first pin passing through the first arm, and the second lever includes a second plate attached rotatably to the proximal end of the second element of the joint with the purpose of rotating around a second pin passing through the second arm.

In addition, a mechanical device may include a set of first hydraulic cylinders, each of the first hydraulic cylinder attached to the proximal surface of the first plate in order to rotate the first plate around the first pin, and a multitude of second hydraulic cylinders, each of the second hydraulic cylinder attached to the proximal surface of the second plate to rotate the second plate around the second pin.

Brief description of drawings

In Fig. 1 presents a schematic view of a system in accordance with an exemplary embodiment of the present invention;

Fig. 2 illustrates a perspective view of a robotic device of the system shown in Fig. 1;

Fig. 3 illustrates a perspective view of the plot carpal joint robotic device shown in Fig. 1, in a first configuration;

Fig. 4 illustrates a perspective view of site-carpal joint, shown in Fig. 3, in the second configuration;

in Fig. 5 presents an enlarged perspective view of the distal con the and site-carpal joint, presented on Fig. 3;

in Fig. 6 presents a cylindrical host site-carpal joint, shown in Fig. 3;

Fig. 7 illustrates a schematic representation of the hydraulic unit of the system shown in Fig. 1;

Fig. 8 illustrates a schematic representation of an alternative implementation of the hydraulic unit shown in Fig. 7;

Fig. 9 illustrates a perspective view of a robotic device shown in Fig. 2, in which the connecting elements are connected with bone fragments;

in Fig. 10 presents a perspective view of a robotic device shown in Fig. 2, is connected to a connecting element inserted into the site of a bone subjected to fracture;

Fig. 11 illustrates a perspective view of a robotic device shown in Fig. 2, moving the bone fragments to reposition;

Fig. 12 illustrates a perspective view of a robotic device shown in Fig. 2, performed the reposition of bone fragments; and

Fig. 13 illustrates a perspective view of a robotic device shown in Fig. 2, a support fixed in the bone fragments for the commit.

Detailed description

The present invention can be seen in the future with the following description and accompanying Ortega, in which similar elements are designated by the same number of items. The present invention relates to a device for treating fractures and, in particular, relates to a device for the reposition and/or retention of fragments of bone. Exemplary embodiments of the present invention offers a device containing robotic arms that can be attached to a bone subjected to fracture, to move the bones on all axes to perform a reposition of bone fragments for the commit.

As is shown in Fig.1-13, the system 100, in accordance with one exemplary embodiment of the present invention, includes robotic device 102 to move the bone fragments 120 in the desired spatial disposition with respect to each other. As illustrated Fig.1, the robotic device 102 has the opportunity to join the source 104 power, managed through an interface 106 of the user. Robotic device 102 also may include a control unit 110, which processes the input signal from the interface 106 of the user in order to control the movement of the multitude of levers 108 through, for example, hydraulic effort provided a liquid opression-injection apparatus, such as hydraulic the lock 112. Alternatively, the levers 108 can move using one or more motors (not shown) connected with them via any known mechanism, gearing, as will be obvious to experts in this field. Each of the levers 108 may be connected to a given area of bone 120 subjected to fracture, so that the movement of lever 108 has been reposition of bone fragments, in accordance with necessity. Each of the levers 108 may be equipped with an encoder 116, is able to accurately determine the position of the lever 108 so that the position of the bone fragments 120 can carefully tracking and positioning, in accordance with need.

Source 104 power supply can be any power source, in the operating room. For example, the source 104 power supply can be any power source, including battery power. The source 104, the power may be used to power the hydraulic unit 112 for the promotion of hydraulic fluid through the robotic device 102. Specialist in the art it is obvious that hydraulic fluid medium may be any suitable non-compressible fluid, such as, for example, mineral oil or saline. In another embodiment, the system 100 can use gemeau the fluid for liquid or pneumatic system 100. How to move the levers 108 can be entered through an interface 106 of the user and processed by the control unit 110 to control the hydraulic unit 112 in a manner that is required to achieve the desired movement specified by the user, as is obvious to a person skilled in the art. The interface 106 may be a simple device in the form of switch and/or the control knob to actuate the robotic device 102 and guide the movement of the levers 108. In the preferred embodiment, however, the interface 106 may be a personal computer or other processing device, which can be used to input directions of motion for each of the levers 108 and may also allow the user to set the speed of one or more levers. For example, a user may be able to set the vertex point for the bone parts 120 and target point to which you want to move parts of the bone 120.

In accordance with a further embodiment, the system 100 may also include device 114 of the display for the visualization of various fragments of bone 120 so that the bone fragments were depicted on the screen of the display device. System 100 mo the em can be configured to determine the position of each bone fragment relative to each other, so the user can enter the final desired spatial location through an interface 106 of the user. The position of each bone fragment 120 may be defined by a coding device 116 of the lever 108, which is connected to the bone fragments by means of fasteners 122.

As is shown in Fig. 2, the robotic device 102 may be installed on the operating table 118 so that the levers 108 can be attached to the connecting parts 122, is inserted into the bone fragments 120. Alternatively, the robotic device 102 can be installed on a separate table that is moved along the operating table 118. The levers 108 can be installed on the side of the table 118 using longitudinal element 109 so that each of the levers 108 had the opportunity to slide along the longitudinal element 109 to move along the length of the table 118. The longitudinal element 109 may also be configured to move relative to the table 118 via, for example, rotation. Although in the drawings, the robotic device 102 is presented as having two lever 108, specialists in the art it is obvious that the robotic device 102 may contain any number of levers 108.

The levers 108 are adapted to move in three-dimensional space in the pole to the directions and under six angles for to enable positioning of the levers 108, as necessary, relative to each other. To move in six directions, each of the levers 108 includes a first shoulder 140 and the second arm 142 connected with the possibility of rotation. The first shoulder 140 passes between the first end 144 and second end 146, and a second shoulder 142 passes between the first end 148 and a second end 150. The second end 146 of the first shoulder 140 is connected for rotation with the first end 148 of the second arm 142 by, for example, a hinge (not shown), so that the first shoulder 140 and the second arm 142 are able to rotate relative to each other on the hinge. Specialists in the art will recognize that the connection with rotation of the first shoulder 140 and the second arm 142 of the lever 108 may act similarly to the elbow joint of the person. In addition, the second end 150 of the second arm 142 of each of the levers 108 can connect slidable longitudinal element 109 so that the second arm 142 will also be able to rotate about the longitudinal element 109, allowing the levers 108 to move relative to the table 118. Thus, specialists in the art it is obvious that the levers 108, together with the longitudinal element 109, enable the levers 108 to move in three-dimensional space, with the aim korrektirovki the six types of bias (for example, front rear, medial (center) lateral (away from center) and decrease - extension).

The first shoulder 140 of the lever 108 further may contain plot 152 wrist hinge, which is similar to the wrist of a person, it will be obvious to specialists in this field. As is shown in Fig. 3-4, section 152 of the wrist hinge includes a plate 154 which supports and determines the position of the rod 189, which may be hook-coupled device 136 (shown in Fig. 9-13) for attaching fasteners 122. Gripper 136 may be, for example, tapered sleeve, a jaw Chuck or vise adapted to securely hold the connecting part 122. To the plate 154 is also fixed many cylinders 164, which control the movement of the plate 154 and a gripping device 136 to ensure the desired angle of the gripping device 136. The cylinders 164 can be attached to the plate 154 by, for example, beam fiber, wire or pin with the articulator. Plate 154 includes a distal surface 156 and the proximal surface 158 and the rod 189 is connected with the distal surface 156, while the cylinders 164 are attached to the proximal surface 158. The pin 160, which provides axial support for the rod 189, when is outinen to the plate 154. As is shown in Fig. 5, the pin 160 may be connected to the plate 154 by means of hinge bolts 162, absorbed through the proximal surface 158 in the appropriate space of the plate 154. Swivel connection allows the plate 154 to bend at an angle and rotate around the hinge bolt 162, allowing the rod 189 and thereby the gripping device 136 to move at an angle. In a preferred embodiment, a hinge bolt 162 has a spherical shape, so that the plate 154 can be tilted in any desired direction. The cylinders 164 provide hydraulic forces to position the angle of the plate 154 around the hinge bolt 162, allowing the angular movement capture device 136 to adjust the angular deformation in three dimensions (e.g., medial-lateral angular offset, anterior-posterior angular deflection, the inner and outer radial angular offset).

Plate 154 may also contain region 166 of attachment of the tension elements to attach to the fiber tensioning element 168 of each of the cylinders 164. Region 166 of attachment of the tension elements can be located on the proximal surface 156 on the perimeter of the plate 154. Liquid movement through each of the cylinders 164, provide the hydraulic unit 112, enters the force n is each of the tension elements 168, attached to the plate 154, so that the force of the tension elements 168 moves the plate 154 around the hinge bolt 160 and, therefore, the attached rod 189, at different angular locations. In a preferred embodiment, the section 152 of the wrist joint may include four cylinder 164 and four corresponding region 166 of attachment of the tension elements. However, specialists in the art will recognize that any number of cylinders 164 may be included, provided that the number of cylinders 164 is sufficient to ensure full offset angle plate 154 and rod 189 throughout the desired range of motion. As is shown in Fig.6, the tension element 168 may extend from the cylinder 164 beyond the distal end 170 of the cylinder 164. The cylinder may contain a piston 172, impermeable for the fluid medium through the valve 174. The piston 172 may be connected with a thrust 176, through which the tension element 166. Thus, the hydraulic force provided by the hydraulic unit 112 through the cylinder 164 is applied to the tension element 168 passing through it, to result in movement of the plate 154. Although the cylinders 164 are described as attached to the plate 154 by means of fiber tension elements 168, experts in this field consider that the cylinders 164 which may be attached to the plate 154 using a variety of fastening elements, such as, for example, wire or pin with the articulator.

In an alternative embodiment, movement of the plate 154 may be provided through the mechanism of the rectilinear movement of the containing device, gearing, belts or device lead screw. The rectilinear motion mechanism can also be attached to the plate 154 by means of, for example, fibers, wire or pin with the articulator.

As is shown in Fig. 7, the hydraulic unit 112 can apply a hydraulic force through the cylinders 164 on the tension elements 168 to position the plate 154 at an angle by the motor 178 and the pump 180, which expels the fluid from the reservoir 182. The hydraulic unit 112 further includes a valve 184 of the pressure relief valve 186 switch and bypass valve 188. The pump 180 expels the fluid from the reservoir 182, which flows to the valve 184 reset pressure when it leaves the pump 180. Then fluid under pressure is directed either back to the tank 182, or to the valve 186 switch. Fluid under pressure may be directed back to the reservoir 182, for example, upon reaching a predetermined maximum pressure of the system. The valve 186 switch may have three positions. In the first position fluid is forbidden to pass through the valve 186 is pereklucheniya. In the second position, fluid under pressure passes through the valve 186 switch in the first cylinder a, while it is assumed that the fluid from the second cylinder 164b, which at normal pressure, is returned to the reservoir 182. In the third position, fluid under pressure may flow through the valve 186 switching to the second cylinder 164b, while fluid found at normal pressure from the first cylinder a can return to the reservoir 182.

The hydraulic unit 112 may also be positioned so that the robotic device 102 can operate in a neutral or favorable mode, in which the cylinders 164 are moved manually. In a sparing mode valve 186 switching means in the first position, in which fluid does not pass through it, and the bypass valve 188 is set so that through him the liquid flows freely. Then the cylinders 164 and the levers can be moved manually to the desired position and/or orientation, and then block in the desired position. Specialists in the art it is obvious that, although illustrated and described, the hydraulic unit 112 has two cylinder a and 164b, the hydraulic unit 112 may be adapted so that you can use any number of cylinders 164 to d is to achieve plate 154.

In an alternative embodiment, the hydraulic unit 112' may apply hydraulic forces on the first a' and the second 164b' cylinders to ensure the angle of the plate 154 and levers 108, as described above with respect to system 100. The hydraulic unit 112' may include a motor 178', operate the mechanism 180' linear displacement for simultaneous movement of the first a' and 182b of the second' main cylinders, respectively. Depending on the desired movement, one of the first a' and 182b of the second' main cylinder pumps the fluid under pressure in one of the first a' and the second 164b' cylinders, respectively. Similarly, the hydraulic unit 112, the hydraulic unit 112' may be configured in a sparing mode so that the cylinders 164 and thereby the levers 108 could be moved by hand, in accordance with necessity. When working in a sparing mode, the bypass valve 188' is set so that through him, the fluid flows freely.

As is shown in Fig. 9, an exemplary method of using the system 100 includes the introduction of one or more connecting pieces 122 in each of the many fragments of bones of 120 subject reposition relative to each other. Each of the connecting parts 122 may be a bone of fixation the e device such as, for example, screw Trench, the rod or bracket. In an exemplary embodiment, the first end 132A of the first connecting part a is inserted into the first chip 124 dice 120, while the first end 132b of the second connecting part 122b is inserted in the second chip 126 120 bones. As you can see, in this example, the first connection piece a inserted into the proximal section 128 of the bone 120, while the second connection piece 122b is inserted into the distal section 130 120 bones. Although in this example, two fasteners 122 are presented with only the connecting piece 122, is inserted into each of the bone fragments 120, specialists in the art it is obvious that any number of fasteners 122 may be involved in each of the bone fragments 120 to achieve the necessary stability of each of the bone fragments.

As is shown in Fig. 10-11, each of the levers 108 are made with the ability to connect with the bone 120 through the connecting parts 122. For example, the first lever 108A connected to the first connecting piece a, and the second arm 108b is connected with the second connecting part 122b. Specialists in the art it is obvious, however, that any number of levers 108 can be used for independent manipulation of any number of bone fragments is otnositelno each other. As indicated above, each of the levers 108 may include a gripping device 136 connected to the corresponding second end 134 of the connecting part 122. Gripper levers 136 108 may include, for example, a clamp or a vise adapted to securely hold the second ends 134 of the connecting parts 122. Alternatively, the capture device 136 may include tabs or other elements configured for a solid match, with the second ends 134 of the connecting parts 122.

In order to attach the gripping device 136 to the second ends 134 of the connecting parts 122, robotic device 102 may be installed in a sparing mode that allows you to manually move each of the levers 108 in the position in which it can be attached to the corresponding connecting part 122. Specialists in the art it is obvious that sparing regimen can be started via the interface 106 of the user. After attaching a gripping device 136 to each of the connecting parts 122, robotic device 102 can be switched to the lock mode, in which the levers 108 are blocked on all axes of motion. Then, the encoding device 116 on each of the levers 108 are delivered into the system to determine the exact position and placement of each the lever 108. This information is then used to control the movement of the levers 108 and, therefore, the connecting parts 122 and the attached bone fragments, in order to achieve the desired final spatial correlation between different fragments of bone. After entering the lock mode, the user controls the movement of the levers 108 through an interface 106 of the user.

The user can control the movement of the levers 108 through an interface 106 of the user, for example, by selecting one or more levers and manipulating one or more control knobs or other controller in the required direction in order to cause a corresponding movement of the levers 108. If necessary, this process can be repeated for other levers 108 until then, until it reaches the desired spatial relationship between bone fragments. As described above, the levers 108 can move in six linear directions and under six angles by rotating movement of the first 140 and second 142 shoulders and section 152 of the wrist hinge lever 108. If the interface 106 of the user contains a personal computer, a point on the wreckage 124, 126 bones can be referred to as vertices, which can be displaced by assigning the given position data points, as PTS is seen by the experts in this field of technology. In a preferred embodiment, the point denoted as vertices, can be those points on the ruins 124, 126 of the bone with the proximal and distal 128, 130 ends, respectively, which are attached to the levers 108. Specialists in the art will recognize that each of the levers 108 can move independently of the other to achieve the desired spatial relationship between the fragments of bone 120. Alternatively, it is also clear that the experts in the art, any group of levers 108 can move simultaneously in order to maintain the desired spatial relationship between any or all of the bone fragments during the movement to the desired spatial relationship. The user can continue to enter commands corresponding to the desired arrangement of the levers 108 and, consequently, fragments of bone, through an interface 106 user, until all the fragments of the bone 120 will not be set, in accordance with need.

In General, reposition will end when the location of the wreckage 124, 126 bones 120 will be restored as close to their location prior to fracture, as shown in Fig. 12. However, the system 100 can be used to store location dice 120, desirable to have committed.

For example, as shown nafig. 13, the robotic device 102 can rotate the bone 120 relative to the operating table 118 in position, designed to facilitate the introduction of the fixation device, such as a pin for osteosynthesis. The levers 108 can rotate the bone 120 by rotation of the longitudinal element 109 is attached to the levers 108, with respect to the table 118.

In an alternative embodiment, at least one of the levers 108 may be connected to the connecting element or elements, which retains the load-bearing structure that supports the proximal or terminal section end portion 120 bones subjected to fracture. The end part can be attached to the supporting structure via a bone connectors, or may simply lie on a supporting structure on a suitable cotton-gauze pad. This supporting structure contributes to the location of the bone 120 in the desired position, so that the bone 120 may be set or placed for insertion of the fixation device.

For specialists in the art it will be obvious that it can be made various changes and modifications in the structure and method of the present invention, without deviating from the essence and scope of the invention. Thus, it is assumed that the present invention covers the modifications and variations given to the CSOs of the invention, provided they are within the scope of the attached claims and their equivalents.

1. Device for treatment of bone fractures, comprising:
many of levers, each of which departs from the proximal end to the distal end and capable of moving in three-dimensional space, and the proximal end of each arm connected to the frame;
many elements of the joint, and each joint is connected to the distal end of the corresponding lever, where the element coupling capacity with the ability to lock the bone fixation element attached to the corresponding chip of bone in such a way that each of the levers is connected with the corresponding chip of bone;
a mechanical device causing movement of the levers to move each of the arms relative to the frame;
a controller, receiving data corresponding to the desired final position of the bone fragments relative to each other, and managing mechanical device for movement of the levers relative to each other to achieve the desired final position of the bone fragments relative to each other; and
a frame comprising a longitudinal member to which is attached a lot of controls, wherein the longitudinal element is made to rotate in order to rotate the many factors is ahow relative to the frame.

2. The device under item 1, in which each of the levers includes a first shoulder and a second shoulder, interconnected with the possibility of rotation in order to rotate around the first axis.

3. The device according to p. 2, in which the proximal end of each of the levers is connected for rotation with the specified frame so that each of the levers can rotate around the second axis.

4. The device according to p. 3, in which the levers are movable along the longitudinal element along the third axis.

5. The device according to p. 1, further containing a first area of the carpal joint between the distal end of the first lever and the first element of the joint, and the first area of the carpal joint allows the first articulation element to rotate relative to the distal end of the second arm of the first lever.

6. The device under item 5, in which the first area of the carpal joint includes a first plate attached to the proximal end of the first articulation element and the first pin passing through the first arm, and the first pin is attached rotatably to the first plate to allow the first articulation element and the first plate to rotate around it.

7. The device according to p. 6, in which the mechanical device includes a set of first hydraulic cylinders, the rich, each of the first hydraulic cylinder attached to the proximal surface of the first plate, to rotate the first plate around the first pin.

8. The device according to p. 7, in which the first hydraulic cylinders are located essentially at equal distances from each other around the perimeter of the first plate.

9. The device under item 1, in which each of the levers includes the encoder that delivers to the controller information, which is consistent with the position of the respective bone fragment.

10. The device under item 8, in which each of the first hydraulic cylinder is connected to the first lever through a first tension element, which, upon retraction of the first hydraulic cylinder moves the first lever in the desired position.

11. The device under item 1, in which at least one of the elements of the joints made with the possibility of connection with the bearing structure adapted to support the plot of the end portion of the bone.

12. Method for treatment of bone fractures, including:
fixing a first bone fragment to the first bone fixation element and the second bone fragment to a second bone fixation element;
the connection of the distal end of the first arm with the first bone fixation element and the distal end of the second arm with the second bone fixation element, each of the first and second levers is held between the distal end and proximal end, the connection is United with the frame, this frame includes a longitudinal element that is attached to many of the levers, wherein the longitudinal element is made to rotate in order to rotate the first and second arms relative to the frame;
receiving data corresponding to the desired final position of the first and second bone fragments relative to each other; and
control of mechanical device to move the first and second arms relative to each other to achieve the desired final position of the bone fragments.

13. The method according to p. 12, in which each of the first and second levers includes first and second shoulder, connected to each other rotatably.

14. The method according to p. 12, further comprising moving the first and second levers in a longitudinal direction along the frame.

15. The method according to p. 12, in which the first and second arms include first and second wrist joint, respectively, and first and second elements of articulation, respectively, adapted to be coupled with the ability to lock with the corresponding first or second bone fixation element, and the first area of the carpal joint is attached to the distal end of the first lever, connecting with the possibility of rotation of the first element of articulation with the distal end of the first lever and the second stretch knit wrist the aqueous hinge is attached to the distal end of the second lever, connecting with the possibility of rotation of the second element of the articulation with the distal end of the second lever.

16. The method according to p. 12, in which the first lever includes a first plate attached rotatably to the proximal end of the first element of the joint with the purpose of rotating around a first pin passing through the first arm and the second arm includes a second plate attached rotatably to the proximal end of the second element of the joint with the purpose of rotating around a second pin passing through the second arm.

17. The method according to p. 16, in which the mechanical device includes a set of first hydraulic cylinders, each of the first hydraulic cylinder attached to the proximal surface of the first plate in order to rotate the first plate around the first pin, and a multitude of second hydraulic cylinders, each of the second hydraulic cylinder attached to the proximal surface of the second plate to rotate the second plate around the second pin.

18. The method according to p. 17, in which the first hydraulic cylinders are located essentially at equal distances from each other around the perimeter of the first plate.

19. The method according to p. 12, further comprising positioning each of the bone fragments on the basis of Yes is the data received from the encoding device attached to each of the first and second levers.

20. The method according to p. 12, further comprising a visualization of the bone fragments by using the display device to determine the desired spatial disposition of the bone fragments.

21. The method according to p. 12, in which the data corresponding to the desired final position of the first and second bone fragments relative to each other, are entered by the user in the controller that controls the first and second levers to obtain the desired spatial location.

22. The method according to p. 12, in which the data corresponding to the desired final position of the first and second bone fragments relative to each other, are entered by the user by manipulation of control knobs, directing the movement of the first and second bone fragments relative to each other as they move controller that controls the first and second levers, moving the first and second bone fragments, as specified by the user, to obtain the desired spatial location.

23. The method according to p. 12, further comprising the location of the end portion of the first and second bone fragments through the supporting structure, which supports the plot of the end portion, and the supporting structure is Ipanema can travel with the third arm, which is attached to the supporting structure.



 

Same patents:

FIELD: medicine.

SUBSTANCE: distraction apparatus consists of one basic/first oval closed two-plane ring, two oval long semi-rings (second and third) for the II-V fingers and two oval short semi-rings (fourth and fifth) for the I finger. All five elements are rigidly fixed to each other and to the basic/first two-plane ring by means of five braces with a thread and nuts, as well as to the hand bones by pins in the quantity required. The basic/first oval closed two-plane ring has an inclination of 150° taking into account the physiological deviation of the I metacarpal. The supports are fixed by pins to the hand bones in the quantity required. The fingers are formed by rotating the nuts above and below the distal third and fifth semi-rings about the braces four times a day, every 3-4 hours by 90-360° for one day that leads to the gradual travel of the distal semi-rings every time distracting the distal fragments of the extensible bones by 0.1-0.25 mm, and elongating the phalanxes of the formed fingers by 0.4-1.0 mm a day. The invention enables reducing the number of complications in the form of deformities of the formed bone regenerate. Using the apparatus avoids the rotation effect related to the nuts rotation on the distraction brace preventing the regenerate breakage and injuries in the extensible finger segment in the distraction procedure.

EFFECT: using the given distraction apparatus for the fingers formation in children provides the higher clinical effectiveness and quality in the patients with traumatic defects and congenital deformities of the fingers.

2 ex, 2 dwg

FIELD: medicine.

SUBSTANCE: reposition fixator for the intramedullary osteosynthesis of the long bones comprises at least two coupled identical assemblies movable in relation to each other. Each of the above assemblies represents a bearing holder consisting of two portions pivotally connected by a screw clamp in the form of extended parallelepipeds - upper and lower. The upper parallelepiped comprises two pairs of through holes placed in mutually crossing planes. The paired through holes are arranged above each other, and one of the pairs comprises transosseous elements replaceable into another pair, including a rod - a hook and a rod - a pusher with a pointed tip movable along and about their long axes. From a side wall of the upper parallelepiped, there is a handle; from a side wall of the lower parallelepiped, there is a thread shank that is used to couple the bearing holder to a sliding bar to vary a distance in between and to rotate the bearing holder about its long axis. The identical assemblies of the device are coupled by a beam, a cross-bar and two parallel canals formed therefor in the sliding bar and having respective shapes and geometrical sizes. The cross-bar has a projection in its middle portion that is provided with an alternating thread on its outer surface from both sides of the projection; a canal counteracting with the thread has a mating internal thread.

EFFECT: eliminating all the dislocations of the injured long bone fragments with higher reposition accuracy and reduced soft tissue injures within the fracture.

2 dwg

FIELD: medicine.

SUBSTANCE: device comprises two distraction assemblies - the first one - for the first and second phalanges, and the second one - for the second and third phalanges. Each assembly is presented in the form of a pair of threaded rods, at the ends of which there are mounted two axially gradually movable arched supports. Each of the supports is provided with bone fixative holes at the ends. The holes of the adjacent arched supports of the first and second distraction assemblies are combined thereby creating an axis of rotation. In this pair, the arched support of the second assembly has a radius smaller than the radius of the arched support of the first assembly by a value to ensure combining them on the single axis and at different levels. At the top of the arched support with the smaller radius, there is an eye having an elongated hole, either fixed directly, or turning around. An eye body is curved at an angle of up to 175 degrees, and is coupled with one end of the flexing-extending threaded rod; the other end is provided with an end eye for the joint connection with a U-bracket fixed on the top of the adjacent arched support of the greater diameter of the first distraction assembly.

EFFECT: invention provides the distraction of tendons, cicatrices, digital joints of the fingers if observing their full contracture, with eliminating a risk of the distraction injury, simplifying the structure and adjustment, and ensuring the follow-up of the postoperative field in service.

4 cl, 5 dwg

FIELD: medicine.

SUBSTANCE: invention relates to medical equipment, and is applied in traumatology and orthopedics. Device contains first module for bone from one side of joint, second module for bone from the other side of joint and threaded bars for connection of said modules. Said first module consists of bone support with wires and wire clamps. Said second module consists of first and second bone support, threaded rods with nuts, connecting said first and second supports, wire clamps, wire holders for wire tightening, at least, one wire holder for console wires, at least, one regulated wire holder for console wires and repositioning module. First support is intended for joint end. Repositioning module has support plate with holes, rod wire clamps for console wires and posts. Posts are intended for installation of support plate on support for joint end. All said supports are made in form of flat rings and/or half-rings with holes. Brackets are used in said wire holders and in repositioning modules. Brackets represent straps with, at least, one hole and tip with thread, installed on one of strap ends. Each rod wire clamp is made with slot for wire and nuts. Rod wire clamps are installed by means of nuts in hole of brackets, with last tip being installed in holes of support plate by means of nuts. Each post is made from connecting threaded rod and two brackets, one of which is installed with tip by means of nuts in hole of support plate, the other by means of nuts - with tip in hole of support for joint end. Connecting threaded rod is installed in holes of said two brackets by means of nuts. Wire holders for tightening wires are made in form of brackets, in holes of which wire clamps are installed and tips of which are installed on second support of second module by means of nuts. Wire holder for console wires is made in form of bracket, in holes of which wire clamps are located, and tips of which are installed in holes for joint end by means of nuts. Regulated wire holder for console wires is made in form of a pair of brackets, one of which has wire clamp in hole and is by means of nuts installed with tip in hole of another bracket, and the last one is by means of nuts fixed in support holes for joint end.

EFFECT: invention ensures fixation and reposition of epiphysis fragments which results in creation of favourable anatomical and functional conditions for recovery of injured growth zone with further normal course of physiological processes of growth and preservation of extremity biomechanics due to possibility of eliminating displacement of fragments in all planes due to possibility of eliminating displacement of fragments in all planes in the process of treatment without apparatus remounting.

8 dwg

FIELD: medicine.

SUBSTANCE: invention relates to medicine. Apparatus for destruction osteosynthesis of hand and foot bones contains two and more rod modules, connected between each other with screwed bar, which ensures possibility of mutual travel of rod modules on it. Each of rod modules includes case and fixers of transcutaneous rods. Case of each rod module is equipped with straps with longitudinal through slot, in which with possibility of linear and angular travel fixers of transcutaneous rods are fixed. At least, one of rod modules is equipped with compression-destruction screw nut with radial openings for spanner, installed in slot of case, on threaded bar, made with derotation facets along the entire length.

EFFECT: invention provides possibility of realising distraction of small bone fragments destruction, for instance, bones of hand and foot, in passing transosseous elements (rods or wires) into them at different angles, with high stability of fragment fixation, as well as simplification of manipulation of compression or destruction.

4 cl, 8 dwg

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to dentistry, and can be used in increase of volume of bone and soft tissues in case of vertical atrophy of alveolar process with the aim to prepare patient to carrying out dental implantation. Distraction apparatus contains bearing screw and installed on it means of movement of mobilised bone fragment of patient's jaw from basal bone, and fastening screws for fastening said means on bone fragment and basal bone. Said means of bone fragment movement are made in form of mobile and immobile consoles, each of which has a hole, in which fastening screw is installed. Mobile console is installed on bearing screw with possibility of longitudinal reciprocating movement. Hole in immobile console is made polyhedral and in direction to axis of bearing screw. Shank of fastening screw which is in interaction with it is also made polyhedral with possibility of interaction with said polyhedral hole in immobile console. Shank of fastening screw is located transversally to thread part of said fastening screw.

EFFECT: invention provides possibility of growing alveolar process at certain angle to the vertical outwards or inwards.

9 dwg

FIELD: medicine.

SUBSTANCE: invention relates to medical equipment, namely to devices, which are applied in traumatology and orthopedics. Device for destructive osteosynthesis of wrist joint area consists of components of Ilizarov's apparatus set and contains two rings and half-ring, connected with screw bars. On palm-elbow surface of hand and forearm there is expandable external support, which consists of three thread bars, whose length is twice less than adjacent thread bars between ring and half-ring, and three plates, fixed with screw nuts. Connection of half-ring with ring of Ilizarov's apparatus is carried out on perimeter, which exceeds perimetre of half-ring.

EFFECT: invention ensures increased efficiency of treating patients with fractures, fracture-dislocations of wrist joint and their consequences.

2 ex, 5 dwg

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to traumatology-orthopedics. Essence of invention lies in the following: apparatus for treatment of fractures of shin and foot bones contains supports, connected by means of threaded bars, brackets, wire-fixers and intraosteal rods. Circular supports of apparatus are made composite, and consist of similar modules, representing sectoral plates in form of ring quarter with holes located along contour. One end of plate is provided with rectangular open pocket with hole on the side, parallel to plate plane, width of the other end being made equal to width of internal size of pocket. On peripheral sides of plates, closer to their end parts, made are semi-circular projections, located in such a way that holes in them are located between holes along plate contour. Plates are connected to each other by means of bolts with nuts.

EFFECT: invention provides possibility of treating patients with combined injuries of shin and foot, accompanied with bone fractures, vast defects of skin and underlying soft tissues, with simultaneous stabilisation of bone fragments of injured segment, with reconstruction of its axis and possibility of collection of small bone fragments, due to restoration of periosteum tension, performing interventions on vascular-nervous bundles, covering skin defects and underlying soft tissues, with reduction of treatment time and improvement of its outcomes.

7 dwg

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to traumatology and ortghopedics, and is intended for treatment of fractures of long tubular bones. Apparatus contains supports, threaded bars, connecting supports, intraosseous rods, rod-fixers and remote rod-fixers on form of beam. Supports are made in form of arch-like plates, curved on radius in their plane, and bent in said plane in form of projections from terminal parts of plate toward its salience. Projections and terminal parts of plate are provided with holes with bilateral countersink. Holes, located on radius, are made along plate. Beam of remote rod-fixer is immovably fixed on cylindrical pedestal, which has axial threaded hole and is installed on base in form of washer, on the centre of lower surface of which placed is square boss with axial through hole. Base is installed on base with boss in hole, located on radius along plate. On the upper surface of base made are radial teeth, which contact with teeth of respective shape on the lower surface of pedestal. Pedestal and base are connected with support by means of screw connection. On wide sides of rod-fixer beam made are transverse teeth, along axis of said sides made is through oval slot for installation of intraosseous threaded rods, fixation of which in remote rod-fixer is performed by means of special nuts and washers. Nut has spherical head and hexagonal shank, which are connected to each other by means of tube. Washer is made rectangular and is provided with longitudinal oval slot for intraosseous rod. In the centre of slot made is depression of respective shape for head of spherical nut. On the end of upper surface, along short side of said washer, made is step, on the opposite end of lower surface, for the half of washer height - depression in the centre, for the width of central slot. On the lower surface of washer made are transverse teeth, in shape corresponding to teeth on lateral surfaces of remote bracket.

EFFECT: invention ensures increase of fixation rigidity, reduction of operation treatment trauma with improvement of its outcome and creation of comfort for patient.

3 dwg

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to orthopaedics and traumatology. A wire is delivered through a heel bone. It is used for skeletal traction to remove lengthwise bone fragment dislocation. Then two supplementary wires are delivered in a frontal plane: in a distal tibial epimetaphys and in a proximal tibial epimetaphys. The supplementary wires are fixed in supports of a derotation device from two rings of a standard Ilizarov's osteosynthesis kit. The rings are coupled by three telescopic rods. The fracture is reduced. Edgewise dislocation of the bone fragments is removed, and the bone fragments are rotationally dislocated. The telescopic rods are fixed in the achieved position. The skeletal traction wire is removed from the heel bone. The X-ray control follows. A plaster bandage is applied on a shin with covering knee and ankle joints. After the plaster bandage is dried, the derotation device is removed.

EFFECT: method provides tibial and fibular fragment union in an anatomically correct position and reduced length of hospital treatment.

2 cl, 1 ex, 6 dwg

Orthopaedic device // 2517605

FIELD: medicine.

SUBSTANCE: invention relates to the field of medical equipment and is intended for application in traumatology and orthopaedics for resetting a dislocated shoulder. An orthopaedic device contains, at least, one post, on which a seat and a back are placed. The upper edge of the back is made with a hollow for axilla of a patient, who sits sideways on the seat with the arm placed over the back. In the upper part a hollow is made in such a way that it partially embraces from the front and from behind the shoulder joint of the patient, who sits sideways on the seat with the arm placed over the back. On the back surface of the back there is, at least one bearing area for placement of the arm of the patient, who sits sideways on the seat with the arm placed over the back. The orthopaedic device contains traction, made with a possibility of connection with the device for the forearm embracing, made in a form of L-shaped sleeve. Traction is made in a form of mechanical traction from a set of detachable loads and a hook, adapted for placing on it demountable loads and made with a possibility of connection with the L-shaped sleeve.

EFFECT: invention makes it possible to increase efficiency of the shoulder dislocation treatment due to improvement of work conditions, convenience of application, reliability of fixation of the patient's position and position of the shoulder by providing optimal stop, which takes into account anatomic characteristics of the shoulder joint and axilla.

13 cl, 8 dwg

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to traumatology and orthopedics. Through external bone surface formed is hole, going into intramedullary channel. Through said hole into intramedullary channel fixer is introduced and installed in destroyed part of bone. Liquid is supplied into fixer, ensuring even pressure, performed via external surfaces of fixer onto response contact bone surfaces. Fixation of fixer inside bone is realised due to increase of transverse dimension of working part of fixer in accordance with internal diameter of intramedullary channel and tight contact of external surface of fixer with response contact bone surface. Pressure inside fixer is kept stably high for the period from ten days and longer. After that it is gradually reduced to minimal. After eight months after osteosynthesis fixer is removed.

EFFECT: method ensures reduction of trauma of bone and soft tissues when performing manipulations during operation, reduction of possibility of development of early post-operative complications, elimination of delayed or incorrect union of bone fragments, absence of additional immobilisation in post-operative period, reduction of hospitalisation terms.

3 ex, 3 dwg

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, in particular to orthopedics. Skin and subcutaneous fatty tissue are cut on anterior surface of iliac region. Muscular tissue is immobilised in obtuse and acute way. Periosteum of iliac bone between anterior-upper and anterior-lower spines is exposed, periosteum is cut longitudinally and separated with raspatory. Two tunnels are made in front plane by means of drill. After that threaded rods with diameter 5-6 mm are screwed to the depth 3-4 cm. In lower third of femoral bone two cuts are made with scalpel. Trocar is introduced to bone. Through trocar bush two tunnels are frilled in bone, fixing threaded rods are screwed into tunnels. After that, by means of "МКЦ" apparatus gradual distraction and rotation inwards on femoral bone axis is performed at the rate 1-2 mm per day by rotation of nut on threaded rods in various planes for two-three weeks. Fixation of head and neck of hip is realised by bundle of wires, which are installed along hip neck, crossing growth zone. After that "МКЦ" apparatus is dismantled and plaster bandage is applied until bones knit completely.

EFFECT: method ensures gradual reposition of epiphysis, possibility to compensate vascular net to changing spatial position.

1 ex, 8 dwg

FIELD: medicine.

SUBSTANCE: invention concerns medical equipment, namely, traumatology and orthopedy. The apparatus contains blocks-clamps, a screw-coupler, and a basis of longitudinal form with a referring groove. Each block fixative is equal in width to the basis and is executed in the form of a slider with a longitudinal prominence and the clamping plate placed on it which are clamped to the formation of apertures under carving blocking hinges on the interfaced sides of the slider and a clamping plate, and an axis of these apertures axes of blocks-clamps are located perpendicularly. The screw-coupler is located along a longitudinal axis of the basis, and executed with an adjusting aperture on a turn-key basis. Blocks-clamps are clamped to the basis. The basis has section of a double tee with a wall parting the basis on the top and bottom cavities and executed with the referring groove. Each fixative block is supplied by a fixing lath. A prominence of the slider and a corresponding fixing lath of blocks-clamps are located one under the other, consequently, in the top and bottom cavities of a double tee of the basis, on the different sides from its wall, and have sections, reciprocal under the form to sections of corresponding cavities of the double tee. There is not less than four apertures for carving blocking hinges. In a clamping plate, a slider and a fixing lath of blocks-clamps there are coaxial fixing apertures located in front of each other which axes are symmetrised, is perpendicular and with alternating concerning axes of apertures for carving blocking hinges. The screw-coupler is located in two eyes and bound to one of eyes carving bond. The eyes are executed with a fixing aperture and established on clamping plates of the next blocks-clamps and clamped to them a bolt passed through a fixing aperture of an eye, through coaxial to it an aperture executed in the corresponding clamping plate, and fixed on a carving in a corresponding aperture a the slider. The blocks-clamps are clamped to the basis the bolt passed through executed in clamping plate and the slider fixing apertures, spent through referring groove of a wall of a two-Tauri, and fixed on a carving in a corresponding coaxial aperture of a fixing lath. The length of the basis and its height are bound by parity 17.5:1. The length of a referring groove is peer to a difference of length of the basis and the doubled distance from edge of blocks-clamps to the point of an aperture nearest to it under a bolt, executed in a clamping plate.

EFFECT: invention provides expansion of functionality, rising of durability of bracing and reliability of osteosynthesis at treatment of difficult fractures, and also at elongation of long tubular bones, and for replacement of defect of bone after its osteotomy, both at the adult person, and at the child.

3 cl; 5 dwg

FIELD: medicine, orthopedics, traumatology.

SUBSTANCE: the present innovation deals with applying surgical instruments and ways for treating motor system by introducing fixators into a vertebra. It is necessary to fulfill a roentgenogram of deformed vertebral column in frontal projection, then its contour should be identified with that of a marking pattern which should be matched with the centers of bows' roots. Then one should apply needles-marks upon a pattern in transverse plane by matching them with the centers of bows' roots followed by computer tomography at the pictures of which one should detect the angle for introducing fixators, free ends of needles-marks should be curved by matching with the angle of introducing fixators. In operation room, one should place a marking pattern at a patient's back by matching it with the contour of patient's vertebral column followed by roentgenological control, then it is necessary to introduce fixators into bows' roots taking into account the position of needles-marks. Marking pattern contains two supports made of plastic material. Every support has got through steadily located openings and not less than 2 needles-marks. They are designed to be introduced through the openings. Moreover, free ends of needles-marks are designed to have the chance for curvature. Application of the present method enables to shorten the duration of operative interference and, also, decrease the number of roentgenological trials during interference.

EFFECT: higher accuracy and efficiency of detection.

2 cl, 4 dwg, 1 ex

FIELD: medical engineering.

SUBSTANCE: device has rod, units for fixing transosseous members and the transosseous members. The rod is composed of two L-shaped plates connected to each other with their long shelves by means of bolts and nuts. The short shelves of each of them are curved in a plane set in perpendicular to the long shelves and have at least single threaded guide. Oval coaxial holes are drilled in the long shelves for setting holders for fastening wires and rods. Unit for fixing transosseous members is designed as curved strips having junction and holes for introducing guide members. The transosseous members are placed between the strips tightened with the nuts mounted on the guides.

EFFECT: enhanced effectiveness in preventing deformities, persistent contractures and carpal instability.

4 cl, 3 dwg

The invention relates to the field of medicine and medical equipment, in particular to methods and devices for the treatment of musculoskeletal apparatus, and in particular to methods and devices used for external fixation of the spine in its surgical treatment

The invention relates to medicine, namely to traumatology and orthopedics

The invention relates to medical equipment and is designed to reposition and fixation of open, closed, comminuted, granular fractures of the long bones, pelvic bones, and to solve problems orthopedic situations after these injuries

The invention relates to the field of traumatology and orthopedics, and can be used for transosseous osteosynthesis Razmyslov and namyslow fractures of the humerus

FIELD: medical engineering.

SUBSTANCE: device has rod, units for fixing transosseous members and the transosseous members. The rod is composed of two L-shaped plates connected to each other with their long shelves by means of bolts and nuts. The short shelves of each of them are curved in a plane set in perpendicular to the long shelves and have at least single threaded guide. Oval coaxial holes are drilled in the long shelves for setting holders for fastening wires and rods. Unit for fixing transosseous members is designed as curved strips having junction and holes for introducing guide members. The transosseous members are placed between the strips tightened with the nuts mounted on the guides.

EFFECT: enhanced effectiveness in preventing deformities, persistent contractures and carpal instability.

4 cl, 3 dwg

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