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Types and cost of lower limb prostheses. Prosthetics Therapeutic and training limb prosthesis

After hip amputations, also called transfemoral, both modular and framed prostheses can be used. Many original innovations have been proposed in terms of technology and materials for sockets and prosthetic components. Thermoplastics and laminated plastics used as materials for thigh liners have significantly replaced wood, which was previously used for these purposes.

The formation and production of denture receiving cavities can be performed using a computer. A positive model is milled according to the dimensions of the stump using special software, and then a test socket is made from thermoplastic material using this model.

New design developments have expanded the range of knee joints and adapters. For elderly patients, primarily components are used that provide maximum safety and ease of wearing. Guaranteed safety in the standing phase and control of flexion-extension movements in the swing phase are achieved by various types of knee joints. Confident walking on any terrain is achieved by using hydraulic joint fixation in the stance phase and the use of electronic systems to regulate movement resistance at different speeds of movement. The choice of knee joint and prosthetic foot is determined by the needs of the patient, the condition of the stump, and also in order to achieve the most complete rehabilitation. In this case, the knee joint and foot should be considered as a single functional unit of the prosthesis.

With the help of a cosmetic foam lining, the modular prosthesis achieves a close to natural appearance. Such a covering can be individually made to the shape of the patient's preserved leg. Young patients involved in sports in some cases refuse cosmetic veneering and prefer to give their prosthesis a sporty look.

Using special modified prosthetic designs, they achieve amazing results in sports for the disabled. For primary prosthetics after hip amputation, the temporary Habermann prosthesis, which is prescribed immediately after wound healing, has proven itself well. A pre-fabricated thermoplastic socket is finally formed directly onto the stump using a special hair dryer. Therapeutic and training prosthesis allows you to make full use of the time before making a permanent one. It also helps to make the final choice of the design of a permanent prosthesis.

With a very short femoral stump, sometimes the only possible solution is to make a prosthesis with an additional hinge. A hip joint with a lock is installed under the prosthesis socket, which opens when the patient sits down.

Prosthetic legs
Designed to ensure movement at home, public places and on the street. The prosthetic leg can be used both indoors and outdoors at temperatures from + 40°C to - 40°C and relative humidity up to 100%.
Movement is controlled by contracting the muscles that have retained their attachment points on the stump after amputation.

The modular principle of constructing lower limb prostheses is today the standard in prosthetics. Modular components form detachable connections with each other and can be replaced without much difficulty. To meet the individual requirements of patients, a variety of components made of aluminum, titanium and stainless steel are available with different functions.

Therapeutic and training prosthesis of the thigh, lower leg...
Prescribed for primary prosthetics to teach walking skills on a prosthetic leg and form a stump, for people of both sexes and all age categories (after unilateral or bilateral amputation), for any reason for amputation.

Early prosthetics play a very important role in the rehabilitation program. Timely, correctly selected compression on the stump and early mobility of a patient with lower limb amputation have a positive effect on the rehabilitation process.

Prosthetic leg socket

Of great importance for the quality of the leg prosthesis is the socket, which acts as a link between the patient himself and the distal part of the structure. The shape of the socket and the quality of its fit influence the control of the prosthesis and significantly affect the patient’s walking in the prosthetic leg and overall wearing comfort. Maximum coverage of the entire outer surface of the stump, strengthening the function of the truncated muscles creates the opportunity for its adequate load, improves control of the prosthesis, which is achieved in the manufacture of the contact sleeve of the prosthesis. The socket is made individually using a plaster positive of the stump, modeled on the principle of total contact of the stump with the socket. Currently, they are made from thermoplastic polymer materials, which ensure their high strength characteristics, low weight, resistance to aggressive environments, high quality, the possibility of local adjustment when heated, etc. Layered plastics, as well as sheet thermoplastics, are most widespread.

Silicone liners
Currently, both abroad and in our country, new technologies associated with the use of softening silicone covers are increasingly being used in lower limb prosthetics, including primary prosthetics. Fixation of prostheses on the stump becomes more reliable and the skin is protected when walking. Recommended for active patients with leg and femur amputations, as well as for patients with diabetes mellitus and circulatory disorders.
The choice of silicone sheath design for each patient is made strictly individually, taking into account his motor activity, anatomical and functional characteristics of the stump and the level of amputation.

Knee module
It is used for prosthetics for people with unilateral or bilateral amputation of the femur, articulation in the knee or hip joints. A diverse selection of modular knee joints, their range extends from a locking single-axis joint to a hydraulic unit with knee fixation in the stance phase; from an adjustable spring pusher to a miniature hydraulic unit to control the swing phase. A new stage in the development of modular knee joints was the advent of electronic system knee joints C-Leg, in which microprocessor electronics, through hydraulics, control the operation of the unit in all phases of walking. This choice allows you to choose the most optimal option when making a leg prosthesis.

Foot module
It is used for unilateral and bilateral amputation of the femur, lower leg, articulation in the knee or hip joints. The foot has a greater influence on the biomechanical properties of the prosthesis. Our proprietary know-how in material technology, from high-quality plastics and titanium to carbon, ensures defined properties and high strength. The range of modular prosthetic feet is very wide, which allows you to choose the most optimal option when making a prosthetic leg.


Cosmetic veneer
It is intended to give prosthetic and orthopedic products the shape of a preserved limb, and also protects clothing from wear and tear and has the physical and mechanical properties of the soft tissues of a natural limb. Perlon stockings of various sizes and colors with silicone elastic that prevents slipping are an external design element. The cosmetic appearance of a prosthetic leg is as close as possible to the natural appearance of a healthy limb.

Bandages

For additional fixation or fastening of the prosthesis on the stump, various bandages can be used. The knee brace provides additional security and improves the appearance of the condylar-grip prosthetic leg.

Thigh support bandage


Stump covers

Care and hygiene

The skin of people using prostheses is subject to increased stress; special protection and daily care of the stump are of great importance. Together with sweat, toxins, salts, metabolic products, etc. are released from human skin. Sweat is a good environment for pathogenic bacteria, especially in people with skin pH problems. To prevent skin irritation and unpleasant odor, the stump, socket and liner should be washed and cleaned at least once a day. There are special cleansers for this.

Sava Soviet

Socialist

Republics

Automatic dependent certificate no.

Declared 13.1 f.1970 (No. 1405666/31-16), Ch. Cl. A 61g 1/08 with the addition of application No.

Priority

Op;blue. ovanovano 00.P.!972. Vüllsten1, X" 7

Committee on the care and opening of the Lri Council of Mikisov

A. A. Korzh, L. G. Plotnik, V. A. Berdnikov, V. K. Komolov and N. F. Volkov

Applicant

Kharkov Research Institute of Prosthetics, Orthopedics and Traumatology named after. prof. M. I. Sitenko

1; - - . - ; .. ;-; . -., THERAPEUTIC AND TRAINING PROSTHETIC OF THE CHIB

The invention relates to the field of medicine.

Therapeutic and training prostheses of the lower leg, containing a foot, a telescopic socket of the lower leg with a fixing clamp and a device for finding the relative spatial position of the elements of the prosthesis, are simple. However, they have limited functional capabilities.

The purpose of this invention is to create such a therapeutic and training prosthesis, 10 which would provide the ability to determine and fix directly on the prosthesis the parameters that are most advantageous when walking for a particular disabled person.

This goal is achieved by the fact that the prosthesis 15 is equipped with a device for regulating angular and linear parameters, made in the form of two disks with mutually transverse grooves. The disks are connected by a ball joint and locked with screws located on 20 one disk. On the other disk there are linear scales, and arc scales are printed on a removable protractor, made in the form of two doors, hingedly connected to a bar, shaped like a sector of a circular ring. 25

In fig. 1 schematically shows the described prosthesis, general view; in fig. 2—the same, section along A - A in Fig. 1; in fig. 3 - section but B - B "a fig. 2; in fig. 4 - removable protractor in section. 30

The prosthesis contains foot I, telescopic sleeve 2 of the lower leg, a device for attaching a stump receiver and a device for adjusting parameters. The latter is made in the form of disks 4 and 5, connected by a ball joint 6 and fixed with four adjustment screws 7.

In the upper 4 and lower 5 disks there are two mutually perpendicular grooves that allow the disks to move relative to each other in the frontal and sagittal planes when the adjusting screws 7 are loosened. The pin 8 of the ball joint 6 prevents the rotation of the disks relative to each other.

The adjustment screws are located in the frontal and sagittal planes, which ensures adjustment under specified conditions.

To adjust the angular and linear parameters, it is necessary to loosen the adjusting screws 7 and after adjusting the device, the connection should be fixed. The counting of angular parameters is carried out by determining the angle of inclination of the upper disk in relation to the lower disk using a special removable inclinometer by introducing its flaps 9 and 10 into the space between these disks. The doors are hingedly connected by means of a strip 11, which has the shape of a sector of a circular ring. The protractor scale is graduated

Printing house, Sapunova Ave., 2

11 with interval II 1. Linear parameters are measured using linear scales! 2.

To adjust the length of the shin and the angle of rotation of the foot, it is necessary to loosen the clamping screw 18 of the clamp 14 on the lower cut end of the telescopic sleeve 2. After adjustment, the connection should be fixed again.

Subject of the invention

Therapeutic and training prosthesis of the lower leg, with. holding the foot, a telescopic shin sleeve with a fixing clamp and a device for finding the relative spatial position of the elements of the prosthesis, characterized in that, in order to determine and fix directly on the prosthesis the parameters that are most advantageous for a particular disabled person when walking

s an is equipped with a device for regulating angular and linear parameters, made in the form of two disks with mutually transverse grooves, connected by a ball joint and locked by means of screws located on one disk; there are linear scales on the other disk, and arc scales are printed on a removable an inclinometer made in the form of two leaves, hingedly connected to a bar shaped like a separator of a circular ring.

Editor T. Karanova Compiled by N. Eskin

Proofreader E. Usova

Order 743.18 11 building. 1Ga e40 Circulation 448 Subscription

11NI14PI of the Committee for Invention and Discovery of the CoBcTc Ministers of the USSR

10 Moscow,) K-35, 1 Arenskaya embankment, no. 4 5

Similar patents:

The invention relates to the field of medical technology, namely to prosthetics, in particular to methods and systems for controlling an intelligent bionic limb. A method for controlling an intelligent bionic limb comprises the steps of: receiving at least one EMG signal from a patient via a myoelectric reading device; processing the at least one EMG signal of the patient through non-overlapping segmentation of the EMG signal; for each segment obtained in the previous step, a set of EMG signal features is generated based on the amplitude of the EMG signal to classify gestures; transmitting a set of features of the EMG signal of each segment via a data transmission channel to the control system of the intelligent bionic limb; determine the type of gesture based on a set of features of the EMG signal through the use of an artificial neural network; generate a control signal based on a certain type of gesture; transmit the generated control signal to the motors that drive the fingers of the bionic limb; receive feedback from the intelligent bionic limb control system by receiving information from external sensors. The invention makes it possible to increase the accuracy of positioning and making decisions about grasping an object. 2 n. and 11 salary f-ly, 13 ill.

In case of injury to the lower extremities, situations sometimes arise when the only way to save a person’s life is to remove part of the leg.

Amputation followed by prosthetics

The need for amputation arises if:

  • signs of gangrene;
  • limb separations or injuries with no real possibility of full recovery (with severe tissue deformation and bone fragmentation);
  • blockage of blood arteries;
  • congenital anomalies of the structure of the legs;
  • ischemia as a complication of concomitant diabetes, atherosclerosis;
  • tissue necrosis, which occurs, among other things, due to improper application of a tourniquet to stop bleeding.

Alarming symptoms indicating the need for urgent surgery are:

  • the occurrence of acute pain syndrome;
  • numbness of the limb;
  • change in skin color (blueness or blackening);
  • spread of unpleasant odor from the foot;
  • absence of pulsation of the popliteal artery, cessation of blood supply;
  • cooling of the skin.

To finally verify the correctness of the diagnosis and make a decision to remove the leg or part of it, the following is carried out:

  • ultrasound examination of the blood supply to the damaged organ;
  • angiography – a method of examining vascular patency;
  • thermography – a method of determining the area of ​​distribution of the thermal field in the injured area;
  • X-ray – reveals the degree of injury, assesses the condition of bone tissue.

Prostheses are special artificially created devices that imitate limbs (in whole or in part), lost or damaged due to injuries acquired during life or due to existing hereditary diseases, and designed to fulfill their physiological purpose.

Prosthetics is the operation of installing an artificial mechanism. It helps a person return to an active life and live fully in society. In order for the process of restoring the patient’s motor activity to be successful, a long period of rehabilitation is required, which involves undergoing special restorative procedures.

Types of prostheses

Depending on the location of the damage and the part of the limb removed, the following can be used:

  • prosthetic leg above the knee;
  • prosthetic leg below the knee (including the foot).

There are the following types of above-knee leg amputations:

  • removal of the limb occurs at the level of the knee joint;
  • a limb up to a third of the thigh is amputated; as a result of the manipulation, a long stump is formed;
  • the leg is cut off to the middle of the femur or its entire length (along the upper border of the thigh);
  • The entire limb is amputated, including the hip joint.


Prostheses are selected based on the condition of the stump and hip joint; they are fixed using bandages, a pelvic corset, straps or vacuum. A combination fastening is also used. When choosing a variant of a particular model, the following qualities are assessed:

  • ease of construction;
  • use of natural environmentally friendly materials;
  • functionality;
  • creating the appearance of a healthy limb.

Cosmetic prosthetics are also performed (foot prosthesis, phalanges of missing fingers) in order to visually hide the defect.

Modular

They are a device with built-in hinges that replace joints and perform its functions. Motor manipulation in such systems can be carried out by means of a spring or a microprocessor.

Such prostheses consist of one, two or three modules. The latter replace the entire limb and realize all the functionality of the lost leg.

Their main advantages are:

  • possibility of free movement (using an intelligent control system);
  • good mobility;
  • stability in a standing position;
  • no discomfort when sitting;
  • imitation of the contours of a healthy limb.

Sports

Designed for people who, regardless of the injury, continue to lead an active lifestyle, play sports, as well as for Paralympic athletes. They are made taking into account the individual characteristics of the stump, the age category of the patient and the degree of his activity.

Articulated

Used if complete amputation occurs. The design is based on the use of a hinge in the joint area. It provides its owner with the following capabilities:

  • carry out flexion and extension movements in the knee, provides balance support;
  • distribute physical activity evenly on both legs;
  • move around normally.

Advantages:

  • strength, lightness and safety of the structure;
  • good stability;
  • ease of operation;
  • manual knee lock.

Vacuum

They differ in the way they are attached to the stump. With this type of prosthetics, the socket is attached to the deformed area of ​​the limb as a result of the application of negative pressure.

Intelligent

The movements of this type of prosthesis are carried out using a microprocessor with a pneumatic drive. When using such a device, a person is able to feel full movement of the legs and the whole body while walking. The device fully replaces the lost limb, recreates a physiologically correct gait, and does not in any way limit freedom of movement.

Biocybernetic neural interfaces

They are based on microelectric control systems. They perceive muscle and nerve impulses from the stump and transfer them to the prosthesis. As a result, the patient has a feeling of ownership of a healthy limb: the prosthesis moves fully and fully reproduces all the functionality of the lost leg.

The prosthesis has increased strength and resistance to physical impact.

Prosthetic technologies

The technique for installing a prosthetic device depends on the type of limb amputation. In accordance with this, prostheses are distinguished:

  • bionic - work from the willful effort of its owner, developed using advanced technologies;
  • mechanical - are popular, used to replace lost functions, but have a negative effect on the spine with prolonged use;
  • cosmetic – they allow you to visually hide existing defects and imitate the full appearance of the leg.

Based on the installation technique, the units are determined:

  • with the presence of a knee module;
  • without one;
  • corsetry.

Stump formation

In order for the stump to form and heal correctly, after amputation, a number of mandatory recommendations should be followed:

  • Regularly treat the remaining part of the leg with antiseptics, apply and promptly change bandages (immediately after surgery);
  • use antibacterial hygiene products (soap and powders);
  • apply a bandage, elastic bandages, perform lymphatic drainage massage of the legs (in order to prevent fluid stagnation and the formation of edema);
  • take a contrast shower or bath;
  • engage in physical therapy.

Exercises for muscle development

Physical techniques will help prevent muscle atrophy, prevent the development of congestion, help improve blood supply and cell nutrition, and strengthen the muscular-ligamentous system.

During the rehabilitation period, patients are prescribed to perform the following set of physical exercises:

  • bring your legs together, then raise the injured leg to the maximum possible height (body position - lying on your stomach);
  • lie on your back, bend your healthy leg with support on the floor, raise the sick one to knee level first;
  • turn on your side, lift the injured limb and fix it at an angle of 60 degrees.

To achieve a positive result from such gymnastics, classes should be carried out regularly.

Contraindications

Limb prosthetics is contraindicated when diagnosing:

  • pathologies of respiratory and cardiac activity;
  • renal failure;
  • inability to control the prosthesis.

Features of choice

A leg prosthesis must be selected taking into account the individual structural characteristics of the limbs, the level of activity and the age of the patient. Today, the most used are modular, bionic prostheses. Foreign-made devices stand out for their quality, rich functionality and ease of use:

  • Symbionic Leg;
  • Proprio Foot;
  • Endolite Linx;
  • Genium;
  • C-Leg;
  • Genium X3;
  • Rheo Knee;
  • Orion 2.

Price

To estimate how much a prosthesis will cost, you need to take into account its model, functionality, country and manufacturer.

On average, modular prostheses in Moscow can be purchased at a cost of 150 to 180 thousand rubles.

Bionic models are more expensive, their price ranges from one and a half to two and a half million Russian rubles.

In foreign countries, such an operation will cost more.

Care

Basic rules for caring for a prosthetic device include:

  • maintaining cleanliness;
  • damage prevention;
  • avoiding excessive moisture;
  • storage of the prosthesis in certain temperature conditions (installed according to the instructions; this is especially true for high-tech models).

Proper operation and storage of the prosthesis will allow it to increase its service life.

An artificial limb replacement will help a person return to normal life in society: study, work and even play sports. It provides the opportunity for full existence and development, and allows you to quickly recover from the physical and mental trauma associated with the loss of a limb. In order for the recovery process to be successful and go faster, you need to select a prosthesis based on the individual characteristics and physical capabilities of the patient’s body.

A limb prosthesis is a device that replaces missing parts and serves to compensate for cosmetic and functional defects.

Therapeutic and training prosthetic limb

Sometimes they say “training” prosthesis, but this is not an entirely accurate definition. The purpose of prescribing a therapeutic and training prosthesis is, firstly, actually learning to walk, secondly, the further formation of the final morphological parameters of the stump, and sometimes the completion of the development of joint contracture. During the formation of the final volumetric dimensions of the stump, the need arises to change the socket of the prosthesis. As a rule, this is also an integral part of the entire process of primary prosthetics. Among the design features of the therapeutic-training prosthesis, only the absence of cosmetic lining should be noted. Otherwise, this is a product for which all the usual requirements are met.

Permanent prosthetic limb

This is the final version of the prosthetic and orthopedic product. It is intended for use after completion of primary prosthetics or for repeated prosthetics.

Primary permanent prosthesis. Sometimes, due to certain circumstances, a patient may be prescribed a permanent prosthesis without prior appointment of a therapeutic and training prosthesis. From the point of view of efficiency, this method of prosthetics is far from the best and is used relatively rarely, as a rule, when it is clear that a stage-by-stage change of the socket is not required. Such situations sometimes arise with atrophy of the stump tissue. If the patient is not expected to actively use the prosthesis, it can be assumed that the volumetric parameters of the stump will not change for a relatively long time, and a primary permanent limb prosthesis is prescribed. However, we note once again that such cases are quite rare. As a rule, domestic and foreign prosthetists prefer the tactics of therapeutic and training prosthetics.

What affects the effectiveness of a prosthetic limb?

When considering the general principles of prosthetics, one cannot ignore the consideration of factors that determine the effectiveness of prosthetic and orthopedic care.

  • Firstly, this is the patient's health condition. Patients with limb ischemia, as a rule, have severe concomitant cardiovascular pathology - coronary artery disease, cardiac arrhythmias, arterial hypertension, cerebrovascular disease. Since one of the main etiological factors leading to diabetes are complications of diabetes mellitus, they often determine the general condition of the patient. Orthopedic pathology is quite widespread, primarily of large joints. Taking into account the age characteristics of this contingent of disabled people, the prevalence of other concomitant diseases is high, one way or another limiting the possibilities of prosthetics. The state of the patient’s mental health, as well as his personal characteristics, are of great importance.
  • Secondly, an equally significant factor is the condition of the stump itself - its “suitability” for prosthetics. We can quite agree with the thesis: “a bad stump cannot be improved by the best prosthetic limb.”
  • Thirdly, the technological factor is of undoubted importance, i.e. those aspects that are related to the methodological technical sections of the manufacture of prosthetic and orthopedic products. Even if a prosthetic limb is not able to “improve” the stump in any way, then it is absolutely capable of compensating for its shortcomings. An example, in particular, is “prosthetics taking into account contracture” of the hip or knee joint.

It must be said that the importance of all these factors is fully realized in the process of prosthetics, which is not only the most significant, but also the most complex section of prosthetic and orthopedic care for this group of disabled people.