EP0535513A1 - Guide means for the treatment of the lower limbs - Google Patents

Abstract

A guide means (1) is intended, in particular, for the post-operative treatment of a hip joint and, where appropriate, of a knee joint. It has a moving arm (4) extending roughly in parallel with the patient's leg and having pivoting joints (17 and 19) beside the hip joint and the knee joint. On the end near the foot, a support (13) for the foot and the calf is arranged on a transverse extension arm (15), the support being pivotable to and fro by means of a pivoting joint (12) about a pivoting axis (14) extending longitudinally through the stretched leg for a rotary movement of the leg. The pivoting joint (17) is intended for a bending movement of the hip and the pivoting joint (19) is intended for a bending movement of the knee. There is a further pivoting joint (8) for a leg-spreading movement. The pivoting joints are driven by a motor. <IMAGE>

Description

The invention relates to a movement splint for in particular postoperative treatment of a knee and / or hip joint, with a foot or lower leg support and an associated movement arm, which has a swivel joint for a flexion-stretching movement in the hip joint and a swivel joint for a flexion movement of the knee joint .

Movement rails with which knee bend movements can be carried out are already known. These knee exercise splints either only allow movement of the lower leg relative to the thigh or also a lying movement for lying patients, in which a hip flexion movement also takes place.
For movement exercises in the knee area, where simple bending and stretching movements are involved, such movement rails meet the requirements.
When used as a movement rail for the hip joint, these movement rails can only be used to a very limited extent. The hip joint is a ball joint with much more complex movement options, which cannot be taken into account with the known movement rails.

The object of the present invention is to provide a movement rail of the type mentioned at the outset which enables training in which the leg movements can be coordinated with practically all movement coordinates predetermined by the hip joint. The movement rail should be simple in construction and also easy to handle.

To solve this problem, the invention proposes in particular that the movement arm is rotatably mounted about a pivot axis which extends approximately at right angles to the body plane in an extension through the hip joint for a leg spreading movement or a abduction and adduction and / or that the foot or lower leg support on foot-side end of the movement arm about a pivot axis oriented in the longitudinal direction of the movement rail is movable for a rotational movement of the leg and that motor-driven swivel joints are provided for the movements of the exercise rail.

In addition to the flexion movement in the hip joint, this movement rail also allows leg-spreading movements or leg-rotating movements, at least the bending and spreading movements as well as the spreading and rotating movements also being able to be carried out in combination. This also allows complex motion sequences to be simulated. This contributes significantly to the faster attainment of mobility after operations in the hip joint area.

The movement arm is expediently connected to a holder which preferably has a clamping piece or the like for fastening the holder to a bed frame.
This means that a separate support frame is not required, which significantly reduces the overall effort.
The movement rail can be attached to an existing bed frame, this being either right or can be done on the left. This is particularly important in the case of postoperative treatment of patients, since the patients can remain in bed for the movement exercises, so that awkward and sometimes painful laying can be avoided.

An advantageous further development of the invention provides that the swivel joints can be adjusted to the joint axes of the hip or knee to be treated in such a way that their joint axes are aligned with the corresponding joint axes of the patient.
This exact adjustability or alignability of the swivel joint axes of the movement rail to the movement axes of the hip joint and also of the knee joint prevents tensile and / or pushing forces which otherwise act on these joints and result from compensatory movements. Unwanted "side loads" are kept away from the joint so that movement exercises can be started much earlier after an operation.

Additional embodiments of the invention are listed in the further subclaims. The invention with its essential details is explained in more detail below with reference to the drawings.

Fig. 1

eine perspektivische Ansicht einer Bewegungsschiene für Hüftbeuge-,Spreiz- und Rotationsbewegungen sowie für Kniebeugebewegungen,

Fig. 2

eine perspektivische Ansicht einer Bewegungsschiene für Hüftbeuge- und Rotationsbewegungen sowie Kniebeugebewegungenm,

Fig. 3

eine etwa Fig. 1 entsprechende Ansicht, hier jedoch mit einem Fahrgestell und einer Oberschenkelauflage und

Fig. 4

eine Seitenansicht einer Oberschenkelauflage.

It shows:

Fig. 1

a perspective view of a movement rail for hip flexion, spreading and rotational movements and for squat movements,

Fig. 2

a perspective view of a movement rail for hip flexion and rotational movements as well as knee flexion movements,

Fig. 3

a view corresponding to Fig. 1, but here with a chassis and a thigh support and

Fig. 4

a side view of a thigh pad.

A movement rail 1 shown in FIG. 1 is used to treat a hip joint in particular in the form of movement exercises.
For clarification, a leg 2 is shown in the movement rail 1, only the hip joint part located on the femur 3 being shown of the hip joint.

The movement rail essentially has a two-part movement arm 4 with a lower part 4a and an upper part 4b and a holder 5.

In the exemplary embodiment shown in FIG. 1, the movement rail 1 can perform a hip bending movement according to the double arrow Pf1, a spreading movement according to the double arrow Pf2, a rotational movement according to the double arrow Pf3 and a knee bending movement according to the double arrow Pf4.
For the leg spreading movement (abduction and adduction), the movement arm 4 is rotatably mounted about a pivot axis 6 which runs approximately at right angles to the body plane or to the body support plane and through the hip joint. In Fig. 1, this pivot axis 6 is shown in dash-dotted lines extended to the center of the hip joint.
In order to enable this movement, a swivel joint 8 is attached to the free end of the holder formed here by an angle bracket 7, on the output shaft 9 of which a second angle bracket 10 engages. The pivot axis 6 runs through the output shaft 9.

At the other, lower end of the bracket 10, the movement arm 4 is attached. If the drive 11 of the swivel joint 8 is now switched on, the entire movement arm 4 is swiveled with its foot end toward the outside according to the arrow Pf5. Thus, the leg 2 held by the movement arm 4 can be spread outwards and also pivoted back into its starting position.

At the lower end of the movement arm 4, its lower part 4a is connected via a swivel joint 12 to a foot and lower leg support 13 which, in the exemplary embodiment, is half-shell-shaped for inserting the foot or lower leg. If necessary, further fastening means for the leg could also be provided here. It is also possible to provide a thigh support, which is then connected to the upper part 4b of the movement arm.

The swivel joint 12 has a swivel axis 14 oriented in the longitudinal direction of the movement rail, which runs longitudinally through the straight leg and goes through the hip joint pivot point. The swivel joint 12 is attached to a cross arm 15 which is connected at an angle to the lower movement part 4a.
A motor drive 11 is also present in this swivel joint 12. If this is set in motion, the foot and lower leg support 13 is rotated and thus the leg is also rotated. As is preferably the case with all other swivel joints, an adjustable swivel limiter 16 is also provided here, on which the swivel angles provided for the movement exercises can be set.

A swivel joint 17 with one is located laterally on the outside next to the hip joint on the upper movement arm part 4b Drive motor 11 having drive unit. The associated pivot axis 18 runs through the hip joint in its extension. In Figures 1 and 2 it can also be clearly seen that the three axes of movement 6, 14 and 18 for the hip joint movements in their extension form an intersection which lies exactly in the center of rotation of the hip joint. The exemplary embodiment does not show in more detail how the position of the individual swivel joints 8, 12 and 17 can be changed. This can be achieved, for example, by the telescopic design of the holding parts, as can be seen in the movement arm parts 4a, 4b. This alignability of the swivel joints exactly on the hip joint is of essential importance, because this allows compensatory movements and corresponding, undesirable loads on the hip joint to be avoided.

When the swivel joint 17 is actuated, the entire movement arm 4 and thus the leg 2 held by it is raised. Since such a hip flexion movement is only possible to a very limited extent when the leg is stretched, a knee bend swivel joint 19 is also provided. Since the hip flexion movement and the knee flexion movement normally interact, the two swivel joints 17 and 19 can be coupled to one another for synchronous flexion movements. In the exemplary embodiment according to FIG. 1, the upper movement arm part 4b is designed as a tube in which a drive transmission, for example in the form of a drive shaft, is located between the swivel joint 17 and the swivel joint 19. A transmission gear 20 belonging to the drive unit is provided in the swivel joint 19, this transmission and the transmission transmission 21 of the swivel joint 17 having a common motor drive 11. This is expediently arranged directly at the swivel joint 17 for the hip flexion movement.

The housing 22 of the transmission gear 20 is connected to the upper arm 4b, while the output shaft 23 is connected to the lower arm 4a.
In the swivel joint 17 for the hip flexion movement, the transmission gear 21, as already mentioned, forms a drive unit together with the drive motor 11. This is connected to the upper movement arm part 4b and its output shaft 24 is connected to the angle bracket 10.

The output shafts 9 of the swivel joint 8, the output shaft 24 of the swivel joint 17 and the output shaft 25 of the swivel joint 12 can be aligned in such a way that the associated swivel axes 6, 18, 14 are at right angles to one another and their intersection point is in the center of the hip joint.
The pivot axis 26 running through the output shaft 23 of the swivel joint 19 runs approximately parallel to the swivel axis 18 of the swivel joint 17.

To adjust to different leg lengths, the two movement arm parts 4a and 4b are designed to be adjustable in length. For this purpose, they have telescopically interlocking square tube sections which can be locked in the respectively set position by means of clamping screws 27 or the like.

As with the swivel joint 17, motor-gear units are also present as drives for the swivel joints 8 and 12. These drives each include a preferably self-locking gear, for example a worm gear, which is connected to the drive motor 11. The housings of the drive units have fastening connections (not shown in more detail here) and the rotary drive 9, 24 and 25 in each case Maintain movement rail so that it can also serve as a support rail.
A complete drive unit with gear and drive motor 11 could also be provided in the case of the squat swivel joint 19. However, since, as already mentioned, a synchronous movement with the hip swivel joint 17 is generally provided here, a drive connection to the drive unit of the swivel joint 17 is sufficient.
FIG. 2 shows a variant of the drive transmission between the transmission gears 21 and 20. Instead of a shaft within the upper movement arm part 4b as used in the exemplary embodiment according to FIG. 1, a Bowden cable transmission 28 is provided in this embodiment.
The drive units at the swivel joints 8, 17, 12 and optionally also 19 are preferably connected to a control device, not shown here, which in particular has a programmer for presettable movement sequences. The end positions of the respective movements can be preset with the aid of the swivel limits 16 provided in the drives.

In the exemplary embodiment, the holder 5 for the movement arm 4 has a clamping piece 29 for fastening to a side rail 30 of a bed frame 31. The clamping piece 29 is designed so that it can be moved longitudinally on the side rail, so that a first alignment of the movement rail with the position of the patient can take place. The clamping piece 29 can be implemented for the treatment of the right hip joint and connected to the opposite bed frame side member 30. When moving, the part engaging the output of the swivel joint 17 (FIG. 2) or the output 9 of the swivel joint 8 (FIG. 1) is in each case rotated by 180 ° in its rotational position.
If only hip flexion movements and rotational movements of the leg are provided, the movement rail 1a according to FIG. 2 used. In this case, the bracket 7a is connected directly to the output shaft 24 of the swivel joint drive 17.
However, if, as shown in FIG. 1, a leg spreading movement is also provided, there is still the further swivel joint 8 for the leg spreading movement according to the double arrow Pf2 and between this swivel joint 8 and the swivel joint 17 between the end of the angle bracket 7 and the swivel joint 17 remote from the fastening the transmission angle bracket 10. The output shafts 9 and 24 are arranged at right angles to each other.

Except for the rotational movement with the help of the swivel joint 12, which is only carried out in the extended position of the leg, the other intended movements can take place individually and in combination with one another. Provided the leg is stretched, the rotational movement can also take place together with the spreading movement or else a hip flexion movement performed in the stretched position.
The rotational movement is preferably carried out with the leg raised by about 30 ° in the extended position.
The drive units of the swivel joints themselves form the swivel joints in the exemplary embodiments.
As shown in FIG. 3, the holder 5 can also be attached to a support frame, preferably a chassis 32, which can then be positioned next to or under the patient bed. During the treatment, the (undercarriage) frame or the holder 5 can be connected to the bed by means of the clamping piece or can be locked thereon. The bracket 5 is connected via an underside extension 34 to an approximately H-shaped base frame 35, on which four castors 36 are attached.
The undercarriage is particularly advantageous if the movement rail is to be used for several patients, for example in a clinic after treatment of a patient, the device can be easily moved to another patient. You get a mobile, easy-to-use device in connection with the chassis.
FIG. 4 also shows the thigh support 33 which can also be seen in FIG. 3. The support shell 37 is connected via a holding piece 38 to a connecting bracket 39, the other end of which engages with a clamping piece 40 connected to the upper part 4b of the movement arm 4.
By loosening the clamping screw 41, the connecting bracket 39 can be pivoted in accordance with the double arrow Pf 6 for a height or position adjustment of the support shell 37, wherein a position compensation can be carried out by pivoting the shell itself according to the arrow Pf 7 in the holding piece 38.
All the features shown in the description, the claims and the drawing can be essential to the invention both individually and in any combination with one another.

Claims (15)

Movement splint for in particular postoperative treatment of a knee and / or a hip joint, with a foot or lower leg support and an associated movement arm, which has a swivel joint for a flexion-stretching movement in the hip joint and a swivel joint for a flexion movement of the knee joint, characterized in that the movement arm (4) is rotatably mounted about a pivot axis (6) which extends approximately at right angles to the body plane in an extension through the hip joint for a leg spreading movement or an abduction and adduction and / or that the foot or lower leg support (13) is at the foot end the movement arm (4) can be moved about a pivot axis (14) oriented in the longitudinal direction of the movement rail (1,1a) for a rotational movement of the leg (2) and for motor-driven swivel joints (8, 12, 17, 19) for the movements of the exercise rail are provided. Movement rail according to claim 1, characterized in that the movement arm (4) is arranged approximately parallel to the leg to be moved and is divided in the knee area and has a swivel joint (19) for the knee bending movement which can be positioned laterally of the knee area. Movement rail according to claim 1 or 2, characterized in that the movement arm (4) is connected to a holder (5) which preferably has a clamping piece (29) or the like for fastening the holder to a bed frame (31). Movement rail according to claim 3, characterized in that the holder (5) has an angle bracket (7, 7a) or the like attached to the clamping piece (29), on the latter free, in particular over a support for the patient protruding end either the hip bend pivot joint (17) or the leg spread pivot joint (8) is attached. Movement rail according to one of claims 1 to 4, characterized in that on the swivel joint (8) attached to the end of the angle bracket (7) for the spreading movement of the leg, a further second angle bracket, which is approximately parallel to the first angle bracket (7) in the starting position (10) is attached, the other end of which carries the swivel joint (17) for the hip flexion movement. Movement rail according to one of claims 1 to 5, characterized in that the drives of the hip flexion swivel joint (17) and the squat swivel joint (19) are coupled to one another for synchronous flexion movements. Movement rail according to claim 6, characterized in that a shaft or the like or Bowden cables (28), which is preferably guided within the upper part of the movement arm (4b), is provided as the drive connection between the hip flexion swivel joint (17) and the squat swivel joint (19). Movement rail according to claim 6 or 7, characterized in that the common drive motor (11) for the hip bend swivel joint (17) and the knee bend swivel joint (19) is arranged at the hip bend swivel joint (17). Movement rail according to one of Claims 1 to 8, characterized in that the movement arm (4) or its swivel joint (19) on both sides of the squat joint (19) is arranged Arm parts (4a, 4b) are adjustable in length and preferably consist of telescoping interlocking and lockable parts. Movement rail according to one of claims 1 to 9, characterized in that the swivel joints (14, 17, 19, 12) can be adjusted to the joint axes of the hip or knee to be treated in such a way that their joint axes (6, 14, 18, 26) each align with the corresponding joint axes of the patient. Movement rail according to one of claims 1 to 10, characterized in that the drives for the swivel joints each have a self-locking gear, preferably a worm gear, which is connected to an electric motor (11). Movement rail according to one of claims 1 to 11, characterized in that the drives are connected to a control device, which preferably has a program generator for pre-settable movement sequences, and that the drives optionally each have a position transmitter for position feedback to the control device and that, if necessary, the swivel drives on the Swivel range or rotation range of a leg have approximately coordinated swivel limits (16), for example end stops and / or possibly limit switches or the like, or slip clutches. Movement rail according to one of claims 1 to 12, characterized in that the drives have a housing with a fastening connection and a rotary drive and each itself simultaneously form the swivel joint. Movement rail according to one of claims 1 to 13, characterized in that the holder (5) is connected to a support frame, preferably a chassis (32). Movement rail according to one of claims 1 to 14, characterized in that a preferably height-adjustable and pivotable thigh support (33) is attached to the upper movement arm part (4b).

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