The development of Medial hip joint system for reconstruction of paraplegic locomotion

我们一直在开发一种名为内侧系统的矫形系统，用于重建截瘫患者的站立和行走。该系统由内侧单髋关节(MSH)和双侧膝-踝-足矫形器(KAFO)组成，克服了日常使用中矫形器笨重、紧凑的缺点。1.为了进一步完善我们正在开发的改进型MSH(Primewal^R)，我们在关节上增加了铰链机构，允许内外旋转10度。有了这种机制，患者似乎比没有这种机制更容易转向。2.在KAFO下站立，双膝必须以伸展姿势锁定。但这对患者来说是一项非常艰巨的任务。为此，我们研制了MSH-KAFO屈曲站立伸膝辅助装置。该装置由强度为0.56 kg m的螺旋弹簧制成，患者(Th10，Frankel A)使用该系统可以从双杠轮椅上站起或与步行者一起站起来。3.为了明确MSH-Kafo的损伤程度，我们调查了24例MSH-Kafo进行站立和行走锻炼的患者。颈椎损伤患者可以在康复室一名理疗师的协助下站立和行走。胸段脊柱损伤患者可自行使用Walker或Lofstrand拐杖行走，或在一名理疗师的最低限度协助下行走。对于不同损伤程度的不完全性截瘫患者，采用MSH-KAFO进行站立和步行锻炼，从康复早期和实际行走阶段开始，效果良好。

We have been developing the orthotic system called the medial system for reconstruction of paraplegic standing and walking. This system consists of a medial single hip joint (MSH) and bilateral knee-ankle-foot orthoses (KAFO) and overcomes the orthotic demerits of bulkiness and tightness in daily using. 1. For further refinement of our developing modified MSH (Primewalk^R), we added hinge mechanism to the joint permitting internal and external rotation ranging of 10 degrees. With this mechanism patients seemed to turn more easily than without it. 2. Standing up under KAFOs, bilateral knees must be locked with extension position. But it is very difficult task for patients. So we developed the MSH-KAFO with the assistive device for extension of knee standing up from the flexure position. The device is made with coiled spring which strength is 0.56kg m. The patient (Th10, Frankel A) could become to stand up from wheel chair in parallel bars or with walker using this system. 3. To clarify the effect of MSH-KAFO according to impairment level, we investigated 24 cases who have exercised standing and walking with MSH-KAFO. Patients with cervical spinal injury could stand and walk with assist of one physical therapist at rehabilitation room. Patients with thoracic spinal injury could walk with walker or Lofstrand crutches by themselves or minimum assist of one physical therapist. For incomplete paraplegics of various impairment levels, standing and walking exercise with MSH-KAFO was effective from early stage of rehabilitation and practical walking.