Knee joint simulator for practicing intra-articular punctures

Abstract

FIELD: medical equipment.SUBSTANCE: knee joint simulator for practicing intra-articular punctures includes bone (6, 10, 11), ligament (12) and muscle (5) structures of the knee joint. The simulator is made with nine isolated areas of the knee joint: in the deep infrapatellar bursa, in the pes anserinus bursa, in the suprapatellar bursa, in the patellar ligament, in the lateral and medial cavity of the joint, in the medial and lateral entheses of the femur (6) and the lateral enthesis of the fibula (10). Each of the areas contains a contact pad in the form of a plate with a connection to an electronic indication system. The indication system includes a DC source, a common bus connected to a conductive probe, and nine parallel indication circuits. Each circuit includes a series-connected indicator light (1), a current-limiting resistor and one of the specified contact pads. The indication system is designed with the ability to close an electrical circuit when the conductive probe comes into contact with the plate. The conductors (9) from the contact pads are combined into a bundle and led out through a hole in the bone model (6, 10, 11) and the muscle frame (5) to the indicator unit.EFFECT: increased accuracy of training and development of skills for puncture of specific anatomical structures of the knee joint is achieved.7 cl, 4 dwg, 1 ex

Description

[0001] The invention relates to simulators, specifically medical training devices. It can be used in the educational process at medical schools, in residency programs, and in advanced training courses for traumatologists, surgeons, and rheumatologists.

[0002] According to literature, the rate of iatrogenia in knee joint puncture worldwide is up to 5% of cases, this is due to the insufficient qualifications of the specialist.

[0003] A high-quality model for practicing intra-articular knee injections (with an electronic unit) from Uchmedposobie (https: / / uchmedposobie.ru / product / vysokokachestvennaya-model-dlya-otrab-4 / ). This simulator is anatomically identical to the adult knee joint and features precise landmarks for joint puncture. The sensation of the puncture and the passage of the needle through the tissue are realistic. The disadvantages of this simulator include the presence of a single joint capsule without division into isolated anatomical structures, making it impossible to objectively assess the accuracy of needle insertion during practice.

[0004] Another similar device is the INJART-KNEE simulator for practicing intra-articular injections into the knee joint (https: / / spb-maneken.ru / katalog / trenazhery-vnutrisustavnykh-inektsiy / 1740 / ). This simulator represents an anatomically accurate adult knee joint with clear landmarks for intra-articular injections. The disadvantages of this simulator include the presence of a single joint capsule without division into isolated anatomical structures, and the inability to objectively assess the accuracy of needle insertion during practice.

[0005] Currently, the closest analogue of the simulator is the DM-CS6263 trainer for practicing skills in performing intra-articular injections into the knee joint (https: / / www.medtex.nnov.ru / trenazher-vnutrisustavnoj-inekczii-v-kolennyij-sustav-dm-cs6263.htm?ysclid=mg1lhemy1e354156004).

[0006] This simulator has several advantages: its precise anatomical structure allows for the identification of joint puncture landmarks that correspond to real ones. The injection site can be highlighted before the procedure. During needle insertion, the correctness of the procedure can be monitored by withdrawing fluid simulating synovial fluid from the joint cavity or injecting it into a single bursa and withdrawing it through special tubes that drain the fluid. The main disadvantages of this simulator are the single joint bursa, not being divided into isolated anatomical structures, which prevents the development of injection techniques for enthesitis or isolated bursae of the knee joint. Furthermore, it is impossible to objectively assess the correct insertion of the needle and its depth of penetration during the procedure.Our model features 9 of the most relevant and popular sites, connected to LED sensors that illuminate when the target anatomical area is reached, and an audible alert is emitted, allowing for objective assessment of the correct execution of the technique. It is also possible to perform an injection in a closed circuit.

[0007] The technical objective is to improve the qualifications of residents and facilitate the process of teaching medical students intra-articular manipulations on the knee joint using a knee joint simulator for practicing intra-articular punctures by creating an objective tool for monitoring the accuracy of needle insertion through immediate light indication.

[0008] The anatomical and functional knee joint simulator (hereinafter referred to as the simulator) is completely anatomically identical to the human left knee joint and can be used in the training of students and residents of medical specialties. The simulator fully replicates the range of motion in the knee joint, has 9 isolated, topographically precisely located anatomical structures - deep infrapatellar bursa, pes anserinus bursa, suprapatellar bursa, patellar ligament, lateral and medial joint cavities, medial and lateral entheses of the femur and lateral enthesis of the fibula, realistic anatomical structures - muscles, bones, ligaments, which are determined by palpation and during the advancement of the needle, which, when it hits one of the anatomical structures containing a copper tape, closes the circuit and the indicator lamp lights up, allowing you to determine whether the intra-articular puncture technique has been performed accurately, and an audible alert is also issued.The material, which imitates the skin, is waterproof, elastic and completely replaceable, and is similar in density to human tissue.

[0009] The simulator consists of a skin, muscle, and bone-connective framework. Figure 1 shows the rear view of the simulator.

[0010] 1. 9 LED indicators

[0011] 2. Model base in the form of a box

[0012] 3. Wire to conductive syringe

[0013] 4. Height-adjustable base legs

[0014] 5. Muscular frame

[0015] 6. Femur

[0016] 7. Imitation leather and polyester fiber

[0017] 8. Menisci

[0018] 9. Wires from 9 bags

[0019] 10. Fibula

[0020] 11. Tibia

[0021] 12. Screw simulating tibiofibular ligaments

[0022] 17. Power cord.

[0023] Figure 2 shows the front view of the Simulator:

[0024] 1. 9 LED indicators

[0025] 2. Model base in the form of a box

[0026] 3. Wire to conductive syringe

[0027] 4. Height-adjustable base legs

[0028] 14. Conductive syringe

[0029] 15. The external appearance of the simulator itself (imitation leather and PLC on top)

[0030] 16. Legend to LED indicators.

[0031] The skin frame (7) is palpably and visually identical to the skin and subcutaneous fat of the lower third of the thigh, 30 cm from the patella, knee joint, and lower third of the shin, 30 cm from the patella, of an adult. It replicates the folds of the skin by molding it to the muscle frame. The skin frame is easily removed and applied thanks to a glued-in zipper running along the back of the simulator and is not connected to the muscle or bone frames. It can be made of silicone mixed with beige, pink, and brown Pentelast-710 dye.

[0032] The muscle frame (5) is completely identical to the anatomical structures of the lower third of the thigh, knee joint and lower third of the lower leg. It repeats the structure and anatomy of the lower third of the thigh muscles: adductor magnus, gracilis, vastus lateralis, rectus femoris, vastus medialis, sartorius, semitendinosus, biceps femoris, semimembranosus, the upper third of the calf muscles: gastrocnemius muscles, posterior tibialis, peroneus longus, extensor digitorum longus, tibialis anterior. All muscles have a fibrous structure and are cast in a single block without the possibility of separation from each other. The muscle frame is not connected to the bone and skin frames and is freely removable. At the back there is an incision identical to the skin without a zipper. Can be made of silicone with an admixture of the red dye Pentelast-710.

[0033] The bone-connecting framework is represented by the lower third of the femur (6), 30 cm from the patella, the upper third of the tibia (11) and fibula (10), 30 cm from the patella, the patella, which completely repeat the anatomy of the bones of a large man. The femur, fibula and tibia are elastically connected to each other using instant glue and 8 steel springs 5 ​​cm long and 0.8 cm in diameter, simulating the ligamentous apparatus (anterior and posterior cruciate ligaments with 2 springs each, lateral and medial collateral ligaments with 2 springs each). The attachment points of the springs are pre-marked in accordance with the anatomical landmarks, the attachment points of the same ligaments of the knee joint, holes with a diameter of 0.9 cm and a depth of 1 cm are drilled using a drill and steel springs are inserted. The springs are fixed in the holes with instant glue.The springs are tensioned, ensuring the anatomical position and physiologically correct range of motion of the bones relative to each other. The patella is elastically fixed to the tibial tuberosity using one 5 cm long, 2 cm diameter spring. This spring is drilled and additionally secured with instant adhesive, simulating the patellar tendon. The patella is not fixed to the femur. The fibula and tibia are rigidly fixed to each other 20 cm from the knee joint using a 6 cm, 0.3 cm diameter screw, simulating the tibiofibular ligament. Between the articular surfaces of the tibia and femur are cast lateral and medial menisci, anatomically replicating the corresponding menisci of the knee joint. The menisci are rigidly fixed to the tibial surface using instant adhesive, without fixation to the femur, fibula, and patella.Bones can be made of two-component plastic Smooth-Cast ONYX Slow and Crystal Clear 220 in a 1:1 ratio.

[0034] The ligament component of the knee joint (medial and lateral collateral ligaments, anterior and posterior cruciate ligaments, patellar ligament) can be represented by 9 steel springs, 5 cm long, 0.8 cm in diameter. The menisci can be made of silicone with an admixture of pink dye Pentelast-710. At predetermined topographic points (deep infrapatellar bursa, pes anserinus bursa, suprapatellar bursa, patellar ligament, lateral and medial joint cavities, medial and lateral femoral entheses, and lateral fibular enthesis), copper plates are fixed onto the assembled bone-connective framework. The plates can be fixed, for example, using Cosmofen CA12 conductive adhesive (an adhesive conductive compound) to 0.2 mm thick copper contact plates. An insulated copper conductor is soldered to each copper plate.The wires from each anatomical region are carefully laid along the bony structures (9), grouped into a bundle, and brought posteriorly into the cavity of the future muscular frame through a hole created in the distal third of the femur. The soldering and wire routing areas are insulated with silicone sealant to prevent short circuits and mechanical damage.

[0035] The needle placement accuracy demonstration system consists of a copper wire soldered to the inner portion of a metal needle from a 20ml syringe, which is used in actual clinical practice for knee joint puncture. When any of nine anatomical structures (deep infrapatellar bursa, pes anserinus bursa, suprapatellar bursa, patellar ligament, lateral and medial joint cavities, medial and lateral femoral entheses, and lateral fibular enthesis) is punctured and the needle touches a 0.2mm-thick copper plate located in each anatomical structure, the system provides feedback and precise localization by completing the circuit and sending current from the copper plate to 12V diodes connected to a 12W power supply. This produces a visual response and audible alert.

[0036] A plywood box measuring 40 cm in width, 20 cm in depth, and 9 cm in height (2) is assembled and mounted on four height-adjustable furniture legs. The simulator is mounted along the right edge of the box using anchors. The wiring harness, routed along the back of the femur, is routed to the distributor inside the box through a pre-cut 2 cm diameter hole. Each wire is connected to the corresponding terminals on the electronic system's distribution board (distribution connector). The wire from the probe needle is connected to a different terminal on the distribution connector.

[0037] The electronic circuit of the device is a system of nine independent control circuits with a common power bus (Figure 3), built according to the following structure:

[0038] 1. LED indicators HL1-HL9

[0039] 21. Current-limiting resistors R1-R9

[0040] 20. Contact copper plates (sensors) installed in the corresponding anatomical structures (E1-Hl1, E2-HL2, …, E9-HL9)

[0041] 19. Power Supply 5V DC PS1

[0042] 14. Conductive probe (syringe needle with connected conductor)

[0043] • Power supply: 5V DC power supply is used as the power supply.

[0044] • Common bus: From the positive pole of the power source there is a common wire (the "positive" bus), which is connected to: the anodes of all nine indicator lights (HL1-HL9) and one of the contacts of the distributor connector (X1), to which the wire from the needle is connected.

[0045] • Target circuits: For each of the nine anatomical structures, an identical circuit is implemented, consisting of:

[0046] 1. Contact plate (sensor): a copper plate (designated as E1-E9) placed on the joint model at the location of the simulated anatomical structure (E1 - deep infrapatellar bursa, E2 - lateral enthesis of the femur, E3 - lateral enthesis of the fibula, E4 - pes anserinus bursa, E5 - lateral joint cavity, E6 - medial joint cavity, E7 - medial enthesis of the femur, E8 - suprapatellar bursa, E9 - patellar ligament)

[0047] 2. Conductor wire: The wire that connects this terminal plate to the control circuit.

[0048] 3. Current-limiting resistor: A resistor (R1-R9) connected in series in the circuit to limit the current through the indicator light and protect it from burning out.

[0049] 4. Indicator light: LED (HL1-HL9) or low-power incandescent bulb, providing visual feedback. The LED cathode is connected to its contact plate via a resistor.

[0050] • Probe (active electrode): a needle with a wire made of conductive material (steel, copper), connected to the common wire (power bus) through a distributor connector.

[0051] The user, after correctly performing a puncture of a certain anatomical area with a syringe with a needle connected to a common wire, touches the copper plate, closing the electrical circuit along the following path:

[0052] + Power supply -> Connector (X1) -> Needle -> Contact plate (Ex) -> Wire -> Resistor (Rx) -> LED cathode (HLx) -> LED anode -> - Power supply.

[0053] When the circuit is closed, current begins to flow through the HLx LED. The HLx LED corresponding to the given anatomical structure lights up, and an audible alert sounds, signaling the correct target identification. Figure 4:

[0054] 1. LEDs HL1-HL9

[0055] 22. Conductive wire leading from the LED to the contact plates

[0056] 3. Conductive wire leading to the probe

[0057] 17. 220V power cable

[0058] 18. Common bus

[0059] 19. 5V DC Power Supply

[0060] The objective of the invention is to create a knee joint simulator that allows for objective, real-world assessment of skill performance using a pinpoint electronic indicator system containing nine isolated contact zones. The technical result is improved accuracy in training and practicing puncture skills for specific anatomical structures of the knee joint.

[0061] An example of the invention's use: a resident specializing in traumatology and orthopedics is tasked with puncturing the pes anserinus bursa on a knee joint simulator connected to a 220V power supply. He takes a special syringe with a needle connected to a common wire and inserts the needle into the anatomical region. The sensation of puncturing the skin and further passage of the needle through the muscle is similar to the actual sensation of performing the procedure on a patient. As the needle advances deeper, the resident feels a dip and touches a copper plate in the projection of the pes anserinus bursa. At this moment, the electrical circuit closes, a diode lights up, indicating this anatomical structure, and an audible signal sounds. This allows the instructor and students to objectively assess the correctness of the skill.

[0062] During the first simulator training session with 12 residents specializing in traumatology and orthopedics, only 50% of knee joint lesions were correctly punctured. After a month of practical training on the knee joint simulator, this figure increased to 80%.

Claims

1. A knee joint simulator for practicing intra-articular punctures, including bone, ligament and muscle structures of the knee joint, characterized in that it is made with nine areas of the knee joint isolated from each other: in the deep infrapatellar bursa, in the pes anserinus bursa, in the suprapatellar bursa, in the patellar ligament, in the lateral and medial cavity of the joint, in the medial and lateral entheses of the femur and the lateral enthesis of the fibula, in each of which there is a contact pad in the form of a plate connected to an electronic indication system including a DC source, a common bus connected to a conductive probe, and nine parallel indication circuits, each of which includes a series-connected light indicator, a current-limiting resistor and one of the said contact pads, and configured to close an electrical circuit upon contact of a conductive probe feeler gauge with a plate,In this case, the conductors from the contact pads are combined into a bundle and led out through a through hole in the bone model and muscle frame to the indicator unit.

2. The simulator according to paragraph 1, characterized in that it additionally contains a base in the form of a box on which the simulator is installed, and in the base there are placed light indicators associated with each of the contact pads.

3. The simulator according to paragraph 1, characterized in that the ligament apparatus is designed with the possibility of modeling by means of elastic springs.

4. The simulator according to paragraph 1, characterized in that the skin covering is designed with the possibility of fixation on the muscle frame by means of a zipper.

5. The simulator according to paragraph 1, characterized in that the imitation skin is removable, elastic and waterproof.

6. The simulator according to paragraph 1, characterized in that the contact plates are made of copper tape with a thickness of 0.2 mm.

7. The simulator according to paragraph 1, characterized in that the electronic indication system is designed with the possibility of light indication and sound notification of hitting an anatomical formation.

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