PROSTHETICS (fr. prothese, from grech, prosthesis accession, addition) — the type of the medical help to patients and disabled people providing with their various prostheses and orthopedic products as for completion of anatomic defects (at the final stage of medico-social rehabilitation), and with the medical purpose (at stages of recovery treatment).
Organizers of prosthetic matter in our country are G. A. Albrecht, G. I. Turper, R. R. Vreden, N. N. Burdenko, N. N. Priorov, M. I. Sitenko, M. O. Friedland, etc.
P. and the subsequent employment of patients and disabled people in the USSR carry out bodies of health care, social security and education. This function concerning disabled veterans, armies, work, disabled people from the general diseases, disabled from childhood and merit pensioners carry out bodies of social security due to the state allocations; members of artels of producers' cooperation receive appropriate assistance at the expense of means of cooperative insurance, collective farmers and members of their families — at the expense of means of collective farm.
In medical departments of the prosthetic and orthopedic enterprises the account and medical examination of the fitted a prosthesis adults and children are organized, and also quality control of adjustment of prostheses, if necessary using rentgenol, researches is carried out. All this allows to make timely changes to a design of a product and to carry out its further improvement. For service of the disabled people living in the areas remote from the prosthetic and orthopedic enterprise there are special mobile workshops equipped in cars and completed medical and technicians.
Prostheses gather on the prosthetic and orthopedic enterprises located in the republican and regional (regional) centers from the ready nodes and details arriving from the plants on production of prosthetic semi-finished products. Designs of prostheses, devices and orthopedic footwear develop scientific research institute of prosthetics and design groups of companies of the practical Item. The leading role in P.'s process belongs to the orthopedic surgeon (a right choice of a prosthesis taking into account specific features, the nature of defect and the course of a disease); the big contribution to improvement of prosthetic business is made by engineers, master prosthetists, and also the disabled people using prostheses and orthopedic products.
In modern designs of prostheses different types of drive systems — mechanical, pneumatic, electric are used (see Prosthetics bioelectric) that gave the chance considerably to increase not only their functionality, but also serviceability.
Distinguish anatomic and medical P. K to anatomic carry P. of joints (see. Endoprosthesis replacement ) and extremities (see. Prostheses ), teeth and jaws (see. Dentures ), eyes (see. Prosthesis eye ), and also creation of epitez (auricles, nose, fingers, mammary glands, etc.); to medical — providing patients with corsets and orthoses (see), orthopedic footwear (see) to lay down. bandages (see), etc. A specific place is held by acoustical P. (see. Hearing aid ).
P.'s process extremities includes a number of stages: the choice of a design of a prosthesis, removal of a measure, production of a plaster negative and positive of a stump, assembly of a prosthesis to fitting, fitting, refinishing, delivery of a prosthesis and training in use of it. Later inspections of the patient the doctor of medical department of the prosthetic and orthopedic enterprise establishes a design of a prosthesis taking into account age, sex, weight, the general condition, a profession of the patient, time which passed from the moment of amputation and features of a stump. At removal of a measure produce plaster model with modeling of bone ledges and a marking of healthy places. Except production of plaster negatives, and then and positives, carry out the drawing of contours of a stump and healthy extremity for exact adjustment of sleeves, the correct arrangement of tires and hinges of a prosthesis.
P.'s success of extremities depends on a state and readiness of a stump — its length, a tone and force of muscles, absence or existence of malformations and diseases (see the Stump of an extremity), an emotional and strong-willed spirit and the general condition of the disabled person, quality of production (the weight of a product, ways of management of it and designs of its fastening, a kosmetichnost and esthetics of a prosthesis) and individual adjustment of a product, proficiency of the patient to use of a prosthetic and orthopedic product and extent of development of compensatory reactions. Especially fully compensation is shown at development of adaptation in patients with inborn deformations of extremities. At the acquired defects of extremities or dysfunction of extremities elaboration of adaptive reactions of an organism demands considerable time and usually does not reach such level, as at inborn deformations.
Need early medical by P. Tolko at the same time is conventional there is a rational compensatory reorganization of a motive stereotype that promotes recovery of a physical activity and working capacity. Therefore distinguish primary and repeated P. Pervichnoye P. is carried out on 14 — the 21st days after amputation of an extremity. At an inborn malformation of an extremity it should be seen off at the age of 1 — 2 years. Repeated P. at adults is appointed in process of wear of a prosthesis; at children up to 7 years the prosthesis is changed annually, and in the subsequent — in process of growth of the child.
In some cases P. of the lower extremity (express prosthetics) can be made on the operating table directly after operation of amputation or reamputation (see) extremities. P.'s idea directly after operation (express prosthetics) belongs to Marten (F. Martin, 1914). Further development of this method P. is connected with Berlemon's works (M. Berlemont) and Weiss (M. Weiss). In the USSR A. A. Korzh and V. A. Berdnikov (1968), V. G. Sanin (1970) were such P.'s pioneers. The technique of express prosthetics consists in the following. Later amputations (see) or reamputations (see) the lower extremity insert two drainages into a wound and cover area of seams with a sterile bandage. Put on a sterile cotton cover, then the cover from pure unsterile polyurethane foam found in a shape of a stump with openings for a conclusion of drainages a stump. Over covers impose under a nek-eye a tension two layers of plaster bandage, pilots, the airfield and places of a permissible load carefully model. Then plaster bandage attach in advance prepared prosthesis. Advantages of this method P. are the positive psychological effect, decrease in probability of development of postoperative hypostasis of tissues of stump and its muscular atrophy in connection with an early rising and walking on a prosthesis, completion of process of P. in shorter terms. Express prosthetics is not shown at advanced age, and also at diseases of the main vessels of extremities.
Absolute contraindication to P. are cardiovascular diseases in stages of a decompensation, severe forms of defeat of c. N of page, the progressing forms of muscular dystrophy. To relative, or temporary, contraindications should carry diseases and defects of a stump demanding preliminary conservative treatment or reconstructive and recovery operations (see. Stump of an extremity ).
Bibliography: See bibliogr, to St. Prostheses , orthopedic products.
N. I. Kondrashin.