EP1940337A1

EP1940337A1 - Device for angularly positioning a member of a patient lying on an operating table

Info

Publication number: EP1940337A1
Application number: EP06808187A
Authority: EP
Inventors: Alain Lacroix
Original assignee: Individual
Current assignee: Individual
Priority date: 2005-10-25
Filing date: 2006-10-09
Publication date: 2008-07-09
Anticipated expiration: 2026-10-09
Also published as: JP2009513209A; WO2007048892A9; DE602006010590D1; US20080289636A1; EP1940337B1; FR2892300B1; WO2007048892A1; US8020559B2; FR2892300A1; CA2625630C; CN101384236A; CA2625630A1; ATE448766T1

Abstract

The invention relates to a device for angularly positioning a member of a patient lying on an operating table (TO), comprising means for positioning a cradle (Be) supporting the member of the patient relative to lateral guide rails (RG1, RG2) of the operating table (TO). Said positioning means comprise: means (MS1, MS2, MS3) for fixing the cradle positioning means (Be) on either of the two lateral guide rails (RG1, RG2) of the operating table (TO), and; means for positioning this cradle (Be) along an axis (?3) contained in a plane parallel to that defined by the operating table (TO), and perpendicular to the principal axis (Δ) of the operating table (TO).

Description

DEVICE FOR THE ANGULAR POSITIONING OF A MEMBER OF A PATIENT BASED ON AN OPERATING TABLE.

The present invention relates to a device for the angular positioning of a limb of a patient resting on an operating table or on a treatment table.

It applies in particular, but not exclusively, to the positioning of a leg of a patient during a knee operation.

In general, it is known that in order to carry out such positioning, a support device has already been proposed, involving a jack whose rod supports an axis which extends transversely to the jack rod and carries a cradle intended to support the patient's leg. This arrangement of the various members shows a significant lateral torque formed by the weight of the supported leg and the length of the axis carrying the cradle. This torque being integrally applied to the cylinder head and its rod, quickly leads to deterioration and malfunction thereof. In addition, because of its position, this type of bar hinders the surgeon in performing his act and makes it difficult to use concomitant possible devices that may be useful.

There is also provided an apparatus comprising a cradle bar attached to the end of a crank coupled to the rod of a jack by means of a hinge so that the movement of translation of the cylinder rod causes a rotational movement of the cradle bar. This solution is unsatisfactory since the apparatus described is mounted on a side edge of the operating table and therefore, the patient's pelvis tends to tilt causing a movement of the knee that does not occur. not in a vertical plane parallel to the longitudinal axis of the operating table. This results in imprecision on the verticality of the leg and surgery on the knee.

In addition, a device has been proposed for adjusting the angular position of a patient's limb resting on an operating table comprising:

- A shelf provided on two opposite side edges of fixing means with adjustable spacing on the two lateral guide rails of an operating table, and - a gutter door mounted by one of its ends on a rotating transverse shaft carried by the tablet and rotated by a motorization through a connection allowing a translational movement of the gutter door while allowing its rotary drive by said shaft. This solution is unsatisfactory since the patient's pelvis tends to tilt causing a movement of the knee that does not occur in a vertical plane parallel to the longitudinal axis of the operating table.

The invention is more particularly intended to overcome these disadvantages with an apparatus that can be mounted on most operating tables currently used and which adapts to the morphology of patients, taking into account in particular the position of the hip joint; this apparatus also makes it possible to obtain better precision in the conduct of surgical procedures. For this purpose, the apparatus according to the invention comprises means for positioning a cradle supporting the patient's limb with respect to the lateral guide rails of an operating table or a treatment table, knowing that said positioning means comprise: - means for securing said cradle positioning means indifferently on one or the other of the two lateral guide rails of the operating table,

means for positioning said cradle along an axis contained in a plane parallel to that defined by the operating table, and perpendicular to the longitudinal axis of the operating table, which said means for positioning said cradle include: soleplate located in a plane parallel to that defined by the operating table, which soleplate can move parallel to itself in sliding connection with the aforesaid securing means, o a clevis, integral with the aforesaid soleplate, comprising a bearing shaft; rotation, located close to the upper part of said yoke, and whose axis is situated in a plane parallel to said soleplate and perpendicular to the longitudinal axis of the operating table, o an armrest, rotatably mounted around said rotation shaft and actuated in rotation in a plane perpendicular to said soleplate by a motor, disposed substantially parallel to the plane defined by the operating table o a slide, mounted integral with the aforesaid armrest, on the opposite side to the aforesaid motorization, and can guide a slide in a plane perpendicular to said sole, o an arm, integral with the aforesaid slide, whose main axis is parallel to the longitudinal axis of the operating table, a hub, whose axis is situated in a plane parallel to said soleplate and perpendicular to the longitudinal axis of the operating table, and slidable through said arm along the main axis of said arm, a shaft, rotatably mounted and translatable in the aforesaid hub, whose axis is collinear with the above axis of the hub, and supporting at one of its ends the aforesaid cradle.

With these provisions: the device according to the invention can be mounted on operating or treatment tables of varying width and thickness, either on one or the other of the two lateral guide rails of said operation or treatment table,

the shaft supporting the cradle has its axis perpendicular to the longitudinal axis of the operating table, which axis of said shaft is perpendicular to the vertical plane passing through the leg of the patient,

the tilting axis of the assembly consisting of the aforesaid armrest, the aforesaid arm, the aforesaid hub and the aforesaid shaft associated with the cradle, can be brought to the vicinity of the hip joint so that the effort applied by the cradle is evenly distributed on the thigh avoiding excessive compression of the organs (muscles, tendons, veins, arteries) of the thigh and any transverse tilting of the pelvis,

the adjustable length of the cradle is provided so as to avoid any effort under the knee of the patient at the level of the femoro-tibial joint and compression of the popliteal artery; advantageously, the cradle may consist of a fixed jaw secured to the shaft supporting the cradle and a movable sliding jaw, for adjusting the distance between the two jaws according to the morphology of the thigh. Advantageously, the aforesaid motorization for operating in rotation the aforesaid armrest may be disposed substantially perpendicular to the plane defined by the operating table, so as to allow the surgeon easier access to the patient.

Advantageously, the aforesaid rotation shaft, located near the upper part of said yoke, allowing the arm-holder to pivot, may include a bore, in order to accommodate a laser beam generator, of small size and low power or any another light beam generator, to allow the surgeon precise visual positioning of the axis of the aforesaid rotation shaft relative to the hip-femoral joint in the case of a knee operation.

Advantageously, the aforesaid means for securing said cradle positioning means indifferently on one or the other of the two lateral guide rails of the operating table may consist of a substantially vertical shaft integral with the sole of the cradle. apparatus according to the invention, slidable in translation and rotatable in rotation relative to a hub integral with one of the two side rails, so as to allow the surgeon to better position the patient's limb to be treated.

Advantageously, the aforesaid arm comprising the aforesaid slide guided by the aforesaid slide integral with the arm holder, can be actuated in translation by means of a screw / nut assembly, so as to allow the surgeon to accurately position the arm relative to the holder arm.

Advantageously, the cross section of the aforesaid slider of the aforesaid arm may be of similar shape to an omega and in correspondence of shape with the cross section of the aforesaid slide integral with the arm-carrier, in order to allow an angular deflection of both sides. other of a median position of the arm relative to the arm-carrier along the axis of symmetry of the section cross section in the shape of omega, so as to allow the surgeon to better position the member to treat the patient.

Advantageously, the aforesaid arm may not include a hub that can slide through said arm along its main axis; thus the shaft supporting the cradle, will be rotatably mounted and translatable to the end of the arm; several arms of different length can be envisaged, so as to avoid the surgeon to be hindered by the end of the adjustable arm in case it is necessary to position the shaft supporting the cradle near the armrest.

Advantageously, an aseptic cover covering the entire device according to the invention may be provided during the surgical operation; this cover may be disposable after each operation or may be reusable after sterilization.

One embodiment will be described below, by way of non-limiting example, with reference to the accompanying drawings in which:

FIG. 1 is a perspective representation of the device for adjusting the position of a limb of a patient resting on an operating table,

FIG. 2 is a second perspective representation of said device seen at another angle associated with a single rail of the operating table,

FIG. 3 is a third perspective representation of said device seen at another angle associated with a single rail of the operating table,

FIG. 4 is a perspective representation of the cradle associated with its shaft rotatably and translatable mounted in the aforesaid hub, FIG. 5 is a perspective representation of the arm integral with said slide and comprising the aforesaid hub being able to slide through said arm along the main axis of said arm,

FIG. 6 is a sectional representation of said slider and a mechanism for positioning said arm relative to said armrest,

FIG. 7 is a perspective representation of the device for adjusting the position of a limb of a patient according to a second embodiment,

FIG. 8 is a second perspective representation of the device for adjusting the position of a patient's limb according to the second embodiment,

FIG. 9 is a perspective view of the device for adjusting the position of a patient's limb according to a third embodiment; FIG. 10 is a perspective view detailing the adjustment of the positioning of the arm relative to the the arm support,

FIG. 11 is a perspective representation of the arm integral with a slide according to a second embodiment,

FIG. 12 is a perspective representation of the arm integral with a slide according to a third embodiment, and

Figure 13 is a perspective representation of the arm and partially of the shaft supporting the cradle and the cradle, according to a fourth embodiment.

In the example shown in Figures 1, 2, 3, the device 1, comprising means for positioning a cradle Be supporting the member of a patient relative to the lateral guide rails RG ₁ , RG ₂ , d an operation table TO, consists of:

• a sole plate disposed horizontally and laterally along the operating table TO whose longitudinal axis is Δ, represented by a plate L L and its two lateral guide rails RGi, RG ₂ , • securing means MSi, MS ₂ , MS ₃ , said sole Se on one or the other of the two guide rails RGi, RG ₂ , the operating table TO,

A clevis Ch ₅ integral with said sole Se whose cross section is U-shaped,

A rotation shaft Ai located near the upper part of the clevis Ch and whose axis Δi is situated in a plane parallel to the soleplate Se and perpendicular to the longitudinal axis Δ of the operating table TO, • an armrest Po, rotatably mounted around the rotation shaft Ai and actuated in rotation in the vertical plane perpendicular to the soleplate Se, by a cylinder Ve,

A slide, mounted integral with the aforesaid armrest Po, on the opposite side to the cylinder Ve, and being able to guide a slide Co in a plane perpendicular to the plate Se,

An arm Br ₅ integral with the slider Co, whose main axis Δ ₂ is parallel to the longitudinal axis Δ of the operating table TO,

A hub Mo, whose main axis Δ ₃ is located in a plane parallel to the soleplate Se and perpendicular to the axis Δ of the operating table TO ₅ and slidable through the arm Br according to the main axis Δ ₂ of the arm Br,

• An Ar ₅ shaft rotatably mounted and translatable into the hub Mo, whose axis is collinear with the axis Δ ₃ of the hub Mo ₅ and supporting at one of its ends the cradle Be supporting the patient's limb.

Thus, in these conditions, the cradle Be can be positioned above the operating table TO ₅ in a precise manner relative to the patient's leg taking into account its morphology; it can tilt in a plane perpendicular to the plane defined by the operating table TO passing through the leg of the patient and along an axis Δl brought near the hip joint. The securing means MSi, MS ₂ , MS ₃ , of the sole plate Se on one or the other of the two guide rails RGi, RG ₂ , of the operating table TO, consist of at least two shafts. ASi, AS ₂ , AS ₃ , integral with the sole Se on the face opposite to that supporting the positioning means of the cradle Be, oriented perpendicularly to the sole Se, which shafts ASi, AS ₂ , AS ₃ , can each slide in a clamping nut NSi, NS ₂ , NS ₃ , the main axis of which is horizontal and perpendicular to the longitudinal axis Δ of the operating table TO; each of said nuts NSi, NS ₂ , NS ₃ , is integral with a pair of jaws Moi, Mo ₂ , Mo ₃ , whose clamping end is in correspondence of shape with the cross section of the guide rails RGi, RG ₂ , of the operating table TO, the pair of jaws Moi, Mo ₂ , Mo ₃ , consisting of a fixed upper jaw integral with the clamping nut NSi, NS ₂ , NS ₃ , and a lower jaw movable by a clamping handle P ₁ , P ₂ , P ₃ , the upper fixed jaw bearing on the edge, facing the operating table TO, the sole Se.

Thus, the sole plate SE can be displaced and positioned vertically, in a precise manner, being guided on the one hand by the ASi, AS ₂ , AS ₃ and bearing shafts, in the vicinity of its edge oriented towards the operating table. TO, on the vertical face of the fixed jaws.

In general, the operating or treatment tables consist of a plurality of table segments, integral with each other and which can be oriented relative to each other depending on the nature of the operation to be performed. practice on the patient; accordingly, the guide rails associated with said table elements are also segmented and thus have interruptions, called rail breaks, sometimes requiring clamping on two of the three securing means according to said rail break.

The actuator type actuator Ve actuates the arm support Po in rotation by means of a first articulation Ari in connection with a foot integral Pi of the sole Se and a second joint Ar ₂ integral with the armrest Po, which second joint Ar ₂ is disposed between the shaft Ai and the lower part of the armrest Po, for raising or lowering, more or less, the slider Co and therefore the arm Br having the hub Mo, the Ar shaft and the cradle Be.

Generally, the cradle Be is raised in such a way that the patient's leg is located in a vertical plane, thus making it possible to position, satisfactorily, the femoro-tibial joint.

Moreover, the cradle Be that can be positioned on one side of the operating table TO, or on the other side, thus allows the surgical operations to be carried out at the level of the left knee or the right knee.

Of course, a protective cover Ca may be used so as to avoid any contact of the motorized mechanism with the operating table TO and / or any of its accessories.

Thus, the space around the cradle Be is completely released and allows to arrange the devices for the surgical operation according to the constraints defined by said operation.

The motorization Ve may be of the type with electric actuator, pneumatic or hydraulic; control of it may be performed near the TO operating table or remotely remote controlled; the angular positioning of the armrest Po, and therefore of the cradle Be, may be effected by means of mechanical stops, position sensors, or any other angular positioning mechanism or position control, depending morphological parameters of the patient.

In the example shown in FIG. 4, the Ar tree associated with the cradle Be comprises a flattened Me whose length is close to half the length of the Ar shaft and a plurality of circular grooves Gi, G ₂ , G ₃ , equidistant separated by circular orifices O ₁ , O ₂ , O ₃ , O ₄ , passing through the Ar shaft and whose axes are perpendicular to the axis Δ ₃ of the Ar shaft.

Note that the depth of the plurality of grooves Gi, G ₂ , G ₃ , equidistant is less than the depth of the flat Me.

A first cylindrical pin, not shown, passes through the orifice of the hub Mo receiving the Ar shaft, a generatrix tangent the flat Me of the Ar shaft.

Therefore, the Ar shaft can be moved manually along its main axis Δ ₃ when the flat Me is parallel to said first cylindrical pin, and can manually rotate about its main axis Δ ₃ when a groove of said plurality of grooves Gi, G ₂ , G ₃ , is opposite said first cylindrical pin.

Thus, with a rotation of about 90 degrees of the Ar shaft in one direction, followed by a translation of the Ar shaft and a rotation of the same amplitude in the opposite direction to the previous one, the distance between the cradle Be and the hub Mo is adjustable by quantum equivalent to the distance between successive grooves Gi, G ₂ ,

G ₃ .

A immobilization of the Ar shaft in rotation and in translation is effected by means of a second pin Go, diametrically crossing the hub Mo and being housed in the circular orifices O ₁ , O ₂ , O ₃ , O ₄ , passing through the shaft Ar and whose axes are perpendicular to the axis Δ ₃ of the Ar shaft. This second pin Go is shown in FIG.

In the example shown in FIG. 5, the hub Mo, in a longitudinal section containing its main axis Δ ₂ , is an H-shaped structure; the arm Br has a constant width and slightly less than the length of the horizontal upright separating the two vertical uprights of the H-shaped structure ₅ and has a light situated in a plane perpendicular to the axis Δ ₃ of the hub Mo, thus allowing at the hub Mo to slide along the axis main Δ ₂ Br arm, the width of the light being slightly greater than the thickness of the horizontal upright of the H-shaped structure. Therefore, the hub Mo is guided in translation and immobilized in rotation in the Br arm light The aforementioned second pin Go diametrically crosses the hub Mo in one of the two vertical uprights of the H-shaped structure, allowing penetration into the circular orifices O ₁ , O ₂ , O ₃ , O ₄ , passing through the Ar shaft and thus to secure it in relation to the hub Mo.

An AC shaft, having a plurality of grooves, whose main axis is collinear with the main axis A ₂ of the arm Br, is integral with the hub Mo, in the vicinity of one of its ends. A clutch CR, partially shown, whose axis of rotation Δ ₄ is perpendicular to the axis Δ ₂ of the splined shaft AC, allows to lock in translation the splined shaft AC and therefore the hub Mo, by means of a rotation of said clutch CR allowing a tooth to fit formally in one of the plurality of flutes.

Thus, the displacement of the hub Mo and consequently that of the cradle Be is adjustable by quantum equivalent to the distance between two successive grooves.

Advantageously, the clutch CR allows, by means of a second orientation of said Clutch CR, to separate the splined shaft AC associated with the hub Mo, thus allowing free movement of the assembly consisting of the hub Mo, the Ar shaft and the cradle Be, along the main axis Δ ₂ of the Br arm.

Furthermore, the arm Br comprises, in the vicinity of its end opposite to that where the hub Mo described above, the slider Co along an axis Δ ₅ orthogonal to the axes respectively Δ ₃ and Δ ₂ of the hub Mo and the shaft fluted AC, and whose cross section is H-shaped. In the vicinity of the outer face of the arm support Po ₅ facing the arm Br, a slide, the cross section of which is T-shaped, in correspondence with the slide Co of the arm Br, serves to guide the arm Br according to a direction orthogonal to the axes respectively Δ ₃ and Δ ₂ of the hub Mo and the splined shaft AC.

A pull tab Ti actuating a finger Do whose axis Δ ₆ is parallel to the axis Δ ₂ of the splined shaft AC, allows, by engaging the finger Do in an orifice Ox of the plurality of orifices made in the holder. arm Po, to position the arm Br with respect to the armrest Po.

In the example shown in FIG. 6, the sectional representation of the slider Co and the positioning mechanism of the arm Br with respect to said slider Co reveals the H-section of the slider Co associated with the arm Br and the T-section of the slide located in the armrest Po. According to the axis Δ ₆ , the finger Do crosses the slider Co of the arm Br and the slide of the armrest Po, to end in the vicinity of one of its ends in an orifice Ox of the plurality of orifices made in the armrest Po. In the vicinity of its other end, the finger Do is integral with the pull tab Ti positioned in a plane perpendicular to the slide Co of the arm Br. A spring Re, mounted in compression, taking support on the one hand on a flange located near the middle of the finger Do and secondly on a flange Fl obturant the outer face of the slider Co of the arm Br, allows the assembly consisting of the finger Do and the zipper Ti, to keep the finger Do to the fon d of the chosen orifice Ox.

In the example shown in Figures 7 and 8, the device 1 according to a second embodiment, comprising means for positioning a cradle Be supporting the member of a patient relative to the lateral guide rail RGi, d ' an operating table, not shown, consists of: • a sole plate arranged horizontally and laterally along the lateral guide rail RGi, • securing means MSi, MS ₂ , said sole Se on the guide rail RGi,

A clevis Ch, integral with said soleplate Se, whose cross section is U-shaped, with a rotation shaft Ai, located near the upper part of the clevis Ch, and whose axis Δi is situated in a plane parallel to the soleplate Se and perpendicular to the guide rail RGi,

An armrest Po, rotatably mounted around the rotation shaft Ai and actuated in rotation in the vertical plane perpendicular to the soleplate Se, by a jack Ve,

• a slide, mounted integral with the above-mentioned arm Po, the side opposite the cylinder Ve, and can guide a Co slide in a plane perpendicular to the base plate Se ₅

An arm Br, integral with the slide Co, whose main axis A ₂ is parallel to the guide rail RGi,

A hub Mo, whose main axis A ₃ is located in a plane parallel to the soleplate Se and perpendicular to the guide rail RGi, and slidable through the arm Br along the main axis Δ ₂ of the arm Br A shaft Ar, rotatably mounted and translatable in the hub Mo, whose axis is collinear with the axis Δ ₃ of the hub Mo, and supporting at one of its ends the cradle Be supporting the patient's limb. Furthermore, unlike the first embodiment of the device according to the invention, the aforesaid jack Ve for rotating said arm holder Po rotatably mounted about the rotation shaft Ai, is essentially arranged perpendicular to the plane defined by the operating table, thus releasing the space located symmetrically to the cradle Be supported by the arm Br and the armrest Po.

Thus, under these conditions, the cradle Be can be positioned above the operating table, in a precise manner relative to the patient's leg. taking into account its morphology; it can tilt in a plane perpendicular to the plane defined by the operating table passing through the leg of the patient and along an axis Δl brought near the hip joint. Furthermore, the space released by the cylinder Ve can generate a more comfortable space for the patient.

The securing means MSi, MS ₂ , of the sole Se on the guide rail RG ₁ , consist of two shafts ASi, AS ₂ , integral with the sole Se on the face opposite to that supporting the positioning means of the cradle Be , oriented perpendicularly to the sole plate Se, which shafts ASi, AS ₂ , can each slide in a clamping nut NSi, NS ₂ , whose main axis is horizontal and perpendicular to the longitudinal axis of the guide rail RGi; each of said nuts NSi, NS ₂ , is secured to a clameau, respectively CLi, CL ₂ , whose clamping is effected in correspondence of shape with the cross section of the guide rail RGi, the clams CLi, CL ₂ being secured by a clamping handle, respectively PCLi, PCL ₂ . Thus the sole Se can be moved and positioned vertically, in a precise manner, being guided by the ASi, AS ₂ trees.

The motorization Ve, of the actuator type, actuates in rotation the armrest Po by means of a first articulation Ari in conjunction with a foot Pi integral with the soleplate Se via two columns Ci, and a second articulation Ar ₂ integral with the armrest Po, which second articulation Ar ₂ is disposed between the shaft Ai and the upper part of the armrest Po, allowing to raise or lower, more or less, the slide Co and consequently, the arm Br having the hub Mo, the shaft Ar and the cradle Be.

As described above according to the first embodiment of the device according to the invention, the motorization Ve may be of the electric, pneumatic or hydraulic actuator type; in addition, a protective casing It can be used so as to avoid any contact of the motorized mechanism with the operating table.

In the example shown in FIG. 8, the aforesaid rotation shaft Ai, located near the upper part of said clevis Ch, enabling the arm support Po to pivot, may comprise a bore, in order to be able to house a beam generator. Lai laser, LA ₂ , of small size and low power, to allow the surgeon precise visual positioning of the axis of said shaft rotation relative to the articulation of the patient's limb. Said articulation of the patient's limb may be previously marked, or estimated, or palpated; in the case of a knee operation, it will be necessary to determine the position of the hip-femoral joint. The beams of the laser generators can be ordered separately or simultaneously; protection against the risk of dazzling by the laser beam will be provided for this purpose.

In the example shown in FIG. 9, the device 1 according to a third embodiment, comprising means for positioning a cradle Be supporting the member of a patient with respect to the lateral guide rail RGi, of a table operation not shown, is constituted, except means previously described: securing means MSi, MS ₂ , said sole Se on the guide rail RGi.

Unlike the first embodiment of the device according to the invention, the aforesaid securing means MSi, MS ₂ , of the sole plate Se on the guide rail RGi, consist of a shaft AS ₀ , integral with the sole plate Se on the opposite face to that supporting the positioning means of the cradle Be, oriented perpendicularly to the soleplate Se, which shaft AS ₀ , can slide in a clamping nut NS ₀ , whose main axis is horizontal and perpendicular to the longitudinal axis of the RGi guide rail; the tightening of the aforesaid axis shaft AS ₀ in the nut NS ₀ is effected by means of a clamping handle Po; said nut NSo, is secured to two clusters, CLi, CL ₂ , the clamping is effected in correspondence of shape with the cross section of the guide rail RG ₁ , the clams CLi, CL ₂ being secured by means of a clamping handle, respectively PCLi, PCL ₂ . Thus the sole Is slidable in translation and can rotate in rotation relative to a hub integral with one of the two side rails, so as to allow the surgeon to better position the member to treat the patient.

In the example shown in FIG. 10, the arm Br comprises the slider Co guided by the slide secured to the armrest Po; the translation of the arm Br, along the axis A ₅ is performed by means of a screw Vi / Em nut assembly, so as to allow the surgeon to accurately position the arm Br relative to the armrest Po. Two solutions are possible:

either the said screw Ve is integral with the aforesaid slider Co and the knurled nut Em is free to rotate in abutment on the upper face of the armrest Po, the drive of the aforesaid knurled nut Em actuating the arm Br in one direction or in the opposite direction in the direction of rotation of said nut Em,

either the aforesaid life Ve is secured to the knurled nut Em, which screw Ve drives the slider Co through a threaded hole, the drive of the aforesaid knurled nut Em actuating the arm Br in a direction or in the opposite direction according to the direction of rotation of said nut Em.

In the example shown in FIG. 11, the cross-section of the aforesaid slider Co 'of the aforesaid arm Br is of a shape similar to an omega and in correspondence of shape with the cross-section of the aforesaid slide integral with the arm-carrier Po, to allow angular deflection on either side of a median position of the arm relative to the armrest around a As axis of symmetry of the omega-shaped cross-section, so as to allow the surgeon to better position the patient's limb to be treated. The aforesaid slide integral with the armrest Po comprises a clamping element, not shown, for blocking the aforesaid slider Co 'and thus to position the arm Br relative to the armrest Po, according to the deflection angle chosen.

In the example shown in FIG. 12, the hub Mo, in a longitudinal section containing its main axis Δ ₂ , is an H-shaped structure; the arm Br has a constant width and slightly less than the length of the horizontal upright separating the two vertical uprights of the H-shaped structure, and has a light located in a plane perpendicular to the axis Δ ₃ of the hub Mo, thus allowing at the hub Mo to slide along the main axis Δ ₂ of the Br arm, the width of the light being slightly greater than the thickness of the horizontal upright of the H-shaped structure.

Consequently, the hub Mo is guided in translation and immobilized in rotation in the light of the arm Br.

The aforesaid second pin Go diametrically crosses the hub Mo in one of the two vertical uprights of the H-shaped structure, to penetrate the circular orifices O ₁ , O ₂ , O ₃ , O ₄ , passing through the Ar shaft and so to secure it in relation to the hub Mo.

A threaded shaft AF, the main axis of which is collinear with the main axis Δ ₂ of the arm Br, is integral with the hub Mo, in the vicinity of one of its ends. A MOL wheel, whose bore is threaded, in correspondence of shape with the aforesaid AF threaded shaft, is housed in a recess located at the opposite end to the aforesaid hub Mo; this recess allows said wheel MOL to rotate along the axis Δ ₂ , and to be immobilized in translation along the same axis Δ ₂ . Thus, the displacement of the hub Mo and consequently that of the cradle Be is adjustable thanks to the rotation of the wheel MOL, according to its direction of rotation. Moreover, the arm Br comprises, in the vicinity of its end opposite to that where the hub Mo described above, the slider Co along an axis Δ ₅ orthogonal to the axes respectively Δ ₃ and A ₂ of the hub Mo and the shaft AF thread, and whose cross section is H-shaped. In the vicinity of the outer face of the arm holder Po, opposite the Br arm, a slide, whose cross section is T-shaped, corresponding in shape with the slider Co of the arm Br, makes it possible to guide the arm Br in a direction orthogonal to the axes respectively Δ ₃ and Δ ₂ of the hub Mo and the threaded shaft AF. A pull tab Ti actuating a finger Do whose axis Δ ₆ is parallel to the axis Δ ₂ of the threaded shaft AF, allows, by engaging the finger Do in an orifice Ox of the plurality of orifices made in the holder. arm Po, to position the arm Br with respect to the armrest Po.

In the example shown in Figure 13, the aforesaid arm Br has a hub Mo 'located at the opposite end of said arm Br said slider Co; said hub Mo 'does not slide through said arm Br along its main axis Δ ₂ ; thus the Ar shaft supporting the cradle Be, is rotatably mounted and translatable to the end of the arm Br, along the axis Δ ₃ ; several arms of different length can be envisaged, so as to avoid the surgeon to be embarrassed by the end of the adjustable arm in case it is necessary to position the Ar shaft supporting the cradle Be close to the armrest Po.

Thus, the different degrees of freedom that characterize the device 1 according to the invention, namely:

the possibility of positioning the device 1 to the right or left of the operating table TO,

the distance adjustment of the device 1 relative to the operating table TO, the orientation of the arm support Po and of the arm Br supporting the cradle Be in a plane perpendicular to the operating table TO, the height of the arm Br with respect to the axis of rotation Δi of the arm support Po,

the distance from the shaft Ar supporting the cradle Be relative to the axis of rotation Δi of the armrest Po, the distance from the cradle Be relative to the arm Br, allow:

positioning the cradle Be above the operating table T0, in a precise manner with respect to the patient's leg, taking into account its morphology; tipping the cradle Be in a plane perpendicular to the plane defined by the operating table TO passing through the leg of the patient and along an axis Δi brought to the vicinity of the hip joint.

Of course, the device 1 according to the invention will position the upper limb of a patient, in the context of surgical operations performed at the forearm, elbow, arm or wrist. Similarly, it will, for example, to position the neck of a patient in the context of surgical operations performed in the cervical vertebrae.

Claims

claims

1. Device (1) for the angular positioning of a patient's limb resting on an operating table (TO), comprising means for positioning a cradle (Be) supporting the patient's limb with respect to the rails lateral guide (RGi, RG ₂ ) of the operating table (TO), characterized in that said positioning means comprise:

- Securing means (MSi, MS ₂ , MS ₃ ) of said cradle positioning means Be indifferently on one or the other of the two lateral guide rails (RGi, RG ₂ ) of the operating table (TO )

means for positioning said cradle (Be) along an axis (Δ ₃ ) contained in a plane parallel to that defined by the operating table (TO), and perpendicular to the main axis (Δ) of the table of operation (TO), which aforesaid means for positioning said cradle (Be) comprise: o a sole (Se) situated in a plane parallel to that defined by the operating table (TO) ₅ which sole (Se) can move in parallel to itself in sliding connection with the aforesaid securing means (MSi, MS ₂ , MS ₃ ), o a yoke (Ch), integral with the aforesaid sole (Se), comprising a rotation shaft (Ai), located near of the upper part of said yoke (Ch), and whose axis (Δ) is situated in a plane parallel to said flange (Se) and perpendicular to the main axis (Δ) of the operating table (TO) , o an armrest (Po), rotatably mounted around said rotation shaft (Ai) and actuated in rotation in a plane perpendicular to the ladi sole (Se) by a motorization (Ve), a slide, integral with the aforesaid armrest (Po) ₅ on the opposite side to the aforesaid motorization (Ve), and being able to guide a slide (Co) in a plane perpendicular to said sole (Se), o an arm (Br ), integral with said slide (Co), whose main axis (Δ ₂ ) is parallel to the main axis (Δ) of the operating table (TO), o a hub (Mo), whose axis ( Δ ₃ ) is located in a plane parallel to said flange (Se) and perpendicular to the main axis (Δ) of the operating table (TO), and slidable through said arm (Br) along the main axis (Δ ₂ ) of said arm (Br), o a shaft (Ar), rotatably mounted and translatable in the aforesaid hub (Mo), whose axis is collinear with the aforesaid axis (Δ ₃ ) of the hub (Mo), and supporting at one of its ends the aforesaid cradle (Be).

2. Device according to claim 1, characterized in that the said securing means (MS ₁ , MS ₂ , MS ₃ ), comprise:

- At least two shafts (AS ₁ , AS ₂ , AS ₃ ), integral with the sole (Se) each sliding in a clamping nut (NS ₁ , NS ₂ , NS ₃ ),

at least two pairs of jaws (Mo ₁ , Mo ₂ , Mo ₃ ), the clamping end of which is in correspondence with the cross section of the guide rails (RGi, RG ₂ ), of the operating table (TO), each of said pair of jaws (Mo ₁ , Mo ₂ , Mo ₃ ), consisting of a fixed upper jaw integral with the clamping nut (NS ₁ , NS ₂ , NS ₃ ), and a jaw lower movable by a clamping handle (P ₁ , P ₂ , P ₃ ), the upper fixed jaw bearing on the edge, facing the operating table (TO), the sole (Se).

3. Device according to claim I ₅ characterized in that the aforesaid motorization (Ve) ₅ of the actuator type actuates in rotation the arm holder (Po) via a first articulation (Ar ₁ ) in connection with a foot integral (Pi) of the sole (Se) and a second joint (Ar ₂ ) integral with the arm-carrier (Po), which second articulation (Ar ₂ ) is arranged between the shaft (Ai) and the lower part of the armrest (Po).

4. Device according to claim I ₅ characterized in that the aforesaid motorization (Ve) is of the electric actuator type, pneumatic or hydraulic; the control of this one is carried out close to the operating table (TO) or remotely controlled remotely.

5. Device according to claim I ₅ characterized in that the aforesaid tree (Ar) associated with the cradle (Be) comprises a flat (Me) of length close to half the length of the shaft (Ar) and a plurality of circular grooves (Gi, G ₂ , G ₃ ) equidistant, the depth of the plurality of grooves (Gi, G ₂ , G ₃ ) being less than the depth of the flat Me; a cylindrical pin passes through the orifice of the hub (Mo) receiving the shaft (Ar), a generatrix tangent the flat (Me) of the shaft (Ar).

6. Device according to claim I ₅ characterized in that the aforesaid hub (Mo) ₅ in a longitudinal section containing its main axis (Δ ₂ ), is an H-shaped structure, the arm (Br) having a constant width and slightly smaller than the length of the horizontal upright separating the two vertical uprights of the H-shaped structure ₅ and has a light located in a plane perpendicular to the axis (Δ ₃ ) of the hub (Mo), allowing the hub (Mo) to slide along the main axis (Δ ₂ ) of the arm (Br) ₅ the width of the light being slightly greater than the thickness of the horizontal upright of the H-shaped structure.

7. Device according to claim 1, characterized in that the aforesaid arm (Br) comprises:

- a shaft (AC) ₅ having a plurality of grooves, whereof the main axis is collinear with the main axis (Δ ₂₎ of the arm (Br), which shaft (AC) is secured to the hub (Mo), in the vicinity from one of its ends,

- a clutch (CR) whose axis of rotation (Δ ₄ ) is perpendicular to the axis (Δ ₂ ) of the splined shaft (AC), to lock or unlock in translation the spline shaft (AC) and the hub (Mo), by means of respectively a first rotation of said clutch (CR) allowing a tooth to fit in shape correspondence in one of the plurality of splines, or a second rotation of said dog clutch (CR) ) allowing said tooth to escape said plurality of flutes.

8. Device according to claim 1, characterized in that the aforesaid cradle (Be) comprises a fixed jaw secured to the shaft (Ar) supporting the cradle (Be) and a movable sliding jaw, for adjusting the distance between the two. bite according to the morphology of the thigh.

9. Device according to claim 4, characterized in that the aforesaid jack (Ve), for rotating said arm holder (Po) rotatably mounted around the rotation shaft (Ai), is arranged perpendicular to the plane defined by the operation table (TO).

10. Device according to claim 1, characterized in that the aforesaid rotation shaft (Ai) located near the upper portion of the aforesaid yoke (Ch), allowing the arm-carrier (Po) to pivot, has a blind bore at each of its ends, in order to accommodate a laser beam generator (La ^ LA ₂ ), of small size and low power.

11. Device according to claim 1, characterized in that the said securing means (MSi, MS ₂ ) of the sole (Se) on the guide rail (RGl) of said cradle positioning means (Be) ₅ consist of a shaft (AS ₀ ) integral with said sole (Se) on the face opposite to that supporting the aforesaid means for positioning the cradle (Be), oriented perpendicular to said sole (Se), which shaft (AS ₀ ) slides in a clamping nut (NS ₀ ), the main axis of which is horizontal and perpendicular to the longitudinal axis of said guide rail (RGi).

12. Device according to claim 11, characterized in that the clamping of the aforesaid shaft axis (AS ₀ ) in the aforesaid nut (NSO) is effected by means of a clamping handle (P ₀ ), said nut (NS). ₀ ) is integral with two clamps (CLi, CL ₂ ), the clamping is effected in correspondence of shape with the cross section of the guide rail (RGi), the aforesaid clams (CLi, CL ₂ ) being secured via a clamping handle, respectively (PCLi, PCL ₂ ).

13. Device according to claim 1, characterized in that the aforesaid slide (Co) guided by the slide integral with the arm holder (Po) comprises a screw / nut (Vi) / (Em), allowing the translation of the arm ( Br) along an axis (Δ ₅ ) orthogonal to the aforesaid axes respectively (Δ ₃ ), (Δ ₂ ), the aforesaid hub (Mo) and the aforesaid arm (Br).

14. Device according to claim 1, characterized in that the aforesaid slider (Co) guided by the slide integral with the arm-carrier (Po) comprises a cross section in the shape of omega and shape matching with the cross section of the aforesaid slide integral with the arm-carrier (Po), in order to allow an angular deviation on both sides of a median position of the arm (Br) with respect to the arm-carrier ( Po) about an axis (Δ ₈ ) of symmetry of said omega-shaped cross-section.

15. Device according to claim 1, characterized in that the aforesaid arm (Br) comprises:

a threaded shaft (AF) whose main axis is collinear with the main axis (Δ ₂ ) of the arm (Br), which threaded shaft (AF) is integral with the hub (Mo), in the vicinity of the one from its ends,

- a wheel (MOL), whose bore is threaded, in correspondence of shape with the aforesaid threaded shaft (AF), which wheel (MOL) is housed in a recess at the opposite end to the aforesaid hub (Mo), the aforesaid recess allowing said wheel

(MOL) to rotate along the axis (Δ ₂ ), and to be immobilized in translation along the same axis (Δ ₂ ), the rotation of the aforesaid wheel (MOL) allowing the displacement of the hub Mo and consequently that of the cradle (Be).

16. Device according to claim I ₅ characterized in that the aforesaid arm (Br) comprises hub (Mo ') located at the opposite end of said arm (Br) to the slider (Co), the aforesaid hub (Mo') is integral of said arm (Br), the aforesaid shaft (Ar) supporting the aforesaid cradle (Be), is rotatably mounted and translatable to the end of the arm (Br), along the axis

(A ₃ ).

17. Device according to claim 16, characterized in that the aforesaid arm (Br) comprises several different lengths.

18. Device according to one of the preceding claims, characterized in that a protective casing (Ca) avoids any contact of the aforesaid motorization (Ve) with the operating table (TO) and / or with any one of his accessories.