EP1940337B1 - Device for angularly positioning a member of a patient lying on an operating table - Google Patents

Device for angularly positioning a member of a patient lying on an operating table Download PDF

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Publication number
EP1940337B1
EP1940337B1 EP06808187A EP06808187A EP1940337B1 EP 1940337 B1 EP1940337 B1 EP 1940337B1 EP 06808187 A EP06808187 A EP 06808187A EP 06808187 A EP06808187 A EP 06808187A EP 1940337 B1 EP1940337 B1 EP 1940337B1
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EP
European Patent Office
Prior art keywords
mentioned
arm
shaft
axis
hub
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EP06808187A
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German (de)
French (fr)
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EP1940337A1 (en
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Alain Lacroix
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G13/00—Operating tables; Auxiliary appliances therefor
    • A61G13/10—Parts, details or accessories
    • A61G13/12—Rests specially adapted therefor; Arrangements of patient-supporting surfaces
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G13/00—Operating tables; Auxiliary appliances therefor
    • A61G13/0036—Orthopaedic operating tables
    • A61G13/0045—Orthopaedic operating tables specially adapted for hand or wrist surgeries
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G13/00—Operating tables; Auxiliary appliances therefor
    • A61G13/0036—Orthopaedic operating tables
    • A61G13/0063—Orthopaedic operating tables specially adapted for knee surgeries
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G13/00—Operating tables; Auxiliary appliances therefor
    • A61G13/10—Parts, details or accessories
    • A61G13/12—Rests specially adapted therefor; Arrangements of patient-supporting surfaces
    • A61G13/1205—Rests specially adapted therefor; Arrangements of patient-supporting surfaces for specific parts of the body
    • A61G13/1235—Arms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G13/00—Operating tables; Auxiliary appliances therefor
    • A61G13/10—Parts, details or accessories
    • A61G13/12—Rests specially adapted therefor; Arrangements of patient-supporting surfaces
    • A61G13/1205—Rests specially adapted therefor; Arrangements of patient-supporting surfaces for specific parts of the body
    • A61G13/1245—Knees, upper or lower legs

Definitions

  • 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.
  • a support device 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.
  • this type of bar hinders the surgeon in performing his act and makes it difficult to use concomitant possible devices that may be useful.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • the cradle Be can be positioned above the operating table TO, 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 ⁇ 1 brought to the vicinity of the hip joint.
  • the securing means MS 1 , MS 2 , MS 3 , of the sole plate Se on one or the other of the two guide rails RG 1 , RG 2 , of the operating table TO consist of at least two shafts AS 1 , AS 2 , AS 3 , integral with the sole Se on the face opposite to that supporting the positioning means of the cradle Be, oriented perpendicular to the sole Se, which shafts AS 1 , AS 2 , AS 3 , can each slide in a clamping nut NS 1 , NS 2 , NS 3 , whose main axis is horizontal and perpendicular to the longitudinal axis ⁇ of the operating table TO; each of said nuts NS 1 , NS 2 , NS 3 , is integral with a pair of jaws Mo 1 , Mo 2 , Mo 3 , whose clamping end is in correspondence with the cross section of the guide rails RG 1 , RG 2 , of the operating table TO, the pair of jaws Mo 1 , Mo 2 ,
  • the sole plate SE can be displaced and positioned vertically, in a precise manner, being guided on the one hand by the shafts AS 1 , AS 2 , AS 3 , and taking support, in the vicinity of its slice facing the table. TO operation, on the vertical face of the fixed jaws.
  • 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 Ar 1 in conjunction with a foot integral Pi of the sole Se and a second joint Ar 2 secured to the armrest Po, which second joint Ar 2 is disposed between the shaft A 1 and the lower part of the armrest Po, to raise or lowering, more or less, the slider Co and therefore the arm Br having the hub Mo, the Ar shaft and the cradle Be.
  • 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.
  • 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.
  • 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.
  • 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.
  • the Ar tree associated with the cradle Be comprises a flattened Me of length close to half the length of the Ar shaft and a plurality of circular grooves G 1 , 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 3 of the Ar shaft.
  • the depth of the plurality of grooves G 1 , G 2 , G 3 , equidistant is less than the depth of the flat Me.
  • a first cylindrical pin 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 ⁇ 3 when the flat Me is parallel to said first cylindrical pin, and can manually rotate about its main axis ⁇ 3 when a groove of said plurality of grooves G 1 , G 2 , G 3 , is opposite said first cylindrical pin.
  • the distance between the cradle Be and the hub Mo is adjustable by quantum equivalent to the distance between successive grooves G 1 , 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 Ar and whose axes are perpendicular to the axis ⁇ 3 of the Ar shaft.
  • This second pin GB is shown in FIG. figure 5 .
  • the hub Mo in a longitudinal section containing its main axis ⁇ 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 ⁇ 3 of the hub Mo, thus allowing at the hub Mo to slide along the axis principal ⁇ 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.
  • An AC shaft having a plurality of grooves, whose main axis is collinear with the main axis ⁇ 2 of the Br arm, is integral with the hub Mo, in the vicinity of one of its ends.
  • a clutch CR partially shown, whose axis of rotation ⁇ 4 is perpendicular to the axis ⁇ 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.
  • 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.
  • 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 ⁇ 2 of the Br arm.
  • 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 ⁇ 5 orthogonal to the axes respectively ⁇ 3 and ⁇ 2 of the hub Mo and the shaft fluted AC, and whose cross section is H-shaped.
  • a slide In the vicinity of the outer face of the arm support Po, facing the arm Br, a slide, whose cross section is T-shaped, in correspondence with the slider Co of the arm Br, serves to guide the arm Br according to a direction orthogonal to the axes respectively ⁇ 3 and ⁇ 2 of the hub Mo and the splined shaft AC.
  • a pull tab Ti actuating a finger Do whose axis ⁇ 6 is parallel to the axis ⁇ 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.
  • 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 slider located in the arm-holder Po.
  • the finger Do crosses the slider Co of the arm Br and the slide of the arm support Po, to end in the vicinity of one of its ends in an orifice Ox of the plurality of orifices made in the door -bras Po. In the vicinity of its other end, the finger Do is integral with the pull rod Ti positioned in a plane perpendicular to the slider Co of the arm Br.
  • a spring Re mounted in compression, bearing on the one hand on a flange located near the middle of the finger Do and on the other hand on a flange F1 closing the outer face of the slider Co of the arm Br, allows the assembly consisting of the finger Do and the pull tab Ti, to maintain the finger Do at the bottom of the selected orifice Ox.
  • 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 ⁇ 1 brought to the vicinity of the hip joint. Furthermore, the space released by the cylinder Ve can generate a more comfortable space for the patient.
  • the securing means MS 1 , MS 2 , of the sole plate Se on the guide rail RG 1 consist of two shafts AS 1 , AS 2 , integral with the sole plate Se on the face opposite to that supporting the positioning means of the cradle Be, oriented perpendicular to the sole Se, which shafts AS 1 , AS 2 , can each slide in a clamping nut NS 1 , NS 2 , whose main axis is horizontal and perpendicular to the longitudinal axis of the guide rail RG 1 ; each of said nuts NS 1 , NS 2 , is secured to a clameau, respectively CL 1 , CL 2 , whose clamping is effected in correspondence of shape with the cross section of the guide rail RG 1 , the clams CL 1 , CL 2 being secured by a clamping handle, respectively PCL 1 , PCL 2 .
  • the sole Se can be moved and positioned vertically, in a precise manner, being guided by the shafts AS 1 , AS 2 .
  • the motorization Ve actuates in rotation the armrest Po by means of a first articulation Ar 1 in conjunction with a foot Pi secured to the soleplate Se via two columns Ci, and of a second articulation Ar 2 secured to the armrest Po, which second articulation Ar 2 is disposed between the shaft A 1 and the upper part of the armrest Po, allowing to raise or lower, more or less, the slider Co and therefore the arm Br having the hub Mo, the Ar shaft and the cradle Be.
  • 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.
  • the aforesaid rotation shaft A 1 located near the upper part of said clevis Ch, allowing the armrest Po to rotate, may include a bore, in order to accommodate a laser beam generator La 1 , LA 2 , 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.
  • the aforementioned securing means MS 1 , MS 2 , of the sole plate Se on the guide rail RG 1 consist of an AS 0 shaft, integral with the sole plate on the opposite side 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 axis longitudinal guide rail RG 1 ; the tightening of the aforesaid AS shaft shaft 0 in the NS 0 nut is made via a clamping handle P 0 ; said nut NS 0 , is secured to two clams, CL 1 , CL 2 , the clamping is effected in correspondence of shape with the cross section of the guide rail RG 1 , the clams CL 1 , CL 2 being secured by means of a clamping handle, respectively PCL 1 , PCL 2 .
  • the cross section of the aforesaid slider Co 'of the aforesaid arm Br is of similar shape of an omega and in correspondence of shape with the cross section of the aforesaid slide integral with the armrest Po, to allow an angular deviation from and other a median position of the arm relative to the arm-rest around a axis ⁇ 8 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.
  • the hub Mo in a longitudinal section containing its main axis ⁇ 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 ⁇ 3 of the hub Mo, thus allowing at the hub Mo to slide along the main axis ⁇ 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 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 ⁇ 2 , and to be immobilized in translation along the same axis ⁇ 2 .
  • 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.
  • 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 ⁇ 5 orthogonal to the axes respectively ⁇ 3 and ⁇ 2 of the hub Mo and the shaft AF threaded, and whose cross section is H-shaped.
  • a slide In the vicinity of the outer face of the arm support Po, facing the arm Br, a slide, whose cross section is T-shaped, in correspondence with the slider Co of the arm Br, serves to guide the arm Br according to a direction orthogonal to the axes respectively ⁇ 3 and ⁇ 2 of the hub Mo and the threaded shaft AF.
  • 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 ⁇ 2 ; thus the Ar shaft supporting the cradle Be, is rotatably mounted and translatable to the end of the arm Br, along the axis ⁇ 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.
  • the device 1 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.

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

La présente invention concerne un dispositif pour le positionnement angulaire d'un membre d'un patient reposant sur une table d'opération ou sur une table de soins.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.

Elle s'applique notamment, mais non exclusivement, au positionnement d'une jambe d'un patient lors d'une opération du genou.It applies in particular, but not exclusively, to the positioning of a leg of a patient during a knee operation.

D'une manière générale, on sait que pour effectuer un tel positionnement, on a déjà proposé un dispositif de support faisant intervenir un vérin dont la tige supporte un axe qui s'étend transversalement à la tige de vérin et porte un berceau destiné à supporter la jambe du patient. Cet agencement des différents organes fait apparaître un couple latéral important formé par le poids de la jambe supportée et la longueur de l'axe portant le berceau. Ce couple étant intégralement appliqué à la tête du vérin et à sa tige, amène rapidement une détérioration et un dysfonctionnement de celui-ci. De plus, de par sa position, ce type de barre gêne le chirurgien dans l'accomplissement de son acte et rend difficile l'utilisation concomitante éventuelle d'appareils pouvant s'avérer utiles.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.

On a également proposé un appareil (voir par exemple WO-A-9734520 ), comportant une barre porte-berceau attachée à l'extrémité d'une manivelle couplée à la tige d'un vérin par l'intermédiaire d'une articulation de manière à ce que le mouvement de translation de la tige du vérin engendre un mouvement de rotation de la barre porte-berceau. Cette solution n'est pas satisfaisante étant donné que l'appareil décrit se monte sur un bord latéral de la table d'opération et qu'en conséquence, le bassin du patient à tendance à basculer en provoquant un mouvement du genou qui ne s'effectue pas dans un plan vertical parallèle à l'axe longitudinal de la table d'opération. Il s'ensuit une imprécision sur la verticalité de la jambe et sur l'intervention chirurgicale au niveau du genou.We also proposed a device (see for example WO-A-9734520 ), having 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.

On a par ailleurs proposé un dispositif pour l'ajustement de la position angulaire d'un membre d'un patient reposant sur une table d'opération comprenant :

  • une tablette munie sur deux bordures latérales opposées de moyens de fixation à écartement réglable sur les deux rails latéraux de guidage d'une table d'opération, et
  • un porte gouttière monté par l'une de ses extrémités sur un arbre transversal rotatif porté par la tablette et entraîné en rotation par une motorisation grâce à une liaison autorisant un déplacement en translation du porte gouttière tout en permettant son entraînement en rotation par ledit arbre.
    Cette solution n'est pas satisfaisante étant donné que le bassin du patient à tendance à basculer en provoquant un mouvement du genou qui ne s'effectue pas dans un plan vertical parallèle à l'axe longitudinal de la table d'opération.
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 lateral edges of fastening means with adjustable spacing on the two lateral guide rails of an operating table, and
  • a gutter door mounted at one of its ends on a rotary transverse shaft carried by the tablet and rotated by a motorization through a connection allowing a displacement in translation of the gutter 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.

L'invention a plus particulièrement pour but de supprimer ces inconvénients grâce à un appareil pouvant se monter sur la plupart des tables d'opération utilisées à l'heure actuelle et qui s'adapte à la morphologie des patients, en prenant en compte notamment la position de l'articulation de la hanche ; cet appareil permet en outre d'obtenir une meilleure précision dans la conduite des actes chirurgicaux.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.

A cet effet, l'appareil selon l'invention comprend des moyens de positionnement d'un berceau supportant le membre du patient par rapport aux rails latéraux de guidage d'une table d'opération ou d'une table de soins, sachant que lesdits moyens de positionnement comportent :

  • des moyens de solidarisation desdits moyens de positionnement du berceau indifféremment sur l'un ou l'autre des deux rails latéraux de guidage de la table d'opération,
  • des moyens de positionnement dudit berceau selon un axe contenu dans un plan parallèle à celui défini par la table d'opération, et perpendiculaire à l'axe longitudinal de la table d'opération, lesquels susdits moyens de positionnement dudit berceau comprennent :
    • ○ une semelle située dans un plan parallèle à celui défini par la table d'opération, laquelle semelle pouvant se déplacer parallèlement à elle-même en liaison coulissante avec les susdits moyens de solidarisation,
    • ○ une chape, solidaire de la susdite semelle, comportant un arbre de rotation, situé proche de la partie supérieure de ladite chape, et dont l'axe est situé dans un plan parallèle à ladite semelle et perpendiculaire à l'axe longitudinal de la table d'opération,
    • ○ un porte-bras, monté rotatif autour dudit arbre de rotation et actionné en rotation dans un plan perpendiculaire à ladite semelle par une motorisation, disposée essentiellement parallèlement au plan défini par la table d'opération,
    • ○ une coulisse, montée solidaire du susdit porte-bras, du côté opposé à la susdite motorisation, et pouvant guider un coulisseau dans un plan perpendiculaire à ladite semelle,
    • ○ un bras, solidaire du susdit coulisseau, dont l'axe principal est parallèle à l'axe longitudinal de la table d'opération,
    • ○ un moyeu, dont l'axe est situé dans un plan parallèle à ladite semelle et perpendiculaire à l'axe longitudinal de la table d'opération, et pouvant coulisser au travers dudit bras selon l'axe principal dudit bras,
    • ○ un arbre, monté rotatif et translatable dans le susdit moyeu, dont l'axe est colinéaire avec le susdit axe du moyeu, et supportant à une de ses extrémités le susdit berceau.
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 to 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 comprise:
    • ○ a sole located in a plane parallel to that defined by the operating table, which sole can move parallel to itself in sliding connection with the said securing means,
    • A clevis secured to said soleplate, comprising a rotation shaft situated near the upper part of said clevis, and whose axis lies in a plane parallel to said soleplate and perpendicular to the longitudinal axis of the table; operation,
    • An armrest, rotatably mounted around said rotation shaft and actuated in rotation in a plane perpendicular to said soleplate by a motor, arranged substantially parallel to the plane defined by the operating table,
    • A slide, mounted integral with the aforesaid armrest, on the opposite side to the aforesaid motorization, and capable of guiding a slide in a plane perpendicular to said soleplate,
    • An arm, secured to said slider, the main axis of which 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.

Grâce à ces dispositions :

  • le dispositif, selon l'invention, peut se monter sur des tables d'opération ou de soins de largeur et d'épaisseur variables, indifféremment sur l'un ou l'autre des deux rails latéraux de guidage de ladite table d'opération ou de soins,
  • l'arbre supportant le berceau a son axe perpendiculaire à l'axe longitudinal de la table d'opération, lequel axe dudit arbre est perpendiculaire au plan vertical passant par la jambe du patient,
  • l'axe de basculement de l'ensemble constitué du susdit porte-bras, du susdit bras, du susdit moyeu et du susdit arbre associé au berceau, peut être amené au voisinage de l'articulation de la hanche de manière à ce que l'effort appliqué par le berceau se répartisse
  • uniformément sur la cuisse en évitant toute compression excessive des organes (muscles, tendons, veines, artères) de la cuisse ainsi que tout basculement transversal du bassin,
  • la longueur réglable du berceau est prévue de manière à éviter tout effort sous le genou du patient au niveau de l'articulation fémoro-tibiale et une compression de l'artère poplitée ; avantageusement, le berceau pourra être constitué d'un mors fixe solidaire de l'arbre supportant le berceau et d'un mors mobile coulissant, permettant de régler la distance entre les deux mors en fonction de la morphologie de la cuisse.
Thanks to these provisions:
  • the device, according to the invention, can be mounted on operating or care tables of varying width and thickness, either on one or the other of the two lateral guide rails of said operating table or of care,
  • 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 near the hip joint so that the effort applied by the cradle is distributed
  • evenly 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 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.

Avantageusement, la susdite motorisation permettant d'actionner en rotation le susdit porte-bras pourra être disposée essentiellement perpendiculairement au plan défini par la table d'opération, de manière à permettre au chirurgien un accès plus aisé auprès du patient.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.

Avantageusement, le susdit arbre de rotation, situé proche de la partie supérieure de ladite chape, permettant au porte-bras de pivoter, pourra comporter un alésage, afin de pouvoir loger un générateur de faisceau laser, de faible dimension et de faible puissance ou tout autre générateur de faisceau lumineux, pour permettre au chirurgien un positionnement visuel précis de l'axe du susdit arbre de rotation par rapport à l'articulation coxo-fémorale dans le cas d'une opération du genou.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.

Avantageusement, les susdits moyens de solidarisation desdits moyens de positionnement du berceau indifféremment sur l'un ou l'autre des deux rails latéraux de guidage de la table d'opération pourront être constitués d'un arbre essentiellement vertical solidaire de la semelle de l'appareil selon l'invention, pouvant coulisser en translation et pouvant pivoter en rotation par rapport à un moyeu solidaire de l'un des deux rails latéraux, de manière à permettre au chirurgien de mieux positionner le membre à traiter du patient.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.

Avantageusement, le susdit bras comportant le susdit coulisseau guidé par la susdite coulisse solidaire du porte-bras, pourra être actionné en translation au moyen d'un ensemble vis/écrou, de manière à permettre au chirurgien de positionner avec précision le bras par rapport au porte-bras.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.

Avantageusement, la section transversale du susdit coulisseau du susdit bras pourra être de forme voisine d'un oméga et en correspondance de forme avec la section transversale de la susdite coulisse solidaire du porte-bras, afin d'autoriser une déviation angulaire de part et d'autre d'une position médiane du bras par rapport au porte-bras selon l'axe de symétrie de la section transversale en forme d'oméga, de manière à permettre au chirurgien de mieux positionner le membre à traiter du patient.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.

Avantageusement, le susdit bras pourra ne pas comporter de moyeu pouvant coulisser au travers dudit bras selon son axe principal ; ainsi l'arbre supportant le berceau, sera monté rotatif et translatable à l'extrémité du bras ; plusieurs bras de longueur différente pourront être envisagés, de manière à éviter au chirurgien d'être gêné par l'extrémité du bras réglable au cas où il est nécessaire de positionner l'arbre supportant le berceau à proximité du porte-bras.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.

Avantageusement, une housse d'asepsie permettant de couvrir entièrement le dispositif selon l'invention pourra être prévue durant l'opération chirurgicale ; cette housse pourra être jetable après chaque opération ou pourra être réutilisable après stérilisation.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.

Un mode d'exécution sera décrit ci-après, à titre d'exemple non limitatif, avec référence aux dessins annexés dans lesquels :

  • La figure 1 est une représentation en perspective du dispositif pour l'ajustement de la position d'un membre d'un patient reposant sur une table d'opération,
  • La figure 2 est une seconde représentation en perspective dudit dispositif vu sous un autre angle associé à un seul rail de la table d'opération,
  • La figure 3 est une troisième représentation en perspective dudit dispositif vu sous un autre angle associé à un seul rail de la table d'opération,
  • La figure 4 est une représentation en perspective du berceau associé à son arbre monté rotatif et translatable dans le susdit moyeu,
  • La figure 5 est une représentation en perspective du bras, solidaire dudit coulisseau et comprenant le susdit moyeu pouvant coulisser au travers dudit bras selon l'axe principal dudit bras,
  • La figure 6 est une représentation en coupe dudit coulisseau et d'un mécanisme de positionnement dudit bras par rapport audit porte-bras,
  • La figure 7 est une représentation en perspective du dispositif pour l'ajustement de la position d'un membre d'un patient selon un second mode de réalisation,
  • La figure 8 est une seconde représentation en perspective du dispositif pour l'ajustement de la position d'un membre d'un patient selon le second mode de réalisation,
  • La figure 9 est une représentation en perspective du dispositif pour l'ajustement de la position d'un membre d'un patient selon un troisième mode de réalisation,
  • La figure 10 est une représentation en perspective détaillant le réglage du positionnement du bras par rapport au porte-bras,
  • La figure 11 est une représentation en perspective du bras solidaire d'un coulisseau selon un second mode de réalisation,
  • La figure 12 est une représentation en perspective du bras solidaire d'un coulisseau selon un troisième mode de réalisation, et
  • La figure 13 est une représentation en perspective du bras et partiellement de l'arbre supportant le berceau et du berceau, selon un quatrième mode de réalisation.
One embodiment will be described below, by way of non-limiting example, with reference to the accompanying drawings in which:
  • The figure 1 is a perspective view of the device for adjusting the position of a limb of a patient resting on an operating table,
  • The figure 2 is a second perspective representation of said device seen at another angle associated with a single rail of the operating table,
  • The figure 3 is a third perspective representation of said device seen from another angle associated with a single rail of the operating table,
  • The figure 4 is a perspective representation of the cradle associated with its rotatably mounted shaft and translatable in the aforesaid hub,
  • The figure 5 is a perspective representation of the arm, secured to said slide and comprising the aforesaid hub being slidable through said arm along the main axis of said arm,
  • The figure 6 is a sectional representation of said slider and a mechanism for positioning said arm relative to said armrest,
  • The figure 7 is a perspective view of the device for adjusting the position of a patient's limb according to a second embodiment,
  • The figure 8 is a second perspective representation of the device for adjusting the position of a patient's limb according to the second embodiment,
  • The figure 9 is a perspective view of the device for adjusting the position of a limb of a patient according to a third embodiment,
  • The figure 10 is a perspective representation detailing the adjustment of the positioning of the arm relative to the armrest,
  • The figure 11 is a perspective representation of the arm integral with a slide according to a second embodiment,
  • The figure 12 is a perspective representation of the arm integral with a slide according to a third embodiment, and
  • The 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.

Dans l'exemple représenté sur les figures 1, 2, 3, le dispositif 1, comportant des moyens de positionnement d'un berceau Be supportant le membre d'un patient par rapport aux rails latéraux de guidage RG1, RG2, d'une table d'opération TO, est constitué :

  • d'une semelle Se disposée horizontalement et latéralement le long de la table d'opération TO dont l'axe longitudinal est Δ, représentée par un plateau P1 et ses deux rails latéraux de guidage RG1, RG2,
  • des moyens de solidarisation MS1, MS2, MS3, de ladite semelle Se sur l'un ou l'autre des deux rails de guidage RG1, RG2, de la table d'opération TO,
  • d'une chape Ch, solidaire de ladite semelle Se, dont la section transversale est en forme de U,
  • d'un arbre de rotation A1, situé proche de la partie supérieure de la chape Ch, et dont l'axe Δ1 est situé dans un plan parallèle à la semelle Se et perpendiculaire à l'axe longitudinal Δ de la table d'opération TO,
  • d'un porte-bras Po, monté rotatif autour de l'arbre de rotation A1 et actionné en rotation dans le plan vertical perpendiculaire à la semelle Se, par un vérin Ve,
  • d'une coulisse, montée solidaire du susdit porte-bras Po, du côté opposé au vérin Ve, et pouvant guider un coulisseau Co dans un plan perpendiculaire à la semelle Se,
  • d'un bras Br, solidaire du coulisseau Co, dont l'axe principal Δ2 est parallèle à l'axe longitudinal Δ de la table d'opération TO,
  • d'un moyeu Mo, dont l'axe principal Δ3 est situé dans un plan parallèle à la semelle Se et perpendiculaire à l'axe Δ de la table d'opération TO, et pouvant coulisser au travers du bras Br selon l'axe principal Δ2 du bras Br,
  • d'un arbre Ar, monté rotatif et translatable dans le moyeu Mo, dont l'axe est colinéaire avec l'axe Δ3 du moyeu Mo, et supportant à une de ses extrémités le berceau Be supportant le membre du patient.
In the example shown on the figures 1 , 2 , 3 , the device 1, comprising means for positioning a cradle BE supporting the patient's limb with respect to the lateral guide rails RG 1 , RG 2 , of an operating table TO, consists of:
  • of a sole plate disposed horizontally and laterally along the operating table TO whose longitudinal axis is Δ, represented by a plate P1 and its two lateral guide rails RG 1 , RG 2 ,
  • fastening means MS 1 , MS 2 , MS 3 , of said soleplate Se on one or the other of the two guide rails RG 1 , RG 2 , of the operating table TO,
  • a clevis Ch, secured to said sole Se, whose cross section is U-shaped,
  • a rotation shaft A 1 , located near the upper part of the clevis Ch, and whose axis Δ 1 is located in a plane parallel to the sole plate Se and perpendicular to the longitudinal axis Δ of the table of TO operation,
  • an armrest Po, rotatably mounted around the rotation shaft A 1 and actuated in rotation in the vertical plane perpendicular to the soleplate Se, by a cylinder Ve,
  • a slide, integral with the aforesaid armrest Po, on the opposite side to the cylinder Ve, and able to guide a slide Co in a plane perpendicular to the sole plate Se,
  • an arm Br, 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, the main axis Δ 3 is located in a plane parallel to the sole plate and perpendicular to the axis Δ of the operating table TO, and slidable through the arm Br along the axis principal Δ 2 of the Br arm,
  • 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.

Ainsi, dans ces conditions, le berceau Be peut être positionné au-dessus de la table d'opération TO, d'une manière précise par rapport à la jambe du patient en tenant compte de sa morphologie ; il peut basculer dans un plan perpendiculaire au plan défini par la table d'opération TO passant par la jambe du patient et selon un axe Δ1 amené au voisinage de l'articulation de la hanche.Thus, under these conditions, the cradle Be can be positioned above the operating table TO, 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 Δ1 brought to the vicinity of the hip joint.

Les moyens de solidarisation MS1, MS2, MS3, de la semelle Se sur l'un ou l'autre des deux rails de guidage RG1, RG2, de la table d'opération TO, sont constitués d'au moins deux arbres AS1, AS2, AS3, solidaires de la semelle Se sur la face opposée à celle supportant les moyens de positionnement du berceau Be, orientés perpendiculairement à la semelle Se, lesquels arbres AS1, AS2, AS3, peuvent coulisser chacun dans une noix de serrage NS1, NS2, NS3, dont l'axe principal est horizontal et perpendiculaire à l'axe longitudinal Δ de la table d'opération TO ; chacune des dites noix NS1, NS2, NS3, est solidaire d'une paire de mors Mo1, Mo2, Mo3, dont l'extrémité de serrage est en correspondance de forme avec la section transversale des rails de guidage RG1, RG2, de la table d'opération TO, la paire de mors Mo1, Mo2, Mo3, étant constituée d'un mors supérieur fixe solidaire de la noix de serrage NS1, NS2, NS3, et d'un mors inférieur mobile actionnable par une poignée de serrage P1, P2, P3, le mors supérieur fixe prenant appui sur la tranche, orientée vers la table d'opération TO, de la semelle Se.
Ainsi la semelle Se peut être déplacée et positionnée verticalement, d'une manière précise, étant guidée d'une part par les arbres AS1, AS2, AS3, et prenant appui, au voisinage de sa tranche orientée vers la table d'opération TO, sur la face verticale des mors fixes.The securing means MS 1 , MS 2 , MS 3 , of the sole plate Se on one or the other of the two guide rails RG 1 , RG 2 , of the operating table TO, consist of at least two shafts AS 1 , AS 2 , AS 3 , integral with the sole Se on the face opposite to that supporting the positioning means of the cradle Be, oriented perpendicular to the sole Se, which shafts AS 1 , AS 2 , AS 3 , can each slide in a clamping nut NS 1 , NS 2 , NS 3 , whose main axis is horizontal and perpendicular to the longitudinal axis Δ of the operating table TO; each of said nuts NS 1 , NS 2 , NS 3 , is integral with a pair of jaws Mo 1 , Mo 2 , Mo 3 , whose clamping end is in correspondence with the cross section of the guide rails RG 1 , RG 2 , of the operating table TO, the 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 of a movable lower jaw actuable 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 shafts AS 1 , AS 2 , AS 3 , and taking support, in the vicinity of its slice facing the table. TO operation, on the vertical face of the fixed jaws.

D'une manière générale, les tables d'opération ou de soins sont constituées d'une pluralité de segments de table, solidaires les uns des autres et pouvant être orientés les uns par rapport aux autres en fonction de la nature de l'opération à pratiquer sur le patient ; en conséquence, les rails de guidage, associés aux dits éléments de table sont également segmentés et présentent ainsi des interruptions, dites ruptures de rail, nécessitant parfois le serrage sur deux des trois moyens de solidarisation en fonction de ladite rupture de rail.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.

La motorisation Ve, de type actionneur, actionne en rotation la porte-bras Po par l'intermédiaire d'une première articulation Ar1 en liaison avec un pied solidaire Pi de la semelle Se et d'une seconde articulation Ar2 solidaire du porte-bras Po, laquelle seconde articulation Ar2 est disposée entre l'arbre A1 et la partie inférieure du porte-bras Po, permettant d'élever ou d'abaisser, plus ou moins, le coulisseau Co et par conséquent le bras Br comportant le moyeu Mo, l'arbre Ar et le berceau Be.The actuator type actuator Ve actuates the arm support Po in rotation by means of a first articulation Ar 1 in conjunction with a foot integral Pi of the sole Se and a second joint Ar 2 secured to the armrest Po, which second joint Ar 2 is disposed between the shaft A 1 and the lower part of the armrest Po, to raise or lowering, more or less, the slider Co and therefore the arm Br having the hub Mo, the Ar shaft and the cradle Be.

Généralement, le berceau Be est élevé de telle manière que la jambe du patient soit située dans un plan vertical, permettant ainsi de positionner, d'une manière satisfaisante, l'articulation fémoro-tibiale.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.

Par ailleurs, le berceau Be pouvant être positionné soit d'un côté de la table d'opération TO, soit de l'autre côté, permet ainsi de conduire les opérations chirurgicales au niveau du genou gauche ou du genou droit.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.

Bien entendu, un carter de protection Ca pourra être utilisé de manière à éviter tout contact du mécanisme motorisé avec la table d'opération TO et/ou avec l'un quelconque de ses accessoires.
Ainsi, l'espace autour du berceau Be est totalement libéré et permet de disposer les appareils destinés à l'opération chirurgicale en fonction des contraintes définies par ladite opération.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.

La motorisation Ve pourra être de type à actionneur électrique, pneumatique ou hydraulique ; la commande de celui-ci pourra être effectuée proche de la table d'opération TO ou télécommandée à distance ; le positionnement angulaire de la porte-bras Po, et par conséquent du berceau Be, pourra être effectué par l'intermédiaire de butées mécaniques, de capteurs de position, ou de tout autre mécanisme de positionnement angulaire ou d'asservissement en position, en fonction des paramètres morphologiques du patient.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.

Dans l'exemple représenté sur la figure 4, l'arbre Ar associé au berceau Be comprend un méplat Me de longueur proche de la moitié de la longueur de l'arbre Ar et une pluralité de gorges circulaires G1, G2, G3, équidistantes séparées par des orifices circulaires O1, O2, O3, O4, traversant l'arbre Ar et dont les axes sont perpendiculaires à l'axe Δ3 de l'arbre Ar.
A noter que la profondeur de la pluralité des gorges G1, G2, G3, équidistantes est inférieure à la profondeur du méplat Me.
Une première goupille cylindrique, non représentée, traverse l'orifice du moyeu Mo recevant l'arbre Ar, dont une génératrice tangente le méplat Me de l'arbre Ar.
Par conséquent, l'arbre Ar peut être déplacé manuellement selon son axe principal Δ3 lorsque le méplat Me est parallèle à ladite première goupille cylindrique, et peut pivoter manuellement autour de son axe principal Δ3 lorsque une gorge de ladite pluralité des gorges G1, G2, G3, est en regard de ladite première goupille cylindrique.
Ainsi, moyennant une rotation d'environ 90 degrés de l'arbre Ar dans un sens, suivi d'une translation de l'arbre Ar puis d'une rotation de même amplitude en sens opposé au précédent, la distance entre le berceau Be et le moyeu Mo est réglable par quantum équivalent à la distance entre gorges successives G1, G2, G3.
Une immobilisation de l'arbre Ar en rotation et en translation est effectuée au moyen d'une seconde goupille Go, traversant diamétralement le moyeu Mo et se logeant dans les orifices circulaires O1, O2, O3, O4, traversant l'arbre Ar et dont les axes sont perpendiculaires à l'axe Δ3 de l'arbre Ar. Cette seconde goupille Go est représentée sur la figure 5.In the example shown on the figure 4 , the Ar tree associated with the cradle Be comprises a flattened Me of length close to half the length of the Ar shaft and a plurality of circular grooves G 1 , 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 Δ axis 3 of the Ar shaft.
Note that the depth of the plurality of grooves G 1 , 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 G 1 , 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 G 1 , 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 Ar and whose axes are perpendicular to the axis Δ 3 of the Ar shaft. This second pin GB is shown in FIG. figure 5 .

Dans l'exemple représenté sur la figure 5, le moyeu Mo, dans une section longitudinale contenant son axe principal Δ2, est une structure en forme de H ; le bras Br a une largeur constante et légèrement inférieure à la longueur du montant horizontal séparant les deux montants verticaux de la structure en forme de H, et possède une lumière située dans un plan perpendiculaire à l'axe Δ3 du moyeu Mo, permettant ainsi au moyeu Mo de coulisser selon l'axe principal Δ2 du bras Br, la largeur de la lumière étant légèrement supérieure à l'épaisseur du montant horizontal de la structure en forme de H.
Par conséquent, le moyeu Mo est guidé en translation et immobilisé en rotation dans la lumière du bras Br.
La susdite seconde goupille Go traverse diamétralement le moyeu Mo dans un des deux montants verticaux de la structure en forme de H, permettant de pénétrer dans les orifices circulaires O1, O2, O3, O4, traversant l'arbre Ar et ainsi de le solidariser par rapport au moyeu Mo.In the example shown on the figure 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, 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 axis principal 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.

Un arbre AC, possédant une pluralité de cannelures, dont l'axe principal est colinéaire avec l'axe principal Δ2 du bras Br, est solidaire du moyeu Mo, au voisinage de l'une de ses extrémités. Un crabot CR, partiellement représenté, dont l'axe de rotation Δ4 est perpendiculaire à l'axe Δ2 de l'arbre cannelé AC, permet de bloquer en translation l'arbre cannelé AC et par conséquent le moyeu Mo, au moyen d'une rotation dudit crabot CR permettant à une dent de venir se loger en correspondance de forme dans une de la pluralité de cannelures.
Ainsi, le déplacement du moyeu Mo et par conséquent celui du berceau Be est réglable par quantum équivalent à la distance entre deux cannelures successives.An AC shaft, having a plurality of grooves, whose main axis is collinear with the main axis Δ 2 of the Br arm, 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.

Avantageusement, le crabot CR permet, au moyen d'une seconde orientation dudit crabot CR, de désolidariser l'arbre cannelé AC, associé au moyeu Mo, permettant ainsi un déplacement libre de l'ensemble constitué du moyeu Mo, de l'arbre Ar et du berceau Be, selon l'axe principal Δ2 du bras Br.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.

Par ailleurs, le bras Br comprend, au voisinage de son extrémité opposée à celle où se situe le moyeu Mo précédemment décrit, le coulisseau Co selon un axe Δ5 orthogonal aux axes respectivement Δ3 et Δ2 du moyeu Mo et de l'arbre cannelé AC, et dont la section transversale est en forme de H.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.

Au voisinage de la face externe du porte-bras Po, en regard du bras Br, une coulisse, dont la section transversale est en forme de T, en correspondance de forme avec le coulisseau Co du bras Br, permet de guider le bras Br selon une direction orthogonale aux axes respectivement Δ3 et Δ2 du moyeu Mo et de l'arbre cannelé AC.
Une tirette Ti actionnant un doigt Do dont l'axe Δ6 est parallèle à l'axe Δ2 de l'arbre cannelé AC, permet, en engageant le doigt Do dans un orifice Ox de la pluralité d'orifices réalisés dans le porte-bras Po, de positionner le bras Br par rapport au porte-bras Po.In the vicinity of the outer face of the arm support Po, facing the arm Br, a slide, whose cross section is T-shaped, in correspondence with the slider 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.

Dans l'exemple représenté sur la figure 6, la représentation en coupe du coulisseau Co et du mécanisme de positionnement du bras Br par rapport audit coulisseau Co fait apparaître la section en H du coulisseau Co associé au bras Br et la section en T de la coulisse située dans la porte-bras Po.
Selon l'axe Δ6, le doigt Do traverse le coulisseau Co du bras Br et la coulisse du porte-bras Po, pour aboutir au voisinage d'une de ses extrémités dans un orifice Ox de la pluralité d'orifices réalisés dans le porte-bras Po.
Au voisinage de son autre extrémité, le doigt Do est solidaire de la tirette Ti positionnée dans un plan perpendiculaire au coulisseau Co du bras Br.
Un ressort Re, monté en compression, prenant appui d'une part sur une collerette située au voisinage du milieu du doigt Do et d'autre part sur un flasque F1 obturant la face externe du coulisseau Co du bras Br, permet à l'ensemble, constitué du doigt Do et de la tirette Ti, de maintenir le doigt Do au fond de l'orifice choisi Ox.In the example shown on the figure 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 slider located in the arm-holder Po.
According to the axis Δ 6 , the finger Do crosses the slider Co of the arm Br and the slide of the arm support Po, to end in the vicinity of one of its ends in an orifice Ox of the plurality of orifices made in the door -bras Po.
In the vicinity of its other end, the finger Do is integral with the pull rod Ti positioned in a plane perpendicular to the slider Co of the arm Br.
A spring Re, mounted in compression, bearing on the one hand on a flange located near the middle of the finger Do and on the other hand on a flange F1 closing the outer face of the slider Co of the arm Br, allows the assembly consisting of the finger Do and the pull tab Ti, to maintain the finger Do at the bottom of the selected orifice Ox.

Dans l'exemple représenté sur les figures 7 et 8, le dispositif 1 selon un second mode de réalisation, comportant des moyens de positionnement d'un berceau Be supportant le membre d'un patient par rapport au rail latéral de guidage RG1, d'une table d'opération non représentée, est constitué :

  • d'une semelle Se disposée horizontalement et latéralement le long du rail latéral de guidage RG1,
  • des moyens de solidarisation MS1, MS2, de ladite semelle Se sur le rail de guidage RG1,
  • d'une chape Ch, solidaire de ladite semelle Se, dont la section transversale est en forme de U,
  • d'un arbre de rotation A1, situé proche de la partie supérieure de la chape Ch, et dont l'axe Δ1 est situé dans un plan parallèle à la semelle Se et perpendiculaire au rail de guidage RG1,
  • d'un porte-bras Po, monté rotatif autour de l'arbre de rotation A1 et actionné en rotation dans le plan vertical perpendiculaire à la semelle Se, par un vérin Ve,
  • d'une coulisse, montée solidaire du susdit porte-bras Po, du côté opposé au vérin Ve, et pouvant guider un coulisseau Co dans un plan perpendiculaire à la semelle Se,
  • d'un bras Br, solidaire du coulisseau Co, dont l'axe principal Δ2 est parallèle au rail de guidage RG1,
  • d'un moyeu Mo, dont l'axe principal Δ3 est situé dans un plan parallèle à la semelle Se et perpendiculaire au rail de guidage RG1, et pouvant coulisser au travers du bras Br selon l'axe principal Δ2 du bras Br,
  • d'un arbre Ar, monté rotatif et translatable dans le moyeu Mo, dont l'axe est colinéaire avec l'axe Δ3 du moyeu Mo, et supportant à une de ses extrémités le berceau Be supportant le membre du patient.
Par ailleurs, contrairement au premier mode de réalisation du dispositif selon l'invention, le susdit vérin Ve permettant d'actionner en rotation le susdit porte-bras Po monté rotatif autour de l'arbre de rotation A1, est essentiellement disposé perpendiculairement au plan défini par la table d'opération, libérant ainsi l'espace situé symétriquement au berceau Be supporté par le bras Br et le porte-bras Po.In the example shown on the 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 RG 1 , an operating table not shown, is constituted :
  • of a sole plate disposed horizontally and laterally along the lateral guide rail RG 1 ,
  • securing means MS 1 , MS 2 , of said flange Se on the guide rail RG 1 ,
  • a clevis Ch, secured to said sole Se, whose cross section is U-shaped,
  • a rotation shaft A 1 , located near the upper part of the clevis Ch, and whose axis Δ 1 is located in a plane parallel to the soleplate Se and perpendicular to the guide rail RG 1 ,
  • an armrest Po, rotatably mounted around the rotation shaft A 1 and actuated in rotation in the vertical plane perpendicular to the soleplate Se, by a cylinder Ve,
  • a slide, integral with the aforesaid armrest Po, on the opposite side to the cylinder Ve, and able to guide a slide Co in a plane perpendicular to the sole plate Se,
  • an arm Br, integral with the slider Co, whose main axis Δ 2 is parallel to the guide rail RG 1 ,
  • a hub Mo, the main axis Δ 3 is located in a plane parallel to the sole plate and perpendicular to the guide rail RG 1 , and slidable through the arm Br along the main axis Δ 2 Br arm ,
  • 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 cylinder Ve for rotating said arm holder Po rotatably mounted around the rotation shaft A 1 , is essentially arranged perpendicular to the plane defined by the operating table, thus releasing the space symmetrically located in the cradle Be supported by the arm Br and the armrest Po.

Ainsi, dans ces conditions, le berceau Be peut être positionné au-dessus de la table d'opération, d'une manière précise par rapport à la jambe du patient en tenant compte de sa morphologie ; il peut basculer dans un plan perpendiculaire au plan défini par la table d'opération passant par la jambe du patient et selon un axe Δ1 amené au voisinage de l'articulation de la hanche. Par ailleurs, l'espace libéré par le vérin Ve permet de générer un espace plus confortable destiné au patient.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 Δ1 brought to the vicinity of the hip joint. Furthermore, the space released by the cylinder Ve can generate a more comfortable space for the patient.

Les moyens de solidarisation MS1, MS2, de la semelle Se sur le rail de guidage RG1, sont constitués de deux arbres AS1, AS2, solidaires de la semelle Se sur la face opposée à celle supportant les moyens de positionnement du berceau Be, orientés perpendiculairement à la semelle Se, lesquels arbres AS1, AS2, peuvent coulisser chacun dans une noix de serrage NS1, NS2, dont l'axe principal est horizontal et perpendiculaire à l'axe longitudinal du rail de guidage RG1; chacune des dites noix NS1, NS2, est solidaire d'un clameau, respectivement CL1, CL2, dont le serrage est effectué en correspondance de forme avec la section transversale du rail de guidage RG1, les clameaux CL1, CL2 étant solidarisés par une poignée de serrage, respectivement PCL1, PCL2. Ainsi la semelle Se peut être déplacée et positionnée verticalement, d'une manière précise, étant guidée par les arbres AS1, AS2.The securing means MS 1 , MS 2 , of the sole plate Se on the guide rail RG 1 consist of two shafts AS 1 , AS 2 , integral with the sole plate Se on the face opposite to that supporting the positioning means of the cradle Be, oriented perpendicular to the sole Se, which shafts AS 1 , AS 2 , can each slide in a clamping nut NS 1 , NS 2 , whose main axis is horizontal and perpendicular to the longitudinal axis of the guide rail RG 1 ; each of said nuts NS 1 , NS 2 , is secured to a clameau, respectively CL 1 , CL 2 , whose clamping is effected in correspondence of shape with the cross section of the guide rail RG 1 , the clams CL 1 , CL 2 being secured by a clamping handle, respectively PCL 1 , PCL 2 . Thus the sole Se can be moved and positioned vertically, in a precise manner, being guided by the shafts AS 1 , AS 2 .

La motorisation Ve, de type actionneur, actionne en rotation la porte-bras Po par l'intermédiaire d'une première articulation Ar1 en liaison avec un pied Pi solidaire de la semelle Se par l'intermédiaire de deux colonnes Ci, et d'une seconde articulation Ar2 solidaire du porte-bras Po, laquelle seconde articulation Ar2 est disposée entre l'arbre A1 et la partie supérieure du porte-bras Po, permettant d'élever ou d'abaisser, plus ou moins, le coulisseau Co et par conséquent le bras Br comportant le moyeu Mo, l'arbre Ar et le berceau Be.The motorization Ve, of the actuator type, actuates in rotation the armrest Po by means of a first articulation Ar 1 in conjunction with a foot Pi secured to the soleplate Se via two columns Ci, and of a second articulation Ar 2 secured to the armrest Po, which second articulation Ar 2 is disposed between the shaft A 1 and the upper part of the armrest Po, allowing to raise or lower, more or less, the slider Co and therefore the arm Br having the hub Mo, the Ar shaft and the cradle Be.

Comme décrit précédemment selon le premier mode de réalisation du dispositif selon l'invention, la motorisation Ve pourra être de type actionneur électrique, pneumatique ou hydraulique ; par ailleurs, un carter de protection Ca pourra être utilisé de manière à éviter tout contact du mécanisme motorisé avec la table d'opération.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.

Dans l'exemple représenté sur la figure 8, le susdit arbre de rotation A1, situé proche de la partie supérieure de ladite chape Ch, permettant au porte-bras Po de pivoter, pourra comporter un alésage, afin de pouvoir loger un générateur de faisceau laser La1, LA2, de faible dimension et de faible puissance, pour permettre au chirurgien un positionnement visuel précis de l'axe du susdit arbre de rotation par rapport à l'articulation du membre du patient.
Ladite articulation du membre du patient pourra être préalablement soit marquée, soit estimée, soit palpée ; dans le cas d'une opération du genou, il s'agira de déterminer la position de l'articulation coxo-fémorale.
Les faisceaux des générateurs laser pourront être commandés séparément ou simultanément ; une protection contre le risque d'éblouissement par le faisceau laser sera prévue à cet effet.In the example shown on the figure 8 , the aforesaid rotation shaft A 1 , located near the upper part of said clevis Ch, allowing the armrest Po to rotate, may include a bore, in order to accommodate a laser beam generator La 1 , LA 2 , 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.

Dans l'exemple représenté sur la figure 9, le dispositif 1 selon un troisième mode de réalisation, comportant des moyens de positionnement d'un berceau Be supportant le membre d'un patient par rapport au rail latéral de guidage RG1, d'une table d'opération non représentée, est constitué, hormis des moyens précédemment décrits :

  • des moyens de solidarisation MS1, MS2, de ladite semelle Se sur le rail de guidage RG1.
In the example shown on the figure 9 , the device 1 according to a third embodiment, comprising means for positioning a cradle Be supporting the member of a patient relative to the lateral guide rail RG 1 , an operating table not shown, is constituted , except for the means previously described:
  • securing means MS 1 , MS 2 , said sole Se on the guide rail RG 1 .

Contrairement au premier mode de réalisation du dispositif selon l'invention, les susdits moyens de solidarisation MS1, MS2, de la semelle Se sur le rail de guidage RG1, sont constitués d'un arbre AS0, solidaire de la semelle Se sur la face opposée à celle supportant les moyens de positionnement du berceau Be, orienté perpendiculairement à la semelle Se, lequel arbre AS0, peut coulisser dans une noix de serrage NS0, dont l'axe principal est horizontal et perpendiculaire à l'axe longitudinal du rail de guidage RG1; le serrage du susdit axe arbre AS0 dans la noix NS0 est effectué par l'intermédiaire d'une poignée de serrage P0 ; ladite noix NS0, est solidaire de deux clameaux, CL1, CL2, dont le serrage est effectué en correspondance de forme avec la section transversale du rail de guidage RG1, les clameaux CL1, CL2 étant solidarisés par l'intermédiaire d'une poignée de serrage, respectivement PCL1, PCL2. Ainsi la semelle Se peut coulisser en translation et peut pivoter en rotation par rapport à un moyeu solidaire de fun des deux rails latéraux, de manière à permettre au chirurgien de mieux positionner le membre à traiter du patient.In contrast to the first embodiment of the device according to the invention, the aforementioned securing means MS 1 , MS 2 , of the sole plate Se on the guide rail RG 1 , consist of an AS 0 shaft, integral with the sole plate on the opposite side 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 axis longitudinal guide rail RG 1 ; the tightening of the aforesaid AS shaft shaft 0 in the NS 0 nut is made via a clamping handle P 0 ; said nut NS 0 , is secured to two clams, CL 1 , CL 2 , the clamping is effected in correspondence of shape with the cross section of the guide rail RG 1 , the clams CL 1 , CL 2 being secured by means of a clamping handle, respectively PCL 1 , PCL 2 . Thus the sole Is slidable in translation and can rotate in rotation relative to a fun integral hub of the two side rails, so as to allow the surgeon to better position the member to treat the patient.

Dans l'exemple représenté sur la figure 10, le bras Br comporte le coulisseau Co guidé par la coulisse solidaire du porte-bras Po ; la translation du bras Br, selon l'axe Δ5 est effectué au moyen d'un ensemble vis Vi/écrou Em, de manière à permettre au chirurgien de positionner avec précision le bras Br par rapport au porte-bras Po.
Deux solutions sont envisageables :

  • soit la susdite vis Ve est solidaire du susdit coulisseau Co et l'écrou moleté Em est libre de tourner en appui sur la face supérieure du porte-bras Po, l'entraînement du susdit écrou moleté Em actionnant le bras Br dans un sens ou en sens opposé selon le sens de rotation dudit écrou Em,
  • soit la susdite vie Ve est solidaire de l'écrou moleté Em, laquelle vis Ve entraîne le coulisseau Co au travers d'un trou fileté, l'entraînement du susdit écrou moleté Em actionnant le bras Br dans un sens ou en sens opposé selon le sens de rotation dudit écrou Em.
In the example shown on the figure 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 Δ 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 arm holder Po.
Two solutions are possible:
  • either the aforesaid 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 a direction or in opposite direction according to 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.

Dans l'exemple représenté sur la figure 11, la section transversale du susdit coulisseau Co' du susdit bras Br est de forme voisine d'un oméga et en correspondance de forme avec la section transversale de la susdite coulisse solidaire du porte-bras Po, afin d'autoriser une déviation angulaire de part et d'autre d'une position médiane du bras par rapport au porte-bras autour d'un axe Δ8 de symétrie de la section transversale en forme d'oméga, de manière à permettre au chirurgien de mieux positionner le membre à traiter du patient. La susdite coulisse solidaire du porte-bras Po comporte un élément de serrage, non représenté, permettant de bloquer le susdit coulisseau Co' et ainsi de positionner le bras Br par rapport au porte-bras Po, selon l'angle de déviation choisi.In the example shown on the figure 11 , the cross section of the aforesaid slider Co 'of the aforesaid arm Br is of similar shape of an omega and in correspondence of shape with the cross section of the aforesaid slide integral with the armrest Po, to allow an angular deviation from and other a median position of the arm relative to the arm-rest around a axis Δ 8 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.

Dans l'exemple représenté sur la figure 12, le moyeu Mo, dans une section longitudinale contenant son axe principal Δ2, est une structure en forme de H ; le bras Br a une largeur constante et légèrement inférieure à la longueur du montant horizontal séparant les deux montants verticaux de la structure en forme de H, et possède une lumière située dans un plan perpendiculaire à l'axe Δ3 du moyeu Mo, permettant ainsi au moyeu Mo de coulisser selon l'axe principal Δ2 du bras Br, la largeur de la lumière étant légèrement supérieure à l'épaisseur du montant horizontal de la structure en forme de H.
Par conséquent, le moyeu Mo est guidé en translation et immobilisé en rotation dans la lumière du bras Br.
La susdite seconde goupille Go traverse diamétralement le moyeu Mo dans un des deux montants verticaux de la structure en forme de H, permettant de pénétrer dans les orifices circulaires O1, O2, O3, O4, traversant l'arbre Ar et ainsi de le solidariser par rapport au moyeu Mo.In the example shown on the figure 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.

Un arbre fileté AF, dont l'axe principal est colinéaire avec l'axe principal Δ2 du bras Br, est solidaire du moyeu Mo, au voisinage de l'une de ses extrémités. Une molette MOL, dont l'alésage est filetée, en correspondance de forme avec le susdit arbre fileté AF, est logée dans un embrèvement situé à l'extrémité opposée au susdit moyeu Mo ; cet embrèvement permet à ladite molette MOL de pivoter selon l'axe Δ2, et d'être immobilisée en translation selon le même axe Δ2. Ainsi, le déplacement du moyeu Mo et par conséquent celui du berceau Be est réglable grâce à la rotation de la molette MOL, selon son sens de rotation.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.

Par ailleurs, le bras Br comprend, au voisinage de son extrémité opposée à celle où se situe le moyeu Mo précédemment décrit, le coulisseau Co selon un axe Δ5 orthogonal aux axes respectivement Δ3 et Δ2 du moyeu Mo et de l'arbre fileté AF, et dont la section transversale est en forme de H.
Au voisinage de la face externe du porte-bras Po, en regard du bras Br, une coulisse, dont la section transversale est en forme de T, en correspondance de forme avec le coulisseau Co du bras Br, permet de guider le bras Br selon une direction orthogonale aux axes respectivement Δ3 et Δ2 du moyeu Mo et de l'arbre fileté AF.
Une tirette Ti actionnant un doigt Do dont l'axe Δ6 est parallèle à l'axe Δ2 de l'arbre fileté AF, permet, en engageant le doigt Do dans un orifice Ox de la pluralité d'orifices réalisés dans le porte-bras Po, de positionner le bras Br par rapport au porte-bras Po.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 AF threaded, and whose cross section is H-shaped.
In the vicinity of the outer face of the arm support Po, facing the arm Br, a slide, whose cross section is T-shaped, in correspondence with the slider 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 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.

Dans l'exemple représenté sur la figure 13, le susdit bras Br comporte un moyeu Mo' situé à l'extrémité opposée dudit bras Br au susdit coulisseau Co ; ledit moyeu Mo' ne coulisse donc pas au travers dudit bras Br selon son axe principal Δ2 ; ainsi l'arbre Ar supportant le berceau Be, est monté rotatif et translatable à l'extrémité du bras Br, selon l'axe Δ3 ; plusieurs bras de longueur différente peuvent être envisagés, de manière à éviter au chirurgien d'être gêné par l'extrémité du bras réglable au cas où il est nécessaire de positionner l'arbre Ar supportant le berceau Be à proximité du porte-bras Po.In the example shown on the 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.

Ainsi, les différents degrés de liberté qui caractérisent le dispositif 1 selon l'invention, à savoir :

  • la possibilité de positionner le dispositif 1 à droite ou à gauche de la table d'opération TO,
  • le réglage en distance du dispositif 1 par rapport à la table d'opération TO,
  • l'orientation du porte-bras Po et du bras Br supportant le berceau Be dans un plan perpendiculaire à la table d'opération TO,
  • la hauteur du bras Br par rapport à l'axe de rotation Δ1 du porte-bras Po,
  • la distance de l'arbre Ar supportant le berceau Be par rapport à l'axe de rotation Δ1 du porte-bras Po,
  • la distance du berceau Be par rapport au bras Br,
permettent :
  • de positionner le berceau Be au-dessus de la table d'opération TO, d'une manière précise par rapport à la jambe du patient en tenant compte de sa morphologie,
  • de basculer le berceau Be dans un plan perpendiculaire au plan défini par la table d'opération TO passant par la jambe du patient et selon un axe Δ1 amené au voisinage de l'articulation de la hanche.
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 the arm Br supporting the cradle Be in a plane perpendicular to the operating table TO,
  • the height of the arm Br relative to the axis of rotation Δ 1 of the armrest Po,
  • the distance from the shaft Ar supporting the cradle Be with respect to the axis of rotation Δ 1 of the armrest Po,
  • the distance from the cradle Be relative to the arm Br,
allow:
  • to position the cradle Be above the operating table TO, in a precise manner relative to the patient's leg taking into account its morphology,
  • to switch 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 Δ 1 brought to the vicinity of the hip joint.

Bien entendu, le dispositif 1 selon l'invention permettra de positionner le membre supérieur d'un patient, dans le cadre d'opérations chirurgicales effectuées au niveau de l'avant-bras, du coude, du bras ou du poignet. De même, il permettra, par exemple, de positionner la nuque d'un patient dans le cadre d'opérations chirurgicales effectuées au niveau des vertèbres cervicales.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 (18)

  1. Device (1) for the angular positioning of a limb of a patient resting on an operating table (TO), comprising means of positioning a cradle (Be) supporting the limb of the patient with respect to the lateral guide rails (RG1, RG2) of the operating table (TO),
    characterised in that said positioning means comprise:
    - means (MS1, MS2, MS3) of securing said means of positioning the cradle Be equally well on one or the other of the two lateral guide rails (RG1, RG2) of the operating table (TO);
    - means of positioning said cradle (Be) according to an axis (Δ3) contained in a plane parallel to that defined by the operating table (TO), and perpendicular to the main axis (Δ) of the operating table (TO);
    which above-mentioned means of positioning said cradle (Be) comprise:
    - a base plate (Se) situated in a plane parallel to that defined by the operating table (TO), which base plate (Se) being capable of moving parallel to itself in sliding connection with the above-mentioned securing means (MS1, MS2, MS3);
    - a bracket (Ch), secured to the above-mentioned base plate (Se), comprising a rotation shaft (A1), situated close to the upper part of said bracket (Ch), and whereof the axis (Δ) is situated in a plane parallel to said base plate (Se) and perpendicular to the main axis (Δ) of the operating table (TO);
    - an arm support (Po), mounted able to rotate about said rotation shaft (A1) and driven rotationally in a plane perpendicular to said base plate (Se) by a drive mechanism (Ve);
    - a guide slot, mounted secured to the above-mentioned arm support (Po), on the side opposite to the above-mentioned drive mechanism (Ve), and capable of guiding a sliding block (Co) in a plane perpendicular to said base plate (Se);
    - an arm (Br), secured to said sliding block (Co), whereof the main axis (Δ2) is parallel to the main axis (Δ) of the operating table (TO);
    - a hub (Mo), whereof the axis (Δ3) is situated in a plane parallel to said base plate (Se) and perpendicular to the main axis (Δ) of the operating table (TO), and capable of sliding through said arm (Br) according to the main axis (Δ2) of said arm (Br);
    - a shaft (Ar), mounted able to rotate and move translationally in the above-mentioned hub (Mo), whereof the axis is collinear with the above-mentioned axis (Δ3) of the hub (Mo), and supporting at one of its ends the above-mentioned cradle (Be).
  2. Device according to Claim 1,
    characterised in that the above-mentioned securing means (MS1, MS2, MS3) comprise:
    - at least two shafts (AS1, AS2, AS3) secured to the base plate (Se) each capable of sliding in a clamping spindle (NS1, NS2, NS3);
    - at least two pairs of jaws (Mo1, Mo2, Mo3) whereof the clamping end has a shape matching the cross-section of the guide rails (RG1, RG2) of the operating table (TO), each of said pairs of jaws (Mo1, Mo2, Mo3) consisting of a fixed upper jaw secured to the clamping spindle (NS1, NS2, NS3), and a movable lower jaw that can be actuated by a clamping handle (P1, P2, P3), the fixed upper jaw bearing on the section, oriented towards the operating table (TO), of the base plate (Se).
  3. Device according to Claim 1,
    characterised in that the above-mentioned drive mechanism (Ve), of actuator type, rotationally drives the arm support (Po) by means of a first articulation (Ar1) in conjunction with a foot (Pi) secured to the base plate (Se) and a second articulation (Ar2) secured to the arm support (Po), which second articulation (Ar2) is disposed between the shaft (A1) and the lower part of the arm support (Po).
  4. Device according to Claim 1,
    characterised in that the above-mentioned drive mechanism (Ve) is of the type with an electric, pneumatic or hydraulic actuator; the control thereof is performed close to the operating table (TO) or remotely controlled.
  5. Device according to Claim 1,
    characterised in that the above-mentioned shaft (Ar) associated with the cradle (Be) comprises a flat surface (Me) with a length close to half the length of the shaft (Ar) and a plurality of equidistant circular slots (G1, G2, G3), the depth of the plurality of slots (G1, G2, G3) being less than the depth of the flat surface Me; a cylindrical pin passes through the aperture in the hub (Mo) receiving the shaft (Ar), whereof a generator is tangential to the flat surface (Me) of the shaft (Ar).
  6. Device according to Claim 1,
    characterised in that the above-mentioned hub (Mo), in a longitudinal section containing its main axis (Δ2), is an H-shaped structure, the arm (Br) having a width that is constant and slightly less than the length of the horizontal post separating the two vertical posts of the H-shaped structure, and has a hole situated in a plane perpendicular to the axis (Δ3) of the hub (Mo), allowing the hub (Mo) to slide according to the main axis (Δ2) of the arm (Br), the width of the hole being slightly greater than the thickness of the horizontal post of the H-shaped structure.
  7. Device according to Claim 1,
    characterised in that the above-mentioned arm (Br) comprises:
    - a shaft (AC), having a plurality of grooves, whereof the main axis is collinear with the main axis (Δ2) of the arm (Br), which shaft (AC) is secured to the hub (Mo), in the vicinity of one of its ends;
    - a claw coupling (CR), whereof the axis of rotation (Δ4) is perpendicular to the axis (Δ2) of the grooved shaft (AC), making it possible to lock or unlock translation-wise the grooved shaft (AC) and the hub (Mo), by means respectively of a first rotation of said claw coupling (CR) allowing a tooth to come to fit with a matching shape in one of the plurality of grooves, or of a second rotation of said claw coupling (CR) allowing the above-mentioned tooth to escape from said plurality of grooves.
  8. Device according to Claim 1,
    characterised in that the above-mentioned cradle (Be) comprises a fixed jaw secured to the shaft (Ar) supporting the cradle (Be) and a sliding movable jaw, making it possible to adjust the distance between the two jaws according to the morphology of the thigh.
  9. Device according to Claim 4,
    characterised in that the above-mentioned cylinder (Ve), making it possible to rotationally drive the above-mentioned arm support (Po) mounted able to rotate about the rotation shaft (A1), is disposed perpendicular to the plane defined by the operating table (TO).
  10. Device according to Claim 1,
    characterised in that the above-mentioned rotation shaft (A1), situated close to the upper part of the above-mentioned bracket (Ch), allowing the arm support (Po) to pivot, comprises a blind bore at each of its ends, in order to be able to house a laser beam generator (La1, LA2), small in size and of low power.
  11. Device according to Claim 1,
    characterised in that the above-mentioned means (MS1, MS2) of securing the base plate (Se) to the guide rail (RG1) of said means of positioning the cradle (Be) consist of a shaft (AS0) secured to said base plate (Se) on the face opposite to that supporting the above-mentioned means of positioning the cradle (Be), oriented perpendicular to said base plate (Se), which shaft (AS0) slides in a clamping spindle (NS0), whereof the main axis is horizontal and perpendicular to the longitudinal axis of said guide rail (RG1).
  12. Device according to Claim 11,
    characterised in that the clamping of the above-mentioned shaft (AS0) in the above-mentioned spindle (NS0) is performed by means of a clamping handle (P0), said spindle (NS0) is secured to two cramps (CL1, CL2) whereof the clamping is performed with a shape matching the cross-section of the guide rail (RG1), the above-mentioned cramps (CL1, CL2) being secured by means of a clamping handle, respectively (PCL1, PCL2).
  13. Device according to Claim 1,
    characterised in that the above-mentioned sliding block (Co) guided by the guide slot secured to the arm support (Po) comprises a bolt/nut (Vi)/(Em) assembly, allowing the translational movement of the arm (Br) according to an axis (Δ5) orthogonal to the above-mentioned axes respectively (Δ3), (Δ2) of the above-mentioned hub (Mo) and the above-mentioned arm (Br).
  14. Device according to Claim 1,
    characterised in that the above-mentioned sliding block (Co) guided by the guide slot secured to the arm support (Po) comprises an omega-shaped cross-section and with a shape matching the cross-section of the above-mentioned guide slot secured to the arm support (Po), in order to enable an angular deviation either side of a median position of the arm (Br) with respect to the arm support (Po) about an axis (Δ8) of symmetry of said omega-shaped cross-section.
  15. Device according to Claim 1,
    characterised in that the above-mentioned arm (Br) comprises:
    - a threaded shaft (AF), whereof the main axis is collinear with the main axis (Δ2) of the arm (Br), which threaded shaft (AF) is secured to the hub (Mo), in the vicinity of one of its ends;
    - a knurled wheel (MOL), whereof the bore is threaded, with a shape matching the above-mentioned threaded shaft (AF), which knurled wheel (MOL) is housed in a recess situated at the end opposite to the above-mentioned hub (Mo), the above-mentioned recess allowing said knurled wheel (MOL) to pivot according to the axis (Δ2), and be immobilised translation-wise according to the same axis (Δ2), the rotation of the above-mentioned knurled wheel (MOL) allowing the movement of the hub Mo and consequently that of the cradle (Be).
  16. Device according to Claim 1,
    characterised in that the above-mentioned arm (Br) comprises a hub (Mo') situated at the opposite end of said arm (Br) to the sliding block (Co), the above-mentioned hub (Mo') is secured to said arm (Br), the above-mentioned shaft (Ar) supporting the above-mentioned cradle (Be) is mounted able to rotate and move translationally at the end of the arm (Br), according to the axis (Δ3).
  17. Device according to Claim 16,
    characterised in that the above-mentioned arm (Br) comprises several different lengths.
  18. Device according to one of the preceding claims,
    characterised in that a protective housing (Ca) avoids any contact of the above-mentioned motorised mechanism (Ve) with the operating table (TO) and/or with any whatsoever of its accessories.
EP06808187A 2005-10-25 2006-10-09 Device for angularly positioning a member of a patient lying on an operating table Active EP1940337B1 (en)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
FR0510867A FR2892300B1 (en) 2005-10-25 2005-10-25 DEVICE FOR THE ANGULAR POSITIONING OF A MEMBER OF A PATIENT BASED ON AN OPERATING TABLE.
PCT/FR2006/002169 WO2007048892A1 (en) 2005-10-25 2006-10-09 Device for angularly positioning a member of a patient lying on an operating table

Publications (2)

Publication Number Publication Date
EP1940337A1 EP1940337A1 (en) 2008-07-09
EP1940337B1 true EP1940337B1 (en) 2009-11-18

Family

ID=36685910

Family Applications (1)

Application Number Title Priority Date Filing Date
EP06808187A Active EP1940337B1 (en) 2005-10-25 2006-10-09 Device for angularly positioning a member of a patient lying on an operating table

Country Status (9)

Country Link
US (1) US8020559B2 (en)
EP (1) EP1940337B1 (en)
JP (1) JP2009513209A (en)
CN (1) CN101384236A (en)
AT (1) ATE448766T1 (en)
CA (1) CA2625630C (en)
DE (1) DE602006010590D1 (en)
FR (1) FR2892300B1 (en)
WO (1) WO2007048892A1 (en)

Cited By (1)

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Publication number Priority date Publication date Assignee Title
EP4062886A1 (en) 2021-03-25 2022-09-28 Ganymed Robotics Limb positioning system

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ES2550078T3 (en) 2011-07-22 2015-11-04 Stryker Corporation Support for a body limb with multiple positions
US8683631B2 (en) * 2012-01-26 2014-04-01 American Sterilizer Company Sacral pad for a medical table
DE102012105264B4 (en) * 2012-06-18 2016-06-09 MAQUET GmbH Device for fixing a femur in hip endoprosthesis
CN103519943A (en) * 2013-10-23 2014-01-22 深圳市思乘创新工业设计有限公司 Stretcher trolley
CN103598958B (en) * 2013-12-09 2015-06-03 冉旭东 Positioning machine
AU2015229719B2 (en) 2014-03-10 2017-04-06 Stryker Corporation Limb positioning system
US9951904B2 (en) 2015-03-24 2018-04-24 Stryker Corporation Rotatable seat clamps for rail clamp
US10197593B2 (en) 2015-07-13 2019-02-05 YIS/Cowden Group Modular portable speedometer calibration stand
EP3618751B1 (en) * 2017-05-03 2021-08-18 Smith & Nephew, Inc. Lockable, hydraulic surgical support apparatus
CN111643310B (en) * 2020-06-05 2022-09-30 泰兴市唯艺传媒广告有限公司 Multi-functional leg support bracket of orthopedics for operation
CN112674983A (en) * 2020-12-23 2021-04-20 华中科技大学同济医学院附属协和医院 Upper limb operation posture support

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FR2605517A1 (en) * 1986-10-27 1988-04-29 Tasserit Ets Mechanical knee support for arthroscopy
FR2631231B1 (en) * 1988-05-11 1994-08-12 Medistef Sarl APPARATUS FOR HOLDING THE THIGH, PARTICULARLY IN THE CASE OF KNEE INTERVENTION
FR2732213B1 (en) * 1995-03-27 1997-10-10 Rousseau Jacques Marie DEVICE FOR POSITIONING A JOINT DURING A SURGICAL INTERVENTION
BE1010080A6 (en) * 1996-03-18 1997-12-02 Legrand Georges Apparatus for supporting leg of a patient for surgery knee.
DE10304433B4 (en) * 2003-02-04 2005-02-24 Dornier Medtech Systems Gmbh Leg support assembly

Cited By (1)

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Publication number Priority date Publication date Assignee Title
EP4062886A1 (en) 2021-03-25 2022-09-28 Ganymed Robotics Limb positioning system

Also Published As

Publication number Publication date
CN101384236A (en) 2009-03-11
US20080289636A1 (en) 2008-11-27
ATE448766T1 (en) 2009-12-15
FR2892300B1 (en) 2007-12-28
EP1940337A1 (en) 2008-07-09
US8020559B2 (en) 2011-09-20
WO2007048892A9 (en) 2008-05-29
WO2007048892A1 (en) 2007-05-03
FR2892300A1 (en) 2007-04-27
CA2625630C (en) 2014-12-02
DE602006010590D1 (en) 2009-12-31
JP2009513209A (en) 2009-04-02
CA2625630A1 (en) 2007-05-03

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