EP2773269A1 - Plaque sternale atraumatique - Google Patents

Plaque sternale atraumatique

Info

Publication number
EP2773269A1
EP2773269A1 EP12780440.9A EP12780440A EP2773269A1 EP 2773269 A1 EP2773269 A1 EP 2773269A1 EP 12780440 A EP12780440 A EP 12780440A EP 2773269 A1 EP2773269 A1 EP 2773269A1
Authority
EP
European Patent Office
Prior art keywords
plate
sternum
pressure plate
atraumatic
sternal
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP12780440.9A
Other languages
German (de)
English (en)
Inventor
Thomas Beck
Bernd Blender
Andreas ELISCH
Theodor Lutze
Pedro Morales
Robert Vogtherr
Jürgen WEGMANN
Dieter Weisshaupt
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Aesculap AG
Original Assignee
Aesculap AG
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Aesculap AG filed Critical Aesculap AG
Publication of EP2773269A1 publication Critical patent/EP2773269A1/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/12009—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B2017/12004—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for haemostasis, for prevention of bleeding

Definitions

  • the present invention relates to an atraumatic sternal plate for
  • Bleeding arrest and in particular an atraumatic sternal plate which in
  • Connection to a retractor is used and either attached to the retractor before it is inserted into the opened sternum or attached to one or both halves of the sternum before a retractor is inserted into the opened sternum.
  • a retractor which has two parallel legs, which by means of a
  • Rack and pinion or similar device can be spaced apart.
  • two valves are arranged, which come with incipient spacing of the retractor legs in abutment against the sagittal cut surface of the respective Sternumhcode and press this as the spacing of the retractor legs progresses, thus causing a spreading of the sternum.
  • the ordinary Valven are not very wide, so the whole force over a very small area in the two
  • Sternum halves is initiated.
  • the required force for spreading the sternum can be considerable. This can cause bones located directly on or under the valves to be damaged, for example, to break out and the surrounding tissue to be severely traumatized. In this way, the healing phase of the patient is extended after the procedure and it also increase the pain of the patient occurring during this time.
  • FIG. 2009 An example of a retractor is shown in US patent application US 2009 0,259,107 A1.
  • This retractor has a single valve on each sternum half and, in order not to excessively traumatize the tissue, pressure sensors which measure the forces acting on the two retractor legs. Detect As the pressure sensors interfere or spike over the course of the pressures, the refractor reduces the distance between the two retractor legs to reduce the pressure on the bones in the two halves of the sternum. But once a pressure drop suddenly occurs, it is probably because a piece of bone has already broken out or splintered. This refractor is therefore due to design not able to break out or splintering of
  • this refractor is disadvantageous because it greatly restricts the field of vision for the surgeon in the patient, as the refractor on the
  • U1 flexible brain spatula consist of a bendable and dimensionally stable material which is surrounded by a soft and elastically deformable material, wherein the deformability with increasing distance from the core material increases. With such a structure, there are no or only small pressure points on the bearing surfaces.
  • JP 2002 102 234 A In order to alleviate the bleeding at the sagittal cut surfaces during a sternal opening, it has been proposed in the prior art (JP 2002 102 234 A) to place a clamp on the sternum halves. This clip hooks on the inside and the outside of the sternum half by means of spikes in the tissue.
  • the middle part of the staple, which covers the sagittal cut surface of the sternum, may be provided with a urethane foam, which is used for
  • the IMA can be damaged when crushed, which may prevent it from being used for a bypass, or at least decrease the usable length of the IMA.
  • the object of the present invention is therefore to provide a means by which the hemorrhages at the sagittal cut surfaces of the
  • Another object of the present invention is to provide such a means, which also in a conversion or
  • the object of the present invention is with an atraumatic
  • the vertical direction in this disclosure refers to the medically vertical direction, that is, regardless of the actual position of the patient (standing, lying) the direction from the vertex to the sole, so referred to the chest and the sternum, the direction from cranial to caudal.
  • Sternum plate refers to the proximal side of the side that faces the sagittal section of the sternum half, while the distal side of that side which faces away from the sagittal cutting surface and faces the other half of the sternum.
  • the medial end of a leaf spring is the end that lies toward the center of the pressure plate.
  • a first aspect of the present invention relates to an atraumatic
  • Bleeding sternal plate for a retractor with a pressure plate and a holding device attached to the pressure plate.
  • the pressure plate is attached by means of the holding device to the Valven a retractor so that the
  • Retractor abuts the sagittal section of a Sternumhget.
  • Such an atraumatic sternal plate is used as follows. The surgeon first opens the patient's sternum in the sagittal plane, causing the two halves of the sternum to slightly pop open and form a certain gap between them. The atraumatic sternal plate is using her
  • the atraumatic sternal plate fulfills several functions. On the one hand, it distributes the sometimes considerable pressure exerted by the retractor valves over a much larger contact surface, ideally the entire surface of the sternum plate.
  • the sternum plate is elastic and has a suitable modulus of elasticity and suitable dimensions. These values can not be given as a whole because they depend very much on the individual patient.
  • the decisive factor here is that the length and the width (or the height) are adapted to the respective patient. The length should correspond as closely as possible to the length of the sternum and the width (height) should be at least the thickness the chest wall, ie the total thickness of sternum and overlying
  • the width should not be much larger than the thickness of the chest wall.
  • their width can also vary over the length, since the thickness of the chest wall can also be variable over the length of the sternum.
  • the thickness of the pressure plate and the modulus of elasticity are dependent on the spreading force to be applied. This in turn depends on the size, age and physical condition of the patient. These sizes are coordinated so that an introduction of force into the cut surface of the sternum half is achieved as evenly as possible over the entire surface of the sternum plate.
  • the atraumatic sternal plate presses against the cut surface of the respective sternum half, thus ensuring a first hemostasis.
  • This function can not take over a valve because it only rests on a small part of the cut surface. Also attached to the Valven towels can this
  • the atraumatic sternal plate may also be attached to the valves such that even if the retractor spreads the sternum, it is still slightly slidable relative to the atraumatic sternum plate without the sternum plate slipping relative to the cut surface of the sternum half. This is achieved by not firmly fixing the sternum plate to the valves of the retractor, but attaching it with sufficient lateral play (lateral meaning here in the area of the sternum plate).
  • the pressure plate has a curved elongate shape to conform to a bulge of the sagittal sectional surface of the sternum half in the vertical direction.
  • the cut surfaces of the sternum are not absolutely straight, but slightly curved, and therefore have approximately the shape of a banana or a very narrow kidney shell. This curvature can be particularly troublesome in the preparation of the Internal Mammary Arteria (IMA), because when using a straight sternum plate, a part of the work area through the sternum plate can be covered, which in the central region (in the longitudinal direction of IMA).
  • IMA Internal Mammary Arteria
  • the shape of the pressure plate is adapted to the shape of the cut surface. Since the cut surface differs from patient to patient and each has a different length and a different curvature and partly very different widths (even beyond the sounds of the cut surface), the shape and size of a prefabricated sternum plate can only to a certain extent with the Match cut surface. Here, a larger number of sternal plates must be kept to all possible
  • the holding device is attached to the distal side of the pressure plate.
  • Arrangement of the holding device on the distal side of the pressure plate is advantageous since in this way the force applied by the refractor can be easily introduced via the valves into the pressure plate.
  • the valves only have to push the pressure plate and the holding device can remain largely free of force.
  • the holding device can in principle also be arranged laterally of the pressure plate, but then, if necessary, also has transverse forces and
  • the holding device consists of two leaf springs, which in
  • each valve Extend substantially parallel to the pressure plate and are secured at its medial end to the pressure plate. In this case, each valve is gently clamped between a free end of a leaf spring and the pressure plate. However, a certain mobility between Sternum plate and valve can be maintained.
  • the holding device consists of a leaf spring, which extends with its two free ends substantially parallel to the pressure plate and which is fastened with its central area to the pressure plate.
  • valves are each arranged between a leaf spring and the pressure plate, or it is first pushed the sternum plate laterally on the first valve (ie substantially in the longitudinal direction of the sternum plate), wherein the first valve is between the first end of the leaf spring and the pressure plate, then the sternum plate is pushed further until the second end of the leaf spring can pass the second valve, and then the sternum plate is pushed in the opposite direction so that the second valve between the second end of the leaf spring and the pressure plate is located until the sternum plate is arranged approximately symmetrically to the Valven.
  • the holding means is a leaf spring which extends substantially parallel to the pressure plate and which is fixed at its lateral ends to the pressure plate.
  • a lateral slippage of the sternum plate is completely excluded from the Valven, but it can not be mounted laterally on the Valven.
  • a second aspect of the present invention relates to an atraumatic
  • Sternum plate for hemostasis with a pressure plate and one at the
  • Pressure plate attached holding device.
  • the pressure plate is by means of
  • At least one holding device so attached to a Sternumhget that the pressure plate is applied substantially to a sagittal section of the sternum.
  • Such a sternal plate is used as follows. The surgeon first opens the patient's sternum in the sagittal plane, causing the two halves of the sternum to slightly pop open and form a certain gap between them. Now the sternum plate is inserted into the gap and with the proximal one Page brought into abutment with the cut surface.
  • the surgeon first opens the patient's sternum in the sagittal plane, causing the two halves of the sternum to slightly pop open and form a certain gap between them. Now the sternum plate is inserted into the gap and with the proximal one Page brought into abutment with the cut surface.
  • Sternum plate can or must the surgeon first fix the sternum plate using the holding device.
  • the holding device is a point at which the surgeon can attach one or more adhesive strips, threads or other fastening means not belonging to the invention.
  • the surgeon may apply the sternum plate only on the outside or on the outside and inside of the sternum at
  • Retractor legs are further spaced from each other. In this way, the atraumatic sternal plates are pressed against the sagittal cut surfaces of the two sternum halves, achieving the effects already described in the first aspect of the invention.
  • a sternal plate is fixed by an adhesive strip or a thread only on the outside of the thorax, ie in the area of the soft tissue, it can easily move away from it in the area of the sternum, as long as no force is applied to the sternum plate by the retractor. However, this has no negative effects on the effectiveness of the sternal plate in splayed sternum.
  • the holding device has at least one projection on at least one longitudinal edge of the pressure plate, which protrudes from the proximal side of the pressure plate.
  • the pressure plate at this point has an L-shaped or even a C-shaped cross-section.
  • Rib cage can be arranged.
  • the projection rests on the inner wall of the sternum, in the other case on the covering soft tissue.
  • Such a printing plate can also be fixed with adhesive strips or threads until the retractor is used and brought into abutment.
  • the at least one projection extends substantially over the entire longitudinal edge of the printing plate.
  • the pressure plate has over in
  • the holding device has at least one projection on both longitudinal edges, so that the sternum plate has a substantially C-shaped cross-section.
  • at least one elastically compressible component is provided on the at least one projection, which presses the sternum from the inside and / or the overlying soft tissue from the outside when using the sternum plate on the patient and thus holds the sternal plate in position.
  • the elastically compressible member may be a compression spring (e.g., coil spring, leaf spring, leg spring), a foam or other elastic body. Since the thickness of the chest wall of the patient can be variable over the length of the star circumference, and since the thickness of the chest wall from patient to patient is different, and only a certain number of different
  • Atraumatic sternal plates can be held with this
  • the elastically compressible component can be arranged only on one side or on both sides of the rib cage, that is, only on one projection or both
  • Sternum plate is kept at the sternum half.
  • the holding device has at least one projection on both longitudinal edges, so that the sternum plate has a substantially C-shaped cross-section.
  • the pressure plate in its transverse direction but telescoping, so that the width and the height of the sternum plate to the thickness of the sternum and the overlying soft tissue of the patient is customizable.
  • no elastic member is needed, which is arranged between one of the projections and the chest wall (inner wall or outer wall or both).
  • the protrusions on the inside and the protrusions on the outside of the thorax come into contact with this.
  • Telescope function can be configured with other features.
  • a tension spring element spiral tension spring, elastic band, etc.
  • the telescoping function can also be subject to such a frictional connection that the pressure plate can indeed be relatively easily telescoped, but the projections can still apply a certain amount of tension to the thorax in order to hold the atraumatic sternal plate in this way against the respective sternum half.
  • a lockable telescopic function that is, the distance of the projections is set manually, for example by the protrusions are pressed together with inserted atraumatic sternal plate, and then a lock is activated, which prevents the projections from moving apart until the lock released again becomes.
  • the pressure plate is composed of at least two segments, wherein the segments are mutually rotatable or slidable in order to be adaptable to a curvature of the sagittal section of the Sternumhcode in the vertical direction.
  • the atraumatic sternal plate can be adapted not only to the curvature of the sternum individually, but in conjunction with the
  • Protrusions can be ensured a particularly good and uniform storage of the same.
  • the frontal area of the sternum half can now be excellently covered and the atraumatic sternal plate can virtually completely surround the sternum half along the inner wall and the outer wall of the thorax. This not only leads to an absolutely minimized influence on the field of vision of the surgeon and to an excellent attachment of the sternum plate to the thorax, but also improves the hemostasis and thus the entry of blood into the breast
  • a pressure plate with mutually rotatable segments can be realized in many ways.
  • a kind of tongue and groove system can be produced in which a part of a segment is rotatably held on or in an adjacent segment. In this case, tongue and groove are perpendicular to the surface of the pressure plate. But it can also be individual
  • Connecting members may be provided between the individual segments, which are rotatably mounted on a segment or on both segments, or the connecting members may be bendable in the desired direction and rigid in the cut surface of the sternum half. It is also possible to use a continuous flat metal strip which extends along the longitudinal direction of the pressure plate to which the segments are attached and which is perpendicular to the surface of the pressure plate. A shift of the individual segments can also be made with a tongue and groove connection, except that in this case tongue and groove in the surface of the pressure plate transversely to the pressure plate run. Despite the rotation of the segments to each other, the entire
  • Sectional area Combinations of the above techniques may also be used. It is important, however, that an adaptation of the shape in the plane of the printing plate can be done, the entire printing plate but their
  • the rotation or displacement of the segments to each other is subject to such friction that the arrangement of the segments exclusively
  • Influence of their own gravity is not changeable. This means that the surgeon can easily adjust manually the position of the individual segments of the pressure plate to each other, but that they are not as loosely attached to each other as chain links, but that the system has such rigidity that it retains the shape even then if it is no longer at the sagittal
  • Cut surface of the sternum is applied.
  • the proximal side of the pressure plate is at least partially provided with a means for
  • a hemostatic agent Possibilities to apply a hemostatic agent to the proximal side of the pressure plate or its segments.
  • the biological agents that can be applied include collagen, elastin, gelatin or sugar (cellulose) and their derivatives and hydrolyzates.
  • Chemical agents are, for example, foamed polyurethane (polyurethane) or other plastics, in particular in the foamed state. However, a mixture of biological and / or chemical agents may also be used.
  • Other known agents for hemostasis are waxes, in particular
  • Bone wax (often a mixture of sterilized beeswax and Vaseline), and various textiles. All of these agents can be applied in foamed form, as a mesh, as a woven, nonwoven or knitted fabric, or incorporated into or applied to such structures. These structures can medium adhesive bond, adhesion, Velcro or the like at the
  • Pressure plate releasably or permanently attached.
  • the means for stopping bleeding consists of a tissue, a fleece and / or another flat component, which is preferably covered or impregnated with a chemical blood coagulant.
  • the pressure plate has at least one perforation and / or predetermined breaking point, with the aid of which at least one dimension of the pressure plate can be adapted to the size and shape of the sternum or the sagittal cut surface of the patient's sternum.
  • the predetermined breaking point may for example consist of one or more embossed notches, which are provided on one side or on both sides of the pressure plate.
  • the predetermined breaking point can also be formed by one or more notches, which in the manufacture of the printing plate or their
  • Embossed predetermined breaking points are suitable for printing plates, which are made of metal, such as stainless steel, titanium or chrome steel.
  • Predetermined breaking points formed directly with the pressure plate are particularly suitable for printing plates made of plastic, for example PEEK
  • Perforations can in principle be formed directly in the production of the printing plate, especially in printing plates made of plastic, but they can also be subsequently produced by punching.
  • At least one perforation and / or predetermined breaking point is arranged between individual segments of the pressure plate.
  • the perforation or predetermined breaking point is located at a projection of a segment which connects this segment to the adjacent segment, or at one
  • the width or height of the atraumatic sternal plate can be adjusted to the thickness of the patient's chest wall.
  • the length of the atraumatic sternal plate is particularly advantageous if individual segments can be separated, so as to adjust the length.
  • the separation between the individual segments is the best choice.
  • a perforation and / or breakage can also be useful provided within the individual segments or on the single segment.
  • the at least one perforation and / or predetermined breaking point can also be used to adjust or adjust the width or height of the printing plate.
  • the perforations and / or predetermined breaking points can thus run in the longitudinal and transverse directions of the atraumatic sternum plate, but they can also run diagonally or (multiply) curved tracks
  • auxiliary lines are printed on one side of the printing plate, which are helpful in cutting the printing plate.
  • a pair of pliers may be provided that has such a jaw shape that fits to specific perforations or predetermined breaking points on the pressure plate. The same applies to predetermined breaking points for the separation of entire segments.
  • the device may be adapted to the connecting means or the segment projections or extensions.
  • the length of the atraumatic sternal plate is adjusted or adjusted before it is attached to the valves of the retractor or to the corresponding sternum half and possibly also before its width or height are adjusted by means of a telescopic device in the Printing plate.
  • the order of adjustment between length and height or width is not decisive in principle, but it makes sense to first adjust the length and then the adjustment of the height or width.
  • Fig. 1 is a perspective view of a first embodiment of the present invention
  • Fig. 2A is a perspective view of a second embodiment of the present invention.
  • Fig. 2B is a view of a detail of Fig. 2A;
  • Fig. 3A is a perspective view of a third embodiment of the present invention.
  • Fig. 3B is a view of a detail of Fig. 3A;
  • Fig. 4A is a perspective view of a fourth embodiment of the present invention.
  • Fig. 4B is a view of a detail of Fig. 4A;
  • Fig. 5A is a perspective view of a fifth embodiment of the present invention.
  • Fig. 5B is a view of a detail of Fig. 5A;
  • Figs. 6A and 6B are cross-sectional views of holding devices for a
  • FIGS. 7A, 7B and 7C are cross-sectional views of retention devices for attaching the atraumatic sternal plate to the sternum of a patient;
  • FIGS. 8A, 8B, and 8C are cross-sectional views of other retainers for attaching the atraumatic sternum plate to the sternum of FIG
  • Fig. 9 shows a cross section of a sixth embodiment of the present invention.
  • Figs. 10A and 10B are cross-sectional views of a pressure plate with a hemostasis agent attached.
  • the atraumatic sternal plate for hemostasis for a retractor has a pressure plate 10 and an on the
  • Pressure plate 10 attached holding device 20.
  • the holding device 20 consists of two projections on the distal side of the pressure plate, which are designed to abut the inner width of the sternum.
  • the pressure plate 10 can be attached to a sternum half by means of the at least one holding device in such a way that the pressure plate 10 abuts substantially against a sagittal sectional surface of the sternum.
  • the atraumatic sternal plate can with the help of a
  • Adhesive tape can be fixed to the chest of the patient.
  • the atraumatic sternal plate does not have a hemostatic agent, but a tissue carrying such agent can be adhered to the pressure plate.
  • the pressure plate has a curved elongated shape to conform to a bulge of the sagittal sectional surface of the sternum half in the vertical direction.
  • the pressure which is usually applied from the valves of a retractor to small areas of the sagittal section at the sternum of the patient, can be distributed over the entire sagittal sectional area. In this way, the load on these areas is greatly reduced.
  • the pressure plate is pressed against the sagittal cut surface, so that the Hemorrhage from the sagittal interface is reduced, if not completely stopped. Due to the curvature of the pressure plate, in particular the adaptation of the shape of the pressure plate to the shape of the sagittal cut surface on the inside of the sternum, the surgeon has a good view of the chest of the patient and especially of the internal mammary artery.
  • atraumatic sternal plate does not have a retainer for attaching the sternum plate to the sternum of the patient but has a
  • the pressure plate 10 has a holding device 30, as shown in Fig. 6A.
  • a leaf spring 30 is mounted, which in the case that the atraumatic sternal plate on a
  • the leaf spring 30 is fixed in the central region of the pressure plate 10 at this and has two free ends which extend in the lateral direction of the
  • Pressure plate 10 extend.
  • a leaf spring 40 may be provided as a holding device which is fixed at its two lateral ends to the distal side of the pressure plate. If the pressure plate is constructed of several segments, then the leaf spring according to the Fig. 6A are divided centrally and each of the two parts can be individually attached to one of the segments. But also the leaf spring according to the Fig. 6B can be divided in the middle and the two parts can be attached to individual segments of the pressure plate. In this case, it may be advantageous if the length of the leaf springs is shorter in the longitudinal direction of the printing plate.
  • an atraumatic sternal plate has a pressure plate 10 and a holder attached to the pressure plate 10.
  • the pressure plate 10 is attached by means of the holding device to the Valven a retractor so that the pressure plate 10 at a Spreading a sternum of a patient by means of the retractor abuts the sagittal section of a sternum half.
  • the holding device is attached to the distal side of the pressure plate 10 and therefore not visible in Figs. 2A and 2B.
  • the pressure plate 10 consists of two parts 10A and 10B, which are hingedly connected by means of a connecting element 10C.
  • the holding device consists of two leaf springs, which extend substantially parallel to the pressure plate 10 and are fastened to the pressure plate 10 at its medial end. More specifically, each leaf spring is attached to a part 10A, 10B of the two-piece pressure plate 10.
  • the connecting member 10C has a main body 10C1 on which two round protrusions 10C2 and an elongated protrusion 10C3 are provided.
  • the two parts 10A and 10B of the pressure plate 10 each have a hole or bore into which one of the round protrusions 10C2 of the connector 10C is inserted.
  • the medial end faces of the two parts 10A and 10B of the pressure plate 10 are shaped so as to allow, in cooperation with the elongate projection 10C3, a mutual relative rotation in a certain angular range. When the limit of this angular range is reached, the end faces of the two parts 10A and 10B abut against the sides of the elongated projection 10C3 and prevent further rotation.
  • a third embodiment of the present invention will be described below with reference to Figs. 3A and 3B.
  • the third embodiment differs from the second embodiment in that no
  • Pressure plate 10 is provided. Instead, the part 10A has an extension 11. In the extension 1 1, which is directed to the other part 10 B of the pressure plate 10, a circular recess 1 1 A and two substantially elongated recesses 1 1 B are provided.
  • the part 10B of the pressure plate has a boss 12A, which forms a hinge connection with the recess 1A, for the two parts 10A and 10B of the pressure plate 10, and two further projections 12B which are arranged in the oblong openings 11B and in this way limit the maximum rotation of the two parts 10A and 10B to each other.
  • a fourth embodiment of the present invention will be described with reference to Figs. 4A and 4B.
  • the atraumatic sternal plate 100 is multi-segmental and consists of a central segment 100A and a plurality of further segments 100B. As shown in FIG. 4B, a segment 100B has an extension 13 and a recess 14.
  • the extension 13 consists of a substantially trapezoidal web and a circular arc segment 13A.
  • the recess 14 consists of a substantially trapezoidal recess and a
  • FIG. 4B shows the mid-plane of the atraumatic sternum plate. This is covered on both sides by means of lids. In this case, the covers on the proximal side form the pressure plate. The lids prevent the extensions 13 from the
  • the holding device consists of two leaf springs (not shown in Fig. 4A and 4B). Each one of these leaf springs, which correspond to those of the third embodiment, is attached to an end segment.
  • the central segment 100A differs from the further segments 100B in that the central segment 100A has no extension 13 but instead two recesses 14.
  • each extension 14 is received in the associated recess 13 so that a certain frictional engagement between the segments prevails, so that the angle between the two segments not due to the gravity of the
  • Sternum plate changes after the surgeon adjusts it to the shape of the patient's sternum or sagittal section.
  • This sternal plate is sensibly first adapted by the surgeon to the shape of the sagittal section of the patient and then attached to the Valve of the retractor. But it is also possible to attach the sternum plate first to the Valve of the retractor and the adaptation of the shape of the Stem plate when inserting it into the opening of the sternum
  • the atraumatic sternal plate is also formed of its own plurality of segments 200.
  • Each segment 200 has a pressure plate 201, which together with the pressure plates of the other segments, the entire pressure plate of
  • atraumatic sternal plate forms.
  • a connecting element 205 is provided on the distal side of the segments 200.
  • the connecting element 205 is a flat band that runs along the longitudinal direction of the sternum plate and is perpendicular to the pressure plate.
  • the flat band is sized (thickness, width) to accommodate the shape of the sagittal section of the patient's sternum in the sagittal plane.
  • the flat band is dimensioned so that it can transmit bending moments from one segment 200 to adjacent segments 200.
  • the width of the band is significantly greater than its thickness.
  • the deformation of the flat band may be an elastic deformation or a plastic deformation. In the latter case, adaptation of the atraumatic sternum plate to the patient may be made prior to insertion of the retractor into the opening of the sternum, since plastic deformation does not compromise fit when the atraumatic sternum plate is removed from the sternum opening and at the valve retraction valve is attached.
  • holding means are the
  • the holding device 20 consists of a projection which is provided on the pressure plate 10 and protrudes to the proximal side thereof.
  • the projection 20 is intended to abut against the outer surface of the patient's thorax, that is to say on the soft tissue WG.
  • the projection 20 may extend over the entire length of the printing plate or only over a certain range.
  • the pressure plate may be formed in one piece or in several parts or Paul. In the latter case, a projection may be provided on each segment or only on a single segment or selected segments.
  • the atraumatic printing plate 10 in addition with an adhesive strip K to the
  • Soft tissue WG of the patient can be fixed.
  • a sternal plate in which the holding device 20 consists of a projection which bears against the inside of the sternum S.
  • the holding device 20 in order to prevent the sternum plate from falling into the chest of the patient, they may be fixed to the soft tissue WG with an adhesive strip K.
  • the adhesive strip is just one example of a known fastener. Other known fasteners and types of attachment are also possible.
  • FIGS. 8A to 8C show further holding devices with the aid of which the sternum plate can be fixed to the sternum.
  • the pressure plate 50 has a projection 51 for engagement with the sternum S and a
  • the pressure plate thus forms together with the projections 51 and 52 substantially a C-shape.
  • a leaf spring 53 is attached so that it can exert a pressure on the soft tissue WG, thus fixing the sternal plate to the sternum S. Even with such a holding device, the sternum plate can be formed Kisegmental.
  • the cross section of the individual segments may differ in this case.
  • the leaf spring of FIG. 8A has been replaced by a coil spring 54.
  • the rest of the construction corresponds to that of FIG. 8A.
  • Fig. 8C a holding device is shown, which has a spring 55.
  • no protrusion of the pressure plate on the side of the soft tissue is provided with respect to FIG. 8A.
  • the pressure plate thus has an L-shaped cross section and the spring 55 is attached directly to the pressure plate.
  • the pressure plate consists of two parts 60 and 62. At each of these parts, a projection 61 and 63 is provided.
  • the projection 61 serves to engage the inner surface of the sternum, whereas the projection 63 serves to engage the soft tissue WG.
  • the part 62 is partially received in the part 60 and the two parts 60 and 62 together form a telekopierbare pressure plate. With the help of this telescoping pressure plate, the pressure plate can be adapted to the thickness of the thorax of the patient be adapted, that is to the width of the sagittal section of the
  • the part 62 may be received in the part 60 so that the friction between these two parts maintains a set width of the pressure plate. But it can also be arranged a tension spring between the two parts 60 and 62, which always pulls the part 62 to the part 60 out. In this case, the sternum S and the soft tissue WG are clamped between the two projections 61 and 63.
  • a tension spring between the two parts 60 and 62, which always pulls the part 62 to the part 60 out.
  • the sternum S and the soft tissue WG are clamped between the two projections 61 and 63.
  • Such a design of the pressure plate is also in conjunction with a
  • a hemostatic agent can be attached to a pressure plate.
  • a body 80 containing or carrying the hemostatic agent is inserted in a recess provided in the pressure plate 70 in a press-fitting manner.
  • the pressure plate 90 has no recess, but has a projection 91 and a projection 92.
  • the body 80 containing or carrying the hemostasis agent is pushed behind a part of the projection 91 and then between projections 91 and Tab 92 pinched.
  • a multi-segmental design of the printing plate can be combined with any holding device and even with the telescoping in the width direction printing plate.
  • a hemostatic agent may be provided either on each individual segment or it may become a body,

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Molecular Biology (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Reproductive Health (AREA)
  • Vascular Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

L'invention concerne une plaque sternale atraumatique permettant l'arrêt de saignements, destinée à un rétracteur, et comportant une plaque de pression et un dispositif de fixation monté sur la plaque de pression. La plaque de pression peut être montée au moyen du dispositif de fixation soit sur les valves d'un rétracteur, soit sur un demi-sternum du patient, de sorte que la plaque de pression porte sur la surface de coupe sagittale d'un demi-sternum lors de l'écartement du sternum d'un patient au moyen du rétracteur.
EP12780440.9A 2011-11-02 2012-10-12 Plaque sternale atraumatique Withdrawn EP2773269A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE102011117413A DE102011117413A1 (de) 2011-11-02 2011-11-02 Atraumatische Sternumsplatte
PCT/EP2012/070275 WO2013064354A1 (fr) 2011-11-02 2012-10-12 Plaque sternale atraumatique

Publications (1)

Publication Number Publication Date
EP2773269A1 true EP2773269A1 (fr) 2014-09-10

Family

ID=47115830

Family Applications (1)

Application Number Title Priority Date Filing Date
EP12780440.9A Withdrawn EP2773269A1 (fr) 2011-11-02 2012-10-12 Plaque sternale atraumatique

Country Status (5)

Country Link
US (1) US20140303664A1 (fr)
EP (1) EP2773269A1 (fr)
JP (1) JP2014534868A (fr)
DE (1) DE102011117413A1 (fr)
WO (1) WO2013064354A1 (fr)

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EP2846678B1 (fr) * 2012-05-08 2019-07-31 Protego Medical Pty Limited Appareil pour recouvrir une extrémité mise à nu d'un sternum sectionné
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KR101547569B1 (ko) 2014-06-13 2015-08-28 강원대학교산학협력단 흉골보호기
US10213194B2 (en) 2016-09-27 2019-02-26 Ethicon, Inc. Surgical retraction systems including sternal retractors and hemostatic inserts
US11317902B2 (en) 2017-06-15 2022-05-03 DePuy Synthes Products, Inc. SST retractor with radiolucent feature

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Also Published As

Publication number Publication date
US20140303664A1 (en) 2014-10-09
WO2013064354A1 (fr) 2013-05-10
DE102011117413A1 (de) 2013-05-02
JP2014534868A (ja) 2014-12-25

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