JP6726268B2 - 手術中の患者の関節駆動可能な支持を容易にする手術用フレーム - Google Patents
手術中の患者の関節駆動可能な支持を容易にする手術用フレーム Download PDFInfo
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Description
[011]本明細書に組み込まれて本明細書の一部を構成する添付図面が本発明の好適な実施形態を示しており、これは、本記述と併せて、本発明の目的、利点および原理を説明する働きをする。
[098]上で考察したように、手術用フレーム10が、手術中に患者Pの上半身(胸部を含む)、臀部、脚部および足を位置決めおよび再位置決めするのを実現し、ならびに/あるいは、多様なサイズの患者に対応するのを実現する。要約すると、患者Pの上半身(胸部を含む)を位置決めおよび再位置決めするために、第1の胸部支持機構40および第2の胸部支持機構42の胸部支持パッド50のロケーションが調整され得る。臀部・上側脚部支持機構70の患者支持プラットホーム130の角度およびロケーションが、患者Pの臀部および上側脚部を位置決めおよび再位置決めするために調整され得る。患者Pの脚部を位置決めおよび再位置決めするために足支持機構72のロケーションが調整され得る。さらに、第1のフレーム部材28に沿わせて移動可能なフレーム部材36を移動させることにより、および、第1のフレーム部材32および第2のフレーム部材34に沿わせてサブフレーム74を移動させることにより、臀部・上側脚部支持機構70および足支持機構72(および、その上で受けられる患者)の位置が変更され得る。さらに、患者Pの肩部および臀部を位置決めおよび再位置決めするために、側方肩部/上部胴機構250の肩部/上部胴接触部分266のロケーション、および、側方臀部支持機構252の臀部接触部分326のロケーションが調整され得る。手術用フレーム10の種々の機構によって実現される移動が、手術中の身体への外科的アクセスの程度を変更するために患者Pの身体の複数の部分を関節駆動するのを実現する。手術用フレーム10の種々の機構によって実現される移動が、さらに、多様なサイズの患者に対応するのを実現する。
[0144]一実施形態では、外部の作業デバイスが、外科医の手で保持されるようにまたは手術用フレームに接続されない外部のフレームから適用されるように適合されて提供され得、これは、手術用フレーム位置を組み合わせること、二重にまたは同時にアクセスすること、ならびに、手術中に器具類または挿入されたツールの特定の側に制御される力を加えること、を目的とする。手術用フレームは球体の位置を360°で変化させることができ、頭部支持体、腕支持体、胴リフト支持体、矢状面調整組立体および冠状面調整組立体による力のベクトルを追加することができる。例えば、患者に截骨術を実施するのに矢状面調整組立体を適用するとき、外部のフレームによるまたは外科医の手による截骨術の1つの面上の固定点が拘束されることで、そのベクトルの力が、総合して、截骨術を軽減するように、矢状面を改善するように、および、患者へのリスクを低減するように、および、矯正を最大限にいかすように、作用するようになる。当技術分野でよく知られる、OKIのライブイメージングなどのライブイメージングを利用することにより、截骨術を軽減するためにそのベクトルの力を適用しながら、アンギュレーション、骨盤パラメータおよび全体のアライメントの変化を実時間で見ることができる。
[0148]例えば、頚部の変形円板疾患(DDD:degenerative disc disease)または変形ならびに腰部のDDDまたは変形を有する患者の場合、この患者はしばしば2つの別個の手術を選択することになる。手術用フレームは、例えば、外科医が、最初に頸部のDDDまたは変形の手術を行い、患者の向きを変え、次に腰部のDDDまたは変形の手術を行うか、あるいは、最初に腰部のDDDまたは変形の手術を行い、患者の向きを換え、次に頸部のDDDまたは変形の手術を行う、というのを可能にする。別法として、手術用フレームは、外科医が、患者をある1つの位置まで回転させ、同じアクセスポイントを介して腰部のDDDまたは変形ならびに頸部のDDDまたは変形の両方の手術を実施する、というのを可能にする。
Claims (15)
- 患者を支持するための位置決めフレームであって、
第1の端部、第2の端部、および、前記第1の端部と前記第2の端部との間を延在する長さ、を有する少なくとも1つの主ビームであって、少なくとも第1の支持構造および第2の支持構造を基準として回転軸を画定し、前記主ビームの少なくとも第1の位置と第2の位置との間で前記回転軸を中心として回転可能であり、前記回転軸が、前記位置決めフレーム上で前記患者が支持されているときの前記患者の頭部−尾部軸に実質的に一致する、少なくとも1つの主ビームと、
前記少なくとも1つの主ビームを支持する前記第1および第2の支持構造であって、前記少なくとも1つの主ビームを地面から離間させる、前記第1および第2の支持構造と、
前記少なくとも1つの主ビームに取り付けられる胴リフト支持体であって、前記患者の胸部を支持するように構成される胸部支持プレートを有し、前記少なくとも1つの主ビームに枢動可能に接続され、前記患者の腹臥位で非リフト位置とリフト位置との間で前記患者の胴を移動させるために前記胴リフト支持体の少なくとも第1の位置と第2の位置との間で前記胸部支持プレートを枢動させるように構成される、胴リフト支持体と、
前記少なくとも1つの主ビームに取り付けられる骨盤傾斜支持体であって、大腿部クレードルおよび下側脚部クレードルを有し、前記大腿部クレードルが前記患者の大腿部を支持するように構成され、前記下側脚部クレードルが前記患者の下側脚部を支持するように構成され、前記大腿部クレードルおよび前記下側脚部クレードルが、前記患者の臀部の調整を容易にするために前記患者の腹臥位で互いに対して枢動可能である、骨盤傾斜支持体と
を備える、
位置決めフレーム。 - 前記少なくとも1つの主ビームが第1の部分および第2の部分を有し、前記第1の部分および前記第2の部分が前記主ビームの前記第1の位置でその前記回転軸に対して横方向に延在し、前記少なくとも1つの主ビームの複数の部分が前記第1の部分および前記第2の部分により前記回転軸からオフセットされる、請求項1に記載の位置決めフレーム。
- 前記少なくとも1つの主ビームがその前記第1の位置において腹臥位で前記患者を支持するように構成され、その前記第2の位置において側臥位で前記患者を支持するように構成される、請求項1に記載の位置決めフレーム。
- 前記胴リフト支持体が前記患者の胴のための所定の回転中心を画定する、請求項1に記載の位置決めフレーム。
- 前記所定の回転中心が、固定または可変のうちの1つであってよい、請求項4に記載の位置決めフレーム。
- 前記胴リフト支持体が、前記患者を過度に伸長させることおよび圧縮することのうちの少なくとも一方を防止するように構成される少なくとも1つの安全停止装置を有する、請求項1に記載の位置決めフレーム。
- 前記胴リフト支持体が、前記少なくとも1つの安全停止装置にフィードバックを提供するように適合される少なくとも1つのセンサを有する、請求項6に記載の位置決めフレーム。
- 前記骨盤傾斜支持体が、前記患者の隣接する腰椎椎体の間の少なくとも1つのスペースを開くように前記患者を扱うように構成され、それにより前記少なくとも1つのスペース内に椎体間デバイスを配置するのを容易にする、請求項1に記載の位置決めフレーム。
- 前記胸部支持プレートに接続される頭部支持体および腕支持体をさらに備え、前記頭部支持体および前記腕支持体が、前記胸部支持プレートの枢動運動中に前記患者の頭部および腕を支持するように構成される、請求項1に記載の位置決めフレーム。
- 前記少なくとも1つの主ビームに取り付けられる冠状面調整組立体をさらに備え、前記冠状面調整組立体が、前記患者の胴の少なくとも一部分を前記少なくとも1つの主ビームの一部分から離すように移動させるように構成される、請求項1に記載の位置決めフレーム。
- 前記少なくとも1つの主ビーム、前記胴リフト支持体および前記骨盤傾斜支持体、のうちの少なくとも1つを関節駆動するための少なくとも1つのアクチュエータをさらに備える、請求項1に記載の位置決めフレーム。
- 患者を支持するための位置決めフレームであって、
第1の端部、第2の端部、および、前記第1の端部と前記第2の端部との間を延在する長さ、を有する少なくとも1つの主ビームであって、少なくとも第1の支持構造および第2の支持構造を基準として回転軸を画定し、前記主ビームの少なくとも第1の位置と第2の位置との間で前記回転軸を中心として回転可能であり、前記回転軸が、前記位置決めフレーム上で前記患者が支持されているときの前記患者の頭部−尾部軸に実質的に一致する、少なくとも1つの主ビームと、
前記少なくとも1つの主ビームを支持する前記第1および第2の支持構造であって、前記少なくとも1つの主ビームを地面から離間させる、前記第1および第2の支持構造と、
前記少なくとも1つの主ビームに取り付けられる胴リフト支持体であって、前記患者の胸部を支持するように構成される胸部支持プレートを有し、前記少なくとも1つの主ビームに枢動可能に接続され、前記患者の腹臥位で非リフト位置とリフト位置との間で前記患者の胴を移動させるために前記胴リフト支持体の少なくとも第1の位置と第2の位置との間で前記胸部支持プレートを枢動させるように構成される、胴リフト支持体と、
前記少なくとも1つの主ビームに取り付けられる骨盤傾斜支持体であって、大腿部クレードルおよび下側脚部クレードルを有し、前記大腿部クレードルが前記患者の大腿部を支持するように構成され、前記下側脚部クレードルが前記患者の下側脚部を支持するように構成され、前記大腿部クレードルおよび前記下側脚部クレードルが、前記患者の臀部の調整を容易にするために前記患者の腹臥位で互いに対して枢動可能である、骨盤傾斜支持体と、
前記少なくとも1つの主ビームに取り付けられる冠状面調整組立体であって、前記患者の胴の少なくとも一部分を前記少なくとも1つの主ビームの一部分から離すように移動させるように構成される、冠状面調整組立体と、
前記少なくとも1つの主ビーム、前記胴リフト支持体、前記骨盤傾斜支持体および前記冠状面調整組立体、のうちの少なくとも1つを関節駆動するための少なくとも1つのアクチュエータと
を備える
位置決めフレーム。 - 前記少なくとも1つの主ビームが第1の部分および第2の部分を有し、前記第1の部分および前記第2の部分が前記主ビームの前記第1位置でその前記回転軸に対して横方向に延在し、前記少なくとも1つの主ビームの複数の部分が前記第1の部分および前記第2の部分により前記回転軸からオフセットされる、請求項12に記載の位置決めフレーム。
- 前記少なくとも1つの主ビームがその前記第1の位置において腹臥位で前記患者を支持するように構成され、その前記第2の位置において側臥位で前記患者を支持するように構成される、請求項12に記載の位置決めフレーム。
- 前記胴リフト支持体が前記患者の胴のための所定の回転中心を画定する、請求項12に記載の位置決めフレーム。
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AU2016308175B2 (en) | 2021-04-01 |
CN107920946B (zh) | 2020-11-17 |
EP3337439B1 (en) | 2021-05-12 |
AU2016308175A1 (en) | 2018-02-15 |
CN107920946A (zh) | 2018-04-17 |
EP3337439A1 (en) | 2018-06-27 |
US11612533B2 (en) | 2023-03-28 |
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