NZ614809B - Cervical traction device - Google Patents
Cervical traction device Download PDFInfo
- Publication number
- NZ614809B NZ614809B NZ614809A NZ61480913A NZ614809B NZ 614809 B NZ614809 B NZ 614809B NZ 614809 A NZ614809 A NZ 614809A NZ 61480913 A NZ61480913 A NZ 61480913A NZ 614809 B NZ614809 B NZ 614809B
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- New Zealand
- Prior art keywords
- load
- patient
- applying means
- support
- support surface
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- 230000001788 irregular Effects 0.000 claims abstract description 11
- 208000007356 Fracture Dislocation Diseases 0.000 claims abstract description 5
- 239000002965 rope Substances 0.000 abstract description 12
- 150000002500 ions Chemical class 0.000 abstract 1
- 206010022114 Injury Diseases 0.000 description 9
- 230000001264 neutralization Effects 0.000 description 9
- 210000000278 Spinal Cord Anatomy 0.000 description 4
- 208000008513 Spinal Cord Injury Diseases 0.000 description 4
- 230000003247 decreasing Effects 0.000 description 4
- 210000003625 Skull Anatomy 0.000 description 3
- 206010039203 Road traffic accident Diseases 0.000 description 2
- 230000000694 effects Effects 0.000 description 2
- 238000000554 physical therapy Methods 0.000 description 2
- 238000004804 winding Methods 0.000 description 2
- 208000004120 Athletic Injury Diseases 0.000 description 1
- 229940052609 Legend Drugs 0.000 description 1
- 210000002832 Shoulder Anatomy 0.000 description 1
- 230000002159 abnormal effect Effects 0.000 description 1
- 210000000038 chest Anatomy 0.000 description 1
- 238000005259 measurement Methods 0.000 description 1
- 238000000034 method Methods 0.000 description 1
- 238000011084 recovery Methods 0.000 description 1
- 230000029058 respiratory gaseous exchange Effects 0.000 description 1
- 238000001356 surgical procedure Methods 0.000 description 1
- XLYOFNOQVPJJNP-UHFFFAOYSA-N water Substances O XLYOFNOQVPJJNP-UHFFFAOYSA-N 0.000 description 1
Abstract
614809 A device for applying traction to the cervical vertebrae, and reducing fracture dislocations of the cervical spine is disclosed. The device allows traction to be applied through a wide angular range so as to place the spine in flexion or in extension or in any of a range of preselected positions between these two extremes. The device includes a support surface (11) adapted to support a patient (10) lying upon his or her back. A load transmitting means, such as a wire rope (14), is connected at one end to a patient under treatment and at the other end connected to a load applying means (17). The load applying means can be moved along a regular or irregular curve guided by a support (18) to any of a range of predetermined positions between a first position which places the patient's cervical spine in flexion and a second position which places the patient's cervical spine in extension. The supporting surface may also tilt to assist in adding load on the patient. A method of applying traction is also disclosed. ions between these two extremes. The device includes a support surface (11) adapted to support a patient (10) lying upon his or her back. A load transmitting means, such as a wire rope (14), is connected at one end to a patient under treatment and at the other end connected to a load applying means (17). The load applying means can be moved along a regular or irregular curve guided by a support (18) to any of a range of predetermined positions between a first position which places the patient's cervical spine in flexion and a second position which places the patient's cervical spine in extension. The supporting surface may also tilt to assist in adding load on the patient. A method of applying traction is also disclosed.
Description
TITLE OF INVENTION: Cervical Traction Device
Field of Invention
The present invention relates to a traction device, and in particular to a device for
applying traction to the cervical vertebrae, and reducing fracture dislocations of the
cervical spine.
Background of the Invention
Any discussion of the prior art throughout the specification is not an admission that
such prior art is widely known or forms part of the common general knowledge in the
field.
Spinal cord trauma can be caused by a wide range of injuries to the spine, resulting
from, for example, motor vehicle accidents, falls, and sports injuries. Spinal cord
trauma affecting the cervical vertebrae, (i.e. C1 – C7 vertebrae) can be especially
serious, in that it affects everything below the side of the trauma, and thus can affect
the arms and legs, as well as causing breathing difficulties. Spinal cord trauma
affecting cervical vertebra is a distressingly common result of motor vehicle accidents,
rugby accidents and diving accidents caused by diving into shallow water.
In all cases of spinal cord trauma, rapid treatment is necessary to reduce the long-term
effects; the treatment usually includes spinal traction to reduce dislocation and
produce the necessary anatomic realignment. Surgery also is necessary in some
cases.
It has been found that rapid treatment (preferably within four hours or less of the
accident) can be particularly effective in the case of low velocity injuries to the cervical
vertebrae. Typically, low velocity injuries are caused by sports accidents, e.g.
accidents during rugby, or trampolining or wrestling or gymnastics. Low velocity
injuries typically cause damage in the form of a kink in the spinal cord, but the damage
is at a sufficiently low level that if traction can be applied rapidly, soon after the injury,
it is possible to achieve a complete, or almost complete, recovery.
Over the last several centuries, a number of devices have been proposed to apply
traction to the spine. Many of the devices for this purpose are essentially
physiotherapy devices, which are designed simply to apply a lower level of traction to
various parts of the spine, as part of a regular physiotherapy treatment, or to relieve
relatively mild discomfort, as opposed to applying traction specifically to realign
damaged cervical vertebrae.
For applying traction for medical treatment purposes, the most commonly used
medical apparatus involves an arcuate harness which is secured to the patient's skull
and connected to one end of a rope, the other of which passes over a pulley and
carries weights. The weights are loaded onto a hangar and can be increased or
decreased as necessary.
This arrangement has the merit of being relatively inexpensive, and simple to use.
However, in this arrangement the weights hang freely near the end of the bed on
which the patient is supported, and are vulnerable to being knocked against and
displaced. Further, once traction has been applied, the patient cannot be moved
whilst under traction. Another drawback is the force applied by the traction cannot be
increased gradually, but only in set increments depending upon the size of the weights
being applied. A further drawback is that it is not possible to vary the angle at which
the weights are applied to the patient.
A number of devices have been proposed, which avoid the use of free hanging
weights – see for example US 6,984,217. However, none of the existing devices for
applying traction allow traction to be applied through a wide angular range, so that the
traction can not only be applied along a neutral line, (i.e. approximately in line with the
undamaged portion of the spine), but can also be applied from above the patient so as
to place the spine in flexion (i.e. forward bend), and below the patient, so as to place
the spine in extension (i.e. backward bend.
Summary of the Invention
An object of the present invention is the provision of a traction device suitable for
applying traction to the cervical vertebrae, which allows traction to be applied through
a sufficiently wide angular range so as to place the spine in flexion or in extension or in
any of a range of preselected positions between these two extremes.
The present invention provides a device for applying traction to the cervical vertebra to
reduce fracture dislocation of the cervical spine, said device including:
– a support surface adapted to support a patient lying upon his or her back;
– a load transmitting means adapted to be connected at one end to a patient under
treatment and lying upon said support surface;
– the other end of said load transmitting means being adapted to be connected to a
load applying means;
– said load applying means being movable along a regular or irregular curve to any of
a range of predetermined positions between a first position which places the patient's
cervical spine in flexion and a second position which places the patient's cervical spine
in extension.
In a preferred embodiment of the present invention, the load applying means is
mounted upon a support which is in the shape of a regular or irregular curve and which
is adapted to be moved relative to said support surface so as to move said load
applying means between said first and second positions. The support may be formed
as a gear rack which is adapted to be moved relative to said support by means of a
pinion connected to said support surface.
Another possibility is to mount said load applying means upon a support in the shape
of a regular or irregular curve, said load applying means being adapted to move
relative to said support, between said first and second positions.
Preferably, the angle between said first and second positions is at least 90°.
The curve through which the load applying means can be moved may be a regular or
irregular curve, but preferably is a regular curve formed as an arc of a circle with a
radius of about 650 mm.
Any suitable load applying means may be used.
The load transmitting means may be any suitable rigid, semirigid or flexible load
transmitting means. Preferably, however, the load transmitting means is flexible, e.g.
a wire or a wire rope, used in conjunction with a load applying means in the form of a
winch which provides a winch drum around which the load transmitting means is
wound.
Preferably, the support surface is adapted to be tiltable between a base position in
which the plane of the support surface is substantially horizontal and a tilted position in
which the plane of the support surface is at at least 45° to the horizontal, and to any of
a range of predetermined positions between said base and said tilted positions.
The actual load to be applied to the patient depends upon a number of factors which
include the type of treatment being used, the weight of the patient, and the angle at
which the load is to be applied. Typical loads are in the range 2 kg to 50 kg.
Preferably, the device includes a load measuring means arranged such that in use the
load measuring means reads the load on said load transmitting means. The load
measuring means may be any suitable measuring device capable of accurate
measurement, and preferably is a load cell. The load measuring means may be
mounted adjacent the load applying means, but could be incorporated in the load
transmitting means or connected between the load transmitting means and the load
applying means.
Brief Description of the Drawings
By way of example only, a preferred embodiment of the present invention is described
in detail, with reference to the attached drawings, in which:–
Figure 1 is a diagrammatic side view of a support surface and a traction device in
accordance with the present invention, showing the application of neutral traction;
Figure 2 is a view similar to Figure 1, but with the support surface tilted;
Figure 3 is a view similar to Figure 2, with the traction device applying maximum
flexion;
Figure 4 is a view similar to Figure 1, but with the traction device applying maximum
extension;
Figure 5 is a view of part of the traction device, on a larger scale, with the rack and
pinion shown straight rather than curved, for clarity;
Figure 6 is a side view of the load applying means; and
Figure 7 is a plan view of the load applying means.
Detailed Description of the Preferred Embodiment
Referring to the drawings, as shown in Figures 1 – 4, a patient 10 to be treated for
fracture dislocations of the cervical spine is supported upon a support surface 11 in the
form of a Howard Wright trauma stretcher. The trauma stretcher is of known type, and
provides a mattress 12 carried upon a mobile base 13 which can be adjusted in angle
(see Figures 2 and 3). The base 13 can be tilted from the ‘base’ position shown in
Figure 1, in which the plane of the base is substantially horizontal, up to a position in
which the plane of the base is at about 25° to the horizontal, or even up to 45°. The
base 13 also may be tilted to any of a range of positions between these extremes.
The stretcher also provides means for securing the patient to the stretcher, so that
traction can be applied as described below without actually pulling the patient along
the stretcher.
For clarity, in the drawings the head of the patient 10 is shown unsupported, with the
patient's shoulders aligned with the end of the mattress; in practice the patient's head
is supported by a pillow.
A flexible load transmitting means 14, in the form of a wire rope, is connected at one
end to the patient 10 by Gardner Wells tongs 15. The tongs are of known design, and
the free ends of the tongs are connected directly into a patient's skull.
The other end of the wire rope 14 is wound around the drum 16 of a load applying
means in the form of a winch 17 (see Figures 6 and 7).
The winch 17 is mounted at one end of a curved support 18 which forms the rack of a
rack and pinion drive, the pinion 19 being rigidly secured to the midpoint of the end of
the trauma stretcher 11, adjacent the head of a patient 10 in use, by means of a
bracket 20 and a clamp 21.
It is important that the length of the bracket 20 is sufficient to space the device from
the head of the stretcher:– there must be room for the rack 18 to move relative to the
pinion whilst remaining clear of the stretcher, and the length of the wire 14 between
the patient and the winch should be at least 300 mm at the start of the procedure, to
allow adequate scope for increasing the tension as necessary.
The pinion 19 is curved to match the curve of the rack 18. The rack 18 is shown as a
smooth, arcuate, curve, but may in fact be formed as any of a range of regular or
irregular curves, and preferably is formed as a C shape. Forming the rack 18 as a
smooth arc with a radius of about 650mm has been found to work well in practice. In
practical terms, the radius of the curve of the rack 18 (if regular) or the shape of the
rack 18 (if irregular) must be such that the load applying means can be positioned to
apply everything from a maximum extension load, through a neutral load, to a
maximum flexion load to a patient, but such that the rack 18 does not contact the floor
or the stretcher in any position; and preferably such that the rack 18 is not
inconveniently high above the stretcher either. Within these practical limits, the radius
and shape of the curve of the rack may be varied as required.
The above described arrangement of means that the angle at which traction is applied
to a patient can be varied by moving the rack 18 relative to the pinion 19 to raise or
lower the winch 17 relative to a patient supported upon the stretcher, and the angle
can also be varied by tilting the stretcher, as shown in Figures 2 and 3.
The degree of traction applied to a patient can be increased or decreased by winding
more or less of the wire rope 14 around the drum 16 of the winch 17, but also can be
varied by varying the angle at which the traction is applied:– increasing the angle at
which traction is applied will not only increase the degree of flexion of the cervical
vertebrae, but also increase the load applied. Conversely, decreasing the angle at
which traction is applied will decrease the degree of flexion, and if the neutral point has
been passed, (i.e. where the load is applied aligned with the undamaged portion of the
patient’s spine) will increase the extension, and will also increase the load applied.
Figure 5 shows a detail of the rack and pinion, but with both the rack and the pinion
shown straight rather than curved, for clarity. The rack 18 is formed along the whole of
its length as a gear rack which engages with a pinion 19 mounted inside a mounting
box 23. The pinion 19 can be rotated by means of a handle 24 via a right angle
geared worms/worm wheel drive (not shown) of known type. Preferably, the gear ratio
is 40:1, so that very fine adjustments can be provided by rotating the handle. It would
of course be possible to drive the pinion using motorised drive means, if preferred.
Thus, rotating the handle 24 moves the rack 18 up or down relative to the pinion 19,
depending upon the direction of rotation of the handle.
Figures 6 and 7 show the winch 17 in greater detail. The winch 17 is carried on a
plate 25, which also supports a load cell 26 as described below. The underside of the
plate 25 is secured to the upper end of the track 18 such that in the neutral position
shown in Figure 1, the plane of the plate 25 is substantially horizontal.
The winch 17 is a small geared winch powered by a winding handle 27 which can be
manually rotated to rotate the winch drum 16 around an axle 16a, via a right angle
geared drive (not visible) mounted below the winch drum 16. Preferably the gear ratio
is 30:1 so that very small movements of the winch wire 14 are possible. The winch 17
could be driven by a motor if preferred.
One end of the wire rope 14 is permanently secured to the drum 16; the winch wire 14
passes from the drum 16, between a freely rotatable guide pulley 28 and a peg 29,
and over a second free rotatable guide pulley 30 which directs the winch wire 14
outwards to hook onto the Gardner Wells tongs 15 secured to the patient, by means of
a hook 31 secured to the free end of the wire rope.
One side of the winch 17 is mounted on an angled plate 32 which is bent through a
right angle. The other side of the plate 32 is apertured to receive a bolt 33 which
provides a load transmitting connection to the load cell 26. The other end of the load
cell 26 is anchored by means of a bolt 34 to the plate 25. The winch 17 and plate 32
can slide relative to the plate 25, so that the load on the wire rope 14, which is of
course transmitted to the winch drum 16, is recorded by the load cell 26. Thus, as the
handle 27 of the winch is rotated in either direction, the increase or decrease of the
load on the wire 14 can be read directly from the display 35 of the load cell 26.
The above described device is used as shown in Figures 1 – 4. The patient 10 lies on
the stretcher 11 and is secured using known means (not shown). A Gardner Wells
tongs 15 is connected to the patient's skull in known manner, and the wire rope 14
from the winch 17 is hooked onto the tongs 15 by the hook 31.
In the position shown in Figure 1, the stretcher 11 provides a support surface in the
horizontal plane, and the rack 18 is positioned so that the winch 17 is approximately
opposite the end of the patient's spine. This means that the wire rope 14, when
tensioned by the winch 17, applies a neutral traction to the patient, i.e. in a direction
aligned with the undamaged portion of the patient's spine.
The objective of the traction is to rapidly but gently reduce any distortion of the spinal
cord, to remove abnormal pressure from the spinal cord, and to realign any displaced
portions of the spine.
In the neutral position shown in Figure 1, the winch wire is used to apply a loading of
(typically) 2 to 2.5 kg. X-rays normally are taken before starting treatment, and also
taken at every stage during treatment with the device:– the patient is x-rayed after
every five kg increase in loading.
In the next stage of treatment, the leg end of the stretcher 11 is lowered to an angle of
about 16° to the horizontal, as shown in Figure 2. This maintains a straight, (i.e.
neutral) traction on the patient, but increases the load applied to the patient, e.g. to 5
kg. The rack 18 is then slowly moved relative to the pinion 19, using the hand wheel
24, to raise the winch 17 to the position shown in Figure 3 thus gradually increasing
the flexion of the cervical spine, to realign that portion of the spinal cord to the correct
alignment. The full limit of maximum flexion is when the patient's chin contacts his or
her chest. If necessary, the load applied by the winch 17 may be raised during this
stage, e.g. to 15 kg.
In general, increasing the angle of the load increases the degree of flexion of the
cervical vertebrae and also increases the load applied. Decreasing the angle of the
load decreases the degree of flexion and also decreases the load applied, until the
neutral loading point has been passed, as described above.
It will be appreciated that the degree of loading, and the angle at which the traction is
applied, both are varied depending upon the patient's size and weight and the degree
and type of damage to the spine:– a constant monitoring of the treatment by means of
x-rays of the cervical spine area are needed to make sure that both the traction and
the degree of flexion or extension are kept to the minimum needed for the desired
effect.
When the x-rays indicate that the dislocated vertebra(e) has been correctly reduced,
i.e. realigned, the stretcher 11 is gradually moved back to the horizontal position
shown in Figure 4, and the angle of traction is gradually reversed to place the cervical
spine in extension rather than flexion:– this means that the winch 17 is actually at a
level below the patient's head, as shown in Figure 4. Maintaining the cervical spine in
extension, at a relatively low traction loading, maintains the reduction of the spine
without over distracting the spine. When the spine is in extension, typically the loading
in kilograms applied by the winch is the same as the number of the vertebra at the
break – C5 break has a 5 kg loading, C4 break has a 4 kg loading, and so on.
Claims (12)
1. A device for applying traction to the cervical vertebrae to reduce fracture dislocation of the cervical spine, said device including: 5 • a support surface adapted to support a patient lying upon his or her back; • a load transmitting means adapted to be connected at one end to a patient under treatment and lying upon said support surface; • the other end of said load transmitting means being adapted to be connected to a load applying means; 10 • said load applying means being movable along a regular or irregular curve to any of a range of predetermined positions between a first position which places the patient’s cervical spine in flexion and a second position which places the patient’s cervical spine in extension. 15
2. The device as claimed in claim 1, wherein the angle between said first and second positions is at least 90°.
3. The device as claimed in claim 1 or claim 2, wherein the load applied by the load applying means is in the range 2 kg – 50 kg.
4. The device as claimed in any one of the preceding claims wherein said device further includes a load measuring means arranged such that in use said load measuring means measures the load on said load transmitting means. 25
5. The device as claimed in claim 4, wherein said load measuring means comprises a load cell.
6. The device as claimed in claim 4 or claim 5 wherein said load measuring means is located in a position selected from: adjacent the load applying means; incorporated in 30 the load transmitting means; connected between the load transmitting means and the load applying means.
7. The device as claimed in any one of the preceding claims wherein the load transmitting means is flexible and the load applying means consists of a winch 35 providing a winch drum around which the load transmitting means is wound.
8. The device as claimed in any one of the preceding claims wherein said support surface is adapted to be tiltable between a base position in which the plane of the support surface is substantially horizontal and a tilted position in which the plane of the support surface is at at least 45° to the horizontal, and to any of a range of 5 predetermined positions between said base and tilted positions.
9. The device as claimed in any one of the preceding claims wherein said load applying means is mounted upon a support which is in the shape of a regular or irregular curve and which is adapted to be moved relative to said support surface so 10 as to move said load applying means between said first and second positions.
10. The device as claimed in claim 9 wherein said support is formed as a gear rack which is adapted to be moved relative to said support surface by means of a pinion connected to said support surface.
11. The device as claimed in any one of claims 1 – 9, wherein said load applying means is mounted upon a support in the shape of a regular or irregular curve, and said load applying means is adapted to move relative to said support, between said first and second positions.
12. The device as claimed in any one of the preceding claims wherein said load applying means is movable along a regular curve which comprises an arc of a circle having a radius of about 650 mm.
Publications (2)
Publication Number | Publication Date |
---|---|
NZ614809A NZ614809A (en) | 2013-10-25 |
NZ614809B true NZ614809B (en) | 2014-01-28 |
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