RU206163U1 - NEUROSURGICAL EXPANDER - Google Patents

Abstract

The claimed utility model relates to medical technology, in particular to devices for holding open a surgical incision during surgery, namely to retractors, and can be used, for example, to expand an operating wound, displacement and fixation of a skin-muscle-aponeurotic flap during surgical operations on the brain. The technical result achieved when using the claimed utility model consists in expanding the arsenal of known surgical instruments, in particular, retractors. The claimed technical result is achieved in that the neurosurgical retractor, including a composite annular element, including at least two pivotally connected segments, on which the holders are removably fixed, is equipped with a means of attaching it to the bracket, and each holder is a bar with a number of holes , at the end of which curved pointed hooks are located, while grooves are made around the circumference of the annular elements to accommodate the holder strip with central holes to align with the holes of the holder strip.

Description

Technology area

The claimed utility model relates to medical technology, in particular, to devices for keeping open the surgical incision during the operation, namely, to retractors, and can be used, for example, to expand the surgical wound, displacement and fixation of the musculocutaneous-aponeurotic flap when surgical operations on the brain.

State of the art

One of the main keys to the success of neurosurgical operations on the brain is adequate expansion of the surgical wound, which is achieved by fixing the musculocutaneous-aponeurotic flap in a given position, based on each specific surgical approach (Gaivoronsky A.I., Kondakov E.N., Svistov D.V., Gulyaev D.A.Guide for doctors: Operative approaches in neurosurgery.Volume 1. Head / Edited by Academician of RAS B.V. Gaidar. - St. Petersburg: Spec Lit, 2015. - P. 12) ... Adequate expansion of the surgical wound when performing an operative approach based on the skull provides minimal atraumatic traction of the brain tissue (Cherekaev V.A., Belov A.I., Vinokurov A.G. Surgery of hyperostotic cranio-orbital meningiomas / Edited by Academician A.N. Konovalov. - M., 2005. - S. 112). Various devices are used to expand the surgical wound during brain surgery, which have a number of disadvantages, such as limited functionality, limited access of the surgeon's hands to the surgical field, design complexity, problems with sterilization of the device, high cost of devices, etc.

Thus, the development of new, simple and easy-to-use devices for widening an operating wound and fixing a musculocutaneous-aponeurotic flap during surgical operations on the brain is an urgent task of modern medicine.

Known retractor Gilbash from AESCULAP (https://www.bbraun.ru/ru/products/b/general-surgicalinstruments.html). The Gilbash system consists of two arcuate metal parts connected to each other. Hooks attached to the specified arcuate parts are used to expand the edges of the wound.

This device has a low degree of reliability, since the hooks attached to the arcuate metal parts often come off, and when using spring hooks, due to the stretching of the springs, it is not possible to expand the wound as needed by the surgeon. This fact is especially important in "keyhloe" surgery (mini-access), where every additional millimeter of the surgical wound counts. In addition, if the spring hook slides off the edges of the wound, the hands of the surgical team may be injured, which is unsafe from the point of view of epidemiology and antiseptics.

Ring retractors are predominantly known in the field of abdominal surgery. Most often, retractors used in abdominal surgery or trauma surgery are self-retaining. Self-retaining models can be displaced during surgery, as they are fixed by relatively mobile soft tissues. In neurosurgery, the use of self-retaining retractors is inapplicable, since when performing neurosurgical manipulations, mixing instruments in a wound can damage the brain tissue, cranial nerves, and great vessels. Therefore, the retractor must be stationary and securely fixed.

So, solutions of retractors are known (https://medstock.ua/retraktor-ranorasshiritel-abdominalnyi-denis-browne-wh6390) containing an annular support, to which the retaining blades are movably fixed.

These devices have limited functionality, since the blades can only be radially displaced as a result of rearrangement.

Known surgical retractor (RU194319U1), consisting of an annular housing with threaded bushings pressed into it in the radial direction, in which the blades are installed. Each blade is fixed to the ring through an overhead retainer, which, in turn, is attached to the ring with screws. The device is designed to increase the working space during the surgical intervention, however, it has a rather complex structure with fine tuning, which requires a significant time for installing the retractor.

The closest in technical essence to the claimed utility model is the solution of a surgical ring retractor disclosed in patent publication US6659945B2. The device is made of two half-rings connected together by hinges to form a complete ring. The hinges allow two half rings to bend or rotate 180 ° relative to the plane of the ring. Each half ring includes a plurality of axial protrusions (relative to the plane of the half ring), the shape of which provides the ability to put on retractors and / or auxiliary instruments. In addition, each protrusion is provided with a slot made with the possibility of fixing suture material therein.

The retractor scapula with long ends are used to dilute the edges of the wound, mainly in abdominal surgery, since in this area the surgical wound is deep due to the anatomical features of the structure of the anterior abdominal wall. In neurosurgery, there is no need to use such scapulae; the use of hooks is much more effective for spreading the edges of soft tissues, since the wound is not deep and is represented only by the scalp and in some places by the muscle. Moreover, paddles such as those disclosed in the prior art can harm a patient during surgery.

Thus, the known designs of retractors cannot be used in the field of neurosurgery without the risk of harm to the patient.

The technical problem solved by the claimed utility model consists in the need to overcome the disadvantages of analogues and prototype by creating a simple and easy-to-use design of an annular retractor for use in the field of neurosurgery, made with the ability to attach to the Mayfield brace (MAYFIELD®). The Mayfield Brace is a three-point cranial stabilization system that is used in open craniotomy, providing a rigid fixation of the patient's head, which in turn is attached to the operating table.

Brief disclosure of the essence of the utility model

The technical result achieved when using the claimed utility model consists in expanding the arsenal of known surgical instruments, in particular, retractors.

The claimed technical result is achieved in that the neurosurgical retractor, including a composite annular element, including at least two pivotally connected segments, on which removable holders are fixed, according to the technical solution, is equipped with a means of attaching it to the staple, and each holder is It is a bar with a row of holes, at the end of which curved pointed hooks are located, while grooves are made around the circumference of the annular elements to accommodate the holder bar with central holes to align with the holes of the holder bar. The angle between adjacent segments of the annular element is 180 to 150 degrees. The means for fastening the retractor to the staple is made in the form of a block rigidly connected to the annular element with a through hole designed to accommodate the staple tube, and a perpendicularly oriented hole for placing a locking screw. The holders are arranged with strips in the recesses of the annular element with the alignment of the holes and are secured through the indicated holes with pins.

Brief Description of Drawings

The claimed device is illustrated by the following drawings and images, where

figure 1 shows a General view of the claimed device in assembly,

figure 2 shows an image of the means for attaching the annular element to the rack,

Fig. 3 shows an image of a hinge assembly, which makes it possible to change the mutual angular position of the parts of the annular element,

Figure 4 shows the retractor holder.

Positions in the drawings indicate:

1. Ring element,

2. Parts of the ring element,

3. Hinge connection of parts of the ring element,

4. Notch,

5. Through hole in the recess of the annular element,

6. Means of fastening to the rack,

7. Holder,

8. Holder bar,

9. Holes in the holder bar,

10. Hook,

11. Pin.

Implementation of the utility model

The inventive device is a reusable medical device used in the process of carrying out neurosurgical operations when it is necessary to dilute the wound. The retractor includes an annular element configured to be attached to a medical post or Mayfield bracket, and a set of holders configured to be individually attached to the annular element. The annular element is assembled from several, preferably two or three parts (segments), interconnected by means of hinge joints. Parts of the ring element can be made of stainless metal alloy. The shape of the profile used for the production of the annular element can be any shape, for example, round or rectangular. The articulated joints provide the ability to change the angle of relative position of the parts of the retractor ring element in the range from 180 to 150 degrees. The possibility of mutually changing the angle of inclination of the segments of the annular element allows the use of a retractor for operations taking into account the curved surface of the skull. The pivot connection can be achieved, for example, by positioning and fixing a fastening bolt in the coaxial holes of two mating portions of the annular element. On the outer side of the annular element there is a means for attaching the retractor to the support post or bracket. Such means can be made, for example, in the form of a support piece rigidly fixed to the annular element with a through hole for accommodating the post and a perpendicularly oriented hole for accommodating and fixing the locking screw.

Around the circumference of the annular element, recesses are preferably uniformly formed, the profile of which corresponds to the profile of the holder strip. The number of such recesses can be any, technologically possible for circumferential execution, however, the optimal number of recesses is 10-16 pieces. The depth of the recesses is no more than half the thickness of the ring element segment, which allows maintaining the rigidity of the structure. A through hole is made in the central part of each recess, the diameter of which is equal to the diameter of the hole on the holder bar.

The device includes a set of holders, removably mounted around the circumference of the annular element. Each holder is a strip not more than 0.4 cm thick, preferably of a flattened profile, at the end of which curved hooks are fixed. Holders can be made of stainless steel alloy. The strips of the holders have a length slightly exceeding the radius of the ring element, not more than 30 mm. Through holes of equal diameter are made along the entire length of the holder strip. The hooks at the end of the plank are pointed, consisting of two teeth. The distance between the teeth of one holder is 0.5 - 0.7 cm, and the thickness of the teeth is no more than 0.3 cm, which is due to the field of application of the inventive retractor. The holders are installed with strips in the grooves of the annular elements with the alignment of the holes in the grooves and the holes in the strips of the holders and are fixed with pins. By moving the holder bar and fixing it in the appropriate position, the radial position of the hooks relative to the annular element is adjusted.

The claimed device operates as follows.

To use the retractor, the patient's head is fixed to the Mayfield brace. A support stand made in the form of a metal tube is fixed to the bracket. The ring element of the retractor is fixed to the rack through the fastening means by installing the tube of the support rack into the through hole of the support part and fixing it in this position with a locking screw. The annular retractor element is positioned over the operating wound in the area of the planned incision. The segments of the annular element are set at the required angle to each other and fixed with pivot joints. After making the incision using the hooks of the holders, the edges of the wound are separated to the required distance and installed through the holes on the strips of the holder in the grooves of the annular element, after which the holders are fixed in the grooves of the annular element with pins through the holes of the strap and the annular element. As a result, the surgeon gets full access to the surgical wound. At the same time, since the retractor is indirectly attached to the Mayfield brace, which rigidly fixes the patient's skull, there is no risk of displacement of the retractor relative to the patient's head. Thus, a high structural reliability is achieved.

An example of a specific implementation

In accordance with the claimed utility model formula, a prototype of a neurosurgical retractor has been manufactured, containing an annular element with a diameter of 300 mm, made of two metal segments 10 mm thick. The ring is made composite, with a hinge dividing it into 2 parts, which can change the angle relative to each other from 180 to 150 degrees for more comfortable access to the surgical wound. Along the circumference of the annular element, 16 recesses are uniformly made to accommodate the strips of the holders. Each holder of the set is made in the form of a strip 160 mm long with 22 holes, at the end of which curved pointed hooks 20 mm long are made. The set of holders consists of 4 pieces, symmetrically fixed to the ring element.

Claims (4)

1. Neurosurgical retractor, including a composite annular element, including at least two pivotally connected segments, on which removable holders are fixed, characterized in that it is equipped with a means of attaching it to the staple, and each holder is a bar with a number of holes , at the end of which curved pointed hooks are located, with recesses made around the circumference of the annular element to accommodate the holder strip with central holes to align with the holes of the holder strip. 2. The retractor according to claim 1, characterized in that the angle between adjacent segments of the annular element is from 180 to 150 degrees. 3. The retractor according to claim 1, characterized in that the means for attaching the retractor to the staple is made in the form of a block rigidly connected to the annular element with a through hole designed to accommodate the staple tube and a perpendicularly oriented hole to accommodate the locking screw. 4. The retractor according to claim 1, characterized in that the holders are arranged with strips in the recesses of the annular element with alignment of the holes and are secured through the said holes with pins.

Images