RU2161942C1 - Apparatus for fixation of patient in the process of endoprosthesis of coxofemoral joint - Google Patents

Abstract

FIELD: medicine, in particular, operative orthopedics. SUBSTANCE: apparatus has two rear fixing lugs, guiding plate for connecting rear lugs and three front fixing lugs, movable bracket for attachment of instruments, for instance wound expander, lug fastening clips and slots of rear fixing lugs for fastening of guiding plate, fastening legs for rear fixing lugs, and fixing legs for front fixing lugs. Apparatus units and parts are attached in three mutually perpendicular planes. Such construction provides correct laying and reliable fixation of patient on operating table. EFFECT: increased efficiency and enhanced reliability in operation. 8 dwg, 1 ex

Description

 The device relates to medicine, namely to operative orthopedics.

 Endoprosthetics of the hip joint in the patient’s position on the side provides for the correct placement and firm fixation of the patient on the operating table. In this case, the frontal plane of the body was strictly perpendicular to the plane of the operating table, the body was straightened in the frontal (physiological curvature of the spine is preserved) and sagittal planes.

 Known for special fixators included in the set of an orthopedic table, and other original devices that allow you to fix the patient in a lateral position: Kerboull M. Arthroplastie total de hanche sur luxation congenitale. Encyclopedie Medico-Chirurgicale (Elsevier, Paris), Technique chirurgicales - Orthopedie-Traumatologie, 44-665-B, 1994, 11p; Bauer, F. Kerschbauer, S. Poisel, A. Harle S. Abord trasthoracique du rachis dorsal de T4 a T11. Tchniques en chirurgie orthopedique. 1993. T.1. P. 13-24.

Closest to the claimed device is a device for fixing the patient on the operating table in the side position: Kerboull M. Arthroplastie total de hanche sur luxation congenitale. Encyclopedie Medico-Chirurgicale (Elsevier, Paris), Technique chirurgicales - Orthopedie-Traumatologie, 44-665-B, 1994, 11p;
However, these devices, due to their technical capabilities, can allow inaccuracies in laying the patient on the operating table in the side position.

 The objective of the invention is to ensure the correct laying and strong fixation of the patient on the operating table.

 This object is achieved in that the proposed device to ensure proper placement and strong fixation of the patient is additionally equipped with two rear locking tabs and a guide plate connecting the rear locking tabs to each other, and having grooves and clamps for the latter, and the guide plate is equipped with a movable bracket for instrumentation fasteners (for example, for a retractor), the front three fixing legs, two of which are fixed on the rod with the ability to move in three planes s, the technical solution of the device and its method of attachment to the operating table ensure mutual perpendicularity of the positions of all parts of the device in 3 planes (mutually perpendicular).

 The invention is illustrated by figures.

 Figure 1 shows a device (prototype) for fixing the patient on the operating table in a position on the side.

 In FIG. 2 presents a complete set of the device fixing the patient on the operating table in a position on the side.

 Figure 3 shows the rear locking tabs in different positions.

 Figure 4 shows the rear locking tabs connected to the guide plate.

 In Fig.5 - the front three legs and the mounting rod.

 Figure 6 - front two locking tabs connected by a rod.

 Figure 7 shows the fixation of the patient with the hind legs connected by a guide plate.

 On Fig - fixation of the patient with the front paws.

 The device consists of two rear locking tabs 1, a guide plate 2 for connecting the rear tabs 1, three front locking tabs 3, a rod 4 for connecting two front locking tabs 3, a movable bracket 5 for mounting tools on the device (for example, a retractor) , clamps 6 for attaching the tabs 1, clamps 7 and grooves 8 of the rear locking tabs 1 for mounting the guide plate 2, mounting legs 9 of the rear locking tabs 1, mounting legs 10 of the front locking tabs 3.

 The device operates as follows.

 The patient is placed on the operating table in a position on the side (Fig.7 and 8). The rear locking tabs 1 are installed on the sacral region and on the rib cage in the interscapular region (Figs. 7 and 8) and fastened with their struts-clamps 11 (included in the operating table) to the operating table. The rear locking tabs 1 are connected to each other by a guide plate 2, the latter is inserted into the grooves 8 of both rear locking tabs 1, fixed to the tabs by clamps 7 mounted on the rear surface of the rear tabs 1 (Fig. 7).

 The guide plate 2, mounted in the hind legs, allows you to install both hind legs on the same axis in the sagittal and frontal planes, which allows you to correctly lay the patient on the operating table so that the frontal plane of the patient’s body is strictly perpendicular to the plane of the operating table, and the longitudinal axis body coincides with the longitudinal axis of the operating table, which in turn allows you to maintain the natural inclination of the pelvis relative to the body in the sagittal plane, which is very important for correct installation of a cup of the hip joint prosthesis. The length of the guide plate 2 allows you to fix the rear locking tabs 1 at the required distance between them, in proportion to the length of the body.

 The front two locking tabs 3, mounted on the shaft 4 (FIGS. 5 and 8), are set so that the upper locking tab secures the front-upper spine of the ilium located in the upper position, the second front locking tab secures the front-upper spine of the ilium lower position of the ilium. Rod 4 is attached to the operating table with clamps attached to the operating table. The third front foot 3 fixes the chest in the sternum and is attached by the stand-lock 11 to the operating table.

Clinical example
Patient P., born in 1931, I / B N 715-579, was admitted to the medical institution TMO-2 on September 21, 1999 for planned surgical treatment.

 Diagnosis: False joint of the neck of the left thigh. Insolvency of osteosynthesis of the left femoral neck. Pronounced brush-like reconstruction of the head of the left thigh. Bending-contracting contracture. Pain syndrome NF joint 4th degree.

 Concomitant diagnosis: IHD. Angina is unstable, stabilization in the second FC. H1. Hypertensive b-n, 2 tbsp., Mild labile hypertension. Chronic bronchitis with asthmatic component. PTB of the left lower leg. Common osteochondrosis.

 September 28, 1999, Operation N 213-214 - Endoprosthetics of the left hip joint with a Muller Cup N 50 on bone cement “Palakos R”, M. Müller leg N 11 on a bone cement “Palakos R”. P / O diagnosis: the same.

 Khir: Kolesnik A.I. Ass. Brezhneva N.L., Ivanova G.P.

Duration: 3 hours 35 minutes Blood loss: 1200 ml
Anesthesiologist: Chursin Yu.M.

Anesthesia: endotracheal anesthesia
Op. sister: Yakovleva T.M.

 Exodus: Discharged on 12.10.99.

Protocol
7 and 8 depict the moments of fixation of patient P. on the operating table in position on the right side using the proposed device.

 1. A section of up to 21 cm long on the outer surface of the joint layer-by-layer exposed the trochanteric region of the femur. Hemostasis and toilet wounds with antiseptics - during the operation.

 2. Removed a three-blade nail and a screw.

 3. The capsule of the joint is exposed. Hemostasis and toilet wounds with antiseptics - during the operation. The capsule is dissected. The head is free from the neck. The head is dislocated from the cavity; it is deformed, flattened. Hemostasis and toilet wounds with antiseptics during the operation.

 4. After preliminary processing of the acetabulum with cutters NN 48 - 52, a Müller cup N 50 was implanted on Palakos R bone cement.

 5. The proximal femur is treated with a rasp N 7.5, -11.25.

 6. The canal of the femur is blocked by a silicone plug, the clinical use of which is approved by the Ministry of Health of the Russian Federation.

 7. An Müller leg N 11.25 was implanted on the Palakos R bone cement.

 8. Selected head MX32.

 9. The head is set into the cavity. The range of motion in the joint is sufficient.

 10. Toilet wounds with an antiseptic. Layer wound closure with 2 drains left for active aspiration. Rubber graduates in subcutaneous fat.

 11. Elastic bandaging of the legs.

 Thus, the proposed device compares favorably with the prototype, its technical solution allows to achieve the task set in the invention due to the fact that the device is equipped with two rear tabs and a guide plate, and the front two locking tabs are fixed on the rod with the ability to move in three planes, allowing carry out the correct laying and firm fixation of the patient on the operating table so that the frontal plane of the patient’s body is strictly perpendicular to the plane on the table, and the longitudinal axis of the body coincide with the longitudinal axis of the operating table, and will preserve the natural slope of the pelvis in relation to the housing body in the sagittal plane. Moreover, the technical solution of the device and the method of attachment to the operating table provide mutual perpendicularity of the position of all parts of the device in 3 planes (mutually perpendicular).

Claims (1)

 A device for fixing the patient during hip replacement, consisting of legs that fix the pelvis, and racks that fix these legs, characterized in that to ensure proper installation and strong fixation of the patient, it is additionally equipped with rear locking legs and a guide plate connecting the rear locking legs between each other, and having grooves and clamps for the latter, and the guide plate is equipped with a movable bracket for mounting tools, and the front two locking tabs are fixed camping on the rod movable in three planes, the fastening device and all its interperpendicular nodes in three planes.

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