RU2674233C1 - Retractor-lift of sternum and costal arches - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine and can be used for surgical interventions in cardiovascular surgery. Retractor-lift of the sternum and costal arches includes a height-adjustable vertical support with a fastening element to the operating table in the form of a vice, a height-adjustable vertical stand, horizontal console with a slide with a lock, a lifting mechanism, a removable rocker in the form of a plate and two removable hooks. Vertical support is connected by means of a bracket with a vertical stand, on which a horizontal console with a slide is mounted with a lifting mechanism installed on it. Lifting mechanism includes the first and second cardans with clamps, the driving screw with two parallel flats, a cylindrical boss with a central through hole and an adjusting nut. First cardan is installed on the vertical pin of the ram. Second cardan with a through slot in the center, the vertical section of which has the shape of a rectangular trapezium, is mounted on the lateral pin of the first cardan, which is angled at an angle. Spindle with the adjusting nut is inserted into the through slot of the second cardan. Between the adjusting nut and the cardan there is a boss, the cylindrical contact surface facing the slot of the second cardan. At the end of the spindle, ending with a ball bearing, a removable rocker arm with two detachable hooks is suspended. Hooks have ball bearing. Slots for installation of ball bearings hooks are made on the rocker.

EFFECT: easy operation and maintenance of a simple design.

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Description

The invention relates to devices used in surgical interventions in cardiovascular surgery, namely when performing a standard median sternotomy followed by traction of the dissected sternum and costal arches in the cranial direction (up) and the allocation of an autoarterial graft with its subsequent use for myocardial revascularization in coronary artery disease hearts.

The prototype of the proposed device is a surgical retractor Rultract Skyhook manufactured by Rultract Inc. (http://www.rultract.net/Root/pdf/4100-SPLN-S50.pdf). The known device consists of a vise of a complex spring-clamp structure with a groove for installation and for fixing a vertical rack to the bar of the operating table. At the end of this vertical stand, an additional vertical stand with a horizontal console is mounted and fixed. On the horizontal section of the console, a lifting device is installed and fixed in the right position, which is a slider and a winch with a cable mounted on it. A latch is fixed at the end of the cable, on which the beam is suspended. Two hooks are pivotally attached to the ends of the rocker arm, which hook the sternum after its dissection and provide its traction in the necessary direction, creating surgical access of the right size to highlight the sternal mammary artery.

The disadvantages of the prototype are the design complexity and low ergonomics.

The design of the prototype winch is complex, and its open sections for the passage of the cable are free for biomaterial to enter during the operation. Full sterilization of the winch is impossible without its extremely complex and lengthy disassembly and subsequent assembly using special tools. The ingress of biomaterial between the wires of the cable makes its full sterilization impossible. The design has a limited ability to install hooks relative to the rocker arm, changing their center distance only two times, and to change the position of the hooks a long (10-15 minutes) procedure for reinstalling the hooks is required, which is inconvenient for the surgeon.

The objective of the proposed invention is to simplify the design of the device while increasing its ergonomics.

The problem is solved in that the straddle-lifter of the sternum and costal arches includes a height-adjustable vertical support with an attachment to the operating table, a height-adjustable vertical stand, a horizontal console with holes for securing the slide in the desired position with a latch, a lifting mechanism, a removable rocker arm in the form of a plate and two removable hooks, while the fastening element of the vertical support to the operating table is made in the form of a vise with an opening for installing a vertical support and a fix ator, which simultaneously fixes the vertical support at the required height and rigidly fastens the vice to the operating table, a bracket with a hole and a latch is installed on the end of the vertical support, made in the form of a polyhedron, for mounting and fixing the vertical rack at the required height, a horizontal console is installed on the vertical rack while the end of the vertical rack is made in the form of a polyhedron, combined with the corresponding polyhedron curved at right angles to the end of the horizontal console;

a lifting mechanism, including the first and second cardan with clamps, a spindle with two parallel flats, a cylindrical boss with a central through hole and an adjusting nut, is mounted on a slider of the horizontal console,

wherein

the first cardan is mounted on a vertical slider pin, the second cardan with a through hole in the center, the vertical section of which is in the shape of a rectangular trapezoid, is mounted on an angled side pin of the first cardan, a threaded spindle with an adjusting nut is inserted into the through slot of the second cardan, and between the adjusting nut and the boss is a boss, cylindrical contact surface facing the slot of the second cardan;

on the end of the lead screw ending in a ball joint, a removable beam with two removable hooks is suspended, the hooks having a ball bearing, and slots for making the ball joint of the hooks are made on the beam.

The vertical support and the hole in the vice, as well as the vertical stand and the hole in the bracket, are made in such a way as to prevent them from turning. The rocker arm has 10 slots for installing hooks.

The technical result of the invention is to simplify the design of the retractor-lift of the sternum and costal arches, facilitating the work of the surgeon and servicing the device.

The invention is illustrated by the following figures:

FIG. 1 is a schematic illustration of the proposed device;

FIG. 2 is a view A of FIG. 1 vertical section (mounting the device to the operating table);

FIG. 3 is a view In FIG. 1 vertical section (connection of vertical supports and racks);

FIG. 4 is a view C of FIG. 1 vertical section (connection of a vertical rack with a horizontal console);

FIG. 5 is a view D of FIG. 1 vertical section (enlarged image of the lifting mechanism);

FIG. 6 is a photograph of a prototype lift expander;

FIG. 7 is a photograph of the lifting mechanism of a prototype lift expander.

The retractor-lift sternum and costal arches includes a vertical support 1, attached to the planks of the operating table with a vise 2 with a latch 3 (Fig. 1). The vertical support 1 is inserted into the hole in the vise 2, and the latch 3 simultaneously secures it at the required height and rigidly fastens to the bar of the operating table (Fig. 2). To prevent turning, the vertical support 1 and the hole in the vise 2 have parallel flats. The upper end of the vertical support 1 is made in the form of a dodecahedron, on which a bracket 4 with a retainer 5 is mounted. A bracket 4 with a retainer 5 connects the vertical support 1 and the vertical strut 6 and serves to install the vertical strut 6 at the desired height (Fig. 3). The twelve-sided slot in the bracket 4 prevents the vertical support 1 from turning, and the shaped hole with two flats prevents the vertical rack 6, also made with two flats, from being turned. The horizontal console 7 is worn with a bent at right angles to the upper 12-tigered end of the vertical rack 6 (Fig. 4). At the other end of the horizontal console 7, having a square section, with holes along the axis, a slider 8 moves, which is fastened in the desired position relative to the horizontal console 7 with a latch 9 (Fig. 1). A cardan 10 with a latch 11 is put on the vertical pin of the slider 8 (Fig. 5). A second gimbal 12 with a lock 13 is put on an angled lateral pin of the cardan 10. A boss 14 is inserted in the cylindrical recess of the cardan 12, which has a central through hole with a vertical section in the form of a rectangular trapezoid, with a cylindrical contact surface facing the cardan 12. the screw 15 inserted into the slot of the universal joint 12 and the hole of the boss 14, screwed the adjusting nut 16. The through slot of the universal joint 12 provides the necessary movement of the spindle 15 in the vertical plane. At the end of the lead screw 15, ending with a ball bearing, a beam 17 is hung in the form of a plate, in the slot of which two hooks 18 with ball bearings are installed (Fig. 1). The lead screw 15 is made with two parallel flats so that, when the adjusting nut 16 is rotated, resting its flanges against the walls of the slot in the universal joint 12, it can perform translational motion along its axis.

The device is installed and operates as follows.

On the plank of the operating table, a vise 2 is installed in the right place, a vertical support 1 is inserted into the vise hole 2 and these parts are mutually rigidly clamped with a latch 3. A bracket 4 with a latch 5 is put on the 12-tigered end of the support 1. A vertical rack is inserted into the hole of the bracket 4 6, install it at the desired height and tighten with a latch 5. Then, on the 12-tigered end of the vertical strut 6, put on a horizontal console 7 with a slider 8, which is fixed in the desired position with a latch 9. Install and hold on the vertical pin of the slider 8 they are secured by a latch 11 of the cardan 10 of a pre-assembled lifting mechanism consisting of a cardan 10, mounted on its side pin of the cardan 12 and fixed by a clamp 13, boss 14, spindle 15 and adjusting nut 16. The beam 17 is hung on the end of the spindle 15. The device is ready for work.

After the surgeon performs a standard median sternotomy, the surgeon sets the scapula of the hooks 18 into the cut of the sternum, and inserts the ends of the hooks with ball bearings into the slots of the rocker arm 17. Rotating the nut 16 creates a preliminary tension of the hooks of the expander lift. The direction of traction and the angle of inclination of the hooks 18 are regulated by raising and lowering the vertical strut 6, and also by moving the slider 8 along the horizontal console 7. After correcting the correct position of the hooks 18 in space, the further rotation of the nut 16 continues to raise the sternum and create an operating access field of the desired size. The presence of a vertical axis of rotation of the universal joint 10, which allows you to move the entire lifting mechanism of the retractor-lift in the horizontal plane, taking into account the horizontal axis of rotation of the boss 14, which gives movement to the mechanism in the vertical plane, as well as the axis of rotation of the universal joint 12, which gives movement in the frontal plane, creates a unique the ability to create traction at any point in three-dimensional space and in any direction, which allows you to instantly adjust the hooks and the entire lifting mechanism to individual features nnosti the patient's chest. In the prototype, the traction force is always directed only along the axis of the cable to a point on the axis of rotation of the winch, significantly narrowing the spatial limitations of the possible direction of traction.

The proposed device in comparison with the prototype has a simpler design. The prototype uses an attachment element to the plank of an operating table of complex design: one device, a vise, presses the retractor to the planks of the operating table, another device fixes the vertical rack in height. In the proposed design, one vice simultaneously fixes the vertical support at the required height and fastens it to the operating table, which simplifies installation and makes the entire structure more rigid.

In the prototype, a winch with a cable is used as a lifting mechanism, which is very difficult structurally and extremely difficult during sterilization cleaning and sterilization. It is impossible to ensure full sterilization between the strands of a metal cable, as well as the inside of the winch. In the proposed design, a lifting mechanism is used, which is simpler structurally and significantly more convenient in operation compared to the prototype, and also simple when sterilizing the instrument.

To create an even distribution of force on the hooks during the operation, a rocker is used. In the prototype, the places of articulation of the hooks in the beam are fixed. To change the position of the hooks, it is necessary to unscrew the four screw pairs with a special key, move the hooks to adjacent positions and screw the screw pairs again. It takes 10-15 minutes, and is not convenient for the surgeon. In the present invention, the rocker arm 17 has 10 slots for installing the ball joint of the hooks 18. You can use 5 center distances symmetrical with respect to the ball joint in the rocker arm 17 and their numerous combinations with the asymmetrical arrangement of the hooks that the surgeon chooses, depending on the particular reason for the surgical intervention, and which can be used for both children and adult patients with a very developed chest. Changing the position of the hooks takes a few seconds and is not difficult for the surgeon.

A prototype lift retractor (Fig. 6, 7) was clinically tested in the cardiac surgery department of the Interregional Clinical and Diagnostic Center in Kazan, the cardiac surgery department of the Academician B.V. Russian Scientific Center of Surgery Petrovsky in Moscow and in the cardiac surgery department of the Regional Clinical Hospital No. 1 named after S.V. Ochapovsky, Krasnodar. According to surgeons, the use of a multivariate installation of hooks on the rocker ensures a uniform load distribution on the inner surface of the sternum after sternotomy, which avoids postoperative complications such as sternal fractures and subluxations in the sternocostal joints, pressure sores and soft tissue ischemia due to poor regeneration of the surgical wound . In addition, the so-called stage of hanging the patient on the operating table using this retractor makes it possible not to interfere with the anesthetic process when applying anesthesia: vertical traction of the sternum with a rocker with two hooks does not affect the volume of the chest excursion and the volume of mechanical ventilation, which does not make it difficult to isolate proximal autograft.

Thus, the proposed retractor-lift of the sternum and costal arches in comparison with the prototype has a simpler design, more convenient to operate and maintain.

Claims (5)

1. The retractor-lift sternum and costal arches, including a height-adjustable vertical support with an attachment element to the operating table, a height-adjustable vertical stand, a horizontal console with holes for securing the slide in the desired position with a latch, a lifting mechanism, a removable rocker in the form of a plate and two removable hooks, while the fastening element of the vertical support to the operating table is made in the form of a vise with an opening for installing the vertical support and a latch that simultaneously fixes the vertical support at the required height without the possibility of turning and rigidly fastens the vice to the operating table, at the end of the vertical support, made in the form of a polyhedron, is installed bracket with a hole and a latch for installation and fastening at the required height without the possibility of turning a vertical rack, on a vertical rack and horizontal cantilever, the end of the vertical strut is configured as a polyhedron, coupled with the corresponding polyhedron bent at a right angle to horizontal cantilever; the lifting mechanism, including the first and second cardan with clamps, a spindle with two parallel flanges, a cylindrical boss with a central through hole and an adjusting nut, is mounted on the slider of the horizontal console, while the first cardan is mounted on the vertical slider pin, the second cardan with a through slot the center, the vertical section of which is in the form of a rectangular trapezoid, is mounted on an angled lateral pin of the first cardan, a running gear is inserted into the through slot of the second cardan Int with the adjusting nut, and between the adjusting nut and the cardan located boss, a cylindrical contact surface facing the slots of the second gimbal; on the end of the lead screw ending in a ball joint, a removable beam with two removable hooks is suspended, the hooks having a ball bearing, and slots for making the ball joint of the hooks are made on the beam. 2. The retractor lift according to claim 1, characterized in that the beam has 10 slots for installing hooks.

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