RU2712341C1 - Patient's fixation device - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: disclosed is a device for fixing a patient and treating a femoral bone, comprising two frames fixed at the edges of an operating table, a horizontal bar attached to the frames to move along the frames and be fixed thereon, two frames with lugs for fixation of pelvis, four clamping plates for fixation of pelvis, made arched-bent, meter. Device comprises a horizontal T-shaped guide arranged on each frame. Arched-bent clamping plates for fixing the pelvis are arranged in pairs on each horizontal T-shaped guide, on the horizontal plank there are two frames with lugs for fixation of the pelvis. Device comprises two stands of knee retainers, fixed on end of operating table along edges, on each of which is located knee joint retainer with possibility of movement along long and short sides of operating table. Measuring device made in the form of three lines rigidly connected by their ends to each other and located perpendicular to each other is fixed to the fixator of the knee joint on the outer side. To the front side of each knee joint articulated with the scales there is a vertical plank with possibility of its movement and fixation in the vertical plane, on the lower end of the vertical plank the ankle retainer is rigidly fixed.

EFFECT: device improves accuracy of patient placement when performing preoperative X-ray patterns and accuracy of performing surgical approach in operations on femoral, hip and knee joints.

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Description

The invention relates to medicine, namely to surgical traumatology and orthopedics and can be used when performing operations on the femur, hip and knee joints, as well as for performing preoperative radiographs for planning surgical interventions.

The following devices for fixing the patient are known.

A device for fixing a patient is described, described by V. Orlyansky, M. Golovakh. Manual on knee arthroscopy / Dnepropetrovsk.: Thresholds. - 2007. - S. 23. The device contains a horseshoe-shaped retainer of the knee joint and a belt. This fixative is used when performing arthroscopic operations on the knee joint. The disadvantage of this device is the inability to fix the pelvis and lower leg of the patient.

The device described Traumatology: national leadership / ed. G.P. Kotelnikova, S.P. Mironova. - M.: GEOTAR-Media, 2008. - p. 390. It includes a vertical pelvic retainer located in the perineum, a knee joint retainer in the form of a staple with a spoke, and an operating table frame. This device does not provide rotational stability of the femur when performing operations on the femur. For example, in the case of osteosynthesis of a femoral diaphysis fracture, the device allows only traction of fragments of the femur along its axis.

The device does not contain any measuring instruments and, accordingly, does not allow accurate marking when performing operations on the femur, for example, if there is a tumor in the femoral canal, access to it requires the use of an electron-optical transducer and x-ray radiation for accurate marking her position. The device does not allow to assess the entry point into the femoral canal from the knee joint when performing operations of retrograde osteosynthesis of the femur.

The closest known device to the claimed is a device, patent of the Russian Federation for the invention No. 2688304. The device contains paws and clamping straps that fix the front and rear upper and lower iliac spines, as well as the wings of the ilium. The device also includes a U-shaped platform, a movable bar with a scale, a block and a meter for estimating the distances between the protruding parts of the bones of the lower limb belt and the lower limb.

The disadvantage of this device is the lack of fixation of the hip and lower leg of the patient.

The objective of the invention is to increase the accuracy of laying the patient when performing preoperative radiographs, improving the accuracy of performing surgical access during operations on the femur, hip and knee joints.

To solve the problem in a known device for fixing the patient consisting of two racks, fixed at the edges of the operating table, located perpendicular to the plane of the operating table, a horizontal bar attached to the racks with the ability to move along the racks and fixed fixation on them, two racks with tabs for fixing pelvis, four clamping strips for fixing the pelvis, made in the form of a cylinder, arcuate-curved, meter, additionally introduced a horizontal T-shaped guide, ra located on each stand perpendicular to it, facing the table, with the ability to move along the stand and fixed on it and move perpendicular to the stand parallel to the short side of the operating table, while arcuate-curved clamping bars for fixing the pelvis are located in pairs on each horizontal T-shaped guide with the possibility of fixed fixing on it and moving along the long side of the operating table, two racks with tabs for fixing the pelvis are located horizontally The lath with the ability to move along the horizontal lath and fixed on it, also introduced two racks of fixators of the knee joint, fixed at the end of the operating table along the edges, on each of which is a latch of the knee joint with the ability to move along the long and short sides of the operating table and fixed fixation on the stand, to the knee joint retainer on the outside there is a meter made in the form of three rulers fixedly connected by their ends to each other and arranged perpendicular to each other so that the first ruler is located along the long side of the operating table, the second along the short side of the operating table, and the third is vertical, it is possible to move the meter along the long side of the operating table, as well as up and down and fixed fixation on the knee latch joint, to the front side of each fixator of the knee joint by means of two hinges with scales a vertical bar is attached, with the possibility of moving it and fixed fixation in the vertical plane parallel to the long side of the operating table, as well as in the vertical plane parallel to the short side of the operating table, the ankle joint fixator is fixedly fixed on the lower end of the vertical bar.

In the study of other well-known structural and technical solutions in this field of medicine, the specified set of features that distinguishes the invention from the prototype was not identified.

In FIG. 1 is a structural diagram of a device for fixing a patient; FIG. 2 is a schematic representation of the patient’s position (device on the left leg was not used), FIG. 3 is a diagram of measuring distances using a meter (other elements of the device are not shown), FIG. 4 is a diagram of the movement of the elements of the device (elements of the device, the locking basin is not shown).

In FIG. 1 the following notation is accepted:

1 - operating table guide;

2 - rack lock;

3 - clamping straps that fix the pelvis;

4 - horizontal bar;

5 - rack;

6 - meter;

7 - knee joint fixer;

8 - a clamp of a rack of a clamp of a knee joint;

9 - the third line;

10 - the first hinge;

11 - the second hinge;

12 - vertical bar;

13 - ankle joint fixer;

14 - stand with legs for fixing the pelvis;

15 - T-shaped guide;

16 - the first line;

17 - the second line;

18 - a rack of a clamp of a knee joint;

19 - operating table.

In FIG. 2 adopted the following notation:

2 - rack lock;

3 - clamping straps that fix the pelvis;

4 - horizontal bar;

5 - rack;

6 - meter;

7 - knee joint fixer;

8 - a clamp of a rack of a clamp of a knee joint;

9 - the third line;

13 - ankle joint fixer;

14 - stand with legs for fixing the pelvis;

15 - T-shaped guide;

16 - the first line;

17- second line;

18 - a rack of a clamp of a knee joint;

19 - operating table.

In FIG. 3 adopted the following notation:

9 - the third line;

16 - the first line;

17 - the second line;

20 - femur;

A - neoplasm of the femur;

8 - entry point to the femoral canal;

L is the distance from the intercondylar axis to the entry point;

M is the distance from the meter to the entry point;

N is the distance from the meter to a point on the femur.

In FIG. 4 the following notation is accepted:

7 - knee joint fixer;

9 - the third line;

10 - the first hinge;

11 - the second hinge;

12 - vertical bar;

13 - ankle joint fixer;

16 - the first line;

17 - the second line;

18 - a rack of a clamp of a knee joint;

21 - belt.

The inventive device for fixing the patient includes two racks 5, fixed at the edges of the operating table 19 with the latch of the rack 2 on the guide 1. In this case, it is possible to move the racks 5 along the operating table and fixed fixation in the required position. Racks 5 are located perpendicular to the plane of the operating table 19. A horizontal bar 4 is attached to the racks 5 with the possibility of movement along the racks 5 and fixed fixation on them. The device also includes two racks with tabs for fixing the pelvis 14, which are located on the horizontal bar 4 with the possibility of movement along the horizontal bar 4 and fixed fixation on it. The device contains two horizontal T-shaped guides 15, each of which is located on the stand 5 perpendicular to it, facing the side of the table 19, with the possibility of movement along the stand 5 and fixed fixation on it and move perpendicular to the stand 5 parallel to the short side of the operating table 19. On each horizontal T-shaped guide 15 is arranged in pairs arcuate-curved clamping straps for fixing the pelvis 3. In this case, it is possible to move the clamping straps for fixing the pelvis 3 along the length th side of the operating table 19 and fixed fixation on the T-shaped guide 15. Also, the device includes knee brace posts 18, fixed to the ends of the operating table at the edges with the help of knee brace brace 8. The knee brace 18 is located the knee joint retainer 7, while it is possible to move it along the long and short sides of the operating table 19 and fixed fixation on the stand 18. To the knee joint retainer 7 from the outside fixed meter 6, made in the form of three rulers 9, 16, 17, fixedly connected by their ends to each other and located perpendicular to each other so that the first ruler 16 is located along the long side of the operating table 19, the second 17 along the short side of the operating table 19, and the third 9 is located vertically. It is possible to move the meter 6 along the long side of the operating table 19, as well as up and down and fixed fixation on the retainer of the knee joint 7. To the front side of each retainer of the knee joint 7 by means of two hinges 10, 11 is attached a vertical bar 12, with the possibility of moving it and fixed fixation in a vertical plane parallel to the long side of the operating table 19, as well as in a vertical plane parallel to the short side of the operating table 19. At the lower end of the vertical plate APIS 12 fixedly secured ankle lock 13.

The components of the claimed device for fixing the patient can be implemented as follows.

The latch of the rack 2, the latch of the rack of the latch of the knee joint 8 are typical clamps that are part of the orthopedic table and are used to attach various external devices, stops to the table. They can be moved along the operating table 19 and fixed in the required position.

The clamping straps fixing the basin 3 can be made in the form of a profile pipe of circular cross section. The bending of the clamping straps is necessary so that they repeat the shape of the wings of the ilium, which they fix.

The meter 6 is a three ruler, motionlessly interconnected.

The fixator of the knee joint 7 and the fixator of the ankle joint 13 are typical joint fixators used in arthroscopic operations on the joints.

The first hinge 10 and the second hinge 11 are uniaxial metal hinges. A scale can be plotted on the hinges to accurately assess the angle of rotation in the hinge.

The vertical bar 12, the T-shaped guide 15 are metal guides, which can be made in the form of a profile pipe of rectangular cross section.

As a rack with paws for fixing the pelvis 14 can be used a typical emphasis, which is part of the operating table.

All components of the device can be made of metal (medical steel), rubber pads can be additionally installed on the legs for contact with the patient’s skin. Perhaps the implementation of the elements of the device from x-ray negative materials.

Thus, the implementation of the inventive device for fixing the patient is not in doubt, since for its manufacture typical designs, parts and materials used in traumatology and orthopedics are used.

The principle of operation of the claimed device is as follows.

Preoperative planning.

A description of preoperative planning is given on the example of planning a hip joint operation.

Planning operations for the replacement of the hip joint is carried out according to the radiographs of the pelvis, made in direct and lateral projections. To accurately determine the position of the components of the endoprosthesis and their sizes, it is necessary that the patient's pelvis and femurs 20 (Fig. 2) are located in a strictly defined way. Practice shows that with the development of coxarthrosis and other diseases in the area of the hip joint, contracture develops, most often flexion-leading. Multiple pelvic deformity is noted. The presence of spinal deformities in patients, for example, scoliosis, also leads to an incorrect position of the pelvis on the table. This leads to the fact that it is very difficult, and sometimes almost impossible, to perform proper patient placement.

To perform correct radiographs, the device can be fixed to an X-ray table or an operating table. In the case of using the operating table 19, an X-ray cartridge is placed under the patient. Fixation of the patient is as follows. The patient is laid on table 19 in a supine position. In order to exclude possible displacement of the pelvis in the horizontal plane of the patient, racks with paws for fixing the pelvis are installed on the anterior superior iliac spine 14. They uniformly press the pelvis against the plane of the operating table 19. Moving the racks with paws for fixing the pelvis along horizontal bar 4 allows you to set them directly to the anterior superior iliac spine (Fig. 2). Pressing them to the anterior superior iliac spines is carried out by moving the horizontal bar 4 down along the racks 5 and fixing them in the required position.

In order to exclude the displacement of the pelvis of the patient in the frontal plane of the patient, clamping strips are used to fix the pelvis 3. They fix the wings of the ilium. For this, the T-shaped guide 15 is moved towards the patient along the short side of the operating table 19 and is fixed. The clamping straps fixing the pelvis 3 move along the T-shaped guide 15 and clamp the wings of the ilium from above and below. Their movement along the T-shaped guide 15 is necessary due to the fact that the thickness of the subcutaneous adipose tissue in the area of the wings of the ilium in patients is different. Accordingly, in patients with normal body weight, the clamping bars securing the pelvis 3 are located close to each other, and in patients with overweight they are further apart from each other, taking into account the thickness of the subcutaneous fat.

Thus, the above-described elements of the device allow you to position the patient's pelvis in the middle of the operating table, excluding its displacement in all three planes. Accordingly, performing an x-ray with centering the beam of the x-ray machine to the symphysis allows you to get the correct image of the pelvis, necessary for the correct preoperative planning of the acetabular component of the endoprosthesis according to x-ray.

In order to carry out the correct planning of the femoral component of the endoprosthesis, it is necessary that the femurs 20 are parallel to each other and also in the same rotation in the hip joint. The presence of contracture in the hip joint also does not allow the correct placement of the lower limbs of the patient.

To fix the lower limbs of the patient (Fig. 2), they are placed in the fixators of the knee 7 and ankle 13 joints. For fixing, if necessary, belt 21 can be used. Moving the knee joint retainer 7 along the knee joint retainer post 18 and fixing on the arm allows the patient's hips to be parallel to each other. In order to ensure the same rotation of the femur 20, the vertical straps 12 are rotated at the same angle. This allows you to derive the necessary projection of the neck of the femur 20, taking into account the angle of the torsion of the neck. It is possible to produce several radiographs or perform fluoroscopy to evaluate the angle of torsion of the neck of the femur 20 and to make the optimal picture.

Use of the device during surgical interventions.

Surgical interventions on the femur 20 often require an accurate assessment of the position of the fragments of the femur 20, tumors, ossifications and other structures (Fig. 3). This is required for accurate access.

If necessary, for example, access to the neoplasm A located in the canal of the femur 20, a patient undergoes a preoperative X-ray examination using the device as described above. In this case, before performing the x-ray, the pointer 6 is set so that the second ruler 17 touches the skin of the patient in the area of the knee joint. Mark the marker at the point of contact. On the x-ray in direct projection on the first ruler 16 measure the distance N from the second ruler 17 to neoplasm A.

During the operation, the patient’s limb is fixed by the device as well as during radiography and the first ruler 16 measures the exact distance N from the second ruler 17 to the neoplasm A. Since the second ruler is applied to the skin and a marker is made at this point, this allows you to set meter 6 in the same position as in radiography, while the position of the meter takes into account not only bone landmarks, but also soft tissues in the joint area, which allows maximum precision nyat positioning of surgical access.

When performing intramedullary osteosynthesis operations, when it is necessary to position the entry point into the bone marrow canal with maximum accuracy (Fig. 3, “B”), an X-ray in front and side projections is necessary before the operation. For this, the limb of the patient is also fixed by the device. The meter is placed so that it touches the patient’s skin, markings are made at the points of contact with a marker. To assess the entry point into the bone marrow canal ("B" in Fig. 3), the distance L and M are measured on the promo and lateral radiographs. During the operation, the limb is fixed by the device in the same way as when performing x-ray, and on the meter 6 determine the distance L and M, estimated on preoperative radiographs.

Thus, the meter 6, which is part of the device, creates a fixed three-dimensional coordinate system of the femur, which allows you to evaluate the position of the structures of the femur 20 at the stage of preoperative planning by x-ray. This coordinate system can also be used during surgery to assess the position of the structures of the femur. The device can be used for high-precision surgical approaches (both standard and minimally invasive) to the structures of the femur 20.

The technical result of the claimed invention is to increase the accuracy of laying the patient when performing preoperative radiographs, improving the accuracy of performing surgical access during operations on the femur, hip and knee joints.

Claims (1)

A device for fixing a patient, consisting of two racks fixed at the edges of the operating table, located perpendicular to the plane of the operating table, a horizontal bar attached to the racks with the ability to move along the racks and fixedly fix on them, two racks with tabs for fixing the pelvis, four clamping bars for fixing the pelvis, made in the form of a cylinder, arcuate-curved, measuring device, characterized in that it additionally introduced a horizontal T-shaped guide located on each the stand perpendicular to it, facing the table, with the ability to move along the stand and fixed on it and with the ability to move perpendicular to the stand parallel to the short side of the operating table, while the arcuate-curved clamping straps for fixing the pelvis are located in pairs on each horizontal T-shaped guide with the possibility of fixed fixing on it and moving along the long side of the operating table, two racks with tabs for fixing the pelvis are located on a horizontal plate Anke with the ability to move along the horizontal bar and fixed fixation on it, also introduced two racks of fixators of the knee joint, fixed at the end of the operating table along the edges, on each of which there is a clamp of the knee joint with the ability to move along the long and short sides of the operating table and fixed fixation on the stand, to the latch of the knee joint, a meter is fixed on the outside, made in the form of three rulers, motionlessly connected by their ends to each other and located perpendicular to each other so that the first ruler is located along the long side of the operating table, the second along the short side of the operating table, and the third is vertical, it is possible to move the meter along the long side of the operating table, as well as up and down and fixed fixation on the knee latch joint, to the front side of each fixator of the knee joint by means of two hinges with scales a vertical bar is attached with the possibility of moving it and not An ankle joint is fixedly fixed in the vertical plane parallel to the long side of the operating table, as well as in the vertical plane parallel to the short side of the operating table, at the lower end of the vertical bar.

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