Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
  • A61B17/0206—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors with antagonistic arms as supports for retractor elements
• • F—MECHANICAL ENGINEERING; LIGHTING; HEATING; WEAPONS; BLASTING
  • F16—ENGINEERING ELEMENTS AND UNITS; GENERAL MEASURES FOR PRODUCING AND MAINTAINING EFFECTIVE FUNCTIONING OF MACHINES OR INSTALLATIONS; THERMAL INSULATION IN GENERAL
  • F16B—DEVICES FOR FASTENING OR SECURING CONSTRUCTIONAL ELEMENTS OR MACHINE PARTS TOGETHER, e.g. NAILS, BOLTS, CIRCLIPS, CLAMPS, CLIPS OR WEDGES; JOINTS OR JOINTING
  • F16B9/00—Connections of rods or tubular parts to flat surfaces at an angle
  • F16B9/05—Connections of rods or tubular parts to flat surfaces at an angle by way of an intermediate member
  • F16B9/054—Connections of rods or tubular parts to flat surfaces at an angle by way of an intermediate member the intermediate member being threaded
• • F—MECHANICAL ENGINEERING; LIGHTING; HEATING; WEAPONS; BLASTING
  • F16—ENGINEERING ELEMENTS AND UNITS; GENERAL MEASURES FOR PRODUCING AND MAINTAINING EFFECTIVE FUNCTIONING OF MACHINES OR INSTALLATIONS; THERMAL INSULATION IN GENERAL
  • F16B—DEVICES FOR FASTENING OR SECURING CONSTRUCTIONAL ELEMENTS OR MACHINE PARTS TOGETHER, e.g. NAILS, BOLTS, CIRCLIPS, CLAMPS, CLIPS OR WEDGES; JOINTS OR JOINTING
  • F16B9/00—Connections of rods or tubular parts to flat surfaces at an angle
  • F16B9/05—Connections of rods or tubular parts to flat surfaces at an angle by way of an intermediate member
  • F16B9/056—Connections of rods or tubular parts to flat surfaces at an angle by way of an intermediate member the intermediate member extending through the flat surface; the rod or tubular part extending through the flat surface
• • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
  • Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
  • Y10T—TECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
  • Y10T403/00—Joints and connections
  • Y10T403/32—Articulated members
  • Y10T403/32254—Lockable at fixed position
  • Y10T403/32426—Plural distinct positions
  • Y10T403/32442—At least one discrete position
  • Y10T403/32451—Step-by-step adjustment

Definitions

• the present invention relates to a widenable surgical retractor, and particularly, but not exclusively, to a retractor which is intended for use in holding tissue, etc. , away from the field of operation in operation wounds/surgical incisions in the region of a patient's 10 spine, said retractor including two mutually-connected retractor halves.
• the invention thus relates to a widenable, more par ⁇ ticularly an angularly extendable retractor by means of 15 which tissue, etc., can be held away from the field of operation, and then particularly from the field of an operation wound in the region of a patient's spine.
• subcutaneous fascia and the muscular tissue which lies beneath or inwardly of the fascia must be held to one side in the region of the operation wound, so that the wound can be held open and thereby provide access to the vertebrae.
• the retractor is first inserted into the opera-
• the restraining wings or plates of the known retractor which bear against the walls of an operation 'wound and function to hold the wound open have a verti- cal extension such that the plates extend from the bottom of the wound up to the surface of the surrounding skin, even when the operation wound/incision is rela ⁇ tively deep.
• the vertical extension of the re ⁇ tractor plates covers the walls of the operation wound over the whole of their depth, including the uppermost layer of skin and associated fascia.
• the fascia is far less elastic than the inwardly-lying muscular tissue, and consequently the separating force which the retractor needs to exert between the walls of the opera ⁇ tion wound (when the retractor is adjusted to its wound widening and restraining state is determined primarily by the smaller elastic resistance of the fascia. It has also been found that a retractor whose restraining plates have the aforesaid vertical dimensions has a pronounced tendency to slide upwards and out of the operation wound as a result of tension in the fascia. This tendency is, of course, particularly problematic during the course of an operation, since it necessitates repeated adjustment of the position of the retractor.
• this known retractor causes muscular atrophy as a result of the high surface abutment pressure which prevails between muscle and the respective vertical front and rear edges of the restraining plates, this abutment being essentially a line contact between said edge and said muscle.
• the retractor shall therefore be constructed so as to provide sufficient space for the spine-vertebrae and not least for the spinal vertebrae arches with the spinous and transverse spinelike processes of the vertebrae.
• the object of the present invention is to provide a novel type of openable, hinged retractor which is cap ⁇ able of solving the aforesaid problems.
• each of the retractor halves which are pivotally connected together for relative movement in a scissor-like fashion, comprises a hinge part which on the side thereof which faces away from the hinge merges with a downwardly- extending shaft at a radial distance from the hinge axis or from the extension of said axis, a wound widening and wound-restraining part which projects laterally away from the hinge axis and which is intended to be placed against the muscle tissue on one side of the operation wound, a latching means which is intended to be placed in the region of the hinge formed by the hinge-parts of respective retractor halves such as to mutually latch said halves in an outwardly angled active position (functional position).
• a retractor of this construction enables the wound widening and would-restraining parts of the retractor to be placed in the operation wound so as to act primarily on the muscular tissue beneath (inwardly of) the overly- 'ing fascia.
• the problem caused by the retractor sliding up out of the operation wound is avoided, be ⁇ cause the wound-restraining parts of the retractor are located beneath the fascia.
• the wound widening and restraining parts of the retrac ⁇ tor have a generally constant vertical extension within the greater part of their longitudinal extension and are curved in mutually opposite directions, with the concave inner surfaces facing towards each other, wherein the centres of curvature of respective curves preferably form lines which extend generally parallel with the hinge axis.
• the free outer edges of the wound widening and restraining parts of the retractor remote from the shaft are inwardly concave so as to increase the functional pressure on the muscle tissue against which said parts engage in their angularly-extended positions.
• the inventive retractor is intended to be used so that the aforesaid retractor parts will normally engage muscle tissue with the fascia and associated skin layer lying above the upper defining edge of said parts, it may be necessary to provide separate means for support ⁇ ing the fascia and the fat layers of the skin, these means being removably insertable into the upper part of the wound widening and restraining retractor parts.
• each said part may suitably be provided with mutually spaced and mutually parallel attachment holes for accommodating insertable support elements which function to form an edge support (for skin layers and fascia) in the region above the upper defining edge of the wound widening and restraining part, said attach ⁇ ment holes extending generally parallel with the shaft of the retractor halves and/or the hinge axis.
• This support element may, for instance, have the form of a U-shaped metal device whose legs preferably parallel legs can be inserted into the attachment holes in respective wound widening and restraining parts of the retractor.
• Figure 1 and Figure 2 are side views of a respective retractor half which when hingedly-connected are able to angle outwardly, in a scissor-like fashion, and which form the inventive retractor;
• Figure 3 illustrates the retractor half shown in Figure 1, seen in the direction of the arrow A;
• Figure 4 illustrates the same retractor half seen in the direction of the arrow B;
• Figure 5 is a side view of a latching device for an inventive retrac- tor;
• Figure 5a is an end view of the latching device;
• Figure 6 illustrates a retractor from above.
• FIG. 7 is a perspective view of a slightly different embodiment of a complete retractor according to the invention, in which the latching means is differ- ent to that of the Figure 5 embodiment and in which the support element is different to that of the Figure 2 embodiment;
• Figure 8a is a front view and Figure 8b a sectional view (taken on the line VHI-VTII in Figure '8a) of a third type of support element;
• Figure 9 is a perspective view of the latching means used in the Figure 7 embodiment.
• FIG. 1 and Figure 2 each illustrate a respective half 2 and 4 of the inventive retractor whose active parts can be angled outwardly relative to one another, in a scissor-like fashion.
• Each retractor half includes three main parts, i.e. respective hinge parts 6 and 6' which merge down- wardly with a depending shaft 8.
• a wound widening and restraining part 10 extends outwardly from the lower part of the shaft 8 in a direction opposite to respec ⁇ tive hinge parts 6, 6', said wound widening and res ⁇ training part 10 hereinafter being simply referred to as restraining part.
• the hinge part 6 has an outwardly-projecting shoulder 12, which is pro ⁇ vided with penetrating holes 14, whereas the hinge part 6', shown in Figure 2, has a fork-like structure which includes two legs 16, 18, with mutually coaxial pene- trating holes 20, 22.
• the two hinge parts 6, 6' are positioned so that the three holes 20, 14, 22 are mutu ⁇ ally in register and can receive a common hinge pin (not shown) .
• the retractor halves 2, 4 have a generally constant thickness in the hinge part, the shaft and restraining part.
• the retractor halves are preferably made of metal, for instance stainless steel, although the retractor halves may, alternatively, be made of a suitable plastic material, such as a rein ⁇ forced fibre plastic.
• the two restraining retractor parts 10 have a substantially constant height or vertical extension.
• the retractor halves have a flat shape, and the restraining parts are subsequently curved in mutu ⁇ ally opposite directions prior to joining the retractor halves together, through the medium of their respective hinge parts 6, 6' .
• the curvature of said restraining parts is indicated by the chain line K in Figure 4, where the radius of curvature is referenced R.
• the two restraining retractor parts are curved so that their respective concave inner surfaces 24, 26 (see Figure 6) face towards one another.
• the radius of curvature R of said wound restraining parts will prefer ⁇ ably lie in the range of 50-70 mm, and may suitably be about 60 mm.
• concave recesses 28, 30, Formed in the lower part of the shaft 8 are concave recesses 28, 30, whose radius of curvature is suitably in the order of 15-35 mm, preferably about 25 mm.
• the free outer edges of the restraining parts 10 remote from the shaft are provided with inwardly concave re ⁇ Des, as illustrated by the outer contour line 32 in Figure 1.
• the radius of curvature of this concave recess 32 is in the order of 15-35 mm, preferably about 25 mm.
• Each restraining part 10 has provided therein a number of mutually-spaced and mutually-parallel attachment holes 34 into which support elements 36 can be inserted. These support elements are intended to form edge sup ⁇ ports (primarily for skin layers and fascia) in the region above the upper-defining edge 38 of a respective restraining part.
• the support element 36 may suitably have the shape of an inverse-U, as shown in Figure 2.
• the support element has the form of a metal wire that has been bent to a U-shape.
• the two legs of the U- shaped support are inserted into a pair of attachment holes 34, in the manner shown.
• Disc-like hooks or barbs 39 which project out from the convex side of the part 10 of the retractor may be provided on the underside 37 of said restraining part 10 and there form additional muscle engaging means which assist in preventing the retractor from sliding up out of the operation wound.
• FIGS 5 and 5a illustrates an exemplifying embodiment of latching means whereby the retractor halves 2, 4 can be locked mutually in an outwardly angled, active posi ⁇ tion or functional position.
• the latching means 40 is a latching element which is intended to straddle the hinge formed by the pivotally-connected hinge parts 6, 6'.
• this latching element is a U-shaped metallic element 42 whose legs 44, 46 define therebetween a V- shaped space 48 which enables the latching element 40 to be placed lockingly over the hinge from above.
• the latching means may have many other alternative forms.
• the one essential feature of the latching means is that it can be placed easily in position in the region of the hinge, and that it will positively lock the two retractor halves 2, 4 in relation to one another when the latching means is brought to its locking position.
• the wound-restraining parts 10 may be provided conve- niently with engagement slots or grooves 49 on their respective concave inner surfaces, as shown in Figures 1 and 4. These slots or grooves are intended to form anti-slipping engagement locations for, e.g., the legs Of an instrument used to open (angle outwardly) the wound widening and restraining parts of the inventive retractor to the desired extent, wherein the retractor is then locked in position by applying the aforesaid latching means 40, i.e. the latching element or stirrup 42 in the case of the illustrated embodiment.
• latching means 40 i.e. the latching element or stirrup 42 in the case of the illustrated embodiment.
• the two halves 2, 4 of the embodiment of the inventive retractor illustrated in Figure 7 are hingedly connected at the hinge parts 6, 6' by means of an L-shaped hinge pin 50, through the holes 20, 14, 22.
• the illustrated retractor half 4 is provided with a support element 52 which is detachably fitted to the restraining part 10 by means of attachment parts 58, 60 each of which is locat ⁇ ed at the lower part of a respective leg 54, 56 of the support element, these attachment parts being fitted over the restraining part from above, so as to straddle said part.
• the support element 52 has the form of a U-shaped wire element, or wire stirrup, wherein that part of the stirrup-like element which lies above the defining edge 38 has gener- ally the form of an inverse V.
• the downwardly directed end parts 57 of the attachment parts 58, 60 have inward ⁇ ly directed abutment portions 59 which hook firmly against the edge of the underside 37.
• Figures 8a and 8b are respectively front and side views of an alternative form of a support element 62, which includes a U-shaped wire stirrup-like element 62, which has two legs 64. Provided on the lower parts of the legs 64 are saddle-like attachment parts 66. The support element 62 is fitted onto the relevant restraining part 10, by placing the two attachment parts 66 of the sup ⁇ port element over the edge 38 of the restraining part 10 so as to straddle said edge.
• the latching means is a disk shaped latching element 68 which has mutually converging side edges 70 and 72 on the active locking-wedge part 74. As will be seen from Figure 9, this locking-wedge part 74 is provided at the top there ⁇ of with an angled gripping part 76.
• the latching element is shown in Figure 7 solely in chain contour. Formed in the side edge 72 is a series of arcuate recesses or notches 78 which give the edge a sawtooth-like configu ⁇ ration.
• the latching element 68 coacts with an outwardly widened projection 80 on the inside of the upper hinge parts 6, 6' of the retractor halves 2, 4.
• the latch ⁇ ing element 68 When in its downwardly inserted latching position between the projections 80, the latch ⁇ ing element 68 is fixed wedgedly by virtue of the en ⁇ gagement of one of its edge recesses 78 with the adjacent projection 80.
• each projection 80 may be attached to the inner surfaces of the hinge parts 6, 6' in any desired man ⁇ ner, it is preferred that each projection 80 is com- prised of the end part of an externally threaded fasten ⁇ er pin which has threaded portion 82 that is screwed into a penetrating threaded hole in a respective hinge part 6, 6', this latter alternative affording a particu ⁇ larly rational solution.
• the threaded portion 82 of the fastener pin projects out from the hinge part on the outer side thereof and therewith forms a screw-threaded pin attachment for coaction with the internally screw- threaded end of a tubular shaft 84, which is shown in chain contour in Figure 7.
• the other hinge part also has a fastener pin which is provided with a similar projection 80 and with a similar screw-threaded part 82 which coacts with a corresponding tubular shaft 84.
• the two tubular shafts 84, 84 together 'form a practical device for manually separating, or manually swinging apart, the two retractor halves 2,4 to a desired angular position, said halves then being fixed in this position by inserting the latching element 68 down between the projections 80-
• pins 86 there is suitably provided close to the lower edge of the restraining parts 10 of the retractor halves 2, 4 one or more outstanding pins 86, on the curved, convex outer surfaces of said parts 10. These pins, or points, 86 form muscle engaging means which assist in preventing the retractor from sliding up out of the operation wound.
• the pins 86 thus form an alternative to the hooked barbs 39 of the embodiment illustrated in Figures 1 and 4.
• pins 86 may be attached to the restraining parts 10 in any appropriate manner, in practice said pins will preferably be comprised of the outwardly directed point of a pin means which has a rear, externally screw-threaded attachment part 88 which is screwed into a screw-threaded penetrating hole locat ⁇ ed in the near vicinity of the lower edge of respective restraining parts 10.

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• Engineering & Computer Science (AREA)
• General Engineering & Computer Science (AREA)
• Health & Medical Sciences (AREA)
• Life Sciences & Earth Sciences (AREA)
• Mechanical Engineering (AREA)
• Surgery (AREA)
• Heart & Thoracic Surgery (AREA)
• Biomedical Technology (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• Medical Informatics (AREA)
• Molecular Biology (AREA)
• Animal Behavior & Ethology (AREA)
• General Health & Medical Sciences (AREA)
• Public Health (AREA)
• Veterinary Medicine (AREA)
• Surgical Instruments (AREA)
• Prostheses (AREA)

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Citations (4)

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• 1991
  • 1991-03-20 SE SE9100845A patent/SE470124B/sv not_active IP Right Cessation
• 1992
  • 1992-03-17 JP JP4505848A patent/JPH06505893A/ja active Pending
  • 1992-03-17 WO PCT/SE1992/000163 patent/WO1992016151A1/en active Application Filing
  • 1992-03-17 US US08/108,603 patent/US5429121A/en not_active Expired - Fee Related

Patent Citations (4)

Non-Patent Citations (1)

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