WO2010086015A1

WO2010086015A1 - Surgical retractor

Info

Publication number: WO2010086015A1
Application number: PCT/EP2009/050900
Authority: WO
Inventors: Thierry Marnay; Rudolf Bertagnoli; Christophe Geisert
Original assignee: Geisert Square Gmbh; Metec Motric S.A.
Priority date: 2009-01-28
Filing date: 2009-01-28
Publication date: 2010-08-05

Abstract

The present invention relates to a surgical retractor (1) for holding open an operating field, having a blade (2) for retaining tissue. A guide handle (3) is provided, comprising a mounting plate (20) on a distal end (18) thereof, by means of which the guide handle (3) can be mounted in a mounting frame, and providing a guide for the blade (2). The guide handle (3) and the blade (2) can take on at least two states, wherein the guide handle (3) and the blade (2) are mutually locked by means of a locking device (15) in a first state, and wherein the guide handle (3) and the blade (2) are mutually released in a second state, so that a sliding relative motion (70) can take place between the guide handle (3) and the blade (2).

Description

Surgical retractor

The present invention relates to a surgical retractor for holding open a surgical field with a blade for retaining tissue.

Retractors are surgical instruments that are used to make access to an operating field open or even possible. This group includes a variety of different instruments, such as retractors, specula, Wundspreizer, levers and forceps. The present invention relates in particular to retractors, wound spreaders and levers.

For the latter, the so-called Hohmann lever is an example. It provides access to bones, for example in spinal or hip surgery. In a specific variant of the Hohmann lever, the proximal end of the blade, ie the end which faces the patient and thus the bone, is provided with a tip, via which the Hohmann lever can be hooked into or knocked into a bone. The bone serves as an abutment for the Hohmann lever. The other end of the Hohmann lever can be clamped in a frame, so that the lever does not have to be held by a human, usually by a medical assistant, but the operating field is kept mechanically open. By way of example, reference is made in this connection to a mounting system, which is marketed under the trade name SynFrame of the company Synthes ^® (see www.synthes.com). The mounting frames, such as the SynFrame, are firmly connected to the operating table. The retractor, for example a Hohmann lever, is in turn firmly connected to the mounting frame. As a result, when the patient changes position, as occurs, for example, during the work of the surgeon on the bone, the retractor can become detached from the tissue. Especially with Hohmann levers, regardless of whether the blade has been hammered into the bone or anchored to the bone as an abutment, it happened that the Hohmann lever was released. As a result, not only is the access to the surgical field suddenly closed, but the loosening, frequently leaping retractor repeatedly caused injuries during the operation. In particular, in work in which the surgeon must perform his surgical tool very accurately, a leaping retractor, through which he loses the leadership of the surgical instrument, have tragic consequences. Especially nerves and blood vessels become very light in this way injured. Also, such a violation can already be done by the leaping retractor itself. Because of this, there is a great need for a surgical retractor, which, in particular in cooperation with mechanical mounting frame prevents the retractor dissolves during movements of the patient.

Surgeons who use the SynFrame assembly technique manage to solve the problems described by using the so-called guide rod, i. H. an adapter over which the retractor is normally attached to the retaining ring of the mounting system, vice versa use around. Usually, the retractor at the end of the guide rod, inside the retaining ring, d. H. the surgical field, is inclined to be attached via a mounting plate. The other end of the guide rod is bent into an annular eyelet on which the surgeon can manually pull to open the surgical field using the retractor attached to the guide rod. Surgeons confronted with the problem of springing out the retractor turned this guide rod around, so that the end of the guide rod with ring-shaped eyelet inside, d. H. facing the surgical field lies. Through this eyelet they carry a conventional one-piece retractor, such as a Hohmann lever through. Due to a widening at the distal end of the Hohmann lever, the retractor remains caught in this eye of the guide rod, which ensures a certain mobility of the retractor. Apart from the fact that no defined fixation of the retractor is possible because these eyelets allow not only a movement in the vertical, but also in the horizontal direction, is further disadvantageous that the ends of the retractors, for example, the Hohmann lever, survive on the guide rod and hamper the work of the surgeon. There is always a risk that the surgeon will hit the retractor and release the retractor from its anchorage. As a result, the described practice is a makeshift solution that does not satisfactorily solve the problem of lack of flexibility.

In the prior art WO 2006/076127 A1 an approach could be recognized for a certain flexibility in the mechanical fixation of retractors. Disclosed is a holder which is firmly attached to the operating table. Retractors are fixed to this holder by means of flexible loops, for example rubber loops. Although this solution has some flexibility, so that certain movements of the patient can be compensated, but on the other hand, the setting of the retractor, which is essential to apply the necessary force so that the surgical field are kept open at all can, extremely difficult to adjust or may not reach. Furthermore, there is of course the risk that the rubber loop breaks.

US 2008/0215081 A1 discloses a specific expansion mechanism for minimally invasive lumbar spine surgery. Described are three different retractors, each with different functionality and technical function, which serve to create the smallest possible access and keep open. About joints and locking systems, a certain flexibility of the different hooks is achieved, with the three different hooks are designed for different types of tissue and designed according to the compliance. Furthermore, this flexibility is only possible in one direction. The solution is not transferable to surgical retractors in general, and in particular to the specific problems described above with bone-fixed Hohmann levers.

It is therefore an object of the present invention to provide a surgical retractor for holding open a surgical field with a tissue retaining blade which permits movement of the patient during the operation while still keeping the surgical field open so that the surgeon can operate and access the surgical procedure Operating field is as consistent as possible during the operation. In particular, a loosening of the retractor should be avoided.

This object is achieved by a surgical retractor according to claim 1. Advantageous embodiments are the subject of the dependent claims.

The inventive surgical retractor has a blade for retaining tissue. According to the invention, a guide handpiece is provided, which has a fastening plate at a distal end, via which the guide handpiece can be fastened to a fixing frame, and which provides a guide for the blade. The guide handpiece and the blade may occupy at least two states. In a first state, the guide handpiece and the blade are mutually locked via a locking device. In a second state, the guide handpiece and the blade are mutually released, so that a sliding relative movement between the guide handpiece and the blade can take place. In other words, this means that a multi-part retractor is provided. A first part is via a mounting plate to a fixing frame, such as a Retaining ring, as described above, attachable. A second part is the blade, via which the attachment takes place in the tissue, for example in or on the bone. Guide handle and blade are in a state that could be described as dissolved, relative to each other movable. In other words, this means that the mutual relative position between the guide handpiece and the blade can change. This movement is a sliding movement. In other words, it is stepless, so that a relative movement without restriction is possible. In addition to this movable state, another state is receivable, in which guide handpiece and blade are locked together. A relative movement, as described above, is not possible in this state.

In the operation, the surgeon provides access and introduces the locked surgical retractor of the present invention. The surgeon will now position the retractor so that the access is at least kept open, in most cases even further opened, for example by retracting tissue by inserting the blade under a bone and supporting it against the bone or by inserting the blade into the bone Bones are hammered. As soon as the desired position has been reached, the retractor is fastened to a fixing frame, in particular a retaining ring. This attachment takes place via a mounting plate on the guide handpiece in a mechanical and previously known manner, for example by screwing Ver. Subsequently, the surgical retractor is in its second state, i. H. in the dissolved state, transferred by the lock is released. Now, a sliding relative movement between the blade and guide handpiece is possible. The surgeon can now operate and movements of the patient are intercepted by the relative movement between the blade and guide handpiece. The relative movement preferably takes place along a longitudinal axis of the surgical retractor. Usually, this will therefore result in a relative vertical movement, since surgical retractors are often used in a vertical position in the surgical field.

Another advantage of the present invention is that the guide handpiece has at its distal end a mounting plate, via which the attachment to the fixing frame as the retaining ring takes place. There are no extraneous parts or elements so that the surgeon has unrestricted access to the surgical field and is not hampered by any protruding parts, as was the case with the above-described makeshift arrangement for achieving some flexibility. According to a preferred embodiment of the invention, guide handpiece and blade form a rigid unit in the first, in the locked state. In this state, the retractor may, for example, be hammered into a bone or inserted into an access and positioned so that the surgical field is kept open. According to the invention, only a single locking position is preferably provided. Thus, the functions of the invention are fulfilled and the relative movement in the released state is not limited by further locking positions.

It is further preferred that the blade has a shank, which is insertable into the guide handpiece and over which the locking of blade and guide handpiece takes place. The blade is taken up, so to speak, in the guide handpiece, for example in a vaginal arrangement.

According to a preferred embodiment, the guide handpiece is so long that the possible relative movement of the blade relative to the guide handpiece is completely absorbed in a longitudinal extension of the guide handpiece. The patient movements to be compensated are movements which are within a maximum range of up to 10 cm, usually between a few millimeters and about 5 cm. The guide handpiece has a length correspondingly so that the blade in this guide handpiece is completely received when it is moved relative to the guide handpiece. Thus, even in the fully inserted state, the blade does not project beyond the distal end of the guide handpiece but is received by it. As a result, the surgeon is not hindered in the operation and he does not have to expect that when the patient moves the distal end of the blade could suddenly emerge from the distal end of the guide handpiece.

According to a preferred embodiment, the locking device is a lever with a latching nose, which can be latched in a corresponding recess of the blade or the blade shaft, so that the blade is locked against the guide handpiece. In particular, it is provided that the lever is a rotatably mounted rocker arm. This has at its one end the latching nose described, which is releasable by actuation of the other end of the rocker arm from the recess of the blade or the shaft, whereby the blade is released. According to a further preferred embodiment, a tensioning device, for example a spring is provided, which is biased so that the latching lug is pressed against the blade or the shaft. This has the advantage that the locking s device has a certain bias, so that in a corresponding sliding movement, when the blade slides past during its relative movement relative to the guide handpiece with the recess on the locking lug, takes place a lock. In this way, unintentional falling out of the blade from the guide handpiece can be avoided. The locking lug is preferably provided at the proximal end of the guide handpiece, whereas the recess on the blade or the shaft of the blade is preferably provided in the region of its distal end.

According to a further preferred embodiment, the pivot point of the rocker arm is arranged outside the center, so that a first arm of the rocker arm, at whose end the latching lug is provided, is shorter than a second arm of the rocker arm. As a result of this asymmetrical mounting of the rocker arm, a tendency of the latching nose to enter into the recess on the blade or the shaft is forced. Already by off-center storage, the locking lug is pressed against the blade, so that a locking in the recess is favored.

The locking device preferably extends in the longitudinal direction of the guide handpiece and thus of the surgical retractor. The relative movement is correspondingly a sliding movement along a longitudinal axis of the locking device. By this arrangement, a compact and slim design is possible. The slim design is very advantageous in the cramped conditions in the operating field. It should be noted that not only the retractors in the surgical field are arranged, but also, for example, even more instruments such as aspirators or flushing lines must be laid. The slender construction contributes that the locking device extends parallel to a longitudinal axis of the retractor.

The invention will be explained in more detail with reference to the drawings and described. Show it:

Figure 1 shows a surgical retractor according to the invention in perspective

Representation, wherein Figure IA shows a first state of the retractor and Figure IB shows a second state of the retractor; Figure 2 is a front view of the retractor of Figure IA;

Figure 3 is a rear view of the retractor of Figure IA;

Figure 4 is a perspective view of a blade according to the invention;

Figure 5 is a front view of a blade according to the invention;

Figure 6 is a perspective view of a guide handpiece;

Figure 7 is a front view of a guide handpiece;

Figure 8 is a rear view of a guide handpiece;

Figure 9 is a perspective view of the guide handpiece without

Locking device;

FIG. 10 shows the locking device in a perspective front view;

11 shows the locking device in a perspective rear view;

Figure 12 is an exploded view of the guide handpiece; and

Figure 13 is a schematic representation of a second embodiment of the

Invention.

FIG. 1 shows two states which the surgical retractor 1 can assume. In Figure IA, the surgical retractor 1 is shown in a first state in which the guide handpiece 3 and the blade 2 are locked together. In Figure IB, a second state is shown; Guide handpiece 3 and blade 2 are mutually solved. In the second state, a sliding relative movement between the guide handpiece 3 and the blade 2 is possible, as indicated in Figure IB by the double arrow 70. The blade 2 slides in the guide handpiece 3rd

In the embodiment shown in Figures 1 to 12 is a blade, as it is known from Hohmann levers, more specifically, an inventively modified version of a so-called Hohmann lever is shown, ie a lever, to its retention function to interact with a bone by either being hammered into it or the bone serves as an abutment against which the proximal end 6 is supported, or the tip 7 is hooked under the bone. The retractor 1 is thus a novel Hohmann lever. However, the element of the subject invention, referred to herein by the term "blade", may take on any other configuration and shape as long as it fulfills the retention function Depending on the blade 2 used in combination with the universal guide handpiece 3, various retractors, retractors , Levers etc. be assembled. For example, the tip 7 can be omitted and only the widened region 8 can be formed, whereby a wound spreader is present. As a result, a universally applicable and multifunctional retractor is provided by the invention. The illustrated embodiment exemplifies any retractor.

As can be seen in particular from FIGS. 4 and 5, the blade 2 in the present embodiment has a distal end 5 and a proximal end 6. By distal, in the context of the present invention, is meant that something is remote from the patient, whereas the term proximal means that something is facing the patient. The distal end 5 is thus remote from the patient, in the sense that it is closer to the guide handpiece 3 than the proximal end 6. The proximal end 6 has a tip 7 which interacts with a bone (not shown). At the proximal end 6, moreover, there is formed a diffused portion 8 having a tissue retaining function.

At the distal end 5 of the blade 2, a recess 9 is formed, which interacts with a latching lug 10 (see in particular FIGS. 1 and 6). The distal end 11 of the recess 9 is made less high compared to the proximal end 12 of the recess 9; In other words, this means that the depth of the recess 9 changes over its length. Thus, an enlarged stop edge 13 is provided at the proximal end 12 in order to create a particularly good contact and therefore particularly good locking in the locked state (FIG. 1A). Since the illustrated version of the retractor 1 can be hammered into a bone, forces on the attachment plate 20 (see FIG. 7) occur in the direction of the proximal end 6 of the blade as a result of the impacts on the attachment plate 20. Since the recess 9 is recessed proximally, the latch 10 can not jump out of the recess 9 even with strong shocks. The direction of force during hammering is shown in Figure 2 by the arrow K.

The edges 14 of the blade 2 are preferably bevelled, which supports the sliding movement and sharp edges are avoided. Even a rounded edge version is favorable. It is preferably provided that the blade 2 is provided in different lengths, for example in three different lengths. Thus, different local conditions of the surgical field are taken into account - it will be necessary, for example, for the operation of an obese patient, a longer blade, due to the thickness of the aufzuspreizenden layers of fat, as compared to an operation with a very lean patient. If the surgeon recognizes during the operation that the selected blade 2 is too short or too long, it can simply be replaced by a correspondingly longer or shorter one.

Figures 6-8 show the guide handpiece 3 with locking device 15 in detail. The illustrated embodiment of the guide handpiece 3 is a one-sided open. It is a shell 16 is provided which is self-contained and covers the back of the guide handpiece 3. In other words, in the region covering the one side of the guide handpiece 3, the shell 16 has no openings, openings, holes or the like, but is of continuous design. Of course, the shell 16 may also be broken, for example, grid-like or formed by rods. The shell 16 forms with its upper part 42 and its lower part 43 a scabbard which is open on one side and which receives the shaft 4 of the blade 2. The shell 16 could therefore also be called a receptacle. Since it is a one-sided closed shell, the front of the guide handpiece 3 is open, whereby the instrument can be easily disassembled, for example for cleaning and sterilization purposes. In addition, the surgeon can immediately see how far the blade 2 has entered the guide handpiece (compare Figures IA and IB). He can easily decide, for example, whether a shorter or longer blade 2 must be used to maintain the retractor function.

The locking device 15 (shown separately in Figures 10-11, assembled with the guide handpiece 3 in Figures 6-7) is a spring loaded rocker arm in the illustrated embodiment. The locking device 15 is mounted on a bearing 19 and tiltable, as indicated by the double arrow 71. As can be seen in particular Figures 7, 10 and 11, the locking device 15 is eccentrically mounted, ie, the first arm 21 is shorter than the second arm 22. Thus, the distal second arm 22 is longer than the proximally located first arm 21. At the locking lug 10 opposite end of the lock s device 15, a pusher plate 23 is provided. By pressing this pusher plate 23 and thus lifting the latch 10, the lock between the blade 2 and guide handpiece 3 is released. The locking lug 10 moves upwards and releases the shaft 4. By loosening the lock, both the second, released state is assumed, as shown in Figure IB, as well as an exchange of the blade 2 by pulling out of the shell 16 and thus from the guide handpiece 3 is possible.

The blade 2 is inserted via the shaft 4 into a corresponding receiving opening 24 at the proximal end 17 of the guide handpiece 3. At the distal end 18 of the guide handpiece 3, a mounting plate 20 is provided. About the mounting plate 20, the attachment to a fixing frame (not shown). In the case of using the SynFrame system, the mounting plate is attached to a guide rod and fixedly connected thereto, and the guide rod itself is in turn fixed to the retaining ring. The mounting plate 20 also serves as a clubface when the blade 2 is to be hammered into a bone. The surgeon strikes the mounting plate 20 with the hammer, blade 2 and guide handpiece 3 having to be locked against each other.

The guide handpiece 3 is so long that the possible relative movement (reference numeral 70) of the blade 2 relative to the guide handpiece 3 is completely absorbed in a longitudinal extension of the guide handpiece. In the guide handpiece 3, more precisely in the illustrated embodiment in the shell 16, a sliding distance is formed, designated by the reference numeral 25. In this sliding section 25, the sliding relative movement of the blade 2, more precisely the shaft 4 of the blade 2. The length L of Sliding distance 25 (see FIG. 7) is preferably dimensioned such that the shaft 4 can be completely or almost completely received, shown in FIG. 5 by the distance SL, which corresponds approximately to the length of the shaft 4. It can be seen (see in particular FIG. 2) that the sliding movement takes place along a longitudinal extension or longitudinal axis A of the retractor 1. The locking device 15 likewise extends in the longitudinal direction of the retractor 1.

Instead of a shell 16 open on one side, the guide handpiece 3 could also be closed on all sides, for example in the manner of a sword scabbard. Furthermore, the rocker arm, ie the locking device 15, also be mounted centrally. The illustrated locking device 15 is a rocker arm which is designed like a rocker. FIGS. 9-12 show details of the guide handpiece 3 and the locking device 15. FIG. 9 shows the shell 16 of the guide handpiece 3 in detail. At the proximal end 17, a receiving opening 24 is formed, in which the blade 2 can be inserted. In the illustration of Figure 9, the special design of the guide is track 25 to recognize well. It is a sliding space, with the reference numeral 28 is formed, in which the blade 2 and the shaft 4 slides. This sliding space 28 is bounded on one side by the rear side of the shell 16. On its upper side, the sliding space 28 is bounded by an upper sliding groove 33, which is located on the underside of the upper part 42 of the shell 16, and on its underside by a lower sliding groove 32, which is the upper side of the lower part 43 of the shell 16. In the illustrated embodiment, the sliding grooves 32 and 33 are T-slots. The upper sliding groove 33 is thus formed by a continuation of the shell 16 on the front side of the guide handpiece 3, so that a kind of housing is formed. On the outside, more precisely on the front outside, of this housing, the locking device 15 is fastened (compare FIG. 12 with FIG. 6). The shank 4 or the blade 2 thus slides behind the locking device 15. The shell 16, which is open on one side, and the locking device 15 together form a housing, also referred to as a receptacle, in which the blade 2 or the shaft 4 can slide , Since the shell 16 is not closed on all sides, but is open on one side, the view of the blade 2 is released. The locking device 15 is designed in the preferred embodiment, as shown, broken, thus providing mechanical protection, without restricting the view more. The openings are denoted by the reference numeral 44 and the webs which delimit the openings 44 are designated by the reference numeral 45.

At the distal end 18 of the guide handpiece 3, the actuator plate 20 is formed. In the illustration of Figure 9 it can be seen that the actuating plate 20 towards the back of the guide handpiece 3, ie that side on which the shell 16 is substantially closed, protruding, that is cantilevered. Thus, the impact surface is increased and at the same time finds an insertion slot 31 space, via which the connection with the fixing or mounting frame, for example, with a guide rod can be done. Moreover, a protection 30 is provided at the distal end 18. This is formed by surviving material. The protection 30 has a dual function, on the one hand by the supernatant material, as well as by the rear projection, the impact surface of the actuator plate 20 is increased, which facilitates the impacting the surgeon. To the Others, a shield is formed against inadvertent operation of the pusher plate 23, which is mounted immediately in front of it (see Figure 6).

In FIGS. 10 and 11, the locking device 15 is shown in detail. In particular, reference is made to the leaf spring, designated by the reference numeral 26, which is supported on the spring abutment 29 of the shell 16. It will be appreciated that by pressing the pusher plate 23, the spring is cocked so that it releases after releasing the pusher plate 23 and the distal end of the locking device, d. H. raise the second arm 22, and thus lower the first arm 21 with the locking lug 10. The lock s device 15 is connected by means of a screw 35 (Figure 12) through the opening 34 and the corresponding opening 36 on the shell with that. Thus, the bearing 19 is formed.

From a synopsis of all figures representing the guide handpiece 3, it is also clear that the guide handpiece 3 is ergonomically designed, which facilitates the operation. There are recesses 38 and bearing surfaces 39 are provided in particular on the upper side 37 of the guide handpiece, and on the underside 40, a projection 41 which lies in the region of the palm. The support surface 39 and the recesses 38 on the top 37 serve the finger system.

In the figures 9 and 10, moreover, the interaction of the locking lug 10 with the latching nose receptacle 27 can be seen. In the released state, the locking lug 10 is received in the latching nose receptacle 27. If the locking of guide handpiece 3 and blade 2, so the locking lug 10 is locked in the recess 9.

Figure 13 shows a second embodiment of the invention in a highly schematic representation. A guide handpiece 103 and a blade 102 are shown in FIG. 13A. The guide handpiece 103 is connected via the actuating plate 120 to a guide rod 150, which is shown only in sections. In Figure 13B, the distal end 105 of the blade 102 is shown. At the distal end 105, a recess 109 is formed, which interacts with the latching lug 110 of the locking device 115. In the illustration of FIG. 13A, the blade 102 is completely received in the guide handpiece 103. It will be appreciated that as the blade 102 moves out of the guide handpiece 103, ie, moves toward the patient, At some point a point is reached, where the detent 110 engages in the recess 109 and so blade 102 and guide handpiece 103 locked against each other.

The locking device 115 is also spring loaded. In this case, a coil spring is provided, designated by the reference numeral 126. The locking device 115 is disposed approximately centrally, so that the first arm 121 and the second arm 122 are approximately the same length. The bearing is designated by the reference numeral 119. At the distal end, a pusher plate 123 is provided. Upon actuation thereof, the latching lug 110 is raised, so that the latched blade 102 is released, since the latching lug 110 is removed from the recess 109. In the shell 116 and thus in the guide handpiece 103, a latching nose receptacle 127 is formed, which receives the latching lug 110. The locking device of Figures 1-12 is a rocker arm, which was eccentrically mounted and on its upper side, wherein pusher plate 23 and locking lug 10 are each formed on the top thereof. The blade 2 is received in a sliding space 28 between shell 16 and locking device 15 and slides in the same. The retractor 101 of FIG. 13 differs. The locking device 115 has pusher plate 123 and latching lug 110 on opposite sides, ie the latching lug 110 is located on its underside, whereas the pusher plate is formed on the upper side of the locking device. Thus, the locking device 115 is formed rather in the manner of a latching hook. However, it will be apparent to those skilled in the art that the locking device 15 or 115 may be provided in different configurations as long as it fulfills the function of locking guide handpieces 3 and 103 and blades 2 and 102, respectively.

LIST OF REFERENCE NUMBERS

1, 101 retractor

2, 102 blade

3, 103 Leadership

4 shaft

5, 105 distal end of the blade

6 proximal end of the blade

7 tip

8 widened retention area

9, 109 recess

10, 110 latch

11 distal end of the recess

12 proximal end of the recess

13 proximal stop edge of the recess

14 edge

15, 115 locking device

16, 116 shell

17 proximal end of the guide handpiece

18 distal end of the guide handpiece

19, 119 bearings

20, 120 B efe sition plate

21, 121 first arm of the locking device

22, 122 second arm of the locking svorrichtung

23, 123 pusher plate

24 receiving opening

25 sliding distance

26, 126 spring

27, 127 snap-in nose

28 sliding room

29 spring bearing

30 protection

31 insertion slot

32 lower sliding groove

33 upper sliding groove

34 opening

35 screw

36 opening

37 top

38 deepening

39 bearing surface

40 bottom

41 advantage

42 shell of the shell

43 Lower part of the shell

44 opening

45 footbridge

70 double arrow

71 double arrow 150 guide rod

L length of the sliding section

SL length of the shaft

K direction of force when hammering

A longitudinal axis of the retractor

Claims

claims

A surgical retractor (1, 101) for holding open a surgical field with a blade (2, 102) for retaining tissue, characterized in that a guide handpiece (3, 103) is provided at a distal end (18)

Attachment plate (20, 120), via which the guide handpiece (3, 103) on a

Fixing frame is fastened, and which provides a guide for the blade (2, 102), and that the guide handpiece (3, 103) and the blade (2, 102) can assume at least two states, wherein in a first state, the guide handpiece (3 , 103) and the

Blade (2, 102) are mutually locked by a locking device (15, 115), and wherein in a second state, the guide handpiece (3, 103) and the blade (2, 102) are mutually released, so that a sliding relative movement (70 ) between the

Guide handpiece (3, 103) and the blade (2, 102) can take place.

2. Surgical retractor (1, 101) according to claim 1, characterized in that the guide handpiece (3, 103) and the blade (2, 102) form a rigid unit in the first state.

3. Surgical retractor according to claim 1 or 2, characterized in that the blade (2, 102) has a shank (4, 104) which is insertable into the guide handpiece (3, 103) and via which the locking of the blade (2 , 102) and guide handpiece (3, 103) takes place.

4. Surgical retractor (1, 101) according to any one of the preceding claims, characterized in that only a single locking position is provided.

5. A surgical retractor (1, 101) according to any one of the preceding claims, characterized in that the guide handpiece (3, 103) is so long that the possible relative movement (70) of the blade (2, 102) relative to the guide handpiece (3, 103) is completely received in a longitudinal extension of the guide handpiece (3, 103).

6. A surgical retractor (1, 101) according to any one of the preceding claims, characterized in that the locking device (15, 115) is a lever with a latching lug (10, 110) in a corresponding recess (9, 109) of the blade (2, 102) or the shaft (4) can be latched so that the blade (2, 102) is locked.

7. A surgical retractor (1, 101) according to claim 6, characterized in that the lever is a rotatably mounted rocker arm having at its one end the latching lug (10, 110) which by actuation of the other end of the recess (9 , 109) of the blade (2, 102) or the shaft (4), whereby the blade (2, 102) is released.

8. surgical retractor (1, 101) according to claim 6 or 7, characterized in that a tensioning device, in particular a spring (26, 126), is provided, which is biased so that the latching lug (10, 110) against the blade ( 2, 102) or the shaft (4) is pressed.

9. A surgical retractor (1) according to claim 7 or 8, characterized in that a pivot point of the rocker arm is provided off-center, so that a first arm (21) of the rocker arm, at the end of the latching lug (10) is provided, is shorter than a second arm (22) of the rocker arm.

10. A surgical retractor (1, 101) according to any one of the preceding claims, characterized in that the relative movement (70) is a sliding movement along a longitudinal axis of the locking device (15, 115).

11. A surgical retractor (1, 101) according to any one of the preceding claims, characterized in that the locking device (15, 115) extends parallel to a longitudinal axis (A) of the retractor (1, 101).

12. A surgical retractor (1, 101) according to any one of the preceding claims, characterized in that the blade (2, 102) is designed so that it can interact with a bone, so that an anchoring of the retractor (1, 101 ) by the interaction with the bone, thereby keeping the surgical field open.

13. Surgical retractor (1, 101) according to claim 12, characterized in that the retractor (1, 101) is anchored in a bone retractor (1, 101) and that the mounting plate (20, 120) a striking plate for driving the Retractor (1, 101) is in the bone.