Operating Table Apparatus Used for Hip Fracture Surgical Fixing
Operations
D E S C R I P T I O N
Technical Field
This invention is related to an operating table apparatus used for hip fracture surgical fixing operations.
Prior Art
Hip fractures are the second fracture type that is encountered in elderly people after wrist fractures and it is expected to increase in prevalence. In surgical fixing operations due to hip fracture traction apparatus (20) and C-armed scopy device (19) (fluoroscopy device) are used together. Traction is a drawing technic applied on a body part in order to detract fractured parts from each other and it is the traction apparatus (20) that performs this operation. C-armed scopy device (19) on the other hand, is a device that is operated by an operator upon directives of the surgeon and ensures obtaining x-ray image. In an operation where traction apparatus (20) is used, C-armed scopy device (19) is absolutely used as well. Fracture reduction (placement of the fracture to its place) is performed by means of these two equipment and positions of the implants to be advanced to the bone are determined. This is the first and the most important step of the operation because if it is not done correctly, it is not possible to perform further operation correctly either.
The conventional technic summarized above has some disadvantages and does not cover needs. Operating tables commercially available in the market are far from covering these needs. Accordingly, problems encountered are as follows:
- It is not easy to capture an image with a scopy device (19) that is operated by an operator other than the surgical team. Therefore scans are made from different angles many times and the patient and the operation room personnel are exposed to radiation during each scan.
-There may be nonunion fractures due to the technical errors made as the result of not obtaining proper image and sending fixing materials in suitable position despite of all care and attention of the physicians. - Most of the energy and time spent during the surgeries is the time spent on the traction table for capturing a suitable image with c-armed scopy device.
Purpose of the Invention The purpose of the invention is to increase the rate of success in hip fracture operations. Success rate of the operation is increased by obtaining a proper x-ray image thanks to the invention.
Another purpose of the invention is to shorten the operation times. Hip fracture surgical fixing operations last for about 90 minutes after performing anesthesia. When this period is examined, main operation steps and their periods are;
-10 minutes for washing and covering operations,
- 10 minutes for taking the patient onto the traction table,
- 10 minutes for fracture reduction,
- 20 minutes to sending fixing materials,
and total operation time is 50 minutes in average. Remaining period of 40 minutes is the time spent for operating the C-armed scopy fluoroscopy)(19) device and this corresponds to 44% of total operation period. This period is long since the scopy device (19) and traction apparatus (20) used currently in operation do not run in harmony with each other. As the result, it takes time to capture a suitable image.
Since these devices are not used apart from each other and they function in
harmony with each other within an integrated system thanks to the invention which is requested to be registered, such 40 minute period is reduced to 5 minutes.
Another purpose of the invention is to reduce the rate of exposure to radiation by the operating room staff and the patient. In current technic, it is possible to obtain the patient's anterior-posterior hip radiography in the 4th scan and lateral hip radiography in the 6th scan correctly. Furthermore this process is repeated in every scan since the device location or position cannot be maintained. It is possible to obtain anterior-posterior and lateral images at once since it is possible to capture 2 images at once with the invention and there is no need to make re-setting every time. About 80% lower radiation exposure occurs as image is obtained with less scans.
Another purpose of the invention is to reduce personnel expenses. There is a need for a technician who is capable of operating the C-armed scopy device (19) according to the directives of the physician. Annual cost of an x-ray technician is about 42,000 TL. Since this necessity is eliminated with invention, not only the costs reduce, but also less people are exposed to radiation. Another purpose of the invention is to maintain sterilization at maximum level during the surgery. While performing lateral scan, tube part of the c-armed scopy device (19) passes from not-sterile areas (areas below the waist are not considered as sterile) when circling it underneath the table. This constitutes a risk in terms of the sterilization of the operation. Furthermore, decreasing the number of assistant personnel in the operating room thanks to the invention, increases the sterilization safety. Thus, it is expected that the invention will reduce infection risk in operations.
The apparatus which has been developed for realizing aforesaid purposes is composed on two main parts which are the traction mechanism and imaging mechanism. These parts, which form the system, run in integration to each other.
The apparatus that is composed of the traction mechanism and imaging mechanism is mounted on the operating table.
Description of Figures
Attached Figure - 1 , is the general appearance of the apparatus (2) and operating table (1).
Figure - 2, is the general view of the apparatus (2) and operating table (1).
Figure - 3, is the general view of the apparatus (2) and operating table (1). Figure - 4, is the top view of the apparatus (2) and operating table (1) when the imaging mechanism (10) is open at left leg.
Figure - 5, is the top view of the apparatus (2) and operating table (1) when the imaging mechanism (10) is open at right leg.
Figure - 6, is the general view of the imaging mechanism (10).
Figure - 7, tilted view of the part where the horizontal x-ray tube (15) on the imaging mechanism (10) is connected to the bearing arm (11).
Figure - 8, is the general view of the C-armed scopy device (19) in current technic.
Figure - 9, is the view of the C-armed scopy device (19) and traction apparatus (20) on the operating table (1) in current technic.
Numbers and names of main parts and elements stated in the figures are given below. (1) Operating table
(2) Apparatus
(3) Axis
(4) Supporting cylinder
(5) Traction mechanism
(6) Traction arms
(7) Traction joint
(8) Foot holder lever
(9) Foot holder
(10) Imaging mechanism
(11) Bearing arm
(12) Bearing arm joint
(13) Vertical x-ray tube
(14) Vertical image intensifier
(15) Horizontal x-ray tube
(16) Horizontal image intensifier
(17) Switch pedal
(18)Monitor
(19) C-armed scopy device in current technic.
(20) Traction apparatus in current technic.
Detailed Description of the Invention
The apparatus is composed on two main parts which are the traction mechanism (5) and the imaging mechanism (10). These parts, which form the system, are integrated to each other. The apparatus (2) that is composed of the traction mechanism (5) and the imaging mechanism (10) is mounted on the operating table (1).
Traction mechanism (5) incorporates the supporting cylinder (4), traction arms (6), traction joint (7), foot holder lever (8) and Foot holder (9). The patient to be operated is positioned on the operating table (1) in a manner that his/her legs are fixed on both sides of the supporting cylinder (4) and feet are fixed on the foot holder (9) on the foot holder lever (8). Telescopic traction arms (6) are moved through the traction joint (7) and fractured parts are departed from each other.
Traction mechanism (5) has two basic functions in this system. These are; performing the traction function (drawing the leg) which is the main function and providing a suitable ground for the imaging mechanism (10) which is the second main part of the system. Bearing arm (11) and imaging mechanism (10) which are
other parts of the system are mounted on the traction mechanism (5). In the alternative application of the invention, the imaging mechanism (5) and the traction mechanism (10) can be mounted on the operating table (1) independent of each other.
Imaging mechanism (10) incorporates the Bearing arm (11), Bearing arm joint (12), Vertical x-ray tube (13), Vertical image intensifier (14), Horizontal x- ray tube (15) and Horizontal image intensifier (16). There are two x-ray tubes (13,15) and two image intensifiers (14,16) suitable positioned in two different planes on a bearing arm (11) in the imaging mechanism (10) in order obtain proper anterior, posterior and lateral x-ray image of the fractured area. Vertical x- ray tube (13) and vertical image intensifier (14) are positioned in order to obtain anterior-posterior hip image at vertical (coronal) plane. Horizontal x-ray tube (15) and horizontal image intensifier (16) are positioned in order to obtain lateral hip image at horizontal (sagittal) plane. Following detracting fractured parts from each other through the traction mechanism (5); positions of the implants (screw- wire-stud etc.) to be advanced to the bones are determined by using the imaging mechanism (10). This is the first and the most important step of the operation because if it is not done correctly, it is not possible to perform further operation correctly either.
Bearing arm (1) has the ability to rotate around the axis (3) with all of its components. Just below the section where horizontal x-ray tube (15) is connected to the bearing arm (11), there is a bearing arm joint (12) that ensures tilting of the bearing arm (11). The section where horizontal x-ray tube (15) is connected to the bearing arm (1 1) has a telescopic structure and it can extend and shorten. When this section is taken to short position and tilted, horizontal x-ray tube (15) is positioned just under the operating table (1). Therefore it is prevented that the tube puts obstacles for the surgeon. Where necessary, horizontal x-ray tube (15) can be passed underneath the operating table (1) and taken to the part where other leg of the patient is located. Thus it is ensured that the imaging mechanism (10) can be easily used in both sides of the operating table (1). Vertical image intensifier (14)
located on the bearing arm (11) and horizontal image intensifier (16) are positioned at diagonal or perpendicular planes to each other. Vertical image intensifier (14) located on the bearing arm (11) and horizontal x-ray tube (15) are positioned at diagonal or perpendicular planes to each other. Likewise, Vertical image intensifier (16) located on the bearing arm (11) and vertical x-ray tube (13) are positioned at diagonal or perpendicular planes to each other. Thus, it is possible to obtain health image in both coronal and saggital planes for both legs. When switch pedal (17) pressed, it is possible to capture both anterior-posterior and lateral hip images properly.
Position of the support cylinder (4) on the operating table (1) can be changed. Thus it can be positioned in the center of the plane where proximal femur image is created in patients with different weights, heights and/or anatomical characteristics. Supporting cylinder (4) does not constitute any obstacle for imaging since it is derived from a material of radiolucent characteristics.