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DE29801807U1 - Device for use in surgical interventions, in particular in bypass operations - Google Patents

Device for use in surgical interventions, in particular in bypass operations

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Publication number
DE29801807U1
DE29801807U1 DE29801807U DE29801807U DE29801807U1 DE 29801807 U1 DE29801807 U1 DE 29801807U1 DE 29801807 U DE29801807 U DE 29801807U DE 29801807 U DE29801807 U DE 29801807U DE 29801807 U1 DE29801807 U1 DE 29801807U1
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Germany
Prior art keywords
arm
foot
heart
fastening
sleeve
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Expired - Lifetime
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DE29801807U
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German (de)
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Classifications

    • 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
    • F16M—FRAMES, CASINGS OR BEDS OF ENGINES, MACHINES OR APPARATUS, NOT SPECIFIC TO ENGINES, MACHINES OR APPARATUS PROVIDED FOR ELSEWHERE; STANDS; SUPPORTS
    • F16M11/00—Stands or trestles as supports for apparatus or articles placed thereon ; Stands for scientific apparatus such as gravitational force meters
    • F16M11/20—Undercarriages with or without wheels
    • F16M11/24—Undercarriages with or without wheels changeable in height or length of legs, also for transport only, e.g. by means of tubes screwed into each other
    • F16M11/26—Undercarriages with or without wheels changeable in height or length of legs, also for transport only, e.g. by means of tubes screwed into each other by telescoping, with or without folding
    • F16M11/28—Undercarriages for supports with one single telescoping pillar
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/02—Surgical instruments, devices or methods for holding wounds open, e.g. retractors; Tractors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/50—Supports for surgical instruments, e.g. articulated arms
    • 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
    • F16M—FRAMES, CASINGS OR BEDS OF ENGINES, MACHINES OR APPARATUS, NOT SPECIFIC TO ENGINES, MACHINES OR APPARATUS PROVIDED FOR ELSEWHERE; STANDS; SUPPORTS
    • F16M11/00—Stands or trestles as supports for apparatus or articles placed thereon ; Stands for scientific apparatus such as gravitational force meters
    • F16M11/20—Undercarriages with or without wheels
    • F16M11/2007—Undercarriages with or without wheels comprising means allowing pivoting adjustment
    • F16M11/2014—Undercarriages with or without wheels comprising means allowing pivoting adjustment around a vertical axis
    • 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
    • F16M—FRAMES, CASINGS OR BEDS OF ENGINES, MACHINES OR APPARATUS, NOT SPECIFIC TO ENGINES, MACHINES OR APPARATUS PROVIDED FOR ELSEWHERE; STANDS; SUPPORTS
    • F16M11/00—Stands or trestles as supports for apparatus or articles placed thereon ; Stands for scientific apparatus such as gravitational force meters
    • F16M11/20—Undercarriages with or without wheels
    • F16M11/2007—Undercarriages with or without wheels comprising means allowing pivoting adjustment
    • F16M11/2021—Undercarriages with or without wheels comprising means allowing pivoting adjustment around a horizontal axis
    • 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
    • F16M—FRAMES, CASINGS OR BEDS OF ENGINES, MACHINES OR APPARATUS, NOT SPECIFIC TO ENGINES, MACHINES OR APPARATUS PROVIDED FOR ELSEWHERE; STANDS; SUPPORTS
    • F16M11/00—Stands or trestles as supports for apparatus or articles placed thereon ; Stands for scientific apparatus such as gravitational force meters
    • F16M11/20—Undercarriages with or without wheels
    • F16M11/2092—Undercarriages with or without wheels comprising means allowing depth adjustment, i.e. forward-backward translation of the head relatively to the undercarriage
    • 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
    • F16M—FRAMES, CASINGS OR BEDS OF ENGINES, MACHINES OR APPARATUS, NOT SPECIFIC TO ENGINES, MACHINES OR APPARATUS PROVIDED FOR ELSEWHERE; STANDS; SUPPORTS
    • F16M11/00—Stands or trestles as supports for apparatus or articles placed thereon ; Stands for scientific apparatus such as gravitational force meters
    • F16M11/20—Undercarriages with or without wheels
    • F16M11/24—Undercarriages with or without wheels changeable in height or length of legs, also for transport only, e.g. by means of tubes screwed into each other
    • F16M11/40—Undercarriages with or without wheels changeable in height or length of legs, also for transport only, e.g. by means of tubes screwed into each other by means of coilable or bendable legs or spiral shaped legs
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
    • A61B2017/00238—Type of minimally invasive operation
    • A61B2017/00243—Type of minimally invasive operation cardiac
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/02—Surgical instruments, devices or methods for holding wounds open, e.g. retractors; Tractors
    • A61B2017/0237—Surgical instruments, devices or methods for holding wounds open, e.g. retractors; Tractors for heart surgery
    • A61B2017/0243—Surgical instruments, devices or methods for holding wounds open, e.g. retractors; Tractors for heart surgery for immobilizing local areas of the heart, e.g. while it beats
    • 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
    • F16M—FRAMES, CASINGS OR BEDS OF ENGINES, MACHINES OR APPARATUS, NOT SPECIFIC TO ENGINES, MACHINES OR APPARATUS PROVIDED FOR ELSEWHERE; STANDS; SUPPORTS
    • F16M2200/00—Details of stands or supports
    • F16M2200/02—Locking means
    • F16M2200/021—Locking means for rotational movement
    • F16M2200/022—Locking means for rotational movement by friction
    • 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
    • F16M—FRAMES, CASINGS OR BEDS OF ENGINES, MACHINES OR APPARATUS, NOT SPECIFIC TO ENGINES, MACHINES OR APPARATUS PROVIDED FOR ELSEWHERE; STANDS; SUPPORTS
    • F16M2200/00—Details of stands or supports
    • F16M2200/02—Locking means
    • F16M2200/025—Locking means for translational movement
    • F16M2200/027—Locking means for translational movement by friction

Landscapes

  • Engineering & Computer Science (AREA)
  • General Engineering & Computer Science (AREA)
  • Health & Medical Sciences (AREA)
  • Mechanical Engineering (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Animal Behavior & Ethology (AREA)
  • Public Health (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • General Health & Medical Sciences (AREA)
  • Biomedical Technology (AREA)
  • Veterinary Medicine (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Pathology (AREA)
  • Ultra Sonic Daignosis Equipment (AREA)
  • External Artificial Organs (AREA)
  • Surgical Instruments (AREA)

Description

Anm.: Ralph Mathar · j ·* . ; ·Note: Ralph Mathar · j ·* . ; ·

&ugr;.&Idigr;.: GM 1732/1-98 *..··..· '..*&ugr;. &Idigr;.: GM 1732/1-98 *..··..· '..*

Vorrichtung zur Verwendung bei operativen Eingriffen,
insbesondere bei BypassoperationenDevice for use in surgical procedures,
especially in bypass operations

Diese Erfindung betrifft eine Vorrichtung zur Verwendung bei operativen Eingriffen, insbesondere bei Bypassoperationen am Herzen.This invention relates to a device for use in surgical procedures, in particular in cardiac bypass operations.

Bei Bypassoperationen am Herzen sind chirurgische Eingriffe aufgrund der pulsierenden Bewegung des Herzens mit Schwierigkeiten verbunden. Bei den meisten invasiven Eingriffen, die von weniger erfahrenen Ärzten vorgenommen JO werden, wird ein künstlicher Herzstillstand erzeugt und die Herzfunktionen von einer Herz-Lungen-Maschine übernommen. Bei einer geringeren Anzahl invasivex Eingriffe, wenn die betroffenen Ärzte über größere Erfahrungen verfugen, wird die Bypassoperauon am schlagenden Herzen durchgeführt.In heart bypass surgery, surgical interventions are difficult due to the pulsating movement of the heart. In most invasive procedures, which are performed by less experienced doctors, an artificial cardiac arrest is induced and the heart functions are taken over by a heart-lung machine. In a smaller number of invasive procedures, when the doctors involved have more experience, the bypass surgery is performed on the beating heart.

Eine bekannte Vorrichtung besteht aus einem Fuß in Form einer Gabel mit zwei Zinken. Der Fuß wird in der Nahe der Stelle am Herzen plaziert, an der die Bypassoperation vorgenommen werden soll. Die Position des Fußes wird so gewählt, daß sich jeder Zinken der Gabel auf einer Seite des Operationsfelds befindet, so daß der Bereich zwischen den Zinken ruhiggestellt wixd. Di.ese bekannte Vorrichtung ist mit einer Befestigungsvorrichtung versehen, die an einer Unterlage, z. B. einem Operationstisch befestigt wird und mittels eines Stangensystems den Fuß nach unten zum Herzen führt und ihn dort in Position Mit.One known device consists of a foot in the form of a fork with two prongs. The foot is placed near the place on the heart where the bypass operation is to be performed. The position of the foot is chosen so that each prong of the fork is on one side of the operating field, so that the area between the prongs is immobilized. This known device is provided with a fastening device which is attached to a base, e.g. an operating table, and by means of a rod system guides the foot down to the heart and holds it there in position.

Die bekannte Vorrichtung hat jedoch u. a. den Nachteil, daß die Führung des Fußes nach unten und das Festhalten des Fußes an anderen Stellen des Herzens als der direkt am obersten, nach oben gewendeten Teil des Herzens mit Schwierigkeiten verbunden ist. Operationen können somit ausschließlich am obersten, nach oben gewendetenTeil des Herzens vorgenommen werden.However, the known device has the disadvantage that it is difficult to guide the foot downwards and to hold the foot in place at other points on the heart than directly at the top, upward-facing part of the heart. Operations can therefore only be performed on the top, upward-facing part of the heart.

3030

• ··

Die US-PS 3.858.578 beschreibt eine weitere Vorrichtung für Operationen, die neben einer Befestigungsvorrichtung zur Befestigung der Vorrichtung an einer Unterlage einen Arm unu0^ der die Befestigungsvorrichtung mit einem Fuß verbindet, wobei der Fuß so beschaffen ist, daß er an einem Teil eines Körpers anliegt und diesen ruhig stellt, wobei der Arm mindestens drei gegeneinander bewegliche Glieder umfaßt, die von einer durch die Glieder geführten Zugvorrichtung zusammengehalten werden, die am Fuß befestigt und so beschaffen ist, daß sie die Glieder mittels einer an der Befestigungsvorrichtung angebrachten Spanneinrichtung verspannt. Diese Vorrichtung kann bei schwieriger zugänglichen Teilen des Körper als z. B. dem obersten, nach oben gewendeten Teil des Herzens zum Einsatz kommen, da die Verspannung der Glieder eine Fixierung derselben gegeneinander zur Folge hat, wodurch der Arm steif wird, Diese bekannte Vorrichtung hat eine Spanneinrichtung bestehend aus einem Druckzylinder, der über ein Ventil mit Druckluft beladen wird, wobei die Zugvorrichtung in Form eines Drahts angezogen und der Arm fixiert wird. Der Zylinder wird über das Ventil ebenfalls entlüftet, wobei sich der Draht entspannt und der Arm wieder frei beweglich wird und in eine neue Stellung geführt werden, kann. Die Vorrichtung gemäß dieser US-Schrift hat einen komplizierten Bau und verlangt eine Druckluftversorgang mit dazu passendem Ventil und passenden Schläuchen im Operationssaal.US-PS 3,858,578 describes a further device for operations which, in addition to a fastening device for fastening the device to a base, has an arm and a foot which connects the fastening device to a foot, the foot being designed in such a way that it rests against a part of a body and immobilizes it, the arm comprising at least three members which can move relative to one another and are held together by a pulling device which runs through the members and which is attached to the foot and is designed in such a way that it tightens the members by means of a tensioning device attached to the fastening device. This device can be used for parts of the body which are difficult to access, such as the uppermost, upward-facing part of the heart, since the tightening of the members results in them being fixed relative to one another, whereby the arm becomes stiff. This known device has a tensioning device consisting of a pressure cylinder which is charged with compressed air via a valve, whereby the pulling device in the form of a wire is tightened and the arm is fixed. The cylinder is also vented via the valve, whereby the wire relaxes and the arm becomes freely movable again and can be moved into a new position. The device according to this US document has a complicated construction and requires a compressed air supply with a suitable valve and suitable hoses in the operating room.

Aufgabe der vorliegenden Erfindung ist es, einen verstellbaren, flexiblen Haltearm für Herzoperationen zu schaffen, der einfach aufgebaut ist, keine Zusatzeinrichtungen und Druckluftversorgung verlangt und darüber hinaus einen günstigen Anschaffungspreis hat.The object of the present invention is to create an adjustable, flexible holding arm for cardiac operations, which is simple in construction, does not require any additional equipment or compressed air supply and, moreover, has a low purchase price.

Die Aufgabe wird ertlndungsgemäß durch eine Vorrichtung der im Oberbegriff von Anspruch 1 beschriebenen Art gelöst, wobei die Spanneinrichtung einen drehbaren Handgriff hat, der über ein Schraubengewinde mit der Zugvorrichtung verbunden ist.The object is achieved according to the invention by a device of the type described in the preamble of claim 1, wherein the tensioning device has a rotatable handle which is connected to the pulling device via a screw thread.

So kann die Zugvorrichtung durch Drehen des Handgriffes gespannt und damit der Arm in der gewünschten Stellung fixiert werden und durch Drehen des Handgriffs in entgegengesetzte Richtung gelockert und der Arm wieder beweglich gemacht werden. Es handelt sich hier mit anderen Worten um eine sehr viel einfachere Konstruktion als die des Stands der Technik, wobei die Funktionalität bewahrt bleibt. Gleichzeitig wird die Möglichkeit für Bypassoperationen geschaffen, bei denen ein Operationsfeld am oberen, nach oben gewendeten Teil des Herzens nicht zwingend vorgeschrieben ist. Mit einem bekannten Fuß sind so mehrere verschiedene Operationen möglich. Es ist demgemäß nicht notwendig, eine Operation an einem schlagenden Herzen mit sich bewegendem Operationsfeld vorzunehmen oder eine Herz-Lungen-Maschine anzuschließen, wenn Operationen an schwerer zugänglichen Stellen des Herzens vorgenommen werden müssen.The traction device can be tightened by turning the handle and thus the arm can be fixed in the desired position, and loosened by turning the handle in the opposite direction and the arm can be made mobile again. In other words, this is a much simpler construction than that of the state of the art, while the functionality is retained. At the same time, the possibility of bypass operations is created in which an operating field on the upper, upward-facing part of the heart is not mandatory. Several different operations are thus possible with a known foot. It is therefore not necessary to perform an operation on a beating heart with a moving operating field or to connect a heart-lung machine if operations have to be carried out on parts of the heart that are difficult to access.

)5 Als Zugvorrichtung kommen neben dem genannten Stahldraht auch andere Vorrichtungen wie Ketten und Kunststoffseile in frage.)5 In addition to the steel wire mentioned above, other devices such as chains and plastic ropes can also be used as traction devices.

Anspruch 2 lehrt, daß die Befestigungsvorrichtung eine Muffe zwischen dem Handgriff und einem äußersten Glied des Armes umfaßt, welche Muffe eine Stange quer zur Symmetrieachse der Muffe aufweist. Die Stange kann zur Fixierung am Operationstisch verwendet werden, wodurch eine einfache Integration des Arms mit dessen Halteeinrichtungen erreicht wird.Claim 2 teaches that the fastening device comprises a sleeve between the handle and an outermost member of the arm, which sleeve has a rod transverse to the axis of symmetry of the sleeve. The rod can be used for fixation to the operating table, thereby achieving a simple integration of the arm with its holding devices.

Um die Einstellmöglichkeiten des Arms weiter zu verbessern umfaßt die Befestigungsvorrichtung vorzugsweise eine fixierbar montierte Stange, die in einem Rohr axial verschiebbar ist, welches Rohr in einem drehbaren Gelenk an einem Stativ befestigt ist, siehe Anspruch 3.In order to further improve the adjustment possibilities of the arm, the fastening device preferably comprises a fixably mounted rod which is axially displaceable in a tube, which tube is fastened in a rotatable joint to a tripod, see claim 3.

Anspruch 3 beschreibt eine bevorzugte und einfache Ausführung der Spanneinrichtung, wobei die Zugvorrichtung an dem der Spanneinrichtung am nächsten gelegenen Ende mit einem Gewindezapfen und der Handgriff mit einer Gewindebuchse versehen ist.Claim 3 describes a preferred and simple embodiment of the clamping device, wherein the pulling device is provided with a threaded pin at the end closest to the clamping device and the handle is provided with a threaded bushing.

Wird über den Arm ein Strumpf gezogen, der die. Glieder des Armes und einen Teil der Befestigungsvorrichtung bedeckt, können die schwerer zugänglichen Haken zwischen den Gliedern vor Verunreinigung geschützt und so die mechanische Reinigung des Armes zwischen zwei Operationen verringert werden. 5 If a stocking is pulled over the arm, covering the links of the arm and part of the attachment device, the more difficult to access hooks between the links can be protected from contamination and the mechanical cleaning of the arm between two operations can be reduced. 5

Die Erfindung wird im folgenden genauer an Hand der Zeichnung erläutert. Dabei zeigtThe invention is explained in more detail below with reference to the drawing. Shows

Fig. 1 eine Photographic einer Ausführung einer erfindungsgemäßen Vorrichtung,Fig. 1 is a photograph of an embodiment of a device according to the invention,

Fig. 2 eine Skizze von Teilen einer Ausführung einer erfindungsgemäßen Vorrichtung,Fig. 2 is a sketch of parts of an embodiment of a device according to the invention,

Fig. 3 eine Photographic einer ersten Stellung der erfmdungsgemäßen Vorrichtung,Fig. 3 is a photograph of a first position of the device according to the invention,

Fig. 4 eine Photographic einer zweiten Stellung der erfmdungsgemäßen Vorrichtung, und
20 Fig. 4 is a photograph of a second position of the device according to the invention, and
20

Fig. 5 eine Photographie einer erfmdungsgemäßen Vorrichtung während einer BypassoperationFig. 5 a photograph of a device according to the invention during a bypass operation

Fig. 1 zeigt eine Ausführung einer erfindungsgemäßen Vorrichtung. Die Vorrichtung umfaßt eine Unterlage in Form eines ersten Stangenabschnitts 1. Der erste Stangenabschnitt 1 ist mit einer ersten Muffe 2 versehen. Die Vorrichtung umfaßt des weiteren einen Ann 3. Der Arm besteht aus acht Gliedern 4. An einem ersten Ende des Armes ist dieser mit einem ersten Anschlag 5 in Form einer Gewindebuchse versehen. Die Gewindebuchse 5 bat einen querliegenden Stift 6, der als Handgriff zur Bedienung der Gewindebuchse 5 dient. Am anderen Ende weist der Arm einen zweiten Anschlag 7 in Form eines Fußes auf. Der Fuß 7 ist mit einer Gabel 8 mit zwei Zinken 9 versehen. Die beiden Zinken 9 umschließenFig. 1 shows an embodiment of a device according to the invention. The device comprises a base in the form of a first rod section 1. The first rod section 1 is provided with a first sleeve 2. The device further comprises an arm 3. The arm consists of eight links 4. At a first end of the arm, it is provided with a first stop 5 in the form of a threaded bushing. The threaded bushing 5 has a transverse pin 6, which serves as a handle for operating the threaded bushing 5. At the other end, the arm has a second stop 7 in the form of a foot. The foot 7 is provided with a fork 8 with two prongs 9. The two prongs 9 enclose

einen Zwischenraum 10. Die Gabel 8 dient dazu, so auf einem Herzen (nicht dargestellt) plaziert zu werden, daß sich eine Operationsfeld, z. B. für eine Bypassoperation, im Zwischenraum 10 zwischen den beiden Zinken 9 befindet.a gap 10. The fork 8 is designed to be placed on a heart (not shown) in such a way that an operating field, e.g. for a bypass operation, is located in the gap 10 between the two prongs 9.

Ein Draht (siehe Fig. 2), vorzugsweise ein Stabldraht, verläuft vom Fuß 7 durch Öffnungen (siehe Fig. 2) in jedem der acht Glieder 4 zu einem Gewindezapfen 1L Der Gewindezapfen verläuft durch die erste Muffe 2 und greift in die Gewindebuchse 5 ein. Die Gewindebuchse 5 liegt somit über die erste Muffe 2 an einem ersten Glied 4' an, der Fuß 7 an einem letzten Glied 4".A wire (see Fig. 2), preferably a bar wire, runs from the foot 7 through openings (see Fig. 2) in each of the eight links 4 to a threaded pin 1L The threaded pin runs through the first sleeve 2 and engages in the threaded bushing 5. The threaded bushing 5 thus rests on a first link 4' via the first sleeve 2, the foot 7 on a last link 4".

Wenn der Gewindezapfen 11 durch die erste Muffe 2 verläuft und die Gewindebuchse 5 mittels des querliegenden Stiftes 6 angezogen wird, wird die Gewindebuchse 55 die den ersten Anschlag darstellt, gegen den Fuß 7 verspannt, der den zweiten Anschlag darstellt. Eine Spannscheibe zwischen der Gewindebuchse 5 und der ersten Muffe 2 erleichtert das Anziehen der Gewindebuchse 5 am Gewindezapfen 11.When the threaded pin 11 passes through the first sleeve 2 and the threaded bushing 5 is tightened by means of the transverse pin 6, the threaded bushing 5 , which represents the first stop, is clamped against the foot 7, which represents the second stop. A clamping disk between the threaded bushing 5 and the first sleeve 2 facilitates the tightening of the threaded bushing 5 on the threaded pin 11.

Die Flexibilität des Armes 3 ist abhängig von der Verspannung zwischen der Gewindebuchse 5 und dem Gewindezapfen 11. Für das Plazieren der Gabel 8 am Fuß 7 am Herzen wird die Gewindebuchse 5 weniger stark angezogen, so daß der Arm 3 eine höhere Flexibilität hat. Wenn die Gabel 8 am Fuß 7 auf dem Herz anliegt, wird die Gewindebuchse 5 mehr angezogen, so daß die Flexibilität des Armes 3 geringer wird. Dabei werden der erste Anschlag und der zweite Anschlag Ln Form der Gewindebuchse 5 bzw. des Fußes 7 sowie jedes der Glieder 4 mehr verspannt, um die Gabel 8 am Fuß 7 in der gewählten Position am Herz zu halten.The flexibility of the arm 3 depends on the tension between the threaded bushing 5 and the threaded pin 11. To place the fork 8 on the foot 7 on the heart, the threaded bushing 5 is tightened less so that the arm 3 has greater flexibility. When the fork 8 on the foot 7 rests on the heart, the threaded bushing 5 is tightened more so that the flexibility of the arm 3 is reduced. The first stop and the second stop in the form of the threaded bushing 5 or the foot 7 as well as each of the links 4 are tightened more to hold the fork 8 on the foot 7 in the selected position on the heart.

Fig. 2 ist eine Skizze von zwei der acht Glieder 43 dem Draht 12, dem Gewindezapfen 11 am Ende des Drahts 12 sowie des ersten Anschlags 5 und des zweiten Anschlags 7. Die Skizze ist aus darstellerischen Gründen nicht maßstabsgerecht, in dem konkreten Ausfühmngsbeispiel sitzen die Glieder 4, der erste Anschlag 5 und der zweite Anschlag 7 enger zusammen. Die Glieder 4 sind jeweils becherförmig mit einem konkaven Teil 13 und einem konvexen Teil 14.Fig. 2 is a sketch of two of the eight links 4, 3 the wire 12, the threaded pin 11 at the end of the wire 12 and the first stop 5 and the second stop 7. The sketch is not to scale for illustrative reasons; in the specific embodiment, the links 4, the first stop 5 and the second stop 7 are closer together. The links 4 are each cup-shaped with a concave part 13 and a convex part 14.

Das konkave Teil 13 greift in. das konvexe Teil 14 des benachbarten Glieds ein. Jedes Glied 4 weist eine Öffnung 15 auf. Der Draht 12 verläuft durch diese Öffnungen 15 vom Gewindezapfen 11 bis rum zweiten Anschlag 7.The concave part 13 engages the convex part 14 of the adjacent link. Each link 4 has an opening 15. The wire 12 runs through these openings 15 from the threaded pin 11 to the second stop 7.

Fig. 3 zeigt eine erste Stellung des Fußes 8, der ein Teil der erfindungsgemäßen Vorrichtung ist. Die Photographic zeigt den Fuß 8, den aus Gliedern bestehenden Arm 3 und den erste Stangenabschnitt 1. Darüber hinaus ist erkennbar, daß der erste Stangenabschnitt 1 an einer zweiten Muffe 20 angebracht ist, die ein Teil des zweiten Stangenabschnitts 21 ist. Der erste Stangenabschnitt 1 ist parallel zu einer JO Längsachse A des zweiten Stangenabschoitts 21 verschiebbar. Der erste Stangenabschnitt 1 kann außerdem um die Längsachse A des zweiten Stangenabschnitts 21 gedreht werden. Die zweite Muffe 20 ist mit einem Spanngriff 22 zum Fixieren des ersten. Stangenabschnitts 1 gegenüber o.em zweiten Stangenabschnitt 21 versehen.Fig. 3 shows a first position of the foot 8, which is a part of the device according to the invention. The photograph shows the foot 8, the arm 3 consisting of links and the first rod section 1. Furthermore, it can be seen that the first rod section 1 is attached to a second sleeve 20, which is a part of the second rod section 21. The first rod section 1 is displaceable parallel to a longitudinal axis A of the second rod section 21. The first rod section 1 can also be rotated about the longitudinal axis A of the second rod section 21. The second sleeve 20 is provided with a clamping handle 22 for fixing the first rod section 1 relative to the second rod section 21.

Der zweite Stangenabschnitt 21 weist ein Kugelgelenk 23 auf, das in einer Kugelschale 24 montiert ist die wiederum Teil eines dritten Stangenabschnitts 25 ist. Der zweite Stangenabschnitt 21 ist seitlich in einer beliebigen Kreisbahn um das Zentrum des Kugelgelenks 23 verschiebbar. Der zweite Stangenabschnitts 21 kann außerdem in jeder beliebigen seitlich zur Kugelschale 24 verschobenen Position des zweiten Stangenabschnitts 21 um die Längsachse A gedreht werden. Die Kugelschale ist mit einem SpanngrÜf 26 zum Fixieren des zweiten Stangenabschnitts 23 gegenüber dem dritten Stangenabschnitt 25 versehen. Der dritte Stangenabscbnitt 25 wird mit Hilfe des Spanugriffs 27 an einer Unterlage wie einem Operationstisch 28 befestigt.The second rod section 21 has a ball joint 23 which is mounted in a ball socket 24 which in turn is part of a third rod section 25. The second rod section 21 can be moved laterally in any circular path around the center of the ball joint 23. The second rod section 21 can also be rotated about the longitudinal axis A in any position of the second rod section 21 moved laterally relative to the ball socket 24. The ball socket is provided with a clamping grip 26 for fixing the second rod section 23 relative to the third rod section 25. The third rod section 25 is attached to a base such as an operating table 28 using the clamping grip 27.

Fig. 4 zeigt eine zweite Stellung des Fußes 8. Die Gewindebuchse 5 ist mittels des querliegenden Stifts 6 weniger fest angezogen, so daß die acht Glieder 4 des Armes 3 locker aneinanderliegen. Der Fuß 8 wird danach in eine zweite, von der ersten in Fig. 3 gezeigten Position abweichende Stellung geführt. Danach wird die Gewindebuchse 5 angezogen und so die Beweglichkeit der acht Glieder 4 des Armes 3 gegeneinander verringert und der Fuß 8 in seiner zweiten StellungFig. 4 shows a second position of the foot 8. The threaded bushing 5 is tightened less tightly by means of the transverse pin 6, so that the eight links 4 of the arm 3 lie loosely against one another. The foot 8 is then guided into a second position, which differs from the first position shown in Fig. 3. The threaded bushing 5 is then tightened, thus reducing the mobility of the eight links 4 of the arm 3 against one another and the foot 8 is in its second position.

gehalten. Die Verspannung der acht Glieder wird durch ein mehr oder weniger kräftiges Verspannen der Gewindebuchse 5 und des Fußes 8 gelockert bzw. erhöht.The tension of the eight links is loosened or increased by more or less strongly tightening the threaded bushing 5 and the foot 8.

Fig. 5 zeigt die Anwendung der erfindungsgemäßen Vorrichtung bei einer Bypassoperation eines Herzens 29. Die Gewindebuchse 5 (nicht dargestellt) ist zunächst nur leicht angezogen, so daß die acht Glieder 4 des Armes 3 locker aneinanderliegen. Der Fuß 8 wird daraufhin so auf dem Herzen plaziert, daß das Herzkranzgefäß 30 im Zwischenraum 10 zwischen den beiden Zinken 9 des Fußes 8 zu liegen kommen. Die Gewindebuchse 5 wird dann angezogen, so daß die acht Glieder 4 des Armes 3 gegeneinander verspannt werden. Die Position des Fußes 8 am Herzen 29 mit dem Herzkranzgef&ß 30 im Zwischenraum 10 zwischen den beiden Zinken 9 des Fußes 8 ist so während der Operation fixiert.Fig. 5 shows the use of the device according to the invention in a bypass operation on a heart 29. The threaded bushing 5 (not shown) is initially only slightly tightened so that the eight links 4 of the arm 3 lie loosely against one another. The foot 8 is then placed on the heart so that the coronary artery 30 comes to lie in the space 10 between the two prongs 9 of the foot 8. The threaded bushing 5 is then tightened so that the eight links 4 of the arm 3 are braced against one another. The position of the foot 8 on the heart 29 with the coronary artery 30 in the space 10 between the two prongs 9 of the foot 8 is thus fixed during the operation.

Die einzelnen Teile der erfindungsgemäßen Vorrichtung werden vorzugsweise aus Edelstahl hergestellt, u. a. so, daß die einzelnen Teile autoklavierbar sind. In einer alternativen Ausführung der erfindungsgemäßen Vorrichtung ist der Ann vollständig oder teilweise mit einem Strumpf, vorzugsweise aus Gummi, versehen, so daß sich Verunreinigungen nicht zwischen den einzelnen Teilen der erfindungsgemäßen Vorrichtung ansammeln können.The individual parts of the device according to the invention are preferably made of stainless steel, among other things so that the individual parts are autoclavable. In an alternative embodiment of the device according to the invention, the arm is completely or partially provided with a sock, preferably made of rubber, so that contaminants cannot accumulate between the individual parts of the device according to the invention.

Die Erfindung ist hier unter Verweis auf ein bestimmtes Ausführungsbeispiel für die erfindungsgemäße Vorrichtung beschrieben. Es ist jedoch durchaus möglich, daß jedes der acht Glieder eine andere Form als die eines Bechers hat, z. B. eine konische Form. Es ist auch denkbar, eine größere oder kleinere Anzahl Glieder als acht Glieder zu verwenden. Das Verspannen des Anns gegenüber der Gewindebuchse und damit des Fußes kann durch andere Vorrichtungen als einen Gewindezapfen und eine Gewindebuchse erfolgen, z. B. durch einen Exzenter.The invention is described here with reference to a specific embodiment of the device according to the invention. However, it is entirely possible for each of the eight members to have a shape other than that of a cup, e.g. a conical shape. It is also conceivable to use a larger or smaller number of members than eight. The clamping of the stem relative to the threaded bushing and thus the foot can be carried out by devices other than a threaded pin and a threaded bushing, e.g. by an eccentric.

Claims (5)

ANSPRÜCHEEXPECTATIONS 1. Vorrichtung zur Verwendung bei operativen Eingriffen, insbesondere bei Bypassoperationen am Herzen, mit einer Befestigungsvorrichtung zur Befestigung der Vorrichtung an einer Unterlage und einem Arm, der die Befestigungsvorrichtung mit einem Fuß verbindet, wobei der Fuß so beschaffen ist, daß er an. einem Teil eines Körpers, insbesondere eines Herzens, anliegt, wobei, der Arm mindestens drei gegeneinander bewegliche Glieder umfaßt, die von einer durch die Glieder geführten Zugvorrichtung zusammengehalten werden, die am Fuß befestigt und so beschaffen ist, daß sie die Glieder mittels einer an der Befestigungsvorrichtung angebrachten Spanneinrichtung verspannt, dadurch gekennzeichnet, daß die Spanneinrichtung einen drehbaren Handgriff bat, der über ein Schraubengewinde mit der Zugvorrichtung verbunden ist.1. Device for use in surgical interventions, in particular in bypass operations on the heart, with a fastening device for fastening the device to a base and an arm which connects the fastening device to a foot, the foot being designed such that it rests against a part of a body, in particular a heart, the arm comprising at least three members which can move relative to one another and are held together by a pulling device which is guided through the members and which is fastened to the foot and is designed such that it tightens the members by means of a tensioning device attached to the fastening device, characterized in that the tensioning device has a rotatable handle which is connected to the pulling device via a screw thread. 2. Vorrichtung nach Anspruch 1, dadurch gekennzeichnet daß die Befestigungsvorrichtung eine Muffe zwischen dem Handgriff und einem äußersten Glied des Armes umfaßt, welche .Muffe eine Stange quer zur Symmetrieachse der Muffe aufweist.2. Device according to claim 1, characterized in that the fastening device comprises a sleeve between the handle and an outermost member of the arm, which sleeve has a rod transverse to the axis of symmetry of the sleeve. 3. Vorrichtung nach Anspruch 2, dadurch gekennzeichnet, daß Befestigungsvorrichtung eine fixierbar montierte Stange, die in einem Rohr axial verschiebbar ist, welches Rohr in einem drehbaren Gelenk an einem Stativ befestigt ist, aufweist.3. Device according to claim 2, characterized in that the fastening device has a fixably mounted rod which is axially displaceable in a tube, which tube is fastened to a tripod in a rotatable joint. 4. Vorrichtung nach einem der obigen Ansprüche, dadurch gekennzeichnet, daß die Zugvorrichtung an dem der Spanneinrichtung am nächsten gelegenen Ende mit einem Gewindezapfen und der Handgriff mit einer Gewindebuchse versehen ist.4. Device according to one of the above claims, characterized in that the pulling device is provided with a threaded pin at the end closest to the tensioning device and the handle is provided with a threaded bushing. 5. Vorrichtung nach einem der obigen Ansprüche, dadurch gekennzeichnet, daß über den Arm ein Strumpf gezogen ist, der die Glieder des Armes und einen Teil der Befestigungsvorrichtung bedeckt5. Device according to one of the above claims, characterized in that a stocking is pulled over the arm, which covers the limbs of the arm and part of the fastening device
DE29801807U 1997-02-04 1998-02-03 Device for use in surgical interventions, in particular in bypass operations Expired - Lifetime DE29801807U1 (en)

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DK199700059U DK9700059U1 (en) 1997-02-04 1997-02-04 Apparatus for use in by-pass operations and the use of such apparatus

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