RU2634030C1 - Device for patient fixation during complete hip endoprosthetics - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: device for patient fixation during hip endoprosthetics consists of two front legs for pelvis fixation with a post that can be moved and fixed on one of its posts under each other, rear foot for chest fixation with a post that can be moved and fixed on its post. The difference is the addition of two identical front and rear lower guides for iliac bones wings fixation and two identical front and rear upper guides for iliac bones wings fixation. The front upper and lower guides for iliac bones wings fixation can be moved and fixed to one of their posts below each other and the rear upper and lower guides for iliac bones wings fixation are arranged to be moved and fixed to one of their posts below each other, the upper and lower clamping bars for pelvis fixation are in the form of a cylinder, arcuate-curved. The lower clamping bars for pelvis fixation are connected and that can be moved and fixed to the front and rear lower guides for iliac bones wings fixation and are located on the outer side of posts securing the front and rear lower guides for iliac bones wings fixation, over the lower clamping bars for pelvis fixation there are upper clamping bars for pelvis fixation, that are connected and can be moved and fixed to the front and rear upper guides for iliac bones wings fixation, and are arranged on the outer side of posts, fixing the front and rear upper guides for for iliac bones wings fixatio, two rear feet for pelvis fixation with a post, which are arranged to be moved and fixed to one of their posts below each other, the third front foot for pelvis fixation with a post, which is arranged to be moved and fixed to its post, all mentioned posts are fixed on the edges of the operating table.

EFFECT: increased accuracy of stowage and stiffness patient fixation on the operating table during total hip replacement in the position on the side.

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Description

The invention relates to medicine, namely to operative orthopedics, and can be used in hip arthroplasty.

For the correct orientation of the acetabular component of the endoprosthesis, the correct placement and strong fixation of the patient on the operating table is of great importance. Endoprosthetics of the hip joint in the patient’s position on the side involves fixing the patient on the operating table so that the pelvis is perpendicular to the floor, i.e. the bispinal line (the frontal plane of the body) was perpendicular to the plane of the operating table, and the longitudinal axis of the body was parallel to one of the sides of the operating table [Manual for hip arthroplasty. / Ed. P.M. Tikhilova, V.M. Shapovalova. - SPb .: RNIITO named after P.P. Vredena, 2008 .-- p. 196-197] (Fig. 1, 8).

The following devices are known for fixing the patient on the operating table during hip replacement.

The clamps that make up the orthopedic table [N. Zagorodni Hip replacement. Basics and practice. Leadership. - M.: GEOTAR-Media, 2012 .-- p. 442-443], are abutments located in the region of the pelvic bone and lumbar spine from the back side, and the abutment located in the area of the pubic bone in front.

The disadvantage of these fixatives is the lack of rigid fixation of the patient’s pelvis during surgery: only displacement of the patient’s pelvis anteriorly and posteriorly is excluded, while there is no pelvic fixation in the patient’s frontal plane, as the authors themselves point out [N. Zagorodni. Hip replacement. Basics and practice. Leadership. - M.: GEOTAR-Media, 2012 .-- p. 443-444]. Also, these stops do not allow the patient to be laid in such a way that the longitudinal axis of the body is parallel to one of the edges of the operating table, since there are no stops for fixing the chest. If the patient has scoliosis of any part of the spine, these stops do not allow the pelvis to be fixed in the correct position, in which the bispinal line is perpendicular to the plane of the operating table, due to the fact that the bispinal line is not perpendicular to the axis of the spinal column (Fig. 9).

A device for fixing the patient on the operating table in the side position (patent US 20140059773), consisting of two front stops for fixing the pelvis and chest in front and two rear stops for fixing the pelvis and chest in the back, located on the mounts of the operating table.

The disadvantage of this device is the lack of fixation of the pelvis in the frontal plane of the patient, and therefore it is possible to displace the pelvis in this plane in the presence of scoliosis of the spine or in the presence of joint contracture, after the elimination of which a change in the position of the pelvis can occur [Guidelines for hip joint replacement. / Ed. P.M. Tikhilova, V.M. Shapovalova. - SPb .: RNIITO named after P.P. Vredena, 2008 .-- p. 196-197].

The closest known device for fixing the patient during hip replacement to the claimed is the device according to the invention patent RU No. 2161942 of 11/03/1999, consisting of front legs that fix the pelvis, legs that fix these legs, the back legs that fix the pelvis, the guide plate connecting the hind legs to each other, and the mounting device and all its nodes are mutually perpendicular in three planes.

The prototype has the following disadvantages. The device excludes only the displacement of the patient's pelvis anteriorly and posteriorly, i.e. in the horizontal plane of the patient, while there is no fixation of the pelvis in the frontal plane of the patient and the pelvis is not rigidly fixed in the sagittal plane of the patient.

If the patient has scoliosis of any part of the spine, this device does not allow the pelvis to be fixed in the correct position, in which the bispinal line is perpendicular to the plane of the operating table, due to the fact that the bispinal line (axis O in Fig. 9) is not perpendicular to the axis of the spinal column and the pelvis of the patient is not fixed in the frontal plane of the patient (Fig.9).

Since the pelvis is not fixed in the frontal plane of the patient, if the patient has joint contracture, the position of the pelvis changes after it is removed, which does not allow you to accurately navigate the position of the pelvis during surgery [Guidelines for hip joint replacement. / Ed. P.M. Tikhilova, V.M. Shapovalova. - SPb .: RNIITO named after P.P. Vredena, 2008 .-- p. 196-197].

Thus, the main disadvantage of this device is the lack of rigid fixation of the pelvis in three planes, in connection with which there is the possibility of its displacement during surgery. The positioning of the acetabular component of the endoprosthesis - the angle of anteversion and inclination - is based on the correct orientation of the pelvis. If it is displaced during the operation or preoperative incorrect installation, incorrect orientation of the acetabular component of the endoprosthesis is possible, which leads to complications in the postoperative period and, in some cases, to repeated revision surgical interventions.

EFFECT: increased accuracy of laying and stiffness of fixing the patient on the operating table when performing the operation of total hip arthroplasty in the side position.

The inventive device for fixing the patient during hip replacement consists of two front legs (1), fixing the pelvis, located one below the other on the rack (2). Using the back foot (3), the chest is fixed. The front (1) and rear (2) legs can be moved along the uprights (3 and 4, respectively), and fixedly fixed to them.

The device contains two lower guides for fixing the wings of the ilium (NFKPK) (5) - the front and rear, each of which in the middle is motionlessly connected to the racks located perpendicular to it (6), to which are also attached two upper NFKPK (7) - the front and back.

At the same time, the front upper (7) and lower NFKPK (5) are located on one of their racks (6) under each other; the rear upper and lower NFKPK (7) are located on one of their racks (6) on each other.

The upper clamping strips for fixing the pelvis (ZPFT) (8), located on the front and rear upper rails (7) on both sides of the uprights (6), have the shape of a cylinder, made arcuate curved.

The lower ZPFT (9) located on the front and rear lower guides (5) on both sides of the uprights (6) are made in the form of a cylinder bent along the axis.

Two hind legs (10), which fix the pelvis, are located one below the other on the stand (11), the third front foot 12, which fixes the pelvis, is located on the stand (13).

All paws have fasteners that allow you to move along the axes or rigidly fixed to them. Mounts of all device nodes are mutually perpendicular in three planes.

The lower ZPFT (9) and the front and rear NFKPK (5) have a connection; the upper ZPFT (8) and the lower ZPFT (9) are located under each other.

The upper ZPFT (8) and the front and rear upper NFKPK (7) have a connection.

All mentioned racks are fixed at the edges of the operating table.

The components of the claimed device for positioning the femoral component of the hip joint prosthesis can be implemented as follows.

The hind foot (3), which fixes the chest, and the third front foot (12), which fixes the pelvis, are typical stops that are part of the orthopedic operating table.

The front (1) and rear (10) paws holding the pelvis are the same stops fixed on the respective posts (2) and (11) (see Fig. 5). The stand (2), fixing the front legs (1), and the stand (11), fixing the rear legs (10), are made with the possibility of telescopic extension and fixation in the required position using the stand lock (20).

The front and rear lower NFKPK (5), the strut (6), the front and rear upper NFKPK (7) are made in the form of a profile pipe of rectangular cross section, for example, of metal.

The upper FFT (8) and the lower FFT (9) planks are the same. They can be made in the form of a profile pipe of circular cross section, at the end of which there are clamps. On the upper ZPFT (8), it is possible to arrange brackets for holding instruments: retractors, mechanical navigators, electrocoagulators, and other general surgical instruments.

The latches (17), (18), (19), (20), (21) are made in the form of a bolt and a reciprocal thread in the corresponding component of the device. Fixation is carried out by mechanical clamping with a bolt of the corresponding component.

To fix the components of the device to the operating table (14), typical fixators for the operating table (14) are used, which are part of it. Fixation is carried out to the clamp of the operating table (16).

All components of the device can be made, for example, of medical steel, rubber pads can be additionally installed on the legs to contact the patient's skin.

Thus, the implementation of the inventive device for fixing the patient during hip joint arthroplasty is not in doubt, since typical constructions, parts and materials used in arthroplasty are used for its manufacture.

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

The patient is placed in a position on his side on the operating table (14) (see Fig. 7) so that the patient’s frontal plane is strictly perpendicular to the surface of the operating table (14), and the longitudinal axis of the body is parallel to the long side (15) of the operating table ( fourteen). This position is necessary for the correct positioning of the acetabular component of the endoprosthesis in the frontal and sagittal planes of the patient.

The hind foot (3), which fixes the chest located on the stand (4), is set so that it is in line with the hind legs (10), which fix the pelvis, located on the stand (11) (Fig. 1, 5, 8). The line on which they are located should be parallel to the long side (15) of the operating table (14).

The hind legs (10) fixing the pelvis are mounted on the upper hind ilium (22). The hind legs (10), fixing the pelvis, should be located strictly under each other in a vertical plane (a plane parallel to the XZ plane, see Fig. 7). Fixation of the hind (10) and front (1) paws that fix the pelvis is carried out using the tabs of the legs (19).

The front legs (1), fixing the pelvis, located on the rack (2), also set strictly under each other in a vertical plane (a plane parallel to the XZ plane, see Fig. 7).

The front paws (1) fixing the pelvis are mounted on the upper front iliac bones (24). Since the front (1) and hind (10) paws fixing the pelvis are located in a vertical plane, the bispinal line is also located in the same plane, therefore, the patient’s frontal plane is strictly perpendicular to the plane of the operating table (14).

The third front foot (12), which fixes the pelvis, is installed on the symphysis region, which improves the fixation of the pelvis, since the front of the pelvis is fixed at the points in the region of the upper anterior iliac spines and in the symphysis region (see Fig. 7, 8).

To exclude possible displacement of the pelvis in the patient’s frontal plane (XZ plane), the upper (8) and lower (9) clamping plates are displaced along the respective guides to the column (6), which fixes the guides until they fix the wings of the ilium (23) . In this position, they are fixed using the clamps of the upper clamping bars (18).

Upper (8) and lower (9) ZPFT made in the form of a cylinder bent along the axis, while their bend follows the contours of the wings of the ilium (23). The front and rear upper guides (7) are displaced down and along the uprights (6) until reliable fixation of the iliac wings (23) is ensured. In this position, they are fixed using the upper guide rails (17).

Elements of the proposed device are installed on the protruding bone landmarks: the ilium wing (23), the anterior (22) and posterior (23) ilium, which ensures reliable fixation of the pelvis.

Our design allows you to:

by introducing an additional third front foot (12), fixing the pelvis, to increase the stiffness of the fixation of the pelvis in the front-rear direction;

due to fixation of the pelvis in the patient’s frontal plane by the upper and lower ZPFT (8), (9), increase the accuracy of laying in the patient’s frontal plane and prevent possible pelvic displacements during surgery in this plane.

As a result, during the replacement of the hip joint, the installation accuracy of the acetabular component of the endoprosthesis is increased compared to the prototype.

In contrast to the design of the known device for fixing the patient during hip replacement, consisting of two front legs, fixing the pelvis, located one below the other on the stand, fixing the front legs, fixing the pelvis, with the possibility of moving along it and fixed fixing on it, the back leg , fixing the chest, located on the rack, fixing the hind paw, fixing the chest, with the possibility of moving along it and fixedly fixing on it, two additional the front and rear NFKPKs, each of which in the middle are motionlessly connected to the struts fixed perpendicular to them, fixing the NFKPK, two identical front and rear upper NFKPKs, each of which in the middle is movably connected to the racks fixed perpendicular to them, fixing the NFKPK, with the possibility of moving along them and fixed fixation on them, the upper ZPFT located on the front and rear upper rails on both sides of the struts fixing NFKPK, made in the form of a cylinder, curved along the axis , with the possibility of moving along the front and rear upper rails and fixed fixing on them, the lower FFTs are also introduced, located on the front and rear lower rails on both sides of the racks fixing the rails made in the form of a cylinder bent along the axis, with the possibility of moving along front and rear lower guides and fixed fixation on them, also introduced two hind legs, fixing the pelvis, located one below the other on the stand, fixing the hind legs, fixing the pelvis, with the ability to change length along it and fixed fixation on it, the third front foot fixing the pelvis, located on the stand fixing the third front foot fixing the pelvis, with the possibility of moving along it and fixed fixation on it, and the device and all its nodes are mutually perpendicular in three planes.

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

Description to drawings

FIG. 1 - Structural diagram of a device for fixing a patient during hip replacement:

1 - the front legs fixing the pelvis;

2 - the rack fixing the front legs;

3 - hind paw, fixing the chest;

4 - stand, fixing the back foot;

5 - front and rear lower NFKPK;

6 - a rack fixing NFKPK;

7 - front and rear upper NFKPK;

8 - upper clamping strips (ZPFT);

9 - lower clamping strips;

10 - hind legs, fixing the pelvis;

11 - stand, fixing the hind legs;

12 - the third front foot, fixing the pelvis;

13 - stand, fixing the third front foot;

14 - an operating table;

15 - the long side of the operating table;

16 - operating table lock.

FIG. 2 - The design of the racks, fixing the guides:

5 - front and rear lower guides;

6 - rack, fixing the guides.

FIG. 3 - The design of the upper rails:

7 - front and rear upper guides;

17 - the lock of the upper guide.

FIG. 4 - Clamping bar design:

8 - upper clamping strips;

18 - retainer of the upper clamping plate.

FIG. 5 - The design of the rack, fixing the front or rear legs, fixing the pelvis:

1 - front foot, fixing the pelvis;

2 - the rack fixing the front foot;

19 - latch paws, fixing the pelvis;

20 - stand lock, locking tabs.

FIG. 6 - The design of the rack, fixing the third front foot:

12 - the third front foot, fixing the pelvis;

13 - stand, fixing the third front foot;

21 - stand lock, fixing the third front foot.

FIG. 7 - Layout of the patient in a position on the side:

15 is the long side of the operating table.

FIG. 8 - Patient fixation pattern:

3 - hind paw, fixing the chest;

4 - stand, fixing the hind paw, fixing the chest;

5 - front and rear lower guides;

6 - rack, fixing the guides;

7 - front and rear upper guides;

8 - upper clamping strips;

9 - lower clamping strips;

10 - hind legs, fixing the pelvis;

11 - stand, fixing the hind legs, fixing the pelvis;

12 - the third front foot, fixing the pelvis;

13 - stand, fixing the third front foot, fixing the pelvis;

14 - an operating table;

16 - operating table lock;

22 - posterior superior ilium;

23 - the ilium wing;

24 - anterior superior iliac bone.

FIG. 9 - Scheme of the position of the pelvis in scoliosis:

O - bispinal line

Claims (1)

A device for fixing a patient during hip replacement, consisting of two front legs for fixing the pelvis with a stand, located with the possibility of movement and fixed fixation on one of its stances one under the other, the back foot for fixing the chest with a stand that is located with the possibility of moving and motionless fixation on its own stand, characterized in that two identical front and rear lower guides for fixing the iliac wings and two identical front ones are additionally introduced I and the rear upper guides for fixing the wings of the ilium, while the front upper and lower guides for fixing the wings of the ilium are located with the possibility of movement and fixed fixation on one of its racks one under the other, and the rear upper and lower guides for fixing the wings of the ilium with the possibility of movement and fixed fixation on one of its racks one under the other, the upper and lower clamping strips for fixing the pelvis have the shape of a cylinder, made arcuate -bent, while the lower clamping plates for fixing the pelvis are connected and have the ability to move and fixedly fix with the front and rear lower guides for fixing the wings of the ilium and are located on the outside of the racks that fix the front and rear lower guides for fixing the wings of the ilium lower clamping strips for fixing the pelvis are the upper clamping strips for fixing the pelvis, which are connected and have the ability to move and fixed fixation from the front and rear days upper guides for fixing the wings of the ilium and are located on the outside of the racks that fix the front and rear upper guides for fixing the wings of the ilium, two rear tabs for fixing the pelvis with the rack, which are located with the possibility of movement and fixed fixation on one of its racks each other another, the third front foot for fixing the pelvis with the stand, which is located with the possibility of movement and fixed fixation on its rack, all of the mentioned racks are fixed at the edges of the opera Discount table.

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