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WO2012093368A1 - Écarteur à usage chirurgical - Google Patents

Écarteur à usage chirurgical Download PDF

Info

Publication number
WO2012093368A1
WO2012093368A1 PCT/IB2012/050058 IB2012050058W WO2012093368A1 WO 2012093368 A1 WO2012093368 A1 WO 2012093368A1 IB 2012050058 W IB2012050058 W IB 2012050058W WO 2012093368 A1 WO2012093368 A1 WO 2012093368A1
Authority
WO
WIPO (PCT)
Prior art keywords
femur
acetabulum
retractor
arm
blade
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/IB2012/050058
Other languages
English (en)
Other versions
WO2012093368A4 (fr
Inventor
Ian Walter Dryden DYMOND
Graeme Francois Dryden DYMOND
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Individual
Original Assignee
Individual
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Individual filed Critical Individual
Publication of WO2012093368A1 publication Critical patent/WO2012093368A1/fr
Publication of WO2012093368A4 publication Critical patent/WO2012093368A4/fr
Priority to ZA2013/02635A priority Critical patent/ZA201302635B/en
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

Links

Classifications

    • 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
    • A61B17/025—Joint distractors
    • 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
    • A61B17/0206—Surgical instruments, devices or methods for holding wounds open, e.g. retractors; Tractors with antagonistic arms as supports for retractor elements
    • 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
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/72—Intramedullary devices, e.g. pins or nails
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8866—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices for gripping or pushing bones, e.g. approximators
    • 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
    • A61B17/025—Joint distractors
    • A61B2017/0275—Joint distractors for the hip

Definitions

  • the invention is in the field of medical devices, specifically those used for the retraction of tissue during surgical procedures.
  • the acetabulum of the hip joint shall be deemed to include the capsule and labrum of the hip joint.
  • a retractor for use in surgery wherein the retractor includes a first and a second arm in hinged arrangement, a blade for levering against tissue, wherein the blade is pivotably attachable to the first arm, positioning means for positioning the second arm relative tissue and wherein the actuation of the hinged arms permits linear displacement of an end of the blade relative the positioning means.
  • the positioning means may be in fixed arrangement relative the second arm thereby preventing rotation and translation of the second arm.
  • the positioning means may be in the form of a spike and/or a collar and/or a blade.
  • the second arm may be stationery.
  • At least one of the arms may be configured to receive auxiliary instrumentation.
  • the second arm may be configured to receive auxiliary instrumentation.
  • Auxiliary instrumentation may include any one or more of the group including a further retractor and/or a device to measure the force of retraction and/or a lighting means.
  • the pivotable attachment of the blade on the first arm may allow for rotation without translation, thereby diffusing and reducing the retraction force exerted on the tissue.
  • the hinged arrangement may allow for sliding and translation, thereby allowing for displacement of the first arm relative the stationery second arm whilst optimising the linear displacement relative the angle of rotation of the hinged arrangement.
  • a retractor for use in hip surgery wherein the retractor includes a first and a second arm in hinged arrangement, a blade for levering against at least a part of the acetabulum of the hip socket, wherein the blade is attachable to the first arm, a femur spike receivable by the femur shaft, post amputation of the femur head, wherein the femur spike is attachable to the second arm and wherein the actuation of the hinged arms permits displacement of the long axis of the femur relative the acetabulum and simultaneous displacement of the joint capsule, thereby facilitating exposure of the acetabulum.
  • the hinged arrangement may be an expansile hinged arrangement.
  • the blade may be levered against the capsule of the acetabulum.
  • the blade may be L-shaped and may include at least one row of angled teeth for assisting in maintaining the blade's position relative the acetabular tissue.
  • the blade may be pivotally mounted on the first arm.
  • the mounting means may include any one or more of the group including nuts and bolts; pins; dowel pins; screws and the like.
  • the mounting means may include a pin and socket arrangement.
  • the femur spike may be pivotally mounted on the second arm by way of mounting means.
  • the femur spike may be mounted in fixed, immobile arrangement on the second arm by way of mounting means.
  • the mounting means may include any one or more of the group including nuts and bolts; pins; dowel pins; screws and the like.
  • the mounting means may include a pin and socket arrangement.
  • the hinged arms may be actuated by means of a screw configured to increase an angle of rotation between the arms, thereby permitting the displacement of the long axis of the femur relative the acetabulum and the simultaneous displacement of the joint capsule for facilitation of the exposure of the acetabulum.
  • the screw may permit controlled actuation of the hinged arms.
  • At least one of the arms may be configured to receive auxiliary instrumentation.
  • the second arm may be configured to receive a further retractor for assisting with the exposure of the acetabulum.
  • the further retractor may be a Homman retractor.
  • a retractor for use in hip surgery wherein the retractor includes a first and a second arm in hinged arrangement, a blade for levering against at least a part of the acetabulum of the hip socket, wherein the blade is attachable to the first arm, a femur spike receivable by the femur shaft, post amputation of the femur head, wherein the femur spike is attachable to the second arm and wherein the actuation of the hinged arms permits posterior displacement of the long axis of the femur relative the acetabulum and simultaneous anterior elevation of the joint capsule, thereby facilitating exposure of the acetabulum.
  • the hinged arrangement may be an expansile hinged arrangement.
  • the blade may be levered against the capsule of the acetabulum.
  • the blade may be L-shaped and may include at least one row of angled teeth for assisting in maintaining the blade's position relative the acetabular tissue.
  • the blade may be pivotally mounted on the first arm.
  • the mounting means may include any one or more of the group including nuts and bolts; pins; dowel pins; screws and the like.
  • the mounting means may include a pin and socket arrangement.
  • the femur spike may be pivotally mounted on the second arm by way of mounting means.
  • the femur spike may be mounted in fixed, immobile arrangement on the second arm by way of mounting means.
  • the mounting means may include any one or more of the group including nuts and bolts; pins; dowel pins; screws and the like.
  • the mounting means may include a pin and socket arrangement.
  • the hinged arms may be actuated by means of a screw configured to increase an angle of rotation between the arms, thereby permitting the displacement of the long axis of the femur relative the acetabulum and the simultaneous displacement of the joint capsule for facilitation of the exposure of the acetabulum.
  • the screw may permit controlled actuation of the hinged arms.
  • the second arm may be configured to receive a further retractor for assisting with the exposure of the acetabulum.
  • the further retractor may be a Homman retractor.
  • a method of exposing the acetabulum of the hip joint that includes the steps of:
  • the method of exposing the acetabulum of the hip joint may include inserting a further retractor shaped and dimensioned to elevate the tissue of the hip joint, which may include knocking at least a part of the retractor into the side wall of the pelvis and locating the retractor in one of the hinged arms.
  • a method of replacing a hip joint including the steps of:
  • a further retractor shaped and dimensioned to elevate the tissue of the hip joint which may include knocking at least a part of the retractor into the side wall of the pelvis and locating the retractor in one of the hinged arms;
  • a method of replacing a hip joint including the steps of:
  • a further retractor shaped and dimensioned to elevate the tissue of the hip joint which may include knocking at least a part of the retractor into the side wall of the pelvis and locating the retractor in one of the hinged arms;
  • Figure 1 is a plan view of retractor
  • Figure 2 is a representation of a side view of the retractor
  • Figure 3 is a further view of the retractor
  • Figure 4 -10 are representations of the surgical approach
  • Figure 1 1 is a drawing showing the exposure of the greater trochanter of the femur
  • Figure 12 shows the dislocation of the hip joint
  • Figure 13 and 14 is a representation of the osteotomy of the femur head and removal respectively;
  • Figures 15(A) and (B) depict the insertion and positioning of the blade of the retractor
  • Figure 16 is a drawing of the insertion of the spike into the femur shaft
  • Figure 17 depicts the attachment of the blade to the arm of the retractor
  • Figure 18 depicts the initial retraction where stretch of the joint capsule is obtained
  • Figure 19 depicts further retraction facilitating exposure of the acetabulum
  • Figure 20 (A) - (D) are representations of the placement of the hip joint prosthesis
  • Figure 21 (A) and (B) are drawings of the surgical closure of the wound
  • Figure 22 is a drawing showing the directional vectors of the forces applied by the retractor on the hip joint and surrounding tissue;
  • Figure 23 is a representation of the mechanical principle of an aspect of the invention disclosed herein.
  • FIG. 24A and Figure 24B showing a further embodiment of the invention.
  • a retractor 10 for use in hip surgery having a first arm 12 and a second arm 14 in hinged arrangement.
  • the femur spike 22 can be replaced with any one or more of the group including a blade (not shown) and/or a collar 60.
  • the blade 16 is L-shaped, pivotally mounted by means of a pin and socket arrangement 40 on the first arm 12.
  • the blade 16 includes rows of angled teeth 38 for assisting in maintaining the blade's position relative the joint capsule 36.
  • the femur spike 22 is pivotally mounted, by way of pin and socket arrangement 42 on the second arm 14.
  • the hinged arms 12 and 14 are actuated 26 by means of a screw 44 configured to increase an angle of rotation 46 between the arms 12 and 14, thereby permitting the posterior displacement 28 of the long axis 30 of the femur 32 relative the acetabulum 18 and the simultaneous anterior elevation 34 of the joint capsule 36, thereby facilitating exposure of the acetabulum 18.
  • the screw 44 permits controlled actuation 26 of the hinged arms 12 and 14.
  • the second arm 14 is configured to receive a Homman retractor 48 for assisting with the exposure of the acetabulum 18.
  • Auxiliary instrumentation (not shown) can be attachable to the retractor, the auxiliary instrumentation including a further retractor and/or a device to measure the force of retraction and/or a lighting means.
  • Figures 15 - 19 depicts a method of exposing the acetabulum of the hip joint that includes the steps of inserting a blade 16 into the empty acetabulum 18 of a hip socket 20 (Figure 15A), adjusting the blade 16 relative the acetabulum 18 that the blade 16 lies centrally the acetabulum 18, approximately 10mm from the acetabular rim ( Figure 15B).
  • a femur spike 22 mounted on an arm 14 of a pair of hinged arms 12 and 14 is inserted into the cancellous bone 50 of the femur shaft 24, the femur spike 22 directed towards the lateral cortex 52 of the femur shaft 24 (Figure 16).
  • the blade 16 is then attached to the other arm 12 of the hinged arm pair 12 and 14 ( Figure 16).
  • a Homman retractor 48 is inserted to elevate the tissue of the hip joint and is located on the arm 14.
  • Figures 4 to 21 illustrate a method of replacing a hip joint, the method including the steps of gaining access to the hip joint through an oblique anterior lateral approach, thereby exposing the hip joint through the abductor muscles of the lower limb ( Figures 4 to 1 1 ), dislocating the hip joint ( Figure 12), performing an osteotomy of the femur head and removing same ( Figure 13 and 14).
  • a blade 16 is inserted relative the empty acetabulum 18 of a hip socket 20 ( Figure 15A), adjusting the blade 16, that the blade 16 lies centrally the acetabulum 18, approximately 10mm from the acetabular rim ( Figure 15B).
  • a femur spike 22 mounted on an arm 14 of a pair of hinged arms 12 and 14 is inserted into the cancellous bone 50 of the femur shaft 24, the femur spike 22 directed towards the lateral cortex 52 of the femur shaft 24 ( Figure 16).
  • the blade 16 is attached to the other arm 12 of the hinged arm pair 12 and 14 ( Figure 16).
  • Increasing the angle of rotation 46 between the hinged arms 12 and 14, stretches the joint capsule 36 and facilitates posterior displacement 28 of the femur 32 whilst elevating the capsule anteriorly 34 for visualisation of the acetabulum 18 ( Figures 17 and 18).
  • Figures 20A-D and Figures 21 A and B depict the reaming the acetabulum, broaching the femur shaft, inserting the prosthetic femur head into the shaft of the femur, relocating the femur head in the acetabulum and the surgical closing the wound.

Landscapes

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

Abstract

Ecarteur à usage chirurgical comprenant un premier et un second bras dans une relation articulée, une lame pour faire levier contre un tissu, ladite lame pouvant être fixée pivotante sur le premier bras, un moyen de positionnement pour positionner le second bras par rapport au tissu, l'actionnement des bras articulés permettant le déplacement linéaire d'une extrémité de la lame par rapport au moyen de positionnement. Le moyen de positionnement peut comprendre une pointe destinée à être insérée dans l'os spongieux de l'axe proximal d'un fémur après une ostéotomie de la tête fémorale au cours d'une chirurgie de remplacement de hanche.
PCT/IB2012/050058 2011-01-06 2012-01-05 Écarteur à usage chirurgical Ceased WO2012093368A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
ZA2013/02635A ZA201302635B (en) 2011-01-06 2013-04-12 A retractor for use in surgery

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
ZA201100153 2011-01-06
ZA2011/00153 2011-01-06

Publications (2)

Publication Number Publication Date
WO2012093368A1 true WO2012093368A1 (fr) 2012-07-12
WO2012093368A4 WO2012093368A4 (fr) 2012-10-11

Family

ID=46457277

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/IB2012/050058 Ceased WO2012093368A1 (fr) 2011-01-06 2012-01-05 Écarteur à usage chirurgical

Country Status (2)

Country Link
WO (1) WO2012093368A1 (fr)
ZA (1) ZA201302635B (fr)

Cited By (10)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8900137B1 (en) 2011-04-26 2014-12-02 Nuvasive, Inc. Cervical retractor
US8974381B1 (en) 2011-04-26 2015-03-10 Nuvasive, Inc. Cervical retractor
US9066701B1 (en) 2012-02-06 2015-06-30 Nuvasive, Inc. Systems and methods for performing neurophysiologic monitoring during spine surgery
US9113853B1 (en) 2011-08-31 2015-08-25 Nuvasive, Inc. Systems and methods for performing spine surgery
US9486133B2 (en) 2010-08-23 2016-11-08 Nuvasive, Inc. Surgical access system and related methods
US9655505B1 (en) 2012-02-06 2017-05-23 Nuvasive, Inc. Systems and methods for performing neurophysiologic monitoring during spine surgery
US9757067B1 (en) 2012-11-09 2017-09-12 Nuvasive, Inc. Systems and methods for performing neurophysiologic monitoring during spine surgery
US9795367B1 (en) 2003-10-17 2017-10-24 Nuvasive, Inc. Surgical access system and related methods
CN113017943A (zh) * 2021-03-17 2021-06-25 山东大学齐鲁医院(青岛) 一种髋臼位置变化量测量装置
US11793504B2 (en) 2011-08-19 2023-10-24 Nuvasive, Inc. Surgical retractor system and methods of use

Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4995875A (en) * 1988-05-27 1991-02-26 Cecil Coes Femoral elevating tool
US5931777A (en) * 1998-03-11 1999-08-03 Sava; Gerard A. Tissue retractor and method for use
US6042540A (en) * 1997-08-18 2000-03-28 Pacific Surgical Innovations, Inc. Side-loading surgical retractor
US6309349B1 (en) * 1996-04-10 2001-10-30 Endoscopic Technologies, Inc. Surgical retractor and stabilizing device and method for use
US20030055319A1 (en) * 2001-09-14 2003-03-20 David Chang Surgical retractor
WO2007149122A2 (fr) * 2006-06-21 2007-12-27 Geller Peter L Nouveau rétracteur pour chirurgie herniaire
US20100023016A1 (en) * 2008-07-24 2010-01-28 Gary Botimer Tools and methods for orthopedic surgery
US20120046527A1 (en) * 2010-03-11 2012-02-23 Jason Cianfrani Tissue Retractor and Method of Use

Patent Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4995875A (en) * 1988-05-27 1991-02-26 Cecil Coes Femoral elevating tool
US6309349B1 (en) * 1996-04-10 2001-10-30 Endoscopic Technologies, Inc. Surgical retractor and stabilizing device and method for use
US6042540A (en) * 1997-08-18 2000-03-28 Pacific Surgical Innovations, Inc. Side-loading surgical retractor
US5931777A (en) * 1998-03-11 1999-08-03 Sava; Gerard A. Tissue retractor and method for use
US20030055319A1 (en) * 2001-09-14 2003-03-20 David Chang Surgical retractor
WO2007149122A2 (fr) * 2006-06-21 2007-12-27 Geller Peter L Nouveau rétracteur pour chirurgie herniaire
US20100023016A1 (en) * 2008-07-24 2010-01-28 Gary Botimer Tools and methods for orthopedic surgery
US20120046527A1 (en) * 2010-03-11 2012-02-23 Jason Cianfrani Tissue Retractor and Method of Use

Cited By (24)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US9795367B1 (en) 2003-10-17 2017-10-24 Nuvasive, Inc. Surgical access system and related methods
US11457907B2 (en) 2010-08-23 2022-10-04 Nuvasive, Inc. Surgical access system and related methods
US9924859B2 (en) 2010-08-23 2018-03-27 Nuvasive, Inc. Surgical access system and related methods
US12426866B2 (en) 2010-08-23 2025-09-30 Nuvasive, Inc. Surgical access system and related methods
US10980525B2 (en) 2010-08-23 2021-04-20 Nuvasive, Inc. Surgical access system and related methods
US9486133B2 (en) 2010-08-23 2016-11-08 Nuvasive, Inc. Surgical access system and related methods
US10172515B2 (en) 2010-08-23 2019-01-08 Nuvasive, Inc. Surgical access system and related methods
US8974381B1 (en) 2011-04-26 2015-03-10 Nuvasive, Inc. Cervical retractor
US8900137B1 (en) 2011-04-26 2014-12-02 Nuvasive, Inc. Cervical retractor
US12256916B2 (en) 2011-08-19 2025-03-25 Nuvasive, Inc. Surgical retractor system and methods of use
US11793504B2 (en) 2011-08-19 2023-10-24 Nuvasive, Inc. Surgical retractor system and methods of use
US9113853B1 (en) 2011-08-31 2015-08-25 Nuvasive, Inc. Systems and methods for performing spine surgery
USD814028S1 (en) 2011-08-31 2018-03-27 Nuvasive, Inc. Retractor blade
USD789530S1 (en) 2011-08-31 2017-06-13 Nuvasive, Inc. Retractor blade
US9649099B1 (en) 2011-08-31 2017-05-16 Nuvasive, Inc. Systems and methods for performing spine surgery
US9386971B1 (en) 2011-08-31 2016-07-12 Nuvasive, Inc. Systems and methods for performing spine surgery
US10980527B2 (en) 2011-08-31 2021-04-20 Nuvasive, Inc. Systems and methods for performing spine surgery
US10098625B2 (en) 2011-08-31 2018-10-16 Nuvasive, Inc. Systems and methods for performing spine surgery
US11969162B2 (en) 2011-08-31 2024-04-30 Nuvasive, Inc. Systems and methods for performing spine surgery
US9066701B1 (en) 2012-02-06 2015-06-30 Nuvasive, Inc. Systems and methods for performing neurophysiologic monitoring during spine surgery
US9655505B1 (en) 2012-02-06 2017-05-23 Nuvasive, Inc. Systems and methods for performing neurophysiologic monitoring during spine surgery
US9757067B1 (en) 2012-11-09 2017-09-12 Nuvasive, Inc. Systems and methods for performing neurophysiologic monitoring during spine surgery
CN113017943B (zh) * 2021-03-17 2024-01-09 山东大学齐鲁医院(青岛) 一种髋臼位置变化量测量装置
CN113017943A (zh) * 2021-03-17 2021-06-25 山东大学齐鲁医院(青岛) 一种髋臼位置变化量测量装置

Also Published As

Publication number Publication date
WO2012093368A4 (fr) 2012-10-11
ZA201302635B (en) 2014-04-30

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