Modular Device for Positioning and Immobilisation of a Patient's Body for Surgical Operations and Corresponding Operating Table

Field of the Invention

The invention relates to a modular device for positioning and immo- bilisation of a patient's body for surgical operations and a corresponding operating table equipped with such a modular device. In particular, the invention relates to a modular device for positioning and immobilisation of a patient's body and a corresponding operating table for carrying out minimally invasive surgical interventions on the pelvis and/or limbs of a patient, such as hip joint operations.

Background Art

Used in a known way during operations on the limbs of the skeleton (such as operations on the hip joint) is a traction device for alignment of bones or extension of joints. With this existing technology, only one single movement, which has to be defined before the operation with respect to direction and angle, is possible during the operation. In addition, as no unsterile parts may be touched by the operating surgeon during the operation, on the one hand, and unsterile persons may not come into the vicinity of the operating area on the other hand, it is necessary that control elements for basic setting of the traction device, although well accessible, are positioned in the vicinity of the respective functional component.

Control elements, which are supposed to be manipulated during the operation, must however be positioned sufficiently far away from the operatio- nal field. On the other hand, the whole system should require as little space as possible in the operating room in order to ensure good access to the patient and to other installations at any time.

In principle, two systems are currently known and used for solving this problem: telescopic traction devices, on the one hand, in which the control

elements are located for the most part in the vicinity of the operating field, and designs with long supports, on the other hand, where the traction device can be shifted and which in many cases require a support floor-side.

In addition, with all systems, it must be possible to achieve a posi- tioning and an immobilisation of the patient's body, desired by the operating surgeon, without limiting the access of the operating surgeon or other installations, in particular image intensifying or image making devices (such as X-ray apparatus or other similar devices), to the required portions of the patient's body. In particular during operations on the pelvis, unobstructed access to the patient's body by X-ray apparatus at all times is of the utmost importance.

New operating techniques on the limbs, especially for hip joint operations, make it necessary for the traction apparatus to be able to be adjusted by personnel inside and outside the operating field in all degrees of freedom, even during the operative intervention. Also for economic reasons, the aim is to be able to use a single device for positioning and immobilisation of the patient's body for all disciplines and for the different schools of orthopaedics and traumatology.

Disclosure of Invention

Thus the object of this invention is to propose a new and improved device for positioning and immobilisation of a patient's body which does not have the above-mentioned drawbacks of the prior art and which satisfies the requirements of the new, minimally invasive, operating techniques.

According to the present invention, these and other objects are achieved in particular through the features of the independent claims. In addition, further advantageous embodiments follow from the dependent claims and the description.

In particular, the object of the invention is achieved through a modular device for positioning and immobilisation of a patient's body for surgical op-

erations comprising a first supporting means for supporting the patient's pelvis and at least one second supporting means with a foot tether-connecting means for immobilisation and positioning of a patient's leg, whereby the at least one second supporting means is pivotable in the horizontal and/or in the vertical plane with respect to the first supporting means. The advantage of such a modular device is, among other things, that the patient's legs (but potentially also arms with a corresponding adapted device) can be easily positioned and immobilised for surgical operations. Moreover, the positioning can be performed not only prior to the operation, but also during the operation in an easy way, also by non-sterile persons. Such a modular device makes it thus possible to perform a broad spectrum of different kinds of operations, including the minimally invasive surgical operations on the hip and/or pelvis of a patient.

In an embodiment variant, the pivoting angle of the at least one second supporting means in the horizontal plane is at least 180°. The particular advantage of this embodiment is, among other things, that the second supporting means can be pivoted basically in any defined position, and also moved completely out of the operating field, if necessary. In particular for the minimally invasive operation techniques, it is necessary to allow a very important horizontal displacement of the patient's legs at any time without complicated manipulations.

In another embodiment variant, the pivoting angle of the at least one second supporting means in the vertical plane is between 20° above the horizontal plane and 55° beyond the horizontal plane. This embodiment variant has the particular advantage, among other things, that the freedom of move- ment of the second supporting means can be improved even further. As already indicated in the case of horizontal pivoting, the minimally invasive operation techniques on the limbs and/or pelvis of the patient often require an important displacement of the patient's limbs during the operation. This particular embodiment of the invention thus also allows the carrying out of very demand- ing and challenging surgical operations.

In another embodiment variant, the at least one second supporting means comprises a control means for controlling the pivoting of the second

supporting means. This embodiment variant has the particular advantage, among other things, that the pivoting of the second supporting means can be easily controlled at any time. This control means for controlling the pivoting of the second supporting means can in particular comprise one or more retaining means which are capable of reliably retaining the second supporting means in the current position, when the second supporting means is to be pivoted. This aspect of this particular embodiment of the present invention is of high importance, as the second supporting means is carrying not only its own weight, but also the weight of a portion of the patient's body during the surgical interven- tion. Thus, it is of utmost importance to have means which allow an easy pivoting of the second supporting means.

In a further embodiment variant, the at least one second supporting means comprises a telescopic arm and a length adjusting means, whereby the length of said at least one second supporting means is adjustable through the actuation of said telescopic arm by means of said length adjusting means. The advantage of this embodiment is, inter alia, that the second supporting means can easily be adapted to consistently position and immobilise the leg of any given patient. As different people can have legs of very different lengths, it is very important for the correct immobilisation that the overall length of the sec- ond supporting means can be adjusted to fit the given length of the leg. This optimal adjustment to the given length of the patient's leg is a further improvement of the common devices, and enables the carrying out of even the most complex operating techniques in an easy way.

In a further embodiment variant, the foot tether connecting means is pivotable and/or rotatable in the horizontal and/or in the vertical plane with respect to the second supporting means. The advantage of this embodiment is, among other things, that the foot of the patient, which has to be immobilised during the surgical operation, can also be moved in different directions during the operation itself. Thus, even more complex operating techniques can easily be carried out using this particular embodiment of the present invention.

In another embodiment variant, the foot tether connecting means comprises at least one position controlling means for adjusting the position of

the foot tether connecting means with respect to the at least one second supporting means. This embodiment variant has the particular advantage, among other things, that a higher flexibility can be attained in positioning and immobilisation of the patient's limbs. As the foot tether connecting means can be dis- placed, the modular device according to this particular embodiment of the invention allows for an optimal hold of the foot and thus for optimal results during surgical operations requiring continuous and repeated displacements of the limbs.

In still another embodiment variant, the device comprises a third supporting means for positioning of the patient's hip. The advantage of this embodiment is, inter alia, that the patient's hip can be reliably supported and positioned before and during the surgical operations. When the legs must be displaced in different directions, as in the minimally invasive operational techniques on the pelvis, it is important to guarantee a solid support for the hip at all times. In some embodiments, these third supporting means for positioning of the patient's hips can comprise a fastening means for fastening the patient's body and keeping the required position even in the event of very large displacements of the legs. Moreover, the minimally invasive operating techniques on the hip joint may require the displacement of the hips during the operation itself. This displacement can easily be achieved by means of this third support means.

In a further embodiment variant, the third supporting means comprises a hip support cushion and a controlling means for controlling the position of the hip support cushion with respect to the first supporting means. This em- bodiment variant has the particular advantage, among other things, that these third supporting means fulfil two functions at the same time, namely providing a soft support for the patient's body, on the one hand, so as not to cause any grazing, compressions or similar wounds, and, on the other hand, enabling an easy displacement of the hip, during the surgical operation, by personnel lo- cated outside the operating area.

In another embodiment variant, the at least one second supporting means is connected to the first supporting means by means of a pivotable con-

nection arm. The particular advantage of this embodiment is, inter alia, that the second supporting means can be pivoted in an even easier way. The combination of the two pivotal movements can make the positioning of the second supporting means even more flexible.

In still another embodiment variant, the at least one second supporting means comprises a locking means for locking the second supporting means in position. This locking means can in particular comprise a lever structure or another similar element which can reliably lock the second supporting means in a given position. This embodiment variant has the particular advantage, among other things, that the second supporting means (and the patient's leg supported by this second supporting means) can be reliably locked in a required position, once this position is reached by pivoting of the second supporting means. Since, during the surgical operation, the leg sometimes has to sustain great force, it is very important to be able to guarantee a fixed and solid support of the leg at any time.

In a further embodiment variant, the modular device comprises at least one fourth supporting means for stationary support of the patient's hip. This embodiment variant has the particular advantage, among other things, that the patient's hip can also be supported in a stationary way if no displacement of the hip is required during the surgical operation. This can in particular be the case for the pelvis operations or operations on any other portion of the patient's body, or even when carrying out common operation techniques on the limbs of the patient.

In another embodiment variant, the modular device comprises a fifth supporting means for stationary support of a patient's leg. The advantage of this embodiment is, among other things, that the modular device according to this embodiment can equally be used for carrying out surgical operations on the limbs of a patient or on another part of the patient's body in which no displacement of the patient's legs are necessary. In this case, the modular device can also be used in a completely stationary way, without any pivoting of its constituent parts.

In yet another embodiment variant, the modular device is at least partially composed of a radiotranslucent material. This embodiment variant has the particular advantage, inter alia, that the modular device according to this particular embodiment of the invention can be used in surgical operations which require making radiographs during the operation. Parts of the patient's body can already be rendered accessible to the X-ray or similar apparatus by the pivoting of the second supporting means and/or displacement of the third supporting means. However, the use of a radiotranslucent material can facilitate even more the use of such image-making devices during complex surgical operations.

At this point, it should be stated that, besides the modular device for positioning and immobilisation of a patient's body for surgical operations according to the particular embodiments of the invention, the present invention also relates to an operating table comprising a modular device according to the particular embodiments of the present invention.

Brief Description of Drawings

The present invention will be explained in more detail, by way of example, with reference to the drawings in which:

Figure 1 is a perspectival representation of a modular device for positioning and immobilisation of a patient's body for surgical operations according to an embodiment of the present invention;

Figure 2 is a perspectival representation of an operating table comprising a modular device for positioning and immobilisation of a patient's body for surgical operations according to an embodiment of the present invention;

Figure 3 is a perspectival representation of the operating table of Figure 2 in one possible position during an operation on the hip of a patient;

Figure 4 is a view from above of the operating table of Figure 3;

Figure 5 is a perspectival representation of the first supporting means in the modular device for positioning and immobilisation of a patient's body for surgical operations according to an embodiment of the present invention;

Figure 6 is a perspectival representation of a second supporting means in the modular device for positioning and immobilisation of a patient's body for surgical operations according to an embodiment of the present invention;

Figure 7 is an enlarged view from above of the end portion of the second supporting means of Figure 6, comprising a control means for controlling the pivoting of the second supporting means and a length-adjusting means for adjusting the length of the second supporting means;

Figure 8 is a perspectival representation of the foot tether- connecting means in the modular device for positioning and immobilisation of a patient's body for surgical operations according to an embodiment of the present invention;

Figure 9 is a perspectival representation of the fourth supporting means in the modular device for positioning and immobilisation of a patient's body for surgical operations according to an embodiment of the present inven- tion;

Figure 10 is a perspectival representation of the fifth supporting means in the modular device for positioning and immobilisation of a patient's body for surgical operations according to an embodiment of the present invention;

Figure 11 is a perspectival representation of the third support means in the modular device for positioning and immobilisation of a patient's body for surgical operations according to an embodiment of the present invention.

Description of Specific Embodiments of the Invention

Figure 1 illustrates a modular device 10 for positioning and immobilisation of a patient's body for surgical operations according to an embodiment of the present invention. In Figure 1 , the reference numeral 20 refers to a first supporting means, which can be used for positioning of the patient's pelvis before, during and after the surgical operation. The modular device 10 is designed in particular such that it can be mounted on operating tables provided therefor (as will be illustrated in Figure 2) or also on conventional operating tables. For this purpose, the operating table and the first supporting means 20 can be provided with corresponding connecting means (not shown). The first supporting means 20 can in particular also comprise a counter-traction holder 25 which can hold the patient's body in a given position when one or both legs, or the hip of the patient are displaced during the surgical operation. The structure of a first supporting means 20 of the modular device 10 according to a par- ticular embodiment of the present invention will be described in more detail below, with respect to Figure 5.

The reference numeral 30 in Figure 1 refers to second supporting means which can position and immobilise the legs of the patient before and during the surgical operation. The second supporting means 30 can in parti- cular be designed and installed in such a way that they are telescopic systems which can be managed without any additional support and on which all control elements are installed outside the operating field. The structure of a first supporting means 30 of the modular device 10 according to a particular embodiment of the present invention will be described in more detail below, with re- spect to Figure 6.

The third, fourth and a fifth supporting means are represented in Figure 1 by the reference numerals 60, 70 and 40, respectively. The third supporting means 60 support the hip of the patient when it has to be displaced (in particular with respect to height) during the operation. The fourth supporting means 70, on the other hand, support the hips of the patient in a stationary way, and this way make possible the creation of a closed lying surface for the patient, in collaboration with the first supporting means 20. The fifth supporting

means 40 serve the stationary positioning of the legs of the patient before or during the surgical operation, when the operating surgeon thinks it necessary. The structure of the third 60, fourth 70 and fifth supporting means 40 of the modular device 10 according to a particular embodiment of the present inven- tion will be described in more detail below, with respect to Figures 9, 10 and 11.

Finally, the reference numeral 50 in Figure 1 refers to two foot tether- connecting means. It is perfectly clear for any person skilled in the art, however, that the modular device 10 according to the invention can also have only one single foot tether-connection means, if necessary. The foot tether- connection means are each mounted on a second supporting means 30, and thus allow, in connection with the respective second supporting means 30, a correct positioning and immobilisation of the patient's foot during the operation. Figure 8 illustrates in detail the structure of the foot tether-connecting means 50.

Figure 2 shows in a schematic way an operating table 100 which is equipped with a modular device 10 according to an embodiment of the invention shown in Figure 1. For this purpose, the operating table 100 is provided with connecting means (not shown) for attaching and mounting the modular device 10 to the operating table 100 in a removable way. These connecting means are designed and placed in such a way as to allow an easy and stable connection of the modular device 10 to the table 100. Any common operating table can, in principle, be equipped with the corresponding connecting means in order to be used in combination with the modular device 10 according to the invention.

The reference number 110 in Figure 2 refers to a base plate by means of which the operating table 100 is placed on the floor, a central supporting means 120 for connecting the base plate with a lying down area 130, on which the patient can lie down during the surgical operation. The lying down area 130 can in particular be supplemented by the first, fourth and/or fifth supporting means of the modular device 10. Moreover, the lying down area 130 can be composed of various movable segments, such that an optimal position-

ing of the patient's torso can be guaranteed at any time. The central supporting means 120 can in particular have a height adjusting module (not shown) for adjusting the height of the lying down area 130 with respect to the base plate 110.

Figure 3 shows the operating table 110 in one possible position during an operation on the hip of a patient. The elements which were described with respect to Figures 1 and 2 are referred to with the same reference numerals. The identical configuration of the operating table 110 in a view from above is represented in Figure 4. The following description relates therefore to both Figures.

The modular device 10 has been mounted on the operating table 100 in Figure 3. The fourth supporting means and the fifth supporting means of the modular device 10 have been removed, as they are not required for this type of operation. It is however clear to any person skilled in the art that the fourth and fifth supporting devices can be used again, if required by the operation. The third supporting means 60 for dynamic positioning of the hip of the patient has been mounted on the first supporting means 20 on one side of the first supporting means 20, instead of the fourth supporting means 70 for static positioning of the patient's hip by means of the hold point 27. By means of the control means 61 and the force transmission 62, the hip support cushion 65 has been moved into a position required by the operation. Moreover, the connection arm 21 on the same side of the first supporting means 20 has been pivoted towards the vertical midplane of the modular device 10 in order to position the corresponding second supporting means 30 in the required position. Moreover, this second supporting means 30 has been pivoted around the pivoting joint 32 with respect to the vertical plane in the direction towards the floor. Finally, the other second supporting means 30 has been extended by means of the length adjusting means 31 , as the telescopic arm 35 of this second supporting means 30 has been pulled out. This configuration of the modular device 10 allows for an easy operation of the hip joint according to a minimally invasive operation technique.

Figure 5 shows the first supporting means 20 of the modular device 10 for positioning and immobilisation of a patient's body for surgical operations according to an embodiment of the invention. The first supporting means 20 takes basically the form of a base plate 25 with a cushion 23 positioned on top of it. The cushion 23 can in particular be disposed on the base plate 25 in a removable way. Installed below and mounted to the base plate 25 are two connection arms 21 , which can be pivoted around their fixing point by a 360° angle. Each connection arm 21 is connected to a connection means 22 for connecting the second supporting means to the connecting arm 21 and, there- fore, to the first supporting means 20.

The connection between the connecting arm 21 and the connection means 22 is achieved by means of an articulation or joint 24 which allows pivoting by an angle of 360° around the middle axis. Each articulation 24 can be locked in a play-free way with a toothed wheel locking device or another similar device. This locking unit of the articulation 24 is designed such that the respective weights of the connection arms 21 , second supporting means 30 and of the patient's legs do not have to be lifted at any time. To this end, a particular locking and holding means are provided (not shown). The pivotable connection arms 21 , among other things, make it possible for the user to position all non-radiotranslucent parts of the device 10 outside the later necessary X- ray passage before or even during the surgical operation. Placed on the sides of the base plate 25 are the hold points 27 for the fourth and fifth supporting means (not shown). Thus it is possible, with the cushion 23 placed on, to pivot the connecting arms 21 with the connected second supporting devices 30 freely. Moreover, integrated in the base plate 21 is a receiving element 26 for the counter-traction holder 25 for holding the patient's body in position when displacing the legs.

The second supporting means 30 according to one embodiment of the present invention is illustrated in detail in Figure 6. The second supporting means 30 consists essentially of a traction beam 33 with a connecting joint 32 which allows for the pivoting of the second supporting means 30 in horizontal and/or vertical plane. The traction beam 33 contains a telescopic arm 35 which can be controlled by means of the length adjusting means 31. The foot tether-

connection means 50 is mounted on the end portion of the second supporting means 30.

The second supporting means 30 is able to be adjusted in length by means of the length control means 31 , and thus allows an easy adaptation to the body height of the patient. In addition, both traction force and compressive force can be exerted in this way on parts of the patient (in particular on the legs) during certain operations. If, for reasons of change of traction direction or of repositioning of the patient, the vertical angle of the traction beam 33 has to be changed, this can be done in a continuously adjustable way from 20° over the plane of the lying surface of the operating table 100 to 55° under this plane by releasing the vertical immobilization of the second supporting means 30 by means of actuation of the corresponding locking means 31 ", which is shown in detail in Figure 7. Horizontally, the second supporting means 30 is able to pivot by 90° to the left and right in each case, when the corresponding locking means 31 ' is actuated. In addition, the locking means 31 ' can be brought into a position which allows the horizontal immobilization to be kept released, so that the second supporting device is freely movable in this plane.

A foot tether- connecting means 50 according to a particular embodiment of the invention is illustrated in Figure 8. The connecting element 51 between the second supporting means 30 and the foot tether-connecting means 50 serves the purpose of placement, and makes possible a variable position of the foot tether- connecting means 50 relative to the second supporting means 30, so that the parts of the patient to be operated on are optimally accessible to the operating surgeon and other medical devices. The connecting element 51 is dimensioned such that it can be inserted in the second supporting means 30 with each of the legs of different length, from the left or from the right, the free leg in each case pointing upward or downward.

With the sliding piece 58 and the first clamping screw 58", the foot tether-connecting means 50 is attached on the connecting element 51 at the desired height relative to the second supporting means 30. The basic unit 52 of the foot tether-connecting means 50 allows itself to be pivoted by 360° relative to the connecting element 51 in direction A (represented in Figure 8 by an

arrow). The linear compensation element 53 is easily displaceable toward the basic unit 52 in direction B (also represented by an arrow) by means of a roller guide in order to prevent undesired traction forces on the patient. If traction forces are desired, however, the linear compensation element 53 can be fixed in any position via a second clamping screw 52'. The connecting element for the patient tether 54 is pivotable in direction C (as represented by the corresponding arrow) and direction A when the third clamping screw 56 is released, to enable an optimal alignment of the linear compensation element 53 with respect to the patient. The linear compensation element 53 is in addition ro- tatable in direction D (again represented by an arrow) by 360°, using a handle 57 in the case of increased force requirement. An adjustable free movement 55 (with the positions left, free and right) is integrated into the foot tether - connecting means 50 to facilitate the manipulations. The rotation can be locked via a fourth clamping screw 55".

Figures 9 and 10 show the fourth 70 and fifth 40 supporting means of the modular device 10 according to an embodiment of the present invention. The fourth supporting means 70 have connecting means 73 on both sides for being connected to the hold points 27 of the first supporting means 20. They make possible the creation of a closed lying surface for the patient. The sup- ports 72 of the fourth supporting means 70 can in particular consist of a radio- translucent material in the area of the X-ray passage. The upper side of the fourth supporting means 70 is preferably covered with two removable cushion supports 71.

The fifth supporting means (the leg support cushions) 40 are like- wise fixed in the hold points 27 of the first supporting means 20 by means of the connection holders 41. The fifth supporting means 40 serve the stationary positioning of the legs of the patient before the operation or during the operation, if the operating surgeon thinks it necessary. The upper side of the fifth supporting means 40 is covered in principle with two removable cushion sup- ports 43. In a particular embodiment of the invention, the supports 42 of the fifth supporting means 40 can also consist of a radiotranslucent material in the area of the X-ray passage.

The third supporting means 60 is illustrated in Figure 11 . This third supporting means (or femoral support) is meant to support, position and immobilise the hip of the patient during the surgical operation. It can be fixed to the base plate 25 of the first supporting means 20 (left, right, or on both sides), in- stead of the fourth supporting means 70. This third supporting means is then located directly below the covered operating field, and holds the thigh and the hip of the patient at the height desired by the operating surgeon during the operational intervention. The third supporting means 60 comprises at least one control means 61 for controlling the height of the hip supporting cushion 65. Since this control element 61 is located outside the operating field, the adjustment of the height can be performed by any auxiliary person also during the operation since entry into the operating field is not necessary.

The structural parts under the hip support cushion 65 can in particular be made of a radiotranslucent material since, as a rule, directly after place- ment of a hip prosthesis in a hip joint operation, the position of the prosthesis is checked with an imaging technique (such as X-ray or similar). The height of the hip support cushion 65 can be adapted with the height adjustment unit 66 by means of the lever for the force transmission 62 after the actuation by means of the control means 61. The third supporting means 60 according to the particular embodiment of the invention can also comprise a positioning unit 63 which makes it possible, in combination with the connecting element 64 for connecting the third supporting means to the first supporting means 20, to bring this third supporting means 60 into a position which is well adapted to the anatomy of the patient before the operation.

Although the present disclosure has been described with reference to particular means, materials and embodiments, one skilled in the art can easily ascertain from the foregoing description the essential characteristics of the present disclosure, while various changes and modifications may be made to adapt the various uses and characteristics without departing from the spirit and scope of the present invention as set forth in the following claims.