EP1982680B1 - Patient side positioning device for treatment of the pelvis with a vacuum mattress - Google Patents

Description

The invention relates to a patient side support device for pelvic treatments.

In pelvic treatments, especially in hip replacement surgery, patients are usually operated on the side lying, and it is necessary to fix the patient so that his pelvis is immobilized. This is conventionally done via patient positioners having lower body area support means of the patient. In this situation, it is often difficult to determine navigational information by tapping body landmarks (ASIS and pubis points) as part of a medical navigation, because these characteristic pelvic landmarks are usually hardly accessible, at least in the lower region. Therefore, often work with an X-ray or Fluoroskoperegistrierung.

Many of the conventional patient positioners use cushions or rods that are fixed to an arm table of the operating table or similar fixed devices. Such a mechanical positioner is for example from the US 6,311,349 known.

The US 5,906,205 A relates to a surgical positioning device. The surgical positioning device for supporting the body of a patient in a selected lateral position comprises: a bag made of a flexible, air-impermeable material filled with a filling of elastically deformable foamed polystyrene balls and containing a valve for venting air from the bag so that the bag forms a rigid construction to support the patient's body in the selected position. An inflatable cushion is attached to the upper edges of the bag, at the center thereof, so that when the pad is inflated, it supports the patient's armpit and eliminates pressure, thereby avoiding injury to the patient's brachial plexus.

In addition to the mechanical positioners, there are still those that have navigation reference devices for medical navigation, and such is for example from the WO 2004/089192 A2 known. The reference means are used to indirectly locate the ASIS and pubis points and thereby register the anterior pelvic plane.

Thus, if the registration of the ASIS points and the pubis points is made more difficult by manually picking up the points from the presence of a positioning device, the fluoroscopy registration must be used. There are positioning devices therefor, which are made of a radiotranslucent material as possible and have the above-mentioned support devices, namely rods and cushions, which are fixed to a carrier system (on a guide rail) of the operating table. The main problem of these existing positioning devices for the navigation software arises when on the one hand fluoroscopic images are recorded for registration and on the other hand an imageless registration by starting off the said points with a navigation pointer is to be performed. Despite the at least largely radiolucent material used, the positioning and fixing devices create shadows and edges on the images. In the FIG. 7 On the x-ray 60, a region 61 is marked which shows the shadow of a patient positioner obscuring the left os pubis structure. The FIG. 8 Fig. 11 shows a fluoroscopic image 62 made using a "radiotranslucent" positioner, and again, the shadow 63 of a positioner portion obscures the image content and attenuates the contrast.

Another problem with the known side position positioning devices is that adipose patient tissue overlaps the pelvic margins, making it difficult or impossible to tap these points with a navigation pointer and thus perform an imageless registration. The rods and cushions often hinder such a startup of the pelvic landmarks. For this reason, the patient is initially positioned lying on his back, the registration is carried out and then the patient is put back on his side. This is not only time consuming but also critical in terms of sterility; as this may possibly be lost by repositioning.

All of the above listed registry errors, such as false or missing visual fingerprinting or misinterpretation of fluoroscopic images due to shadows or lack of contrast, can result in misregistration and navigation errors, which in turn can negatively impact treatment outcome.

It is the object of the present invention to provide a patient side support device for pelvic treatments which at least partially overcomes the above-mentioned problems of the prior art. In particular, a fluoroscopic image registration and / or an imageless registration should be simplified and optimized.

This object is achieved by a device according to claim 1. The subclaims define preferred embodiments of the invention.

A pelvic patient lateral support device according to the invention, by means of which the patient is supported in a defined lateral position, comprises a vacuum mattress comprising an upper body support member and a lower body support member and the pelvic region at the front of the patient and at the upper side of the stored patient Essentially spared. In other words, the invention provides a side-storage device with a vacuum mattress, which allows access to those parts of the patient or substantially free those areas on the patient, on the one hand for the treatment and on the other hand for a fluoroscopic registration or a pictureless registration without Obstacle must be accessible.

It should be noted here that with the side storage device according to the invention an optimal imageless registration, ie a tapping of landmark points on the pelvis with a navigation pointer can be performed when the vacuum mattress in the pelvic area only the front of the patient and the top leaves out. The vacuum mattress can be said for Immediate registration may be readily available on the back of the patient to perform another support function.

In one embodiment of the invention, the vacuum mattress also substantially eliminates the pelvic area at the back of the patient. In this embodiment, the radiation path for the fluoroscopic registration is now completely free of any support means, and the resulting images contain high-contrast images that clearly allow landmark assignment in a computer-aided manner. It is thus possible to perform both an imageless and an image-supported registration in an optimized manner.

The vacuum mattress can be made in one piece and have between the upper body support member and the lower body support member has a narrow connecting part, which comes to rest in the patient lateral position substantially below the patient. According to such an embodiment, the vacuum mattress has a wide upper body support part, a narrower lower body support part, and an even narrower connection part therebetween. In particular, the upper body support member is the widest part of the vacuum mattress to support the patient's upper body in the lateral position from below and over a substantial part of the upper body from both sides, while the lower body support member is narrower than the upper body support member at least partially surround at least one leg of the patient, wherein the connecting part is the narrowest part and narrower than the lower body support member.

In another embodiment, the vacuum mattress can also be made in two parts and each individually have an upper body support member and a lower body support member.

According to a further embodiment of the invention, the device further comprises a tiltable in predefined angular positions pad for the vacuum mattress or for parts thereof. The pad may be plate-like formed of a rigid material, and it is possible for the upper-body support member and the lower-body support member to provide a pad, which is in particular formed in two parts, that includes a pad member for the upper body support member and a pad member for the lower body support member.

According to one embodiment variant, the base or its parts has two panel sections standing at a predefined angle which can be tilted over a tilting edge in their connection area. It can be chosen here an angle of about 45 °. It is advantageous if a tilting aid is provided in the region of the tilting edge, in particular a tilting roller along the tilting edge. In order to make the tipping easier for the user, a handling device for lifting or tilting the base can be provided on the base, which can comprise, in particular, grip sections on the plate edges and / or support sections under the plate sections.

The patient positioning device of the present invention is capable of securing the patient in a lateral position on the treatment table, for example, during a hip replacement operation and during fluoroscopic image acquisition, without creating shadows or edges in the fluoroscopic image. In addition to the fact that the radiation of the fluoroscopic image is not hindered, it is still advantageously possible to reposition the patient from a lateral position to a position tilted by approximately 45 ° (and vice versa) in order to maintain the anatomical structures, such as the anatomical structures. B. Pelvic landmarks (ASIS and Pubis points) to register with a navigation pointer. The specially shaped vacuum mattress covers the entire body with the exception of the main part of the pelvic area to be treated (pelvis area) and provides a stable fixation of the patient. Important anatomical structures, such. As the Os-pubis are not covered by fixation material, which is advantageous because such structures of the pelvis are necessary to automatically positionally detect the patient's pool with a software. Furthermore, the surgical field is freely accessible to the surgeon. The fluoroscopic images will not have any annoying shadows and edges that could lead to misregistrations when using the software.

The FIG. 9 shows a fluoroscopic image, which has been created using the Seitenemungsvorrichtung device according to the invention; it has no disturbing shadows and edges, and the contrasts are good enough to perform image-assisted registration.

A second major advantage of the device according to the invention compared to known positioning devices, the Re-positioning mechanism (tilting mechanism) offers. With this integrated mechanism, it is possible to bring a patient from the lateral position in a tilted by about 45 ° position. This feature makes it possible for the surgeon to define the patient in a simple manner and in a 45 ° tilt side position before or after the sterile environment is created. If the patient is so positioned, it is easier to register the anatomical landmarks because any adipose tissue that may be present does not overlap the areas that need to be approached with the pointing device (navigation pointer). After registration, the patient can be quickly and easily re-positioned without loss of sterility.

The inventive system is flexible and can be adapted to any human body shape and to any operating table environment. It fits slim and obese patients, and the soft material of the vacuum mattress prevents injuries and pressure sores on the patient's body.

Figur 1

einen Aufriss einer Vakuummatratze für eine erfindungsgemäße Seitenlagerungsvorrichtung;

Figuren 2 und 3

einen Patienten, der mit Hilfe der erfindungsgemäßen Seitenlagerungsvorrichtung auf einem Operationstisch gelagert ist, von der Vorder- und Rückseite her;

Figuren 4 und 5

einen Repositionierungs- bzw. Kippmechanismus für eine erfindungsgemäße Patienten-Seitenlagerung;

Figur 6

einen gelagerten Patienten in der gekippten Position;

Figuren 7 und 8

ungeeignete Fluoroskopieaufnahmen des Beckenbereichs, wie sie mit Seitenlagerungen gemäß dem Stand der Technik entstehen; und

Figur 9

eine optimale Fluoroskopiebildaufnahme des Beckenbereichs, wie sie mit einer Seitenlagerungsvorrichtung gemäß der vorliegenden Erfindung entsteht.

The invention will be explained in more detail below with reference to an embodiment and with reference to the accompanying drawings. It may include all features described herein individually, as well as in any meaningful combination. In the drawings show:

FIG. 1

an elevation of a vacuum mattress for a side storage device according to the invention;

FIGS. 2 and 3

a patient who is mounted on an operating table with the aid of the lateral support device according to the invention, from the front and rear side;

FIGS. 4 and 5

a repositioning mechanism for a patient lateral support according to the invention;

FIG. 6

a stored patient in the tilted position;

FIGS. 7 and 8

inappropriate pelvic area fluoroscopy images, such as those produced with side bearings of the prior art; and

FIG. 9

an optimal fluoroscopic image of the pelvic area, as it arises with a side bearing device according to the present invention.

A top view (elevation) of a vacuum mattress 10 for a patient lateral support device according to the invention is shown in FIG FIG. 1 to see. It has the basic shape of the Roman numeral I, with an upper body support member 11, a lower body support member 13 and a connecting part 12 between the two said parts 11 and 13. The patient is placed with its side on the central longitudinal axis of the vacuum mattress 10, so that the two wings of the upper body support member 11 can be bent upwards around the upper body and the two wings of the lower body support member 13 from below partially surround the leg lying below. Then, the air is sucked out of the vacuum mattress, and with the styrofoam balls contained therein, the mattress adapts to the body shape and fixes the body. The patient lies then laterally on the operating table, as in the FIGS. 2 and 3 is shown. The FIG. 2 shows the patient from the front; the FIG. 3 from the back. The patient 20 is fixed in the mattress 10, so that the two parts 11 and 13 project upwards in the upper body region or on the leg and effect the fixation. The connecting part 12 lies flat below the patient's basin.

The side bearing takes place on an operating table 40, on its upper plate 41. In the illustrated embodiment is between the vacuum mattress 10 and the table top 41 is still provided a tilting mechanism, the overall reference numeral 30 carries and a pad of two separate, angled plates 31 and 32 and handles 34, 35, 36 and loops 33, 37 includes. The function of the tilting mechanism will be described below with reference to FIGS. 4 and 5 explained in more detail. From the FIGS. 2 and 3 It is also apparent that in the patient lateral positioning according to the invention, the surgical area 21 is completely accessible to the surgeon and also on the front and back of the pelvis there are no parts of the patient fixation, which fluoroscopy recordings or the tapping of registration points (pelvic landmarks) Obstruct navigation pointer.

The function of the embodiment shown for the above-mentioned tilting mechanism is derived from the cross-sectional drawings of FIGS. 4 and 5 before, wherein the patient 20 in the FIG. 4 lies in the straight side position, in which the operation can take place. The location of FIG. 5 is the tilted by 45 ° position, which is also in total FIG. 6 You can see where the front of the patient is pointing diagonally upwards. The cutting plane runs centrally through the handle 33 on the upper body (see FIG. 2 ).

The tilt mechanism is located on top of the table top 41 and includes an angled plate 32 made of a rigid material having two plate portions 32a, 32b joined together to form an angle of 135 ° (interior angle) to each other. Underneath the plate sections 32a, 32b run loops 37 which terminate in handles 34, 35, 36 at the plate section edges. Along the tilting edge extends a tilting roller 38, which has not designated attack projections for the loops 33 and 37. The upper body support member 11 is flat at its lower end and conformed to the plate 32.

If one now wants the patient 20 out of the situation, the in FIG. 2 is shown to be able to bring in the FIG. 6 is shown so that it is inclined by 45 ° and its front side obliquely upward, the pad 30, that is, in each case the plates 31 and 32, tilted by means of the handles 34, 35, 36 in a very simple manner become; she rolls over the tilting roller 38 and can easily in the position of FIG. 5 or the FIG. 6 to be brought. Accordingly, the pad portion 31 ( FIG. 2 ) simultaneously tilted. The fixed support of the patient is still given, because the shape-adapted vacuum mattress now rests on the plate portion 32b.

If the patient has now been brought into the position by the tilting process just described, in the FIGS. 5 and 6 1, the pelvic landmarks (ASIS and Pubis points 51, 52, 53 and 54) are easily accessible and can be easily tapped with a navigated pointer. Thus, the imageless registration is unhindered and reliable. After registration, the patient 20 can be brought back into its original position (90 ° side position) in a simple manner with the aid of the tilting mechanism, without causing sterility problems. Because the pad, that is, the two plates 31, 32 of the tilting mechanism are mounted adjacent to the hip area, they also do not interfere with the fluoroscopic image recordings.

1. 1. Positionierung des Patienten in Seitenlage in der Vakuummatratze
2. 2. Re-Positionierung des Patienten in die um 45° gekippte Position
3. 3. Erzeugung der sterilen Umgebung
4. 4. Anbringung von Referenzanordnungen an dem Patienten
5. 5. Registrierung der anatomischen Landmarken mit einem Navigations-Pointer
6. 6. Re-Positionierung des Patienten zurück in die Seitenlage
7. 7. Beginn der Operation

One possible workflow using the patient lateral support device of the invention is as follows:

1. 1. Positioning the patient in a lateral position in the vacuum mattress
2. 2. Re-positioning the patient in the 45 ° tilted position
3. 3. Generation of the sterile environment
4. 4. Attachment of reference arrangements to the patient
5. 5. Registration of the anatomical landmarks with a navigation pointer
6. 6. Re-positioning the patient back into the lateral position
7. 7. Start of the operation

Claims (10)

1. A patient lateral positioning device for pelvic treatments, by means of which the patient (20) is supported in a defined lateral position, wherein the device comprises a vacuum mattress (10) which comprises an upper body supporting part (11) and a lower body supporting part (13) and substantially omits the pelvic region on the front side of the patient and on the upper side of the positioned patient (20), characterised in that the vacuum mattress (10) is embodied in one part and comprises a narrow connecting part (12) between the upper body supporting part (11) and the lower body supporting part (13), wherein when the patient is in the lateral position, the connecting part (12) comes to rest substantially beneath the patient (20).
2. The device according to claim 1, characterised in that the vacuum mattress (10) also substantially omits the pelvic region on the rear side of the patient.
3. The device according to claim 1 or 2, characterised in that the upper body supporting part (11) is the widest part of the vacuum mattress (10), in order to support the patient's upper body from beneath in the lateral position and from both sides over a substantial part of the upper body, while the lower body supporting part (13) is narrower than the upper body supporting part (11), in order to at least partly encompass at least one of the patient's legs, wherein the connecting part (12) is the narrowest part and is narrower than the lower body supporting part (13).
4. The device according to any one of claims 1 to 3, characterised in that it also comprises a support base (30) for the vacuum mattress (10) or its parts, which can be tilted into predefined angular positions.
5. The device according to claim 4, characterised in that the support base (30) is formed from a rigid material as a plate.
6. The device according to claim 4 or 5, characterised in that a support base (30; 31, 32) is provided for the upper body supporting part (11) and the lower body supporting part (13) which is in particular formed in two parts.
7. The device according to any one of claims 4 to 6, characterised in that the support base (30) or its parts (31, 32) comprise two plate portions (31a, 31b; 32a, 32b) which are at a predefined angle to each other and can be tilted via a tilting edge in their connecting region.
8. The device according to claim 7, characterised in that a tilting aid is provided in the region of the tilting edge, in particular a tilting roller (38) along the tilting edge.
9. The device according to any one of claims 4 to 8, characterised in that a manipulating device (34, 35) for lilting or tilting the support base is provided on the support base (30).
10. The device according to claim 9, characterised in that the manipulating device comprises grip portions (35, 36) on the plate rims and/or supporting portions (33, 37) beneath the plate portions (31a, 31b; 32a, 32b).

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