WO2002007612A1 - Surgical apparatus for manipulating body parts - Google Patents

Surgical apparatus for manipulating body parts Download PDF

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Publication number
WO2002007612A1
WO2002007612A1 PCT/GB2001/003235 GB0103235W WO0207612A1 WO 2002007612 A1 WO2002007612 A1 WO 2002007612A1 GB 0103235 W GB0103235 W GB 0103235W WO 0207612 A1 WO0207612 A1 WO 0207612A1
Authority
WO
WIPO (PCT)
Prior art keywords
manipulating
body parts
frame
parts
joint
Prior art date
Application number
PCT/GB2001/003235
Other languages
French (fr)
Inventor
Alex Watson
Original Assignee
University College London Hospitals Nhs Trust
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 University College London Hospitals Nhs Trust filed Critical University College London Hospitals Nhs Trust
Priority to AU2001270868A priority Critical patent/AU2001270868A1/en
Publication of WO2002007612A1 publication Critical patent/WO2002007612A1/en

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/14—Surgical saws ; Accessories therefor
    • A61B17/15—Guides therefor
    • A61B17/154—Guides therefor for preparing bone for knee prosthesis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/14—Surgical saws ; Accessories therefor
    • A61B17/15—Guides therefor
    • A61B17/154—Guides therefor for preparing bone for knee prosthesis
    • A61B17/155—Cutting femur
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/14—Surgical saws ; Accessories therefor
    • A61B17/15—Guides therefor
    • A61B17/154—Guides therefor for preparing bone for knee prosthesis
    • A61B17/157—Cutting tibia
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/025—Joint distractors
    • A61B2017/0268—Joint distractors for the knee
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations

Definitions

  • the present invention relates to an apparatus for use during surgery. It is particularly, but not exclusively, applicable to orthopaedic operations.
  • Embodiments of the invention provide an apparatus for rigidly holding body parts, such as one or more limbs, in such a way as to allow precise cutting during surgical procedures.
  • Orthopaedic surgery is entering a new era involving computer-assisted, robotic cutting tools that allow greater accuracy in the performance of operations. It is important that, if a programmed cutting tool is to be used accurately, the body part to be cut must be rigidly held in a precise location by a specifically designed apparatus.
  • Known orthopaedic devices have previously been used for fixing body parts, but such devices suffer from the disadvantage that they require elements of the device to be attached to the body parts in such a way as increases the likelihood of trauma. For example, when the body parts comprise bone, they require elements to be screwed or bolted into the bone.
  • the present invention therefore seeks to overcome the disadvantages of the prior art by allowing the relevant body part to be held in a rigid position, but in a minimally traumatic manner as well as in such a manner that allows it to be accurately and flexibly manipulated by the surgeon.
  • the present invention provides an apparatus for manipulating one or more parts of a body during surgery comprising one or more manipulating arms for engaging one or more body parts; and a frame for supporting the arm(s); wherein the frame is variably adjustable in at least one dimension so as to enable manipulation of the one or more body parts.
  • the apparatus is arranged such that the at least one dimension has an axis being substantially parallel to the direction in which the one or more body parts are manipulable.
  • the one or more manipulating arms are supported such that their location with respect to the frame is adjustable.
  • the apparatus may comprise two or more manipulating arms, so enabling separation or proximation of two or more body parts.
  • each manipulating arm comprises two or more load bearing surfaces for clamping the one or more body part(s).
  • the frame is preferably circular.
  • the apparatus of the present invention allows the holding of one or more body parts in such a fashion as to enable precise cutting during surgery.
  • a knee joint may be held to allow precision bone cutting to occur during a total or unicondylar knee prosthesis.
  • the apparatus may also be used to immobilise, and thus allow operation on, other bones and joints in the body, such as the hip (that is, for hip replacement surgery), the shoulder, the elbow, or spine and so forth.
  • each rod has a length of between 30 and 80 cms and preferably the rods are located with respect to one another at an angle of between 90 and 140 degrees; further each supporting arm typically has a length of between 30 and 80 cm., and is generally joinable to the operating table at an angle also of between 90 and 140 degrees.
  • the above mentioned lengths and angles should be preferably adjusted to suit the particular body part in question.
  • the above-described apparatus is adapted for use in manipulating body parts comprised of bone, muscle, ligamentous tissue and/or cartilage.
  • the construction of the apparatus provides a rigid, adaptable frame that is placeable around the body part to be operated on. Further, the frame itself is attachable to the side panels of a standard operating table using conventional theatre clamps.
  • the manipulating arms may be adjustable pin-less fixators, and are attached to the frame so that they may be used to hold the exposed, dissected bones (for example, the femur, and tibia during a knee operation) in a rigid manner. Following attachment of the fixators, the bones may be moved using controlled force to distract the joint into an optimal position for surgery. For extra stability, wedges may be provided, for use in pushing laterally on the body part(s).
  • the remainder of the patient for example the pelvis in operations on the knee
  • the patient's foot may typically be held in a boot-structure which has been designed to be adjustably moved on a ratchet plate that is fixable to the operating table.
  • Such a system allows the surgeon, during operations on a knee joint, to openly dissect tissue down to the knee joint when the patient's leg is extended, and then after flexing the limb the knee may be held in flexion.
  • the exposed bones are then usually rigidly attached to the frame and distracted to optimise surgical access before being finally immobilised.
  • the present invention provides a combination of the above-described apparatus together with a precision cutting machine, which preferably is computer controlled.
  • Figure 1 shows a side view of a frame of the apparatus of the present invention attached to the side of an operating table
  • Figure 2 illustrates a side view of the frame shown in Figure 1 , in which a patient receiving knee surgery is positioned on the operating table with their knee held in a flexed position.
  • Figure 3 depicts an aerial view of the frame shown in Figure 2, in which the apex of the openly-dissected knee is positioned within the frame with the bones held distracted;
  • Figure 4 shows a side view of a boot, according to one embodiment of the present invention, the boot being shown in relation to a ratchet device that is attached to the surface of the operating table;
  • Figure 5 illustrates a similar to view to that shown in Figure 2, and shows a close-up view of the frame placed about a mechanical mock-up of a knee joint;
  • Figure 6 provides a rotated version of the view of Figure 2, again for a mechanical mock-up of a knee joint operation
  • Figure 7 shows a perspective, aerial view of the mechanical mock-up shown in Figures 5 and 6.
  • Figure 1 a frame consisting of two inverted U-shaped metal rods 1 , which are attached (by way of supporting arm sections 1 a) to runners at the sides of an operating table 2.
  • Cross bars 3 are attached to rods 1 to complete the frame.
  • a mono lateral, external fixation (for example telescopic) system allowing the length of the cross bar 3 to be accurately adjusted in length, typically by up to 75 mm (as indicated in Figure 1 by arrows 3a).
  • Figures 2 and 6 show the frame positioned around a patient's knee the patient's foot is strapped within a boot 4, which is held by a ratchet plate 5, that in turn is fixed to a larger base plate 6.
  • the larger base plate 6 is attached to the operating table by side runners 2.
  • the patient's pelvis can be strapped down to the operating table with a belt or crepe bandaging 7.
  • Figures 3 and 7 Views of the apex of the openly dissected knee are shown in Figures 3 and 7, which illustrate how manipulating arms (here shown as pin-less fixators 8), may be clamped onto the bones (that is, the femur and tibia) 9 and attached bi-laterally to the adjustable cross bars 3.
  • manipulating arms here shown as pin-less fixators 8
  • the bones 9 can be distracted when the bodies of cross bars 3 are lengthened (in a direction indicated by arrows 3a in Figures 3 and 7).
  • Figure 7 shows that crossbars 3 may be lengthened by a telescopic action.
  • wedges 10 may be attached to the cross-bars 3 to direct inward force (as indicated by arrows 10a in Figure 3) on the joint.
  • the boot 4 within which the patient's foot is strapped can be moved so as to bring the knee into flexion or so as to extend the knee as indicated in the Figure by arrows 4a.
  • the heel of the boot 4 has a bar 1 1 , which corresponds to ratchets spaces 1 2, that are cut into the ratchet plate 5.
  • the apparatus of the present invention provides surgeons operating on body parts with a means of accurately fixing and precisely manipulating the body parts, whilst minimising trauma thereto.

Abstract

An apparatus for manipulating one or more body parts (9) of a body during surgery comprises one or more manipulating arms (8) for engaging one or more body parts (9); and a frame (1, 3) for supporting the arm(s); wherein the frame (1, 3) is variably adjustable in at least one dimension (3a) so as to enable manipulation of the one or more body parts (9).

Description

SURGICAL APPARATUS FOR MANIPULATING BODY PARTS
The present invention relates to an apparatus for use during surgery. It is particularly, but not exclusively, applicable to orthopaedic operations. Embodiments of the invention provide an apparatus for rigidly holding body parts, such as one or more limbs, in such a way as to allow precise cutting during surgical procedures.
Orthopaedic surgery is entering a new era involving computer-assisted, robotic cutting tools that allow greater accuracy in the performance of operations. It is important that, if a programmed cutting tool is to be used accurately, the body part to be cut must be rigidly held in a precise location by a specifically designed apparatus.
Known orthopaedic devices have previously been used for fixing body parts, but such devices suffer from the disadvantage that they require elements of the device to be attached to the body parts in such a way as increases the likelihood of trauma. For example, when the body parts comprise bone, they require elements to be screwed or bolted into the bone.
The present invention therefore seeks to overcome the disadvantages of the prior art by allowing the relevant body part to be held in a rigid position, but in a minimally traumatic manner as well as in such a manner that allows it to be accurately and flexibly manipulated by the surgeon.
Thus, in a first aspect the present invention provides an apparatus for manipulating one or more parts of a body during surgery comprising one or more manipulating arms for engaging one or more body parts; and a frame for supporting the arm(s); wherein the frame is variably adjustable in at least one dimension so as to enable manipulation of the one or more body parts.
In one embodiment, the apparatus is arranged such that the at least one dimension has an axis being substantially parallel to the direction in which the one or more body parts are manipulable. Preferably, the one or more manipulating arms are supported such that their location with respect to the frame is adjustable.
Optionally, the apparatus may comprise two or more manipulating arms, so enabling separation or proximation of two or more body parts.
In addition, in a preferred embodiment, each manipulating arm comprises two or more load bearing surfaces for clamping the one or more body part(s).
In another embodiment, the frame is preferably circular.
The apparatus of the present invention allows the holding of one or more body parts in such a fashion as to enable precise cutting during surgery. For example a knee joint may be held to allow precision bone cutting to occur during a total or unicondylar knee prosthesis. The apparatus may also be used to immobilise, and thus allow operation on, other bones and joints in the body, such as the hip (that is, for hip replacement surgery), the shoulder, the elbow, or spine and so forth.
For surgery upon the knee joint, preferably each rod has a length of between 30 and 80 cms and preferably the rods are located with respect to one another at an angle of between 90 and 140 degrees; further each supporting arm typically has a length of between 30 and 80 cm., and is generally joinable to the operating table at an angle also of between 90 and 140 degrees.
For operations on body parts other than the knee joint, the above mentioned lengths and angles should be preferably adjusted to suit the particular body part in question.
Typically, the above-described apparatus is adapted for use in manipulating body parts comprised of bone, muscle, ligamentous tissue and/or cartilage.
The construction of the apparatus provides a rigid, adaptable frame that is placeable around the body part to be operated on. Further, the frame itself is attachable to the side panels of a standard operating table using conventional theatre clamps. The manipulating arms may be adjustable pin-less fixators, and are attached to the frame so that they may be used to hold the exposed, dissected bones (for example, the femur, and tibia during a knee operation) in a rigid manner. Following attachment of the fixators, the bones may be moved using controlled force to distract the joint into an optimal position for surgery. For extra stability, wedges may be provided, for use in pushing laterally on the body part(s). In addition, the remainder of the patient (for example the pelvis in operations on the knee) may be strapped to the operating table.
In operations on the knee, the patient's foot may typically be held in a boot-structure which has been designed to be adjustably moved on a ratchet plate that is fixable to the operating table.
Such a system allows the surgeon, during operations on a knee joint, to openly dissect tissue down to the knee joint when the patient's leg is extended, and then after flexing the limb the knee may be held in flexion. The exposed bones are then usually rigidly attached to the frame and distracted to optimise surgical access before being finally immobilised.
In a third aspect, the present invention provides a combination of the above-described apparatus together with a precision cutting machine, which preferably is computer controlled.
The present invention will now be described by way of the following non-limiting example, with reference to the accompanying drawings, in which:
Figure 1 shows a side view of a frame of the apparatus of the present invention attached to the side of an operating table;
Figure 2 illustrates a side view of the frame shown in Figure 1 , in which a patient receiving knee surgery is positioned on the operating table with their knee held in a flexed position.
Figure 3 depicts an aerial view of the frame shown in Figure 2, in which the apex of the openly-dissected knee is positioned within the frame with the bones held distracted; Figure 4 shows a side view of a boot, according to one embodiment of the present invention, the boot being shown in relation to a ratchet device that is attached to the surface of the operating table;
Figure 5 illustrates a similar to view to that shown in Figure 2, and shows a close-up view of the frame placed about a mechanical mock-up of a knee joint;
Figure 6 provides a rotated version of the view of Figure 2, again for a mechanical mock-up of a knee joint operation; and
Figure 7 shows a perspective, aerial view of the mechanical mock-up shown in Figures 5 and 6.
In Figure 1 is shown a frame consisting of two inverted U-shaped metal rods 1 , which are attached (by way of supporting arm sections 1 a) to runners at the sides of an operating table 2. Cross bars 3 are attached to rods 1 to complete the frame. Within the body of each cross bar 3 is a mono lateral, external fixation (for example telescopic) system allowing the length of the cross bar 3 to be accurately adjusted in length, typically by up to 75 mm (as indicated in Figure 1 by arrows 3a).
Figures 2 and 6 show the frame positioned around a patient's knee the patient's foot is strapped within a boot 4, which is held by a ratchet plate 5, that in turn is fixed to a larger base plate 6. The larger base plate 6 is attached to the operating table by side runners 2. The patient's pelvis can be strapped down to the operating table with a belt or crepe bandaging 7.
Views of the apex of the openly dissected knee are shown in Figures 3 and 7, which illustrate how manipulating arms (here shown as pin-less fixators 8), may be clamped onto the bones (that is, the femur and tibia) 9 and attached bi-laterally to the adjustable cross bars 3. By attaching the pin-less fixators 8 to the cross bars 3 and then applying controlled loading via a manual (or pneumatic) device that may be incorporated into the body of the cross-bars 3, the bones 9 can be distracted when the bodies of cross bars 3 are lengthened (in a direction indicated by arrows 3a in Figures 3 and 7). Figure 7 shows that crossbars 3 may be lengthened by a telescopic action. To ensure additional lateral stability is provided, wedges 10 may be attached to the cross-bars 3 to direct inward force (as indicated by arrows 10a in Figure 3) on the joint.
As shown in Figure 4, the boot 4, within which the patient's foot is strapped, can be moved so as to bring the knee into flexion or so as to extend the knee as indicated in the Figure by arrows 4a. To hold the knee at the chosen degree of flexion, the heel of the boot 4 has a bar 1 1 , which corresponds to ratchets spaces 1 2, that are cut into the ratchet plate 5.
The apparatus of the present invention provides surgeons operating on body parts with a means of accurately fixing and precisely manipulating the body parts, whilst minimising trauma thereto.

Claims

CLAIMS:
1 . An apparatus for manipulating one or more parts of a body during surgery, comprising one or more manipulating arms for engaging the one or more body parts; and a frame for supporting the arm(s); wherein the frame is variably adjustable in at least one dimension so as to enable manipulation of the one or more body parts.
2. An apparatus as claimed in claim 1 , wherein the at least one dimension has an axis being substantially parallel to the direction in which the one or more body parts are manipulable.
3. An apparatus as claimed in either claim 1 or claim 2, wherein the one or more manipulating arms are supported such that their location with respect to the frame is adjustable.
4. An apparatus as claimed in any preceding claim, comprising two or more manipulating arms, so enabling separation or proximation of two or more body parts.
5. An apparatus as claimed in any preceding claim, wherein each manipulating arm comprises two or more load bearing surfaces for clamping the one or more body part(s).
6. An apparatus as claimed in any preceding claim, wherein the frame is circular.
7. An apparatus as claimed in any preceding claim, wherein the length of each manipulating arm is between 30 and 80 cm.
8. An apparatus as claimed in any preceding claim wherein each manipulating arm is supported by the frame at an angle of between 90 and 140 degrees.
9. An apparatus as claimed in any preceding claim adapted for use in manipulating body parts comprised of bone, muscle, ligamentous tissue and/or cartilage.
10. An apparatus as claimed in any preceding claim adapted for use in manipulating the parts of one or more joint(s), for example a knee, hip, spinal, elbow and/or shoulder joint.
1 1 . An apparatus as claimed in claim 10, further comprising wedges for supporting each joint in a direction transverse to that in which parts of the joint are being manipulated.
12. An apparatus as claimed in any preceding claim, further comprising a holder for fixing in place a distal part of a limb, whose body parts are to be operated upon, for example a boot for fixing a foot.
13. A combination of an apparatus as claimed in any preceding claim together with a precision cutting machine.
14. A combination as claimed in claim 13, wherein the cutting machine is computer controlled.
PCT/GB2001/003235 2000-07-22 2001-07-18 Surgical apparatus for manipulating body parts WO2002007612A1 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU2001270868A AU2001270868A1 (en) 2000-07-22 2001-07-18 Surgical apparatus for manipulating body parts

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
GB0017964.8 2000-07-22
GBGB0017964.8A GB0017964D0 (en) 2000-07-22 2000-07-22 Surgical apparatus for manipulating body parts

Publications (1)

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WO2002007612A1 true WO2002007612A1 (en) 2002-01-31

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GB (1) GB0017964D0 (en)
WO (1) WO2002007612A1 (en)

Cited By (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
FR2871363A1 (en) * 2004-06-15 2005-12-16 Medtech Sa ROBOTIZED GUIDING DEVICE FOR SURGICAL TOOL
EP1917950A3 (en) * 2006-10-31 2009-02-25 DePuy Products, Inc. Limb stabilizing system for arthroplasty
US8187279B2 (en) 2006-10-31 2012-05-29 Depuy Products, Inc. Surgical instrument system with ball and socket support
US9592096B2 (en) 2011-11-30 2017-03-14 Medtech S.A. Robotic-assisted device for positioning a surgical instrument relative to the body of a patient
US9750432B2 (en) 2010-08-04 2017-09-05 Medtech S.A. Method for the automated and assisted acquisition of anatomical surfaces

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3087489A (en) * 1961-05-01 1963-04-30 Gilbert Herbert Universal orthopedic traction and holding device
FR2632851A1 (en) * 1988-06-16 1989-12-22 Hardy Jean Marie Apparatus for reduction of fractures and method for mounting fixators
US5007912A (en) * 1990-05-30 1991-04-16 Albrektsson Bjoern Arrangement for fixing a knee-joint in defined positions and for positional control of instruments for replacing the knee-joint with a prosthesis
FR2653988A1 (en) * 1989-11-07 1991-05-10 Lacaffiniere Jean Yves De External radiotransparent device for provisional reduction and retention for centromedullary osteosynthesis of fractures of the tibia
US5458599A (en) * 1994-04-21 1995-10-17 Adobbati; Ricardo N. System for the use in the fixation of a fractured bone

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3087489A (en) * 1961-05-01 1963-04-30 Gilbert Herbert Universal orthopedic traction and holding device
FR2632851A1 (en) * 1988-06-16 1989-12-22 Hardy Jean Marie Apparatus for reduction of fractures and method for mounting fixators
FR2653988A1 (en) * 1989-11-07 1991-05-10 Lacaffiniere Jean Yves De External radiotransparent device for provisional reduction and retention for centromedullary osteosynthesis of fractures of the tibia
US5007912A (en) * 1990-05-30 1991-04-16 Albrektsson Bjoern Arrangement for fixing a knee-joint in defined positions and for positional control of instruments for replacing the knee-joint with a prosthesis
US5458599A (en) * 1994-04-21 1995-10-17 Adobbati; Ricardo N. System for the use in the fixation of a fractured bone

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
T.C.KIENZLE ET AL: "TOTAL KNEE REPLACEMENT Computer-assisted surgical system uses a calibrated robot", IEEE ENGINEERING IN MEDICINE AND BIOLOGY MAGAZINE, IEEE INC. NEW YORK, US, vol. 14, no. 3, 1 May 1995 (1995-05-01), pages 301 - 306, XP000505086, ISSN: 0739-5175 *

Cited By (9)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
FR2871363A1 (en) * 2004-06-15 2005-12-16 Medtech Sa ROBOTIZED GUIDING DEVICE FOR SURGICAL TOOL
EP1917950A3 (en) * 2006-10-31 2009-02-25 DePuy Products, Inc. Limb stabilizing system for arthroplasty
US7947862B2 (en) 2006-10-31 2011-05-24 Depuy Products, Inc. Limb stabilizing system for arthroplasty
US8187279B2 (en) 2006-10-31 2012-05-29 Depuy Products, Inc. Surgical instrument system with ball and socket support
US9750432B2 (en) 2010-08-04 2017-09-05 Medtech S.A. Method for the automated and assisted acquisition of anatomical surfaces
US10039476B2 (en) 2010-08-04 2018-08-07 Medtech S.A. Method for the automated and assisted acquisition of anatomical surfaces
US9592096B2 (en) 2011-11-30 2017-03-14 Medtech S.A. Robotic-assisted device for positioning a surgical instrument relative to the body of a patient
US10159534B2 (en) 2011-11-30 2018-12-25 Medtech S.A. Robotic-assisted device for positioning a surgical instrument relative to the body of a patient
US10667876B2 (en) 2011-11-30 2020-06-02 Medtech S.A. Robotic-assisted device for positioning a surgical instrument relative to the body of a patient

Also Published As

Publication number Publication date
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GB0017964D0 (en) 2000-09-13

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