US 3289674 A
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Description (OCR text may contain errors)
Dec. 6, 1966 J. PLATT 3,239,674
SURGICAL TABLE Filed Dec. 24, 1963 5 Sheets-Sheet 1 FIG. l.
INVENTOR JOSEPH 1% PLATT ama M1072,
ATTORNEY J. L. PLATT SURGICAL TABLE Dec. 6, 1966 5 SheetsSheet 2 Filed Dec. 24, 1963 Mam JosEPH ATTORNEYS Dec. 6, 1966 J. L. PLATT 3,239,674
SURGICAL TABLE Filed Dec. 24, 1963 5 Sheets-$heet 5 FIG. 5.
INVEN'JOR JOSEPH L. PLATT BY GWUVZ, WM?
ATTORNEYS United States Patent M 3,289,674 SURGICAL TABLE Joseph L. Platt, 3308 Woodridge Place, Lynchburg, Va. Filed net. 24, 1963, Ser. No. assume 6 Claims. (Cl. 128-71) The present invention relates generally to surgical tables and more particularly to a scoliosis table on which a patient may be supported in a prone position for combining spinal fusion, curve corrections and corrective plaster or jacket applications in one continuous procedure as well as allowing for intratrachial anesthesia.
The surgical treatment of scoliosis by a preoperative correctional plaster followed by spinal fusion has been for many years an accepted standard procedure. However, advances made by the medical profession in the last few years have established that by applying a postoperative rather than a preoperative correctional plaster in cases of scoliosis, the period of hospitalization may be shortened and surgery may be more efficiently and easily performed. In addition, the use of postoperative correctional plaster provides for the availability of vital areas of the patient in the event of cardiac arrests or other emergencies which may occur during the operation.
Heretofore, it was common practice in a scoliosis operation to place the patient in a preoperative correctional plaster. It was felt that such a preoperative correction plaster was necessary to obtain the maximum correction and prevent loss of correction. Such a procedure was accepted despite the diificulty of managability during surgery and dangers resulting from inaccessibility of the patient in the event of emergency arising on the operating table.
Generally, in performing the required surgery, the patient is placed in a prone position and supported on a flat surface. This arrangement causes added pressure to be exerted on the abdomen and chest of the patient due to the flat surface which prevents these parts of the body from moving downwardly. As a result, the back portions of the body are raised or lowered during breathing complicating the work of a surgeon in a scoliosis operation. If the back of the patient is held still to aid the surgeon during the operation and the abdomen and chest are sup-ported by a flat surface, there is added labor to a patient in breathing.
In addition, it has been common practice, where it is desired to have a patient in a prone position, to place the patient on a fiat table and by various weights, stretchers, elevators, and the like, to approach rather than reach a desired position for a particular operation. With the patient in the prone position, the head of the patient must be turned to one side so that the nose and mouth of the patient will be accessible. Such arrangements cause considerable discomfort to the patient when it is necessary to maintain the same position for a lengthy operative period.
While certain surgical tables have been developed which alleviate the problem of supporting the abdomen and chest of a patient during surgery on a flat surface, these tables generally resort to the use of elevators and straps to maintain the patient in the desired position. In such tables, straps are place about the patient with the straps being supported above the patient or otherwise fastened to the frame work of the table. It should be readily apparent that such arrangements, in addition to restricting accessibility to the patient, are totally inadequate for the application of a postoperative corrective plaster and require the patient to be removed to a casting table for application of the cast.
In the present invention, the shortcomings of these prior art tables and devices are overcome and there is provided 3,289,574 Patented Dec. 6, 1966 a surgical table suitable for combining spinal fusion, curve correction and the application of a postoperative correc tive plaster in one continuous procedure.
Accordingly, it is a primary object of the present invention to provide a novel surgical table which maintains a patient in the desired prone position during surgery while allowing for movement of desired parts of the body for surgery.
Another object of the present invention is to provide a novel surgical table which provides a minimum of discomfort to the patient and a maximum of accessibility of the patient for the surgeon.
It is a further object of the present invention to provide a novel surgical table wherein a patient may be supported in a prone position, facedownwardly, with the nose and mouth openings accessible for intra'trachial anesthe-sia.
It is yet another object of the present invention to provide a novel surgical table wherein the patient may be supported in a prone position with the face downwardly with means to angmlarly position the posterior of the body with relation to the trunk for scoliosis correction and to allow for the application of a postoperative correction plaster without removing the patient from the table.
It is remarkable that the novel features of the table; namely, those permitting de-rotation and angular correc tion of the scoliosis curve will allow the use of this table to cheek preoperative correction and even its use to aid in treatment of a curve, thus helping to prevent the necessity of spinal fusion.
In addition to scoliosis surgery, this table also is particularly useful for surgical treatment of spondylolisthesis and plaster immobilization without the inherent dangers encountered in moving the patient from the usual operating table to the usual cast table.
Furthermore, this table is particularly useful in doing lower lumbar intervertebral disc surgery because the flexed position allows easier accessibility and the freedom of pressure on the abdomen prevents engorgement of the epidural veins and thus materially aids in controlling hemorrhage.
This table permits free access for X-ray study to determine levels of surgery and degrees of correction, both preoperative and postoperative.
Other objects of the present invention will appear from the following detailed description of the mechanical structure and mode of operation thereof and, while the specification concludes with claims particularly pointing out and distinctly claiming the subject matter of the present invention, the invention will be understood from the following description taken thereof in connection wit-h the accompanying drawings.
In the accompanying drawings, in which like reference characters indicate like parts,
FIG. 1 is a perspective view of a surgical table of the present invention;
FIGS. 2, 3 and 4 are side, plan and front views, respectively of the leg supports of the present invention;
FIG. 5 is a side elevational view, partly in cross section, of the headrest of the present invention, and
FIG. 6 is a side elevational view of the clamping assembly for the headrest of the present invention.
Referring now to the drawings, and more particularly to FIG. 1, there is illustrated an embodiment of the surgical table of the present invention adapted for supporting a patient during scoliosis surgery in prone position. The surgical table is supported on a conventional base 10 which may be provided with suitable rollers 11, only one of which is shown. The base 10 slidably supports a column 12 for vertical movement. Any suitable driving means may be provided. Such driving means are will known in the art and have found wide application in use with surgical tables. For example, column 12 may be raised and lowered with respect to the base by fluid pressure means actuated through use of a lever (not shown). As column 12 is raised or lowered, parts connected therewith are correspondingly raised or lowered. Rotation of shaft 13 activates a gear which tilts the entire table on base 18 to right or to left.
Connected to column 12 is main frame 14 which supports at one end thereof, a U-shaped tubular column 15. Tubular column 15 is adapted to receive several accessories at its other end, in telescopic engagement therewith. As shown in FIG. 1, a platform 16 is affixed to a tubular support 17 arranged for slidable engagement within column 15. Such a platform can be adjusted in position to serve various functions. For example, it can be used as a seat by the anesthesiologist which positions him in front of the patient to provide direct control of the patient and access to the mouth and throat for intratrachial anesthesia. During surgery, the platform may be used as an accessory table or, the platform can be removed and a standard winch can be inserted to provide longitudinal traction on the patient to permit application of a plaster jacket to immobilize the cervical spine.
Further, and not in connection with scoliosis surgery, the head halter may be replaced with skull traction tongs for use in operations on the cervical spine, through the posterior approach, where it is desirable to stabilize the cervical spine by this means.
A traction support 18 is provided on each side of the frame 14 and comprises arm 19 pinioned at one end at 20 and adjustably clamped at its other end about arm 21 by means of collar 22 and wing nut 23. A suitable traction band support 24 is clamped at the extremity of arm 21. The other end of arm 21 is pinioned on a horizontally adjustable rack 25. Such traction devices are well known and serve to provide lateral traction by the use of traction bands placed about the trunk of the patient.
At the other end of frame 14 there is provided a knee support, more clearly shown in FIGS. 2 and 3, comprising a housing 31 having *a bore 32 adapted to receive the pin 33 of lateral arm 34. Secured to the top of housing 31 is a plate 35 provided with an aperture 36 through which pin 33 extends and a curved slot 37 which serves to guide the lateral bar 34 through approximately 180 rotation through cooperation with lock bolt 38. Bolt 38 is threaded at one end and extends through slot 37 for threaded engagement with an aligned threaded opening 39 in the lateral bar 34. Shoulder 40 limits the movement of bolt 38 through slot 37 and clamps the lateral bar 34 in place against the plate 35 after bar 34 is positioned at the desired horizontal angle. For facilitating the positioning and locking of lateral bar 34 in place, bolt 38 is provided with a suitable handle 41 for rotating bolt 38. Handle 41 is arranged to swing freely about pin 42.
When it is desired to position the lateral bar 34, starting from a locked position, handle 41 is grasped and turned to loosen the gripping action of shoulder 40. The lateral bar 34 may then be swung in a horizontal plane about the axis of pin 33 to the desired position. Handle 41 is then turned to cause shoulder 40 to bear against the plate 35 and lock the lateral bar in place.
For supporting the legs of the patient while the patient is in the prone position there is provided on the surgical table of the present invention a pair of universal leg rests 50 which are fully adjustable in a vertical and horizontal plane and can be swung inwardly and outwardly in an arcuate plane to accommodate patients of various sizes and to enable positioning of the legs as desired. Universal leg rests 50 are adjustable toward and away from frame 14 by means of frame 51 which is slidably positioned along the lateral bar 34. To this end, frame 51 comprises a centrally positioned collar 52 through which lateral bar 34 passes. A plurality of supporting web members 53 provide strength and rigidity to the frame. For securely locking the frame 51 in position on the lateral bar 34, the lateral bar 34 is provided with a slot or groove 54 along its surface adapted to receive a locking screw 55 which passes through a threaded opening 56 in frame 52.
Securely mounted on frame 51 is a pair of leg or knee supports 57 and 58, each of which are identical in structure and operation, and thus, only the structure of one will be described. Each knee support is suspended from the frame 51 by means of a bar member 59 which is pinioned at 60 in a conventional manner. Positioned intermediate the ends of the bar member 59 and fastened thereto by any suitable means is a U-shaped clamp 61. Each arm of the U-shaped clamp 61 is provided with an aperture through which extends a bearing shaft 62 threaded at one end for engagement with a sleeve nut 63 adapted to fasten or lock the arms of the U-shaped clamp 61 on the frame 51 by operating means 64.
As shown in FIG. 4, the lower, outside ends of frame 51 are contoured to provide an arcuate surface 65. This surface 65 extends within the U-shaped clamp member and is in engagement with hearing shaft 62. Thus, it should be readily apparent, each leg support may be swung along the arcuate path defined by the surface 65 and securely locked in the desired position by U-shaped clamp 61.
Knee rests 57 and 58 are slidably positioned on bar 59 for vertical adjustment and comprise L-shaped supporting frames and 71, respectively, which are each provided with suitable padding 72 for the comfort of the patient. Any suitable soft material may be used such as, for example, foam latex (SLI 100% solid, uncored, medium density) covered with double coated rubber sheeting. At the rear of the supporting frame 70 is provided a bracket 73 having a slot 74 receiving bar 59. Frame 71 is simi larly constructed. Bracket 73 is inclined with respect to the vertical axis to permit a slight tilt of the knee rest with respect to the horizontal plane as shown in FIG. 2. The other knee rest is similarly disposed.
For fastening the supporting frames 70 and 71 to the bar 59, frames 70 and 71 are provided with transverse bores arranged to receive in threaded engagement there- 'With a lock bolt 75 rotated by handle 76 for locking the frames in place. Pin 77 extends outwardly from the lower extremity of bar 59 to limit the downward travel of the adjacent knee rest 57 or 58.
Referring to FIG. 1, a scoliosis yoke 80, in slidable and rotatable engagement with lateral bar 34, is adjustably arranged for supporting the patient in line with the anterior-superior iliac spine of the patient. Scoliosis yoke 80 comprises a U-shaped horn 81 having apertures 82 and 83 in each upwardly extending arm 84 and 85, respectively, of the horn 81 through which is passed a metal sword piece 86. Sword 86 is provided with a bend 87 which is clamped by any suitable means such as nut 88 to pin 89 extending from the side horn 81. Centrally located and extending from the underside of horn 81 is a bushing 90 having a bore (not shown) arranged for rotation on bar 91. Bushing 90 is locked in desired position by lock bolt 90'.
Split clamp 92 has secured therein a vertically adjust able bar 91 and is supported for slidable and rotatable movement upon lateral bar 34 which passes through a transverse opening in clamp 92. Lock bolt 93 serves to lock the split clamp 92 after the scoliosis yoke 80 has been located in the desired position.
Sword 86 together with the knee rests 57 and 58 support the weight of the patients body and may be provided with a suitable tubular pad (not shown) to add to the comfort of the patient, prevent undue pressure over the bony parts, and to permit removal after the plaster cast is applied.
It should be readily apparent, that by the interrelation of parts hereinbefore described the yoke 80 is readily movable in an arcuate path about a first vertical axis at bushing 90 and can be rotated about an aXis in a horizontal plane on bar 34-. In addition, clamp 92 permits adjustment for height on an axis formed by bar 91. Thus, any degree of rotary and lateral corrective forces may be obtained on the patient by proper adjustment for correction of scoliosis.
A second yoke 98 is provided for supporting the chest of the patient. Yoke 98 is similar in construction to that of yoke 80 and comprises a horn 99, sword 100, sword fastening means 101 and a bushing (not shown) which is positioned in an aperture (no-t shown) in vertically adjustable table 102. A chest plate, elliptic in shape and padded to reduce pressure over the sternum, may be provided for the upper sword. Table 102 is supported on rack 103 and is vertically adjustable independent of the frame elevating mechanism through a conventional gearing arrangement which is driven by rotation of crank 104. This independent vertical adjustment permits positioning of the upper trunk of the body while the lower portion of the trunk is maintained in its original position.
Table 102 is provided with a groove or channel 105 on each end adapted to receive for supporting engagement therein flat arm supporting platforms 106 and 107. Platforms 106 and 107 are thus spaced from each other by approximately the width of the table 102 to facilitate the use of intratrachial anesthesia administered to the patient whose head is supported face downwardly in the headrest 108.
Headrest 108 is contoured in a desired fashion which may be, for example, U-shaped to allow access to the nose and mouth of the patient and may be suitably padded with a leather covered latex pad 109 affixed to frame 110 (FIG. 5). Frame 110 is provided with a bore which receives, in threaded engagement therewith ball 111 supported in socket 112 to provide universal movement of the headrest 108. Ball 111 is locked in the desired position by means of a retainer 113 which is threadingly engaged in socket 112 and secured by wing bolt 114. Rotation of wing bolt 114, in a locking direction, applies pressure to spacer 115 and piston 116 in a conventional manner to firmly seat the ball in the concave recess 117 of piston 116.
Headrest 108 may be vertically adjusted through its supporting bar 118 which is slidably engaged in collar 119 of the table clamping assembly 120. To this end, collar 119 is provided with a bore within which is received in threaded engagement therewith wing bolt 121. Clamping assembly 120 comprises a pair of plates 122 and 123 which are spaced so as to allow platforms 106 and 107 to pass therebetween. Each plate 122 and 123 has aligned apertures through which pass bolts 124 and 125 to facilitate clamping of the plates to the platform by nuts 126 and 127, respectively. Upper plate 122 has secured thereto a base 128 which is dimensioned to fit snugly between the platforms 106 and 107 to ensure a rigid connection.
There has now been described a novel surgical table particularly adaptable for scoliosis surgery. In operation, the patient is supported on the table with his knees in the knee supports 57 and 58, the lower trunk or pelvis across sword 86, the upper trunk or chest across sword 100 and the head, face down, in the headrest 108. The platform 16 is lowered to provide a seat for the anes thetist who then has direct control of the patient. The spaced platforms 106 and 107 and open headrest 108 allow the use of intratrachial anesthesia. Additional support for the chest can be provided during surgery by positioning straps across the swords 86 and 100 or pillows on the table 102. In neither case is the chest supported on a flat rigid surface. If a complete prone position and/or Trendelenburg is desired, a small table may be rolled into position over the knee supports and the patients limbs supported in an extended position.
For correction of scoliosis, the apparatus. provides for the use of lateral traction bands attached to the adjustable lateral traction arms 21 and supports 24. For longitudinal traction and to permit the application of a plaster jacket to immobilize the neck, table 16 is replaced with a standard winch and longitudinal traction applied through a conventional head halter or skull tongs. Rotary and corrective forces are applied by adjustment of the scoliosis pelvic yoke which is completely adjustable in a left and right lateral direction and rotatable about either plane. Knee supports 57 and 58 are adjustable to accommodate patients of various size and can be abduced or swung arcuately in a vertical plane for better pelvic stability.
Following surgery, a plaster cast can be fashioned in a very short time without removing the patient from the table. Right and left lateral traction bands utilizing arms 21 and traction supports 18 may be applied to obtain the desired correction of the scoliotic curves. The cast may then be fashioned from the axillae to the knees with the back supported in a corrected position.
It is notable that the lumbosacral joint is well positioned so that arthrodesis for unstable spinal conditions, such as spondylolisthesis, will be held as placed by the surgeon. X-rays may show a desirable decrease in the spondylolisthesis with the use of this technique.
The patient is easily removed from the table by tilting the table to one side, using crank activated arm 13, and withdrawing the swords. The patient is then rolled from the table onto a stretcher.
From the foregoing description, it is apparent that there is provided by the present invention a simple and effective surgical table, meeting the several objectives discussed above, which can be utilized for combining spinal fusion, curve correction and corrective plaster application in one continuous operation. Although only one particular embodiment of the invention has been stressed, it will be obvious to those skilled in the art that various modifications may be made and it is intended by the appended claims to cover all such modifications which fall within the true spirit and scope of the invention, including protoscopic and thoracic surgical procedures which may be facilitated by use of this table. It is also understood that the apparatus described may be attached or adapted to any suitable operating or fracture table to provide the novel table to be used in the manner described. As described, the apparatus is specifically adapted for use in conjunction with the American-Albee Fracture Table, manufactured by the American Sterilizer Company.
What is claimed is:
1. In a surgical table for adjusting for surgical purposes, the position of a patient disposed face down, a main frame, spaced knee supports for the patient, means for mounting said supports on and adjustable toward and away from said main frame and adjustable in height with respect thereto and adjustable angularly with respect to each other and with respect to said main frame; a scoliosis yoke for supporting the pelvic region of the patient, means for mounting said yoke on and adjustable toward and away from said main frame and adjustable in height with respect thereto and adjustable angularly in a horizontal plane with respect to said main frame and rotatable about a vertical axis; a chest yoke supporting the patients chest, means for mounting said chest yoke on and vertically adjustable with respect to said main frame; arm rests for the patient carried by said main frame; and a headrest supporting the patients head carried by said arm rests and means for adjusting said head rest toward and away from said main frame.
2. A surgical table as described in claim 1, said scoliosis yoke and chest yoke including removable swords extending across said yokes supporting the patient, said swords being removed after plaster application to facilitate transfer of the patient from the surgical table to a stretcher.
3. In a surgical table for adjusting the position of a patient for surgical purposes, a base, a main frame, means for adjusting said main frame vertically with respect to said base, a lateral bar mounted for horizontal movement on said main frame, means for locking said bar with respect to said main frame, a knee support frame slidably mounted on said bar, lock means between said knee support frame and said bar, a pair of spaced bar members pivotally mounted on said knee support frame, means mounted on each of said bar members for locking each of said bar members in position on said knee support frame, a knee support for the patients knee slidably mounted on each of said bar members, means on each of said knee supports for locking each of said knee supports to the adjacent one of said bar members, a scoliosis yoke for supporting the pelvic region of the patient slidably mounted on said lateral bar, means for locking said yoke to said lateral bar, means for adjusting the vertical height of said scoliosis yoke with respect to said lateral bar, a table disposed above said main frame, means for moving said table vertically with respect to said main frame, a chest yoke supporting the patients chest mounted on said table, a pair of spaced arm supports for the patients arms mounted on said table and a headrest supporting the patients head face down a-djustably positioned on and between said arm supports whereby upon relative move- References Cited by the Examiner UNITED STATES PATENTS 2,306,929 12/ 1942 Bergamini 12871 2,577,17'7 12/1951 Anderson 269322 2,691,979 10/1954 Watson 128-84 3,188,079 6/1965 Boetcker et al. 269-328 FOREIGN PATENTS 657,933 5/1929 France.
921,431 4/ 1947 France.
287,386 4/ 1953 Switzerland.
317,583 1/ 1957 Switzerland.
RICHARD A. GAUDET, Primary Examiner.
I. W. HINEY, JR., Assistant Examiner.