Abstract:
A hip grip table attachment apparatus for positioning and retaining a patient in a position lying on one side during hip or pelvic surgery is disclosed. The hip grip table attachment apparatus attaches to an operating table and has a removable top platform attachment for supporting surgical instruments that extends over and also protects the upper body of a patient lying on one side, an arm support attachment that supports an arm of the patient to prevent rolling, and pelvic positioner attachments that position and retain and the patient&#39;s lower pelvic region.

Description:
BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     This invention relates generally to surgical support devices for positioning and retaining a patient in a position lying on one side during hip or pelvic surgery. More particularly to a hip grip table apparatus that attaches to an operating table and has a removable top platform for supporting surgical instruments that extends over and protects the upper body of a patient lying on one side, an arm support attachment that supports an arm of the patient to prevent rolling, and pelvic positioner attachments that position and retain and the patient&#39;s lower pelvic region. 
     2. Brief Description of the Prior Art 
     Typically in surgical procedures such as hip and pelvic surgery, the patient is supported in a position lying on one side on an operating table, known as the lateral decubitis position, to facilitate a surgical procedure such as hip anthroplasty. In such procedures, it is extremely important to retain the patient in a fixed reference position relative to the operating table in order to achieve optimum fit and function of a hip prosthesis. In most instances the patient is under general anesthesia and cannot cooperate in maintaining the proper position. 
     A variety of patient support devices are known in the art for use in supporting a surgery patient in a position lying on one side (lateral decubitis position) on an operating table during hip or pelvic surgery. Some support devices, such as pelvic positioners or lateral positioners are mounted by clamps or other means onto opposed sides or side edges of the operating table. Conventional pelvic positioners have a pad supported at one end of an elongate rigid rod or arm that is clamped to the side edges or to rails or grooves on the opposed sides of the table by clamps. The opposed pads engage the anterior and posterior pelvic region of the patient and usually are in contact with the soft tissues in the pelvic region, resulting frequently in inadequate patient support and retention. 
     These conventional pelvic positioners or lateral positioners are not particularly suited to support the upper body of the patient who, in the lateral decubitis position, also has one shoulder on the table and the other shoulder extending vertically upward. The sedated or unconscious patient has no muscle control and often the upper body will tend to roll to one side or the other even the the pelvic region may be retained. The upper body is often supported by pillows. The arm on the elevated side of the body is heavy and difficult to properly position, and is often tied to one side of the table. 
     Another problem with conventional pelvic positioners and lateral positioners is that they are usually clamped to the side edges or rails on opposed sides of the operating table directly across from the hip area of the patient and directly in front of the operating surgeon with the clamps disposed at or below the surgeon&#39;s waist. Most conventional operating table clamps have a protruding knob or lever. Thus, the position of the clamps and protruding knob or lever produce a hazard and obstruction. The surgeon may come into bodily contact with the clamp or protruding knob or lever during the operation which can cause movement of the patient or injury to the surgeon, or can snag the surgeons clothing or gown during movement of the surgeon. 
     Still another problem with conventional pelvic positioners and lateral positioners is that the elongate rigid rod or arm that is clamped to the side edges or to rails on the opposed sides of the table and/or the pad supports that engage the anterior and posterior pelvic region of the patient may be made of metallic material which will often prevent good x-rays from being taken during the surgical procedure. 
     Another problem associated with hip and pelvic surgery wherein the patient is supported in a position lying on one side on an operating table is that the patient&#39;s face and upper body may be draped with a sheet but is otherwise unprotected. Thus, the patient may be injured by a surgical instrument being passed over his or her face or upper body, or by a surgical instrument that may be accidentally dropped during the surgical procedure. 
     There are several patents that disclose various work platforms, supports, and pelvic positioner apparatus that are attached to an operating table. 
     Linder, U.S. Pat. No. 4,113,218 discloses an adjustable frame assembly for attachment to the sides of a hospital operating table for supporting a removable surgical tray above the operating table and over the patient in a variety of positions for the convenience of personnel. The frame assembly consists of two upright supporting columns, one attached to each side of the operating table at an appropriate position. A horizontal bar is mounted between the upper ends of the upright supporting columns and extends across the operating table from one side to the other. A rectangular open frame member is supported by mechanical linkages to a pair of vertically-extending posts adjustably mounted, respectively, upon two slidable blocks carried by the horizontal bar. A removable surgical tray may be placed upon the open rectangular frame and clamped into position. The position of the surgical tray may be raised and lowered over the patient, may be moved about in a plane, or may be tilted or inclined as necessitated by the nature of the operation to increase the convenience, efficiency, and speed in the use of the surgical instruments placed upon the tray. There is no provision for positioning the patient, or for supporting an arm of the patient. 
     Lee, U.S. Pat. No. 4,180,254 discloses a surgical apparatus for locating a patient lying on his side to facilitate hip surgery which has a first platform to support the patient&#39;s lower hip, two posts upstanding from respectively opposite sides of this platform to engage the patient about the rear and front of his pelvis, a second platform extending from the first platform to support the patient&#39;s lower leg, at least one further post upstanding from the second platform, and a third platform connected to the further post above the second platform to support the patient&#39;s upper leg. 
     Evans, U.S. Pat. No. 4,390,011 discloses an adjustable surgical arm rest and instrument platform for supporting the arms and hands of a surgeon during a micro-surgical procedure, in which a supporting platform is provided with vertical and angular adjustment mechanisms which permit rapid adjustment of the platform before, during and after the operation. Two or more platforms may be used, and each platform can be adjusted independently of the other platforms. The angular adjustment of a platform can be performed independently of the vertical adjustment of the platform. Each mechanism is provided with a two part securing feature so that the platforms will not move accidentally. 
     Arnold, U.S. Pat. No. 4,583,725 discloses a patient support frame for use on an operating table during posterior lumbar laminectomy surgery that has a frame for attachment to the table and a pair of iliac crest supports slidably mounted on the frame. The iliac crest supports are adjustable to engage the iliacs, or hipbones, of the patient whereby the prone patient is supported so that the abdomen does not touch the table and is substantially without pressure thereon. 
     Mullin et al, U.S. Pat. No. 4,624,245 discloses a device for laterally displacing a femur from a hip socket which includes a mount for attachment to a stationary surface, such as a surgical table, a member for exerting pressure against the femur when the member is placed in a predetermined position in contact with the patient, and an assembly for moving the member relative to the mount. Movement of the member permits a sufficient amount of pressure to be exerted and maintained against the femur to laterally displace it from the hip socket. 
     Kurland, U.S. Pat. No. 4,653,482 discloses an upper-extremity traction tray attachment for operating tables which provides horizontal support form the arm, wrist and hand, or leg of a patient during surgical operations on those parts of the body. The tray comprises a perimetric rectangular metal frame having a pair of spaced-apart, downward-facing, L-shaped projections on each side. Any side of the frame may be secured to the side rail of a typical operating table by securing any of the projection pairs to the side rail on either side of a typical operating table with the common screw-type clamps which may be anchored at any point along the rail. A rigid rectangular sheet of material transparent to both X-rays and visible light spans the gap between the two longitudinal frame sections, a gap being left at either end between the lateral edges of the sheet and each lateral frame section. Traction pulley mounting arm and adjustable support leg assemblies or adjustable support leg assemblies may be mounted on either or both lateral frame sections. The sheet of transparent material has a lateral slot near one end. An elbow post may be slidably mounted at its base within the slot. There is no provision for positioning the patient, or for supporting an arm of the patient. 
     Tari et al, U.S. Pat. No. 4,858,903 discloses a hand surgery operating table connectable to a conventional main operating table and consisting of a forearm support that is rotatable in a horizontal plane as well as pivotable about a horizontal axis, and a base plate carrying a hand support; and up to seven flexible and tensionable arms secured at one end to the base plate and carrying finger-fixing thimbles at the other end. The tension of the arms can be adjusted to any desired extent so that they can either maintain their tensioned fixed position or they can be readily displaced therefrom without having to manipulate their tensioning mechanism. 
     Deluhery, U.S. Pat. No. 5,040,546 discloses a portable positioning device for supporting and holding a patient in a lateral decubitus position on the table of a densitometer or the like which includes a rigid back support having a vertical wall, a buttocks support having a vertical wall extending laterally at an angle relative to the vertical wall of the back support and a restraining means such as a flexible strap for holding the patient against these vertical walls. 
     Michelson, U.S. Pat. No. 5,135,210 discloses a surgical armboard attachment device that permits enhanced adjustability of a conventional surgical armboard. The attachment device permits adjustment of the armboard in three planes, and can be used as an adaptor to an existing armboard, or incorporated as a component of a new armboard structure. 
     Kabanek et al, U.S. Pat. No. 5,152,486 discloses a surgical assistance device used by members of the surgical staff as an arm or hand rest, instrument platform or sterile cloth support. The surgical assistance device has two rectangular shaped platforms covered by a covering capable of being sterilized. The platforms are attached so that the first platform runs parallel to the patient-supporting surface of the surgical table. The second platform is attached to the first platform and is oriented to the first platform at other than a 180-degree angle. The bottom surface of the first platform is attached to a mounting means for securing the surgical assistance device to the longitudinal support surface of a surgical table. 
     The present invention overcomes the above described problems and is distinguished over the prior art in general, and these patents in particular by a hip grip table attachment apparatus for positioning and retaining a patient in a position lying on one side during hip or pelvic surgery which is releasably attached to an operating table and has a removable top platform for supporting surgical instruments that extends over and protects the upper body of a patient lying on one side, an arm support attachment that supports an arm of the patient to prevent rolling, and pelvic positioner attachments that position and retain and the patient&#39;s lower pelvic region. 
     SUMMARY OF THE INVENTION 
     It is therefore an object of the present invention to provide a hip grip table attachment apparatus for positioning and retaining a patient in a position lying on one side during hip or pelvic surgery. 
     It is another object of this invention to provide a hip grip table attachment apparatus that is easily and quickly attached to and removed from a conventional operating table using conventional operating table clamps. 
     Another object of this invention is to provide a hip grip table attachment apparatus that is releasably attached to an operating table and has a removable top platform that extends over the upper body of a patient lying on one side and protects the patient&#39;s face and upper body from accidental injury, and also serves as a convenient work platform for supporting surgical instruments. 
     Another object of this invention is to provide a hip grip table attachment apparatus that is releasably attached to an operating table and has an adjustable horizontal arm support attachment that can be vertically and pivotally positioned adjacent to the upper body of a patient lying on one side to comfortably support the elevated arm of the patient, and also to prevent the patient&#39;s upper body from rolling over. 
     Another object of this invention is to provide a hip grip table attachment apparatus that is releasably attached to an operating table and has adjustable pelvic positioner attachments that engage and retain the lower pelvic region of a patient lying on one side in a proper position during hip or pelvic surgery. 
     Another object of this invention is to provide a hip grip table attachment apparatus for positioning and retaining a patient in a position lying on one side during hip or pelvic surgery that is clamped to a conventional operating table and has adjustable pelvic positioner attachments clamped thereto wherein the clamping elements are disposed a sufficient distance away from the surgeon performing a surgical procedure to prevent bodily contact therewith and snagging of the surgeons clothing during surgical procedures. 
     A further object of this invention is to provide a hip grip table attachment apparatus having pelvic positioner attachments that engage a patient&#39;s lower pelvic region and will not interfere with taking x-rays. 
     A still further object of this invention is to provide a hip grip table attachment apparatus for positioning and retaining a patient in a position lying on one side during hip or pelvic surgery which is simple in construction, inexpensive to manufacture, and rugged and reliable in operation. 
     Other objects of the invention will become apparent from time to time throughout the specification and claims as hereinafter related. 
     The above noted objects and other objects of the invention are accomplished by a hip grip table apparatus for positioning and retaining a patient in a position lying on one side during hip or pelvic surgery. The hip grip table attachment apparatus releasably attaches to an operating table and has a removable upper platform for supporting surgical instruments that extends over and protects the upper body of a patient lying on one side, a lower platform attachment that supports an arm of the patient to prevent rolling, and pelvic positioner attachments that position and retain and the patient&#39;s lower pelvic region. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS 
     FIG. 1 is a perspective view of the hip grip table attachment apparatus in accordance with the present invention shown attached to an operating table and positioned relative to a patient lying on one side during hip or pelvic surgery. 
     FIG. 2 is a perspective view of the hip grip table attachment apparatus shown in larger scale. 
     FIG. 3 is side cross sectional view through the frame of the hip grip table apparatus, showing the top platform attachment installed thereon. 
    
    
     DESCRIPTION OF THE PREFERRED EMBODIMENT 
     Referring to the drawings by numerals of reference, there is shown in FIGS. 1 and 2, a preferred hip grip table attachment apparatus  10 . The hip grip table attachment apparatus  10  has an inverted, generally U-shaped frame  11  formed of bent tubing. The frame  11  has laterally opposed vertical legs  12 , a contiguous horizontal top rail  13 , and a lower horizontal rail  14  a short distance beneath the top rail secured at opposed ends between the legs in parallel vertically spaced relation to the top rail. As seen in FIG. 1, the lower portions of the legs  12  extend through respective conventional operating table clamps  15  which are slidably mounted on the existing rails  16  extending along the longitudinal sides of a conventional operating table  17 . Although only one rail  16  and one clamp  15  is seen in FIG. 1, it should be understood that the second rail and second clamp is disposed on the opposite side of the operating table and would be identical to those shown. 
     A top platform  18  formed of rigid material is removably supported on the frame  11 . The top platform  18  has a flat generally rectangular main portion  19  with a vertical end portion  20  that extends generally vertically downward from one end of the main portion. As shown from the side in cross section in FIG. 3, the lower end of the vertical end portion  20  has a short horizontal portion  21  that extends short distance inwardly in the direction of the main portion  19  and terminates in a short vertical portion  22 . 
     As shown in FIG. 3, the top platform  18  is removably mounted on the frame by holding the main portion  19  upwardly and inserting the lower end of the vertical end portion  20  between the top rail  13  and lower rail  14  so that its short horizontal portion  21  and short vertical portion  22  engage the lower rail  14  and then lowering the main portion downwardly so that the underside of the vertical end portion  20  and main portion  19  rest on one side and top of the top rail  13 . When properly positioned, the underside of the short horizontal portion  21  and short vertical portion  22  of the end portion  20  are engaged on the top and one side of the lower rail  14  and the underside of the vertical end portion  20  and main portion  19  are engaged on the top and one side and top of the top rail  13 , as shown in FIG.  3 . In the installed position, as see in FIGS. 1 and 2, the main portion  19  of the top platform  18  is cantilevered outwardly from the frame  11  and its weight maintains the vertical and horizontal surfaces engaged on the respective top and lower rails. 
     To remove the top platform  18 , the steps described above are reversed. In a preferred embodiment, the top platform  18  has a width which is somewhat narrower than the distance between the legs  12  of the frame  11  so that the top platform may be centered or moved from side to side by sliding it laterally on the rails  13  and  14 . 
     The frame  11  can be raised or lowered and rigidly secured to position the top platform  18  at a selected distance above and parallel to the top of the operating table  17  by loosening the operating table clamps  15  and moving the legs  12  vertically as required and then tightening the clamps, in a well known manner. The frame  11  and top platform  18  mounted thereon can also be positioned at a selected distance from either end of the operating table  17  by loosening the clamps  15  and moving the frame  11  longitudinally along the rails  16  as required and then tightening the clamps, in a well known manner. 
     Referring again to FIGS. 1 and 2, an arm support attachment  23  is adjustably connected to one of the legs  12  on one side of the frame  11 . The arm support  23  has a generally rectangular plate  24  formed of rigid material covered by a pad  24 A. An elongate tubular support rod  25  secured to the underside of the base plate extends outwardly from one end thereof. The outer end of the support rod  25  extends through a clamp  26  which is slidably mounted on one of the legs  12  of the frame  11 . The arm support  23  can be raised or lowered and pivoted beneath and relative to the top platform  18 , and secured at a selected distance above and parallel to the top of the operating table  17  by loosening the clamp  26  and moving it vertically along the leg  12  as required and then tightening the clamp. The distance of the arm support  23  relative to the leg  12  can adjusted by loosening the clamp  26  and moving the support rod  25  horizontally relative to the clamp  26  and leg  12  as required and then tightening the clamp. The lower platform  18  can also be pivoted in a horizontal plane relative to the vertical leg  12  supporting it by loosening the clamp  26  and rotating the clamp on the leg as required and then tightening the clamp. The clamp  26  is a commercially available clamp, and therefore is not shown and described in detail. A suitable clamp is manufactured by Matthews Studio Equipment, of Burbank, Calif. 
     A first pelvic positioner  27 A is adjustably connected to one of the vertical legs  12  of the frame  11 , and a second pelvic positioner  27 B is adjustably connected to the other one of the vertical legs. Each pelvic positioner  27 A, 27 B has a generally L-shaped tubular support rod  28  with an elongate portion  28 A and a shorter portion  28 B at one end that extends angularly outward from the elongate portion. A flat generally oval-shaped or kidney-shaped plate  29  formed of rigid material is mounted on the shorter portion  28 B of each support rod  28  by a swivel connection  30  and covered by a pad  29 A. 
     The end of the elongate portion  28 A of each support rod  28  of the pelvic positioners  27 A,  27 B extend through clamps  31  which are mounted on the vertical legs  12  of the frame  11 . The pelvic positioners  27 A, 27 B extend horizontally outward a distance from the respective vertical legs  12  toward the foot end of the operating table with their padded plates  29 ,  29 A facing inward in opposed facing relation. The clamps  31  are commercially available clamps, and therefore not shown and described in detail. A suitable clamp is manufactured by Matthews Studio Equipment, of Burbank, Calif. 
     Each pelvic positioner  27 A, 27 B and the padded plates  29 , 29 A at their outer ends can be raised or lowered independently and secured at a selected distance above and parallel to the top of the operating table  17  by loosening the clamps  31  and moving the support rods  28  vertically along the respective vertical legs  12 , as required, and then tightening the clamps. Each pelvic positioner  27 A, 27 B and the padded plates  29 , 29 A at their outer ends can be positioned at a selected distance from the respective vertical legs  12  supporting them by loosening the clamps  31  and moving the support rods  28  horizontally relative to the clamps  31  and vertical legs  12 , as required, and then tightening the clamps. Each pelvic positioner  27 A, 27 B and the padded plates  29 ,  29 A at their outer ends can also be pivoted in a vertical or horizontal plane relative to the respective vertical legs  12  supporting them by loosening the clamps  31  and rotating the clamps on the vertical legs as required and then tightening the clamp. In a preferred embodiment, the generally oval-shaped or kidney-shaped base plate  29  at the outer end of the pelvic positioners  27 A, 27 B are sized and shaped so as not to obstruct x-rays taken of the hip area of the patient. 
     Referring again to FIG. 1, a patient P is shown supported in a position lying on one side on an operating table  17 . The legs  12  of the frame  11  are placed into the clamps  15  mounted on the rails  16  on the opposed sides of the operating table. The top platform  18  is installed, as described above, and the frame is raised or lowered to place the main portion  19  of the top platform the desired distance above the elevated shoulder of the patient, and the frame top platform are positioned, as a unit, at the desired distance from the head end of the operating table, and the clamps  15  are then tightened. 
     The elongate support rod  25  of the arm support  23  is placed into the clamp  26  which is mounted on the vertical leg  12  at one side of the apparatus. The arm support  23  is raised or lowered and pivoted beneath the top platform  18 , as described above, to the desired position to support the arm A of the patient in an elevated position, and the clamp  26  is then tightened. The arm A on the elevated side of the patient&#39;s body is then placed onto and supported by the padded plate  24 , 24 A of the arm support  23 . 
     The ends of the elongate portion  28 A of each support rod  28  of the pelvic positioners  27 A,  27 B are placed into the clamps  31  that are mounted on the vertical legs  12  with their padded plates  29 , 29 A disposed toward the foot end of the table and facing inward in opposed facing relation. Each pelvic positioner  27 A, 27 B and the padded plates  29 , 29 A at their outer ends are raised or lowered independently to the desired elevation and are pivoted inwardly, as described above, so that the opposed facing padded plates  29 , 29 A are firmly engaged on the anterior and posterior pelvic region of the patient, and the clamps  31  are then tightened. In a preferred embodiment, the padded base plate  29  at the outer end of the anterior pelvic positioner  27 A is firmly biased against the patient&#39;s pubis and the padded base plate of the posterior pelvic positioner  27 B is firmly engaged against the patient&#39;s sacrum, and both are sized and shaped so as not to obstruct x-rays taken of the hip area of the patient. 
     Thus, the pelvic region of the patient is retained in the desired operating position and the patient&#39;s upper body and arm on the elevated side is supported in a position to prevent the upper body from rolling to one side or the other. 
     It should be noted that the clamps  31  supporting the pelvic positioners  27 A, 27 B are disposed near the head end of the operating table and provide an unobstructed area directly across from the hip area of the patient in which the operating surgeon can move freely. Thus, there are no protruding clamp knobs or levers in which the surgeon may come into bodily contact with during the operation or that might snag the surgeons clothing or gown during movement of the surgeon. 
     The top platform  18  covers and protects the face and upper body of the patient from accidental injury from a surgical instrument being passed over his or her face or upper body, or being accidentally dropped during the surgical procedure. The top platform  18  also serves as a convenient work surface to safely place instruments during the operation. 
     While this invention has been described fully and completely with special emphasis upon a preferred embodiment, it should be understood that within the scope of the appended claims the invention may be practiced otherwise than as specifically described herein.