This invention relates to an apparatus and a method for fixing bodies/body parts, especially of the human body or human body parts.
In many fields of human medicine or medical research and technology secure fixing of the patient or a person under investigation is necessary. This is of greatest importance especially in the field of diagnostic use (radiology), radiotherapy or in operative/surgical interventions (neurosurgery, ENT, etc.) but also during (acute or permanent) pre- or post-operative care of wounds/injuries. The requirements on accuracy and reproducibility, both in determining a stereo-tactical frame system in or on the human body and also in fixing the body itself, have been increased by the introduction of computer technology in diagnosis and therapy.
The following fixing methods are known as the state of the art:
a) fixing the body with adhesive tapes or cuffs: The body of the patient lies on a foam material pad. Tapes tensioned transversely over the body fix the patient on this pad. The following points are disadvantageous:
indentation, pressure points, displacements and/or swelling of the skin can arise from the strong pull of the adhesive tapes;
after removal of the retaining elements (adhesive tapes) it is hardly possible to effect repositioning in exactly the same position again, which is a disadvantage particularly in stereo-tactical operations and in radiotherapy;
the body cannot be fixed adequately; movement in the sideways direction in particular (laterally) cannot be restricted or defined adequately.
b) fixing the body by screwing into the bone: The body of the patient is screwed to a metal frame at various places. The following are disadvantages:
screwing to the bone is an invasive procedure and is thus only possible and justified for particular indications;
the physical stress on the patient is substantial;
the method can only be used for specific positions of the patient and impedes the operator;
fixing of the soft parts (muscles, ligaments, connective tissue) is hardly possible at all.
c) fixing by formworks: The patient is placed on a kind of xe2x80x9cair mattressxe2x80x9d, which is filled with foam material balls. By sucking the air out of this mattress, this becomes solid through the foam material balls lying against one another. The vacuum mattress is thus matched to the body in the first step and is sucked out in the second step. An impression of the body is obtained by this method. Disadvantages in this are:
the xe2x80x9cmattressesxe2x80x9d usually employed do guarantee immobilisation but not fixing with uncooperative or anaesthetised patients adequate immobilisation is hardly possible at all;
an inadequate impression of the patient often results, since the mattress can hardly bear exactly on all body parts;
pressure points often result from formation of folds or too strong pressure, which can lead to pressure points and damage to tissues, especially with anaesthetised patients.
Other moulding materials, such as rails, thermoplastic material or plastics moulds, gypsum, etc. exhibit similar disadvantages. In addition, these methods involve substantial expenditure in money or time and are therefore only used for long-term applications.
The invention is therefore based on the object of providing an apparatus and a method for fixing/making moulds/compressing the human body or body parts, which avoids the cited disadvantages, is of simple structure and simple to use and kind to the patient to a high degree. The apparatus should moreover facilitate the exact application of calibration points (so-called markers) and optimal accessibility to operation regions.
This object is met by an apparatus according to the features described with reference to the present invention and the associated method.
In contrast to the apparatuses and procedures initially described, the fixing of the human body is effected in the proposed apparatus or method essentially by vacuum force. A blanket-like outer element is placed over a body support surface (flexible or rigid) with suction openings and is sucked at least substantially airtight on to the body support surface in its edge region projecting beyond the body (of the patient) A closed vacuum chamber thus results, so that the body is fixed relative to the support surface exactly and immovably in all directions.
The patient simply lies on the body support surface in the preferred arrangement and is xe2x80x9ccovered upxe2x80x9d with the ox-like outer element. The patient or his body part(s) is/are now surrounded by this bag-like structure. Parts of the body (arms, legs, head, back) can emerge from the air or vacuum chamber through xe2x80x9cpeepholesxe2x80x9d and thus remain unfixed, these openings being bounded by airtight arrangements, e.g. rubber bands or airtight cuffs. The air is now sucked out of the space between the body support surface and the outer element and the patient is fixed in the vacuum chamber thus resulting.
The described outer element or the body support surface is formed in the preferred embodiment from structurally reinforced, easily stretched plastics material or a metal foil and can accordingly adapt accurately to the anatomical structure of the body. By suitable choice of the material thickness and/or the level of the vacuum in the vacuum chamber an enhanced fixing or even compression of the body (of the patient) can be realised, so that the foil-like outer element lies like a second skin taut over the body (part).
By virtue of this fixing by means of vacuum it can be ensured that fixation which is always firm, exact and remaining constant is made possible, in particular after repeated use of the apparatus.
Vacuum pumps with adjustable degree of suction, hose connections and shut-off valves can be used as means for creating a vacuum. These devices can also be controlled/regulated in their vacuum action. In order to assist the vacuum action, shallow hollow spaces or vacuum channels can be formed by the creation of pores/channels on the outer element or the body support surface, which ensure uniform sucking out, for example by means of an air-bubble film with bumps known for protective packing. The previously described closed system can thereby also be operated as a semi-open system with constant sucking out of air, especially to facilitate the skin breathing during long operations. A further method of achieving the described effect is to overlay and/or underlay between the outer element and the patient with a net/fleece/foam material or similarly structured material. Such materials ensure optimal flow of the air in all body regions, through the number of their air channels/pores in this application. Other media than air can also be used to create the vacuum. Possible xe2x80x9cair-flow barriersxe2x80x9d which are created by the suction or affect this are thus prevented. Pressure measuring devices serve to control a comparatively constant pressure on the body regions.
With a safety button the patient himself (e.g. in case of sickness or panic) or the operator (e.g. in case of complications during the intervention) can interrupt the vacuum (or even convert the vacuum briefly into a raised pressure) and thus release the body of the patient from the fixing very rapidly and without complication, since the outer element is then lifted xe2x80x9cat a strokexe2x80x9d from the support surface.
The blanket-like outer element, preferably in the form of a heat protective aluminium foil known per se, can be packed sterilely as a disposable article but is also easy to clean and sterilise, so that the operating costs remain small, since all essential parts can be reused.
In addition to the pure fixation/compression/making moulds, auxiliary apparatuses (such as guide devices, optical apparatus, target devices, etc.) can be fitted by means of mechanical/pneumatic or magnetic anchorage, since the blanket-like outer element takes up hardly any additional space. Reproducible application with high accuracy is therefore possible through scaling or similar devices.
The body (part) can be so placed that practically any body region is completely accessible to the treating doctor or other treating person, especially for surgical interventions, while such an aluminum or plastics foil can be opened with a scalpel after application of the vacuum, without a pressure drop. An auxiliary fixing for additional securing of the patient constructed like the blanket-like outer element and thus capable of variable positioning is particularly advantageous. Above all in soft regions of the upper or lower abdomen or in the shoulder region, the fixing action can be enhanced by simple application of splint and support elements. The application of these splints additionally increases the repositioning accuracy. Likewise fixing of the patient, especially in the case of restless patients or of large applications of force from the outside, as in procedures with bones or cartilages, is ensured by this.
In addition this vacuum technique with at least one outer element lying on the body or the skin facilitates particularly uniform pressure distribution and thus relief of the patient. Injuries are practically ruled out, even with anaesthetised patients, who cannot give any indication of pain in case of pressure pain.
A particular advantage is also the application of passive or active calibration points on the outer element or the support surface, which determine reference points and reference planes in modern medicine in the practical application of imaging methods such as CT (computer tomography) or MRI (magnetic resonance imaging). The fixing apparatus thus allows calibration points to be applied to a part of the apparatus (primarily to the body support surface), which can be used as reference points for further measures, with or without fixing of the patient, such as calibration for preparations for operations for example.
If the objective is not only fixation but also reproducible positioning, additional prefabricated formwork, bands, vacuum mattresses can be used, which enhance the reproducibility. Since the body of (the patient) xe2x80x9cwandersxe2x80x9d during the sucking out into the same position, especially with concave support surfaces, a high accuracy of repositioning can be established. The resistance between the patient and the formwork or between the patient and the outer element or body support surface can be kept particularly small by slip films, so that assumption of the correct position is effected by shear forces, without high expenditure of force.
Cushioning underneath further increases the comfort. By variable vacuum regulation the cushioning action can be partially removed by increasing the vacuum and the fixation be enhanced and vice versa, A different vacuum can be applied for different body regions or it can be varied during the course of a fixation, for example in order to exert a massaging effect to increase the blood flow.
The outer element can either by closed pressure tight, as is the case with an aluminium foil, or have fine pores/channels, whereby the desired vacuum can be maintained correctly by a permanent xe2x80x9cflowxe2x80x9d, The air flowing in can be regulated in heat and moisture content, in order to achieve a desired cooling/heating or drying/moistening of the fixed body. It is also possible as a supplement to or instead of the inflowing air to use other gases or fluids, which accelerate the healing process of wounds for example. It is thus also possible to create an artificial climate under the sucked on outer element and in the vacuum chamber thus formed.
The described fix can either be used for the whole body or equally for individual body parts only. Thus broken bones for example and complex fractures can be immobilised by means of the described vacuum fixation, instead of by gypsum bandages. In a preferred method, formwork or splints with the anatomy to be achieved are incorporated in the vacuum bandage. The applied vacuum causes homogenous application of the formwork to the body parts or apply the body pans to these structures. With open wounds or major cut injuries, which result in a lot of scar formation, the vacuum bandage causes the wound edges to lie against one another and thus allows smooth surfaced closure. Thus a skin seam r at the skin surface can be dispensed with in many cases.
A further application is homogenous application and pressing on of materials and fabrics on to the skin surface of the patient. The material or fabric in question is applied to the desired site. The outer element is then laid on as the vacuum dressing. If the air is now sucked out, the applied material is necessarily applied to the skin surface. Instead of direct application to the skid surface the outer element can also be applied on other kinds of fabric and structures.
Cut-outs in the outer element or in the body support surface, which close airtight on the patient through edge seals, allow direct, optimum access to the patient for the operator. This xe2x80x9coperation windowxe2x80x9d, especially in the outer element, can be provided with an anatomically shaped, structure-giving element, depending on the body region, for example with an edge-reinforced rubber band. The airtight closure is achieved either through the characteristic of the outer skin itself, for example an inner rubberising, or through sealing materials (adhesives, rubber strips, etc.),