CN105078563A - Operative module navigation method for improving bone screw entering quality of department of orthopedics - Google Patents
Operative module navigation method for improving bone screw entering quality of department of orthopedics Download PDFInfo
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- CN105078563A CN105078563A CN201410208187.4A CN201410208187A CN105078563A CN 105078563 A CN105078563 A CN 105078563A CN 201410208187 A CN201410208187 A CN 201410208187A CN 105078563 A CN105078563 A CN 105078563A
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Abstract
The invention discloses a module positioning navigation operative method capable of effectively improving accuracy of bone screw entering point, direction and depth. The method includes preparing a model of a preoperative needed area and a navigation module and stripping soft tissue of intraoperative exposed bone surface, and other operative procedures do not need to be changed. When the method is applied in clinical practice, effective quality control on complex and dangerous operative operations, in which screws need to be screwed into bones in the department of orthopedics, brain surgery and dentofacial surgery, like determining screw entering point, angle and depth of pedicle screws of cervical vertebra. If being proceeded strictly according to specified procedures, operative success rate can be increased substantially, error rate can be lowered, and complication can be reduced. A specific implementation method includes: performing CT scanning on bones of a wounded part of a patient; making a bone model which can be formed quickly according to information acquired by scanning; drilling and measuring the model, and making the navigation module by an operative doctor; disinfecting the model and the module which are made before being used during operation.
Description
Technical field
The present invention relates to medical field, particularly a kind of surgical operation, comprise the needs such as orthopaedics, department of cerebral surgery, decorative sursery and to punch in skeleton, be screwed into the operation of screw.Operation consent, first to patient make local skeleton model and navigation module, and in module Design Navigation hole, comply with in operation navigation hole enter nail, can effectively control entry point, direction and the degree of depth, increase substantially surgical quality.
Background technology
At present, in spinal surgery, pedicle screw Internal fixation technology and clinical effectiveness obtain to be affirmed widely.But because spinal column skeleton is irregular, contour structures is complicated, and has the existence of spinal cord, nerve and important blood vessels internal organs around.Punching, when putting nail if any deviation, will cause paralysis, massive hemorrhage, even dead etc., bring misery and economic loss to patient and family members, and hence, limit carrying out and popularizing of some operations.
At present, in clinical operation, put the method mainly manipulation of nail.During operation, position and the direction of entering nail operate by range estimation skeleton dissection mark, and dangerous high, particularly pedicle puts nail.
For solving the problem, some scholars devise computer operation guiding system, put nail operation for assisting.Its accuracy has had and has increased substantially, but there are some realistic problems.As navigation instrument is expensive, non-especially big hospital is difficult to buy, and operation sequence is more complicated, through study after a while, training.For the doctor that skillfully can be grasped navigator and use, still there is the mortality of 4.1%.
In the method that above two kinds of screws are inserted, the former danger is high, and the latter is expensive, is all difficult to popularize.Now introduce a kind of operation and put nail method, and easily study, simple to operate, and can up to the accuracy rate of computer navigation instrument.For hospital, as long as possess CT equipment, all can carry out.
Summary of the invention
Object of the present invention: be under the prerequisite that simple to operate, easy grasp, operating time are short, effectively improves the quality and accuracy that screw inserts, and better strengthens the biomechanical property of screw.It comprises: entry point, direction and length, makes accuracy rate close to 100%.
The present invention is by the following technical programs, a kind of operation method of realization and process.
Comprise:
1: the preoperative preparation of putting nail section model and navigation module.
2: soft tissue is peeled off and the appearing of surface of bone.
Step:
1: the preoperative preparation of putting nail section model and navigation module
1) making of model:
(1) first, carry out CT helical scanning to the Zhi Ding district of patient, thickness requires, within 1.5 millimeters, to be preferably 0.6 millimeter, and other parameters are consistent with conventional sweep, without particular/special requirement.
(2) the dicom initial data obtained after scanning is input in computer, carries out the rewriting of stl file with corresponding medical image processing software.Pay special attention to the extraction of threshold value in the process, ensure that the model of making and organ reach the highest emulation.
(3) stl file after process is input in rapidform machine, processes.Finally generate the phantom that error is no more than 2%.
* in above three processes, (1) has been come by the technician of CT Scan Room, and (2), (3) are completed by rapid shaping company.The business personnel of company, is responsible for making complete model, gives operation doctor on time.
2) making of navigation module:
This process is completed by operation doctor
(1) perform the operation doctor, and reply, according to the three-dimensional reconstruction image of former patient CT, confirms that model is undistorted.
(2) perform the operation doctor, is fixed on by skeleton model on the work top of " model borer ", on the position needing to put nail after boring, inserts the rod iron of respective diameters.
(3) correctness of rod iron position is again checked.Under only guaranteeing the prerequisite that rod iron position in model is correct, the screw position on corresponding skeleton just can be made to be protected.
(4) length of rod iron in measurement model, is the screw length of selection.
(5) rod iron outside model is left the length of 2-3cm, and put thin-wall metal bushing, the inner wall smooth of sleeve pipe is smooth, and casing diameter and rod iron diameter match, not loose not tight.
(6) by separating medium, spread upon on model surface that module wants note attached, after its abundant drying, then the Medical ultrahard Gypsum Fibrosum mixed up or bone cement (or other is at the class commaterial medically allowing to use), be filled in its vicinity.
(7) after super hard gypsum or bone cement harden completely, rod iron is extracted out, by module and model separation.Module making like this with metal canula is complete.A face of module and model surface fit like a glove.In manufacturing process, Gypsum Fibrosum or bone cement be prevented, enter in the wide groove in model crack or surperficial narrow inside, avoid module and model separation difficulty, be difficult to take off.
(8) authentication module and model enter the identical situation around nail repeatedly, guarantee matching surface close contact, and firmly during mobile module, both combine well, fricton-tight phenomenon.
2: soft tissue is peeled off and the appearing of surface of bone:
By for subsequent use after module sterilization, model can be placed on reference under platform, also can sterilize together and take on platform, more convenient during use.In operation process, fully to appear the corresponding surface of bone of module region, thoroughly peel off the soft tissue on surface of bone.Ensure that module and the close of surface of bone are coincide with this.After surface of bone fully appears, comparison model corresponding surface of bone note is attached, module of coincideing.The hole of module inner sleeve to, be the position that skeleton enters nail, now entry point and direction are determined by module.As long as by the metal canula of drill bit insert module, according to the screw length measured, hole.This step should be noted: for deathtrap, during punching, forbids to settle at one go, should from shallow to deep, enter while visit, and carries out image checking in art.Confirm entry point and in the right direction after, just can be screwed into screw, prevent unexpected generation.
3: other work, comprising: anesthesia and postoperative care and routine operation indistinction in Preoperative Method, art.
Accompanying drawing illustrates:
Accompanying drawing 1 is neck bone structural representation.
1) vertebral body, 2) vertebroarterial foramen (transverse foramen), 3) lateral mass, 4) pedicle of vertebral arch, 5) canalis spinalis, 6) vertebral plate, 7) spinous process.
Accompanying drawing 2 is model boring schematic diagrams.
8) three-dimensional working platform, 9) cervical vertebra model, 10) drill bit, 11) pedicle of vertebral arch axis
Accompanying drawing 3 is model pediculus arcus vertebrae boring schematic diagrams.
4) pedicle of vertebral arch, 12) rod iron
Accompanying drawing 4 rod iron is inserted in metal canula schematic diagram.
12) rod iron, 13) sleeve pipe
Accompanying drawing 5 is module making schematic diagrams.
12) rod iron, 13) sleeve pipe, 14) module
Accompanying drawing 6 be with model separation after attached module with well.
15) the surface of bone matching surface of module
Detailed description of the invention:
Below in conjunction with accompanying drawing, specific embodiment of the invention is elaborated and illustrates.
Accompanying drawing 1 is that neck bone dissects schematic diagram.Make the process of navigation module below with regard to pedicle of vertebral arch on the right side of cervical vertebra, elaborate specific embodiment of the invention program.
After operation doctor takes model, first aspect ratio pair is carried out to model and former CT three-dimensional reconstruction image, confirm that error is no more than 2%, undistorted phenomenon.Then, on model, the axial location 11 of right side pedicle of vertebral arch is drawn with pencil.
Accompanying drawing 2 is model boring schematic diagrams.To the model 9 of pedicle of vertebral arch axial location 11 be indicated, fold up on the three-dimensional working platform 8 of borer, and by the adjustment of D translation and rotation, make pedicle of vertebral arch axis 11 and drill bit 10 dead in line, and hole.
Accompanying drawing 3 is that rod iron 12 inserts model pedicle of vertebral arch 4 and to hole schematic diagram.The rod iron 12 with the same diameter of drill bit 10, insertion model pedicle of vertebral arch 4 requires that insertion is extracted smoothly, does not produce again and rock in holing, and attention has model-free to burst apart, the damaged and crooked phenomenon in duct, guarantees correct.
Accompanying drawing 4 rod iron is inserted in metal canula schematic diagram.Metal canula 13 is inserted on rod iron 12, and contacts with model 9.Require that sleeve pipe 13 has certain length, inner wall smooth, diameter and rod iron 12 and drill bit 10 match.Sleeve pipe 13 outer wall requires embossing, or weld metal sheet (fin/rod) etc., increase bed knife with this, and outside Gypsum Fibrosum or cement volume can be reduced, be convenient to put operation in art.
Accompanying drawing 5 is that module 14 makes schematic diagram.Process is as follows: first separating medium is spread upon the region needing the attached Gypsum Fibrosum of note, again the Medical ultrahard Gypsum Fibrosum mixed up or bone cement etc. are filled in sleeve pipe 13 around, lower edge should with entry point around model face 9 combine closely, outer rim is wrapped in metal canula 13, Gypsum Fibrosum or bone cement can not be attached to without separating medium place by note, can not in the attached crack of note, can not in the groove of the attached outer narrow inner width of note, in case separation difficulty, note is answered to invest on same vertebra, can not attach and enter on adjacent vertebral bodies surface of bone, when preventing position chanP in art, adjacent vertebra joint mobile and bring fit with module 9 not good, nail precision is put in impact.Through certain hour (about 30 minutes), after the materials such as super hard gypsum harden completely, extract rod iron 12 out, disjunctive model 9.Module 14 like this with metal canula 13 makes complete.
Accompanying drawing 6 is modules 14 of subsidiary sleeve pipe 13.Should the surface of careful checking module 14 have flawless, and the identical situation of authentication module 14 and model 9 repeatedly, guarantee matching surface 15 close contact, firmly during mobile module 14, both combine well, absolutely not slide.
The complete module 14 of making is carried out disinfection, for subsequent use during operation.In operation, fully to appear the corresponding surface of bone of the attached module region of note, thoroughly peel off the soft tissue on surface of bone.After having appeared, attached, the identical module 14 of note on the corresponding surface of bone of comparison model 9, then in module 14, the hole of collar aperture 13 is to being the position that subjects bones needs into nail, and now entry point and direction are determined by module 14.As long as drill bit is inserted in metal canula 13, according to the screw length measured, hole.This step should note for deathtrap not directly electric drill punching settle at one go, should put in place gradually from shallow to deep, enter while visit and verified by image in art in process, confirmation entry point and in the right directionly just can be screwed into screw afterwards, prevent unexpected generation.
Claims (1)
1. when punching on skeleton, a kind of module operation piloting method controlling entry point, direction and the degree of depth.Its feature comprises: according to the model (9) of the apparatus processing such as rapid shaping, makes the navigation module (14) guiding entry point, direction and the degree of depth.
Procedure of processing is as follows:
1) on model (9), entry point and drilling axis (11) is drawn.Model (9) is stuck on the workbench (8) of borer, is adjusted by three-dimensional, make drawn axis (11) and drill bit (10) axes coincide.
2) confirm after boring to meet the requirements, and respective diameters rod iron (12) is inserted in boring.
3) sleeve pipe (13) is inserted in rod iron (12).Require that sleeve pipe (13) has certain length, inwall flat smooth, diameter mates with rod iron (12) and drill bit (10).The outer wall of sleeve pipe (13) requires embossing process, or is connected with fin or rod, increases bed knife with this, and can reduce outside Gypsum Fibrosum or cement volume, is convenient to put operation in art.
4) making of module (14): first separating medium is spread upon on model (9) face around entry point, again the Medical ultrahard Gypsum Fibrosum mixed up or bone cement (or other are at the class commaterial medically allowing to use) etc. after its drying, be filled in sleeve pipe (13) around.Ready-made module (14), should with entry point around model (9) face combine closely, module (14) is wrapped in metal canula (13).
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201410208187.4A CN105078563A (en) | 2014-05-19 | 2014-05-19 | Operative module navigation method for improving bone screw entering quality of department of orthopedics |
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201410208187.4A CN105078563A (en) | 2014-05-19 | 2014-05-19 | Operative module navigation method for improving bone screw entering quality of department of orthopedics |
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| CN105078563A true CN105078563A (en) | 2015-11-25 |
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Cited By (10)
| Publication number | Priority date | Publication date | Assignee | Title |
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| CN109009401A (en) * | 2018-07-18 | 2018-12-18 | 孟钊 | Vertebral arch root location method in a kind of guiding pyonex for serious scoliotic spine |
| US10653454B2 (en) | 2007-07-13 | 2020-05-19 | Mighty Oak Medical, Inc. | Spinal fixation systems |
| US10743890B2 (en) | 2016-08-11 | 2020-08-18 | Mighty Oak Medical, Inc. | Drill apparatus and surgical fixation devices and methods for using the same |
| USD895111S1 (en) | 2018-06-04 | 2020-09-01 | Mighty Oak Medical, Inc. | Sacro-iliac guide |
| US11039889B2 (en) | 2010-06-29 | 2021-06-22 | Mighty Oak Medical, Inc. | Patient-matched apparatus and methods for performing surgical procedures |
| USD948717S1 (en) | 2018-06-04 | 2022-04-12 | Mighty Oak Medical, Inc. | Sacro-iliac guide |
| US11376073B2 (en) | 2010-06-29 | 2022-07-05 | Mighty Oak Medical Inc. | Patient-matched apparatus and methods for performing surgical procedures |
| US11633254B2 (en) | 2018-06-04 | 2023-04-25 | Mighty Oak Medical, Inc. | Patient-matched apparatus for use in augmented reality assisted surgical procedures and methods for using the same |
| USD992114S1 (en) | 2021-08-12 | 2023-07-11 | Mighty Oak Medical, Inc. | Surgical guide |
| US11806197B2 (en) | 2010-06-29 | 2023-11-07 | Mighty Oak Medical, Inc. | Patient-matched apparatus for use in spine related surgical procedures and methods for using the same |
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| Publication number | Priority date | Publication date | Assignee | Title |
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| US10653454B2 (en) | 2007-07-13 | 2020-05-19 | Mighty Oak Medical, Inc. | Spinal fixation systems |
| US11376073B2 (en) | 2010-06-29 | 2022-07-05 | Mighty Oak Medical Inc. | Patient-matched apparatus and methods for performing surgical procedures |
| US11039889B2 (en) | 2010-06-29 | 2021-06-22 | Mighty Oak Medical, Inc. | Patient-matched apparatus and methods for performing surgical procedures |
| US11806197B2 (en) | 2010-06-29 | 2023-11-07 | Mighty Oak Medical, Inc. | Patient-matched apparatus for use in spine related surgical procedures and methods for using the same |
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| US11925400B2 (en) | 2016-08-11 | 2024-03-12 | Mighty Oak Medical, Inc. | Fixation devices having fenestrations and methods for using the same |
| US11376049B2 (en) | 2016-08-11 | 2022-07-05 | Mighty Oak Medical Inc. | Fixation devices having fenestrations and methods for using the same |
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| US11633254B2 (en) | 2018-06-04 | 2023-04-25 | Mighty Oak Medical, Inc. | Patient-matched apparatus for use in augmented reality assisted surgical procedures and methods for using the same |
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| USD992114S1 (en) | 2021-08-12 | 2023-07-11 | Mighty Oak Medical, Inc. | Surgical guide |
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Application publication date: 20151125 |