CN103800109A - Improved Halo frame and method for assisting in lower cervical vertebrae unilateral zygopophysis blocage reduction using improved Halo frame - Google Patents
Improved Halo frame and method for assisting in lower cervical vertebrae unilateral zygopophysis blocage reduction using improved Halo frame Download PDFInfo
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- CN103800109A CN103800109A CN201410038637.XA CN201410038637A CN103800109A CN 103800109 A CN103800109 A CN 103800109A CN 201410038637 A CN201410038637 A CN 201410038637A CN 103800109 A CN103800109 A CN 103800109A
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Abstract
The invention disclose an improved Halo frame which comprises a brace vest, a head ring and an adjustable support, wherein the head ring is connected with the brace vest through the adjustable support, the adjustable support comprises eight screws, the screws A and A' are located on the lower front portion, the screws B and B' are located on the lower rear portion, spherical rotary shafts are arranged below the positions, corresponding to the screws A, A', B and B', of the support, the screws A, A', B and B' face the left side and the right side of the brace vest respectively, the screws C and C' are located on the upper front portion, the screws D and D' are located on the upper rear portion, and the head ring is provided with a plurality of fixing screws. The invention further discloses a method for assisting in lower cervical vertebrae unilateral zygopophysis blocage reduction using the improved Halo frame. By the adoption of the improved Halo frame and the method for assisting in lower cervical vertebrae unilateral zygopophysis blocage reduction using the improved Halo frame, lower cervical vertebrae unilateral zygopophysis blocage reduction can be achieved effectively, injury to spinal cord can be effectively avoided, and injury to the human body from the fixing screws on the head ring and the screws on the adjustable support can be effectively avoided in use, air permeability is high, chafing and festering of skin can be avoided, and materials used can meet requirements of nuclear magnetic resonance.
Description
Technical field
The present invention relates to a kind of using method of medical apparatus and instruments, relate in particular to a kind of method that the Halo of improvement frame resets for auxiliary lower unilateral cervical facet.
Background technology
Halo-vest frame is the cervical vertebra external fixer that a kind of three-dimensional is strong, and it has light safe, fixed, feature that reset rate is high.Because it is automatic control traction, the postoperative activity of can getting up, has solved the misery that patient's skull is drawn long-term bed.Draw and fixing synergism, do not limit patient's early ambulant, be beneficial to early rehabilitation.
Halo-vest frame is at present unique outer stabilizing brace that can three-dimensional maintain cervical stability, in, art preoperative at emergency transportation, early stage diagnosis and treatment, surgery and can maintain the stability of cervical vertebra in postoperative and early stage during rehabilitation training, be beneficial to remaining functional neurologic recovery, intervertebral bone graft merges and spinal fracture healing.After Halo-vest fixation, can make patient freely movable, solve patient and can only equal the inconvenience that crouches and cause on bed.
Existing Halo-vest frame exists some not enough in use, and first, the support of Halo-vest frame adopts metal material, cannot be suitable for nuclear magnetic resonance check, has limited Cervical Cord Injury patient check; Secondly, the vest of support is airtight, wears for a long time and can make the inflammation of patient's skin of back even fester; The 3rd, regulate the tip of screw of support below to dash forward to chest and back, easily to human body skin even deep tissues cause pressure ulcer; The 4th, the hold-down screw of the headring of traditional Halo-vest frame partially outside, from human body head temple excessively close to, temple position is the weakest part of human body head hardness, therefore, hold-down screw may bring serious wound to people.
The damage mechanism of unilateral cervical facet is that cervical vertebra suffers axial-rotation violence under flexing, lateral bending state, makes the hypozygal that damages the upper vertebral body of sections jump to the superior articular process front of the next vertebral body and mutually push and cause interlocking under the elastic recovery effect of the soft tissues such as muscle, ligament, intervertebral disc; Or under violence effect, collide with each other, separate and cause fracture or dislocate.These damages are the damage of involving cervical spinal column three posts, between the intervertebral disc, forward and backward longitudinal ligament, joint capsule, sour jujube of its dislocation sections, supraspinal ligament, ligamenta flava etc. are all by damage in various degree, it is a kind of unstability damage, the stable damage of row spinal fusion sections after need resetting, completes nerve decompression simultaneously or avoids the segmental shakiness causing due to dislocation to cause the damage of spinal cord Delayed onset.
Mainly Skull traction reduction and open reduction to the mode of lower unilateral cervical facet treatment at present.Adopting Management of Locked Facet of Cervical Spine under Skull traction reduction is most domestic hospital conventional means, and skull traction is better to lower cervical bilateral facet reset effect, but is only 22% to the power that resets to of one-sided facet.Analyze the reason of its closed reduction failure, skull traction is by rope transmitting tractive power, and cervical region many places are in a fixing flexing position, the rotation deformity that cannot correct one-sided facet.The auxiliary closed reduction method of traditional Halo frame, or by traction skull retainer ring, strength is fixed and encircles the support decomposition at rear, can not show a candle to skull traction; Or by upwards strutting the threaded rod of both sides, the spacing stretching is limited, and is to be in a fixing position, can not correct rotation, reset majority is unsuccessful, has more increased the difficulty resetting in the time having fracture of articular process, soft tissue embedding, old interlocking; And, in the closed reduction process of skull traction, patient's cervical region is to be under some fixing flexings position to carry out substantially, the stretching that spinal cord may be subject to along with vertebral body together with the structures such as rear zygapophysial joints, spinal cord front is existed to larger intervertebral disk hernia, and hyper-traction may increase the weight of spinal compression.Operative reduction comprises that the way of escape resets, front road resets and the road combined reset in front and back, if the deficiency that the way of escape resets is that spinal cord front has traumatic intervertebral disk hernia, the way of escape resets and may increase the weight of the damage of spinal cord, and this is danger close, and the road combined reattachment surgery in front and back obviously increases the wound to patient.
Lower unilateral cervical facet patient mostly is incomplete paraplegia, and successfully operation can obtain good effect, and resetting is safely and effectively the key of successful surgery.Correct flexing and rotation double factor but its damage mechanism comprises, clinical reset is more difficult compared with bilateral facet interlocking.Skull traction is because of uncontrollable rotation, and closed reduction success rate is low, the fixing safety reset that has also been difficult to of conventional H alo frame.
Summary of the invention
Technical problem to be solved by this invention is, a kind of improvement Halo frame is provided, comprise brace vest, headring and adjustable support, described headring couples together by adjustable support and described brace vest, described adjusting support comprises 8 screws, wherein A, A` is front lower screw, B, B` is the screw under rear, A, A`, B, the support below that B` is corresponding is spherical rotating shaft, described A, A`, B, B` screw is respectively towards the left and right sides of brace vest, C, C` is front upper screw, D, D` is the screw on rear, described headring has some joint couplings, be positioned at described headring A, A` and C, the hold-down screw spacing of C` mono-side is 3 ~ 6cm.
Further, described headring and adjusting support are that carbon fibre forms.
Further, described brace vest offers several air-vents.
Further, described brace vest is made up of waterproof and breathable material material, and waterproof ventilative material mainly contains three layers of formation: PP spun-bonded non-woven fabrics, PE gas permeable polymer film, PP spun-bonded non-woven fabrics.The effect of spun-bonded non-woven fabrics is mainly to strengthen pulling force and hydrostatic pressing and protection intermediate layer (ventilated membrane), and real breathing freely is mainly by intermediate layer PE gas permeable polymer film
The method that adopts above-mentioned Halo frame to reset for auxiliary lower unilateral cervical facet, comprises the following steps:
The dislocation of rectification flexing:
1) unclamp bolt A, A`, B, B`, D, D`, upwards tighten DD` after lifting by being connected to two pieces of bolts corresponding with DD` on support bar simultaneously, makes to lift on cervical vertebra rear end;
2) unclamp bolt CC`, after being connected to the liftings simultaneously of corresponding with CC` on support bar two pieces of bolts, tighten, from but cervical vertebra front end lift;
3) operate by X-ray examination observation reset case repeating step 1 step 2, until show that by X-ray examination the inferior articular process of a cervical vertebra in articular process aims at the superior vertebral notch of next cervical vertebra;
Correct rotatory dislocation:
4) unclamp CC` and DD` simultaneously, under the normal side direction of cervical vertebra, force down, suffer from a side of articular process and lift, make the inferior articular process of a cervical vertebra on articular process of cervical vertebra insert the inferior vertebral notch of next cervical vertebra, complete reset.
When reset, should guarantee Halo frame when operation adjusting range not excessive, avoid cervical vertebra flexion-extension amplitude excessive and cause further damage, particularly:
The distance of bolt lifting described in described step 1 is 2 ~ 3cm.
The distance of bolt lifting described in described step 2 is 2 ~ 4cm.
The distance pressing down in described step 4 is 2 ~ 3cm.
The distance of lifting in described step 4 is 1 ~ 2cm.
Further, if cervical vertebra complete reset after the lower support of can directly getting except Halo-vest of cervical traction height, otherwise according to the height that reduces gradually described headring and described brace vest with step 1,2 contrary steps, cervical vertebra is replied normally highly and curvature.
After the demonstration of C arm X-ray perspective resets successfully, removal Halo-vest support, row trachea general anesthesia intubation at once, merges internal fixation through anterior cervical decompression.For the lighter patient of vertebral body damage, the simple disc removal+intervertebral fusion internal fixation with steel plate of row; Damage heavier patient for vertebral body, row Subtotal vertebrectomy+titanium cage bone grafting internal fixation with steel plate.
Further, postoperative conventional treatment, wears neck circumference neck 8 ~ 12 weeks.
It should be noted that; closed reduction method of the present invention is carried out under patient's waking state; under waking state, resetting can close observation patient changes of vital signs; under waking state; patient can be reflected at any time that nervous symptoms has or not and increase the weight of; easily neuroprotective function better; if in closed reduction process there is numb limbs and tense tendons in patient; violent and intractable neck or brachialgia and can not tolerate; should abandon closed reduction and change in operative reduction fixing; using this as the foundation of adjusting distraction reduction, avoid secondary spinal cord injury.
Implement the present invention, there is following beneficial effect:
Halo frame of the present invention passes through to improve, the injury that can effectively avoid headring hold-down screw and regulate support screwing to cause human body; Breathability is strong, can not make pressure ulcer fester between the operating period, and its material can also meet the demand of doing nuclear magnetic resonance, NMR.By the stay bolt of flexion-extension activity repeatedly, can effectively make the articular process of dislocation strut, when showing to reset, C arm perspective reaches after " tip to tip ", and by forcing down strong side, can make Ipsilateral articular process nature to back upper place perk rotation, obtain and reset, in flexion-extension process repeatedly, articular process and vertebral body are all the positions in opposite edges, bend-stretch in distraction procedure motion amplitude large, and spinal cord is the position that is in Yi Ge center, according to the metastable principle of rolling process axis, in reseting procedure, the amplitude of variation of spinal cord is minimum, therefore, the probability of Spinal Cord is minimum, in the process of rectification rotation displacement, be in the periphery that peripheral bone structure and zygapophysial joints are equivalent to bearing, be in the fixed axis that inner dural sac and spinal cord are equivalent to bearing, in spinning reduction process, central shaft is metastable, therefore, spinal cord can be avoided damage.Meanwhile, reset is to complete under middle fluoroscopic monitoring, can effectively reduce secondary spinal cord injury.
Accompanying drawing explanation
Fig. 1 is the structural representation that the present invention improves Halo frame;
Fig. 2 is cervical vertebra C5-6 right side facet schematic diagram;
Fig. 3 be in reseting procedure in articular process the inferior articular process of a cervical vertebra aim at the schematic diagram of the superior vertebral notch of next cervical vertebra;
Fig. 4 is the schematic diagram that facet completes reset;
Fig. 5 is the schematic diagram that cervical curvature recovers.
The specific embodiment
For making the object, technical solutions and advantages of the present invention clearer, below in conjunction with accompanying drawing, the invention will be further described.
As shown in Figure 1, Halo frame of the present invention be on traditional architecture basics, carry out improved, comprise brace vest 1, headring 2 and adjustable support 3, described headring 2 couples together by adjustable support 3 and described brace vest 1, described adjusting support 3 comprises eight screws 5, and wherein A, A` represent front lower screw, the screw under B, B` representative is rear, C, C` represent front upper screw, the screw on D, D` representative is rear.
In the present embodiment, also comprise adapter 4, described adapter 4 can be the joint coupling being formed by connecting by two one-directional connector axles, can be also spherical axle connection as shown in the figure.Its role is to avoid directly contact human body skin of screw 41, prevent that screw 41 edges or sharp-pointed place's extruding skin from bringing damage.Described adapter 4 respectively fills two in the front and back of described brace vest 1, connects, thereby realize headring 2, regulate the flexible of support 3 and brace vest 1 at described adjusting support 3 and headring 2 by two or 4.
The adapter 4 adopting in the present embodiment is not limited to scheme shown in figure, can also be those skilled in the art or on the market conventional other there is the universal connector of identity function.
Preferably, in the present embodiment, described brace vest offers several air-vents.
The method that adopts Halo frame described in Fig. 1 to reset for auxiliary lower unilateral cervical facet (as shown in Figure 2), comprises the following steps:
1) unclamp bolt A, A`, B, B`, D, D`, upwards tighten DD` after lifting by being connected to two pieces of bolts corresponding with DD` on support bar simultaneously, makes to lift on cervical vertebra rear end;
2) unclamp bolt CC`, after being connected to the liftings simultaneously of corresponding with CC` on support bar two pieces of bolts, tighten, from but cervical vertebra front end lift;
3) operate by X-ray examination observation reset case repeating step 1 step 2, until show that by X-ray examination the inferior articular process of a cervical vertebra in articular process aims at the superior vertebral notch of next cervical vertebra, as shown in Figure 3;
4) unclamp CC` and DD` simultaneously, under the normal side direction of cervical vertebra, force down, suffer from a side of articular process and lift, make the inferior articular process of a cervical vertebra on articular process of cervical vertebra insert the inferior vertebral notch of next cervical vertebra, complete reset, as shown in Figure 4.
When reset, should guarantee Halo frame when operation adjusting range not excessive, avoid cervical vertebra flexion-extension amplitude excessive and cause further damage, particularly:
The distance of bolt lifting described in described step 1 is 2 ~ 3cm.
The distance of bolt lifting described in described step 2 is 2 ~ 4cm.
The distance pressing down in described step 4 is 2 ~ 3cm.
The distance of lifting in described step 4 is 1 ~ 2cm.
Further, if the lower support of can directly getting except Halo-vest of cervical traction height after cervical vertebra completes and resets, otherwise make cervical vertebra reply normal height and curvature according to the height that reduces gradually described headring and described brace vest with step 1,2 contrary steps, as shown in Figure 5.
Embodiment
From year May in May, 2009 to 2013, go to a doctor and adopt totally 12 examples (2 examples are for changing one-sided interlocking in bilateral facet interlocking closed reduction process).Wherein male 7 examples, female's 5 examples; 22 ~ 56 years old age (average 34 years old).Traumatogenic reason eminence 5 examples, traffic accident wound 4 examples, 2 examples of falling, weight injures 1 example by a crashing object.Pathological changes is involved sections: C6-7, C5-6, C4-5, C3-4 are respectively 5,1,4,2 examples.While being admitted to hospital, function of nervous system's assessment is undertaken by Frankel scoring, wherein, and E level 2 examples, D level 2 examples, C level 4 examples, B level 2 examples, A level 2 examples.Associated injury situation: merge vertebral fracture 7 examples, fracture of articular process 4 examples, spinous process and lamina 3 examples of fracturing, extensive region pivot subluxation 1 example; Merge craniocerebral trauma 3 examples; Damage sections ruptured intervertebral disc 3 examples; MR shows spinal cord abnormality signal 9 examples; Injured to admission time be 1 hour to 32 days, average out to 4 days; Closed reduction was apart from injured 1 day to 35 days.
The lower unilateral cervical facet patient of above-mentioned 12 examples adopts the present invention to utilize the auxiliary reset method of the Halo frame of improvement, and reset required time is the shortest 40 minutes, the longest needs 110 minutes (average 65min).Closed reduction success Hou Jingqian road simple disc removal+intervertebral fusion internal fixation with steel plate 8 examples, premenstrual road Subtotal vertebrectomy+titanium cage bone grafting internal fixation with steel plate 4 examples.All cases all complete operation smoothly, do not occur operation related complication.The Frankel demonstration of marking, art proxima luce (prox. luc) and postoperative function of nervous system's scoring next day no significant difference, show that closed reduction and operation all do not cause spinal nerves infringement to add reconstructed image.
Whole 12 examples all obtain and follow up a case by regular visits to, and the time of following up a case by regular visits to is 3 months after operation to 24 month (average 19.9 months).All cases are not all followed up a case by regular visits to after postoperative 2 years again.In Frankel scoring A level 2 examples, have 1 routine Follow-up After function of nervous system without recovery, other cases all show the improvement of average 2 grades of function of nervous system.There is the performance of syringomyelia in 1 example.Concrete function of nervous system appraisal result is shown in Table 1.
The Frankel of table 1 function of nervous system appraisal result
| Franke classification | A | B | C | D | E |
| Preoperative | 2 | 2 | 4 | 2 | 2 |
| Postoperative |
1 | 2 | 5 | 2 | 2 |
| Last is followed up a case by regular visits to | 1 | 0 | 2 | 3 | 6 |
X-ray film demonstration, 12 examples all obtain firm bone and merge; Cervical intervertebral height, physiological camber, cervical stability recover good; The complication such as steel plate and screw loosening, slippage do not occur, fracture.Recovering and remaining respond well aspect cervical curvature.
This is organized continuous 12 examples and all adopts reset in this way, not yet finds the failed case that resets.Wherein merge fracture of articular process 4 examples, also obtained success.The resetting technique of clinical practice proved improvement is reliable.Its main cause is Halo frame auxiliary reset, not only can drawing-off correct flexing dislocation, can also effectively control rotation.
The above is the preferred embodiment of the present invention; it should be pointed out that for those skilled in the art, under the premise without departing from the principles of the invention; can also make some improvements and modifications, these improvements and modifications are also considered as protection scope of the present invention.
Claims (9)
1. an improvement Halo frame, comprise brace vest, headring and adjustable support, described headring couples together by adjustable support and described brace vest, it is characterized in that, described adjusting support comprises 8 screws, wherein A, A` is front lower screw, B, B` is the screw under rear, A, A`, B, the support below that B` is corresponding is spherical rotating shaft, described A, A`, B, B` screw is respectively towards the left and right sides of brace vest, C, C` is front upper screw, D, D` is the screw on rear, described headring has some joint couplings, be positioned at described headring A, A` and C, the hold-down screw spacing of C` mono-side is 3 ~ 6cm.
2. Halo frame according to claim 1, is characterized in that, described headring and adjusting support are that carbon fibre or titanium alloy form.
3. Halo frame according to claim 1, is characterized in that, described brace vest offers several air-vents.
4. right to use requires the method that described in 1, the auxiliary lower unilateral cervical facet of Halo frame resets, and it is characterized in that, said method comprising the steps of:
The dislocation of rectification flexing:
1) unclamp bolt A, A`, B, B`, D, D`, upwards tighten DD` after lifting by being connected to two pieces of bolts corresponding with DD` on support bar simultaneously;
2) unclamp bolt CC`, after being connected to two pieces of bolts lifting simultaneously corresponding with CC` on support bar, tighten;
3) operate by X-ray examination observation reset case repeating step 1 step 2, until show that by X-ray examination the inferior articular process of a cervical vertebra in articular process aims at the superior vertebral notch of next cervical vertebra;
Correct rotatory dislocation
4) unclamp CC` and DD` simultaneously, under the normal side direction of cervical vertebra, force down, suffer from a side of articular process and lift, make cervical vertebra reposition.
5. method according to claim 1, is characterized in that, the distance of the lifting of bolt described in step 1 is 2 ~ 3cm.
6. method according to claim 1, is characterized in that, the distance of the lifting of bolt described in step 2 is 2 ~ 4cm.
7. method according to claim 1, is characterized in that, the distance pressing down in step 4 is 2 ~ 3cm.
8. according to the method described in claim 1 or 4, it is characterized in that, the distance of lifting in step 4 is 1 ~ 2cm.
9. method according to claim 1, is characterized in that, cervical vertebra completes after reset according to the height that reduces gradually described headring and described brace vest with step 1,2 contrary steps and makes cervical vertebra reply normal height and curvature.
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Cited By (4)
| Publication number | Priority date | Publication date | Assignee | Title |
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| CN104021563B (en) * | 2014-06-19 | 2017-01-25 | 西安电子科技大学 | Method for segmenting noise image based on multi-objective fuzzy clustering and opposing learning |
| CN108095880A (en) * | 2016-11-25 | 2018-06-01 | 钜旺生技股份有限公司 | Fixed frame vest and its constructing method |
| CN108888398A (en) * | 2018-07-18 | 2018-11-27 | 无锡市中医医院 | A kind of medical distal radius anatomical form bracket clamping plate and preparation method thereof |
| CN110353871A (en) * | 2019-08-06 | 2019-10-22 | 邢守军 | A kind of intelligence cervical vertebra healing therapeutic apparatus |
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| CN2367274Y (en) * | 1999-03-28 | 2000-03-08 | 金华市科惠医疗设备有限公司 | Three-dimension cervical vertebra external fixer |
| CN102743217A (en) * | 2012-08-22 | 2012-10-24 | 高州市人民医院 | Halo-pelvic ring traction device |
| CN203815675U (en) * | 2014-01-27 | 2014-09-10 | 汕头大学医学院第二附属医院 | Improved halo frame |
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| CN2099557U (en) * | 1991-07-18 | 1992-03-25 | 杨永昌 | Double shoulder fixed type cervical vertebra tractor |
| CN2367274Y (en) * | 1999-03-28 | 2000-03-08 | 金华市科惠医疗设备有限公司 | Three-dimension cervical vertebra external fixer |
| CN102743217A (en) * | 2012-08-22 | 2012-10-24 | 高州市人民医院 | Halo-pelvic ring traction device |
| CN203815675U (en) * | 2014-01-27 | 2014-09-10 | 汕头大学医学院第二附属医院 | Improved halo frame |
Cited By (5)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN104021563B (en) * | 2014-06-19 | 2017-01-25 | 西安电子科技大学 | Method for segmenting noise image based on multi-objective fuzzy clustering and opposing learning |
| CN108095880A (en) * | 2016-11-25 | 2018-06-01 | 钜旺生技股份有限公司 | Fixed frame vest and its constructing method |
| US11357656B2 (en) | 2016-11-25 | 2022-06-14 | Orion Biotech Inc. | Halo vests and construction methods thereof |
| CN108888398A (en) * | 2018-07-18 | 2018-11-27 | 无锡市中医医院 | A kind of medical distal radius anatomical form bracket clamping plate and preparation method thereof |
| CN110353871A (en) * | 2019-08-06 | 2019-10-22 | 邢守军 | A kind of intelligence cervical vertebra healing therapeutic apparatus |
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Application publication date: 20140521 |