CN104758043A - Method and device for achieving middle-upper thoracic vertebrae semi-pedicle screw fixation in posterior mode - Google Patents
Method and device for achieving middle-upper thoracic vertebrae semi-pedicle screw fixation in posterior mode Download PDFInfo
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- CN104758043A CN104758043A CN201510212508.2A CN201510212508A CN104758043A CN 104758043 A CN104758043 A CN 104758043A CN 201510212508 A CN201510212508 A CN 201510212508A CN 104758043 A CN104758043 A CN 104758043A
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- screw
- pedicle
- upper thoracic
- locking module
- vertebral arch
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
- A61B17/7032—Screws or hooks with U-shaped head or back through which longitudinal rods pass
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- Health & Medical Sciences (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Life Sciences & Earth Sciences (AREA)
- Neurology (AREA)
- Surgery (AREA)
- Heart & Thoracic Surgery (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Medical Informatics (AREA)
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- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
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- Veterinary Medicine (AREA)
- Surgical Instruments (AREA)
Abstract
The invention discloses a device used in cooperation with a middle-upper thoracic vertebrae semi-pedicle fixation operation in a posterior mode. The device comprises a nut, a screw, a connecting rod, a spring cushion and an elastic self-locking module. The end in the perpendicular direction of the elastic self-locking module is connected with the screw, and the end in the horizontal direction of the elastic self-locking module is connected with the connecting rod. When the device is in use, the nut is screwed to enable the elastic cushion and the elastic self-locking module to be meshed, and therefore the screw is locked. The invention further discloses a method for achieving middle-upper thoracic vertebrae semi-pedicle screw fixation in the posterior mode. The problem that due to the fact that a traditional fixation device has no elasticity function and is likely to be loosened and cause screw breakage under the human body kinetics effect after being fixed during an operation, the operation fails is effectively solved. The method is high in safety and strength, good in accuracy and easy to grasp, and the problem that the difficulty and risk of planting a screw into the vertebral pedicle of the middle-upper thoracic vertebrae of a patient in a posterior mode are high is solved clinically.
Description
Technical field
The invention belongs to medical domain, be specifically related to the Upper thoracic way of escape half pedicle of vertebral arch approach in one and put nail fixing means and equipment.
Background technology
Middle Upper thoracic generally refers to T1-T10, and the pedicle of vertebral arch at this place is thin more than pedicle of lumbar vertebral arch, and T4 ~ T9 sections is the narrowest, and the average transverse diameter of pedicle of vertebral arch is less than 5mm.The research of Ebraheim etc. finds, the narrowest pedicle of vertebral arch is 3.8mm at T4, be secondly T5 and T6 is 4mm.
Traditional nail method of planting has Roy-Camille method and Maged method; Nail method of planting popular both at home and abroad has talent scout's technology (Balltip Technique), funnel technique (Funnel Technique) and computer assisted navigation technology.
Traditionally plant nail method Vaccaro etc. once in report Upper thoracic up to 41% pedicle screw penetrated pedicle of vertebral arch scope; The Mao Keya of domestic 301 Hospital reports Upper thoracic pedicle screw in 405 pieces that insert, and pedicle of vertebral arch wears out rate 30.6%.
Plant nail method according to talent scout's technology (Ball tip Technique), pedicle of vertebral arch wears out rate 10 ~ 15%; Plant nail method according to ball funnel technique (Funnel Technique), pedicle of vertebral arch wears out rate 16%; Plant nail method according to computer assisted navigation technology, pedicle of vertebral arch wears out rate 4.6%, but cost is high and operating technology complicated.
Therefore middle Upper thoracic pedicle screw internal fixation is put nail according to the method described above and is difficult to implantation, and there will be 3 large deficiencies: one, pedicle nail is easily charged into canalis spinalis and caused spinal cord injury, occurs paralysis time serious; Its two, because of in Upper thoracic pedicle of vertebral arch comparatively thin, corresponding also comparatively thin for fixing pedicle screw, thus cause internal fixtion loosely, easy broken nail; Its three, because its pedicle of vertebral arch is comparatively thin, after internal fixtion, pedicle of vertebral arch dilatancy changes and occurs fracture, causes internal fixtion intensity to decline.
Due to the restriction of above-mentioned 3 large factors, the pedicle internal fixators technology of middle Upper thoracic is very limited clinically.In addition traditional fixing device ubiquity fixed-area is little, the problem that frictional force is little, after underwent operative is fixing, easily produce under the effect of human body power and loosen, produce broken nail even thus, cause the problem of operative failure, more make the pedicle screw internal fixation of middle Upper thoracic perform the operation and operationally make the matter worse.
In order to overcome, making up the shortcoming and defect of above-mentioned middle Upper thoracic pedicle screw internal fixation operation, research design a kind of safe and effective newly plant nail path and equipment is clinical outstanding problem urgently to be resolved hurrily.
Summary of the invention
An object of the present invention is that a kind of safe and effective middle Upper thoracic of research design fixes new art formula and the way of escape half pedicle of vertebral arch approach puts the new art formula of nail, overcome, compensate for the shortcoming and defect of middle Upper thoracic pedicle screw internal fixation operation, solve middle Upper thoracic sick and wounded patient posterior approach vertebral arch urgently to be resolved hurrily clinically and take root in the difficult problem that nail difficulty is high, risk is large, and cost is lower, easy and simple to handle.
The invention provides a kind of and middle Upper thoracic way of escape half pedicle screw internal fixation to perform the operation the equipment be combined, described equipment adopts high resiliency titanium alloy as material, comprises nut, screw, connecting rod, spring pad and elasticity self-locking module.Described elasticity self-locking module vertical direction one end is connected with described screw, and horizontal direction one end is connected with described connecting rod, tightens described nut and makes described spring pad and the engagement of described elasticity self-locking module, thus lock described screw during installation.
The described elasticity self-locking module be connected with described screw and described connecting rod, side is longitudinally the cylindrical hole suitable with described connecting rod thickness, the side of described cylindrical hole is described screw tail and mutually vertical with described cylindrical hole, the face that described screw tail is vertical with described cylindrical hole arranges a longitudinal furrow, in through described cylindrical hole, and correspondingly cut-away divides cylindrical wall, when described screw tail and described connecting rod are all inserted in described cylindrical hole, when described screw tail and nut are tightened, described longitudinal furrow closes gradually, described screw tail and described nut step up described connecting rod after tightening.
Described screw coordinates with the concave spherical surface of described elasticity self-locking module the angle that can tilt because of spherical, and angular range is 0 ~ 30 °.
Described screw is ball screw, and described nut is hex nut, and described spring pad is stricture of vagina thread form spring pad, and described elasticity self-locking module is stricture of vagina thread form arc rail elasticity self-locking module.
The present invention also provides a kind of and is used for the treatment of the fixing method of middle Upper thoracic sick and wounded implantation half pedicle screws, comprise the steps: that excision pedicle of vertebral arch transverse process is until root, detect boundary up and down and the lateral wall of pedicle of vertebral arch, middle cone in pedicle of vertebral arch lateral wall opens the lateral cortex bone of pedicle of vertebral arch, in the substrate that the cortex bone hole of boring out outside pedicle of vertebral arch probes into forward pedicle of vertebral arch at a certain angle and vertebral body, be screwed into screw after verifying nail road and rod is fixing.
The angle that described cortex bone hole of boring out outside pedicle of vertebral arch probes into forward in the substrate of pedicle of vertebral arch and vertebral body is at a certain angle abduction 15 ° ~ 30 °, and afterbody head rolls oblique 10 ° ~ 25 °.
The diameter of described screw and length are:
The length of T1, T2 place screw is 30 ~ 35mm, diameter 5.5mm.
T3 ~ T5 length is 35 ~ 40mm, the general 5.5 ~ 6.0mm of diameter.
T6 ~ T10 length is about 45mm, the general 6.0mm of diameter.
Beneficial effect of the present invention is:
1, there is higher safety
Approach entry point of the present invention is on the lateral wall of pedicle of vertebral arch, and sagittal plain of entering to fix a point is close to breast marrow plane, and screw is positioned at half pedicle of vertebral arch half part, not easily enters canalis spinalis and injures breast marrow.Ribbed protection outside screw simultaneously, screw is not easily partial to outer and damages pleura.
2, there is sufficient intensity
Half pedicle screw diameter of the present invention is by the restriction of pedicle of vertebral arch thickness, and can select larger-diameter screw, the screw implanted has enough intensity and hold, and through biomechanics experiment with to be clinically verified.And screw is positioned at half pedicle of vertebral arch half part, threaded medial cuts effect, screw inside thread partly can cut half pedicle of vertebral arch half part, effectively improves the intensity of internal fixtion further.
3, put nail accuracy high, be easy to grasp
Method of the present invention can directly be visited and the upper and lower edge of pedicle of vertebral arch and lateral wall, and be can at the underlying nail of direct-view furtherly, handling safety be accurate, is easy to grasp.
4, fixing device has spring function, fixed-area is large, frictional force is large
In fixing device of the present invention, spring pad and elasticity self-locking mode interblock adopt arc rail stricture of vagina tooth to lock and design, make screw have 0 ~ 30 ° of screw-rod angle adjusting range at sagittal plane on the one hand, on the other hand for nut provides flexible fastening, add orthopedic randomness and fixing reliability.In the installation of fixing device, screw links with connecting rod, have employed the elastomeric feature of metal, the longitudinal furrow be connected by screw on block achieves and connecting rod can be made to be securely held to centre extruding, the effect that screw tail cap is locked by the elasticity that its super-elastic metal is outside.Efficiently solve the nonelastic function of traditional orthopedic fixator tool, after underwent operative is fixing, under human body power effect, easily generation loosens, produces broken nail even thus, causes the problem of operative failure.
Below in conjunction with drawings and Examples, the invention will be further described.
Accompanying drawing explanation
Figure 1 shows that the of the present invention and middle Upper thoracic way of escape half pedicle screw internal fixation perform the operation screw and connecting rod in the equipment that is combined combine after front view.
Figure 2 shows that the of the present invention and middle Upper thoracic way of escape half pedicle screw internal fixation is performed the operation the structural representation of the equipment be combined.
Figure 3 shows that and be of the present inventionly used for the treatment of the way of escape half pedicle of vertebral arch approach schematic diagram in the fixing method of middle Upper thoracic sick and wounded implantation half pedicle screws.
In figure, 101-screw tail, 102-nut, 103-spring pad, 104-elasticity self-locking module, 105-screw, 106-connecting rod.
Detailed description of the invention
Hereafter will in conjunction with specific embodiments and accompanying drawing the present invention is described further.It should be noted that the combination of technical characteristic or the technical characteristic described in following embodiment should not be considered to isolated, they can mutually be combined thus be reached better technique effect.
Figure 1 shows that the of the present invention and middle Upper thoracic way of escape half pedicle screw internal fixation perform the operation screw and connecting rod in the equipment that is combined combine after front view.
Figure 2 shows that the of the present invention and middle Upper thoracic way of escape half pedicle screw internal fixation is performed the operation the structural representation of the equipment be combined.
As shown in Fig. 1 and Fig. 2, the invention provides a kind of and middle Upper thoracic way of escape half pedicle screw internal fixation to perform the operation the equipment be combined, described fixing device adopts high resiliency titanium alloy as material, comprises nut 102, screw 105, connecting rod 106, spring pad 103 and elasticity self-locking module 104.Described elasticity self-locking module 104 vertical direction one end is connected with described screw 105, horizontal direction one end is connected with described connecting rod 106, tightening described nut 102 during installation makes described spring pad 103 and described elasticity self-locking module 104 engage, thus locks described screw 105.
The described elasticity self-locking module 104 be connected with described screw 105 and described connecting rod 106, side is longitudinally the cylindrical hole suitable with described connecting rod 106 thickness, the side of described cylindrical hole is described screw tail 101 and mutually vertical with described cylindrical hole, the face that described screw tail 101 is vertical with described cylindrical hole arranges a longitudinal furrow, this longitudinal furrow goes directly in described cylindrical hole, and correspondingly cut-away divides cylindrical wall, when described screw tail 101 is all inserted in described cylindrical hole with described connecting rod 106, when described screw tail 101 is tightened with nut, described longitudinal furrow closes gradually, described screw tail 101 steps up described connecting rod 106 after tightening with described nut.
Described screw 105 coordinates with the concave spherical surface of described elasticity self-locking module 104 angle that can tilt because of spherical.
Described angle of inclination is 0 ~ 30 °.
Described screw 105 is ball screw, and described nut 102 is hex nut, and described spring pad 103 is stricture of vagina thread form spring pad, and described elasticity self-locking module 104 is stricture of vagina thread form arc rail elasticity self-locking module.
Described fixing device is applicable to the orthopedic of complete each position of spinal column, may be used for the middle Upper thoracic way of escape half vertebral arch and takes root in nail.
Figure 3 shows that and be of the present inventionly used for the treatment of the way of escape half pedicle of vertebral arch approach schematic diagram in the fixing method of middle Upper thoracic sick and wounded implantation half pedicle screws.
The present invention also provides a kind of and is used for the treatment of the fixing method of middle Upper thoracic sick and wounded implantation half pedicle screws, and as shown in Figure 3, the method comprises the steps:
Transverse process is excised until root with head of the horse rongeur and laminectomy rongeur, boundary up and down and the lateral wall of pedicle of vertebral arch is detected with nerve dissector hook, the lateral cortex bone of pedicle of vertebral arch is opened with the middle cone of passage-opening awl in pedicle of vertebral arch lateral wall, then in the substrate probeing into forward pedicle of vertebral arch by the cortex bone hole that pedicle of vertebral arch probe bores out outside pedicle of vertebral arch and vertebral body, direction is abduction 15 ~ 30 °, afterbody head rolls oblique 10 ~ 25 °, after verifying nail road with bead probe up and down inside and outside front 5 walls be sclerotin, being screwed into diameter is 4.5 ~ 6.0mm, length is the screw of 30 ~ 35mm, sections fixing as required inserts screw successively and rod is fixing.
The diameter of described screw and length are:
The length of T1, T2 place screw is 30 ~ 35mm, diameter 5.5mm.
T3 ~ T5 length is 35 ~ 40mm, the general 5.5 ~ 6.0mm of diameter.
T6 ~ T10 length is about 45mm, the general 6.0mm of diameter.
A kind of safe and effective middle Upper thoracic of research design of the present invention fixes new art formula and the way of escape half pedicle of vertebral arch approach puts the new art formula of nail, effectively overcome, compensate for the shortcoming and defect of middle Upper thoracic pedicle screw internal fixation operation, solve middle Upper thoracic sick and wounded patient posterior approach vertebral arch urgently to be resolved hurrily clinically and take root in the difficult problem that nail difficulty is high, risk is large, and cost is lower, easy and simple to handle.
Although give some embodiments of the present invention, it will be understood by those of skill in the art that without departing from the spirit of the invention herein, can change embodiment herein.Above-described embodiment is exemplary, should using embodiment herein as the restriction of interest field of the present invention.
Claims (7)
1. to perform the operation with the middle Upper thoracic way of escape half pedicle screw internal fixation the equipment be combined, it is characterized in that, adopt high resiliency titanium alloy as material, comprise nut, screw, connecting rod, spring pad and elasticity self-locking module; Described elasticity self-locking module vertical direction one end is connected with described screw, and horizontal direction one end is connected with described connecting rod, tightens described nut and makes described spring pad and the engagement of described elasticity self-locking module, thus lock described screw during installation.
2. a kind of and middle Upper thoracic way of escape half pedicle screw internal fixation is performed the operation the equipment be combined as claimed in claim 1, it is characterized in that, the described elasticity self-locking module be connected with described screw and described connecting rod, side is longitudinally the cylindrical hole suitable with described connecting rod thickness, the side of described cylindrical hole is described screw tail and mutually vertical with described cylindrical hole, the face that described screw tail is vertical with described cylindrical hole arranges a longitudinal furrow, in through described cylindrical hole, and correspondingly cut-away divides cylindrical wall, when described screw tail and described connecting rod are all inserted in described cylindrical hole, when described screw tail and nut are tightened, described longitudinal furrow closes gradually, described screw tail and described nut step up described connecting rod after tightening.
3. a kind of and middle Upper thoracic way of escape half pedicle screw internal fixation is performed the operation the equipment be combined as claimed in claim 1, it is characterized in that, described screw coordinates with the concave spherical surface of described elasticity self-locking module the angle that can tilt because of spherical, and angular range is 0 ~ 30 °.
4. a kind of and middle Upper thoracic way of escape half pedicle screw internal fixation is performed the operation the equipment be combined as claimed in claim 1, it is characterized in that, described screw is ball screw, described nut is hex nut, described spring pad is stricture of vagina thread form spring pad, and described elasticity self-locking module is stricture of vagina thread form arc rail elasticity self-locking module.
5. one kind is used for the treatment of the fixing method of middle Upper thoracic sick and wounded implantation half pedicle screws, it is characterized in that, comprise the steps: that excision pedicle of vertebral arch transverse process is until root, detect boundary up and down and the lateral wall of pedicle of vertebral arch, middle cone in pedicle of vertebral arch lateral wall opens the lateral cortex bone of pedicle of vertebral arch, in the substrate that the cortex bone hole of boring out outside pedicle of vertebral arch probes into forward pedicle of vertebral arch at a certain angle and vertebral body, be screwed into screw after verifying nail road and rod is fixing.
6. be a kind ofly as claimed in claim 5 used for the treatment of the fixing method of middle Upper thoracic sick and wounded implantation half pedicle screws, it is characterized in that, the angle that described cortex bone hole of boring out outside pedicle of vertebral arch probes into forward in the substrate of pedicle of vertebral arch and vertebral body is at a certain angle abduction 15 ° ~ 30 °, and afterbody head rolls oblique 10 ° ~ 25 °.
7. be a kind ofly as claimed in claim 5 used for the treatment of the fixing method of middle Upper thoracic sick and wounded implantation half pedicle screws, it is characterized in that, the diameter of described screw and length are:
The length of T1, T2 place screw is 30 ~ 35mm, diameter 5.5mm;
T3 ~ T5 length is 35 ~ 40mm, the general 5.5 ~ 6.0mm of diameter;
T6 ~ T10 length is about 45mm, the general 6.0mm of diameter.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201510212508.2A CN104758043A (en) | 2015-04-30 | 2015-04-30 | Method and device for achieving middle-upper thoracic vertebrae semi-pedicle screw fixation in posterior mode |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201510212508.2A CN104758043A (en) | 2015-04-30 | 2015-04-30 | Method and device for achieving middle-upper thoracic vertebrae semi-pedicle screw fixation in posterior mode |
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| Publication Number | Publication Date |
|---|---|
| CN104758043A true CN104758043A (en) | 2015-07-08 |
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|---|---|---|---|
| CN201510212508.2A Pending CN104758043A (en) | 2015-04-30 | 2015-04-30 | Method and device for achieving middle-upper thoracic vertebrae semi-pedicle screw fixation in posterior mode |
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Citations (6)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN201356641Y (en) * | 2008-10-20 | 2009-12-09 | 杨永军 | Elastic arc-track self-locking pedicle orthopedics fixation system |
| US20140249582A1 (en) * | 2005-11-21 | 2014-09-04 | DePuy Synthes Products, LLC | Polyaxial Bone Anchors with Increased Angulation |
| US20140350605A1 (en) * | 2009-12-18 | 2014-11-27 | X-Spine Systems, Inc. | Spinal implant locking member with improved guidance, tactile and visual feedback |
| CN204169917U (en) * | 2014-09-04 | 2015-02-25 | 浙江嘉佑医疗器械有限公司 | The special pedicle nail of PLIF |
| CN104434290A (en) * | 2014-12-06 | 2015-03-25 | 昆明医科大学第二附属医院 | Low-profile pedicle screw adopting flexible connection way |
| CN204233204U (en) * | 2014-11-13 | 2015-04-01 | 嘉兴德康医疗器械有限公司 | A kind of Ultimum Ti connecting device of vertebral column titanium rod |
-
2015
- 2015-04-30 CN CN201510212508.2A patent/CN104758043A/en active Pending
Patent Citations (6)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US20140249582A1 (en) * | 2005-11-21 | 2014-09-04 | DePuy Synthes Products, LLC | Polyaxial Bone Anchors with Increased Angulation |
| CN201356641Y (en) * | 2008-10-20 | 2009-12-09 | 杨永军 | Elastic arc-track self-locking pedicle orthopedics fixation system |
| US20140350605A1 (en) * | 2009-12-18 | 2014-11-27 | X-Spine Systems, Inc. | Spinal implant locking member with improved guidance, tactile and visual feedback |
| CN204169917U (en) * | 2014-09-04 | 2015-02-25 | 浙江嘉佑医疗器械有限公司 | The special pedicle nail of PLIF |
| CN204233204U (en) * | 2014-11-13 | 2015-04-01 | 嘉兴德康医疗器械有限公司 | A kind of Ultimum Ti connecting device of vertebral column titanium rod |
| CN104434290A (en) * | 2014-12-06 | 2015-03-25 | 昆明医科大学第二附属医院 | Low-profile pedicle screw adopting flexible connection way |
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Application publication date: 20150708 |