CN104814786A - Multi-beam reconstruction technology for knee-joint ACL (anterior cruciate ligament) for department of orthopaedics, and application of ACL multi-beam reconstruction technology - Google Patents
Multi-beam reconstruction technology for knee-joint ACL (anterior cruciate ligament) for department of orthopaedics, and application of ACL multi-beam reconstruction technology Download PDFInfo
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- CN104814786A CN104814786A CN201510000742.9A CN201510000742A CN104814786A CN 104814786 A CN104814786 A CN 104814786A CN 201510000742 A CN201510000742 A CN 201510000742A CN 104814786 A CN104814786 A CN 104814786A
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- 210000000629 knee joint Anatomy 0.000 title claims abstract description 21
- 210000001264 anterior cruciate ligament Anatomy 0.000 title abstract description 10
- 238000005516 engineering process Methods 0.000 title abstract description 7
- 210000000988 bone and bone Anatomy 0.000 claims abstract description 93
- 210000002303 tibia Anatomy 0.000 claims abstract description 69
- 210000003041 ligament Anatomy 0.000 claims description 59
- 210000000689 upper leg Anatomy 0.000 claims description 34
- 238000000034 method Methods 0.000 claims description 16
- 230000001054 cortical effect Effects 0.000 claims description 12
- 238000013459 approach Methods 0.000 claims description 6
- 238000003780 insertion Methods 0.000 claims description 6
- 230000037431 insertion Effects 0.000 claims description 6
- 210000000522 condylus lateralis femoris Anatomy 0.000 claims description 3
- 238000005553 drilling Methods 0.000 claims description 3
- 238000002513 implantation Methods 0.000 claims description 3
- 238000009434 installation Methods 0.000 claims description 3
- 210000004872 soft tissue Anatomy 0.000 claims description 3
- 210000002435 tendon Anatomy 0.000 claims description 3
- 210000001694 thigh bone Anatomy 0.000 abstract 1
- 238000010586 diagram Methods 0.000 description 6
- 239000000835 fiber Substances 0.000 description 2
- 230000002159 abnormal effect Effects 0.000 description 1
- 230000009286 beneficial effect Effects 0.000 description 1
- 230000015572 biosynthetic process Effects 0.000 description 1
- 210000002808 connective tissue Anatomy 0.000 description 1
- 230000007812 deficiency Effects 0.000 description 1
- 238000013461 design Methods 0.000 description 1
- 238000002224 dissection Methods 0.000 description 1
- 210000003127 knee Anatomy 0.000 description 1
- CWWARWOPSKGELM-SARDKLJWSA-N methyl (2s)-2-[[(2s)-2-[[2-[[(2s)-2-[[(2s)-2-[[(2s)-5-amino-2-[[(2s)-5-amino-2-[[(2s)-1-[(2s)-6-amino-2-[[(2s)-1-[(2s)-2-amino-5-(diaminomethylideneamino)pentanoyl]pyrrolidine-2-carbonyl]amino]hexanoyl]pyrrolidine-2-carbonyl]amino]-5-oxopentanoyl]amino]-5 Chemical compound C([C@@H](C(=O)NCC(=O)N[C@@H](CC(C)C)C(=O)N[C@@H](CCSC)C(=O)OC)NC(=O)[C@H](CC=1C=CC=CC=1)NC(=O)[C@H](CCC(N)=O)NC(=O)[C@H](CCC(N)=O)NC(=O)[C@H]1N(CCC1)C(=O)[C@H](CCCCN)NC(=O)[C@H]1N(CCC1)C(=O)[C@@H](N)CCCN=C(N)N)C1=CC=CC=C1 CWWARWOPSKGELM-SARDKLJWSA-N 0.000 description 1
- 238000011017 operating method Methods 0.000 description 1
- 230000002980 postoperative effect Effects 0.000 description 1
- 230000006641 stabilisation Effects 0.000 description 1
- 238000011105 stabilization Methods 0.000 description 1
- 230000003068 static effect Effects 0.000 description 1
Abstract
The invention discloses an ACL multi-beam reconstruction technology for a knee-joint ACL (anterior cruciate ligament) for department of orthopaedics, and the technology comprises a thighbone end footprint positioner, a door-type guide frame, a positioning operation channel sleeve, a positioning operation channel sleeve guider, a central hole positioner, an orthopaedics department hollow drill, a cancellous bone extractor, a 12-point positioning guider, a 3/9 point positioning guider, a shin bone end arc-shaped positioning guider, a shin bone end central hole positioning guider, and a shin bone end trepanning guider. The technology is convenient to use, can achieve the protogenetic reconstruction of the knee-joint ACL conveniently, achieves the complete covering of a deserved footprint region, achieves the function of the intersecting of a front beam and a rear beam, and achieves the protogenetic reconstruction after repeated damage.
Description
Technical field
The invention belongs to medical instrument field, be specifically related to a kind of orthopaedics knee joint ACL multi beam reconstruction technique and application thereof.
Background technology
Kneed anterior cruciate ligament, be called for short ACL, to refer to after being attached to knee joint femoral ectocondyle medial surface, after upper, outer dense connective tissue assembles in intercondylar fossa, before oblique knee joint, under, in, terminate in the ligament structure of ridge front depression between tibial plateau condyle and formation.Its femur, tibia stop two ends have vasa and Substance P, and major function controls the abnormal reach of kneed tibia and rotates, and matches with other static(al) kneed and dynamic stabilization devices and maintain kneed stability.But it is once damage, and repair is pretty troublesome thing.
Summary of the invention
Technical problem to be solved by this invention is for above-mentioned the deficiencies in the prior art, a kind of orthopaedics knee joint ACL multi beam reconstruction technique and application thereof are provided, easy to use, can easily the anterior cruciate ligament of primary reconstruction of knee, realize the due footmark district of anterior cruciate ligament to cover completely, the interleaving function of toe-in and posterior cord, and original position Reconstruction of The Function after realizing contingent damage again.
The technical solution adopted in the present invention is: a kind of orthopaedics knee joint ACL multi beam reconstruction technique, comprises femur end footmark district localizer, gate guide housing, positioning work access sheath, positioning work access sheath guider, centre bore localizer, orthopaedics core drill, spongy bone extractor, 12 point location guiders, 3/9 point location guider, ligament tibia end arc locating guider, ligament tibia end centre bore locating guider and ligament tibia end perforate guider;
Described femur end footmark district localizer comprises localizer end, footmark district and footmark district localizer body, described footmark district localizer body is provided with Kirschner wire entrance away from one end of localizer end, footmark district, the position corresponding with Kirschner wire entrance, localizer end, described footmark district is provided with Kirschner wire and exports, Kirschner wire passage is provided with between described Kirschner wire entrance and Kirschner wire export, localizer end, described footmark district is also provided with positioning needle preformed hole and protruding limiting section, and localizer end, described footmark district and footmark district localizer body have certain angle;
Described gate guide housing comprises upper ledge and lower frame, described upper ledge is connected by connecting bolt with lower frame, the face that described upper ledge is relative with lower frame is respectively equipped with upper depression and lower convexity, described upper ledge is respectively equipped with positioning work access sheath passage and fixed sleeving Kirschner wire guide-localization hole, location away from one end of lower frame, lower frame is provided with localizer guide rod passage away from one end of upper ledge, described positioning work access sheath passage is provided with service aisle sleeve pipe set bolt, described localizer guide rod passage is provided with service aisle sleeve pipe set bolt, described localizer guide rod passage is provided with femur end footmark district localizer set bolt,
Described positioning work access sheath comprises cannula tip and telescopic mast portion, described cannula tip side is provided with fixed guide support arm, described fixed guide support arm has the Kirschner wire passage of 3.0mm, described cannula tip also has fixed screw draw-in groove, and described telescopic mast portion is zigzag away from one end of cannula tip;
The guide end portion that described positioning work access sheath guider comprises guide bar portion and is attached thereto;
Described centre bore localizer comprises centre bore localizer end and centre bore localizer bar portion, and described centre bore localizer end sides is provided with positioning seat, and described positioning seat has directional hole, and described centre bore localizer end has center positioning hole;
The drilling rod that described orthopaedics core drill comprises drill bit and is attached thereto;
Described spongy bone extractor comprises working beam and handle, described working beam is connected by Fixed latches with handle, described handle has centre bore guid needle passage, described working beam is hollow structure, spongy bone automatic rebounding spring is provided with in described working beam, the position corresponding with spongy bone automatic rebounding spring, described working beam side is connected with spongy bone baffle plate card by observation port, described spongy bone baffle plate card has guide pin through hole, described working beam side also has observation port, and described working beam is provided with cutting head away from one end of handle;
Described 12 point location guiders comprise 12 ends and 12 bar portions, and described 12 ends have Kirschner wire entrance, and described 12 end sides are provided with positioning seat, and described positioning seat has directional hole;
Described 3/9 point location guider comprises 3/9 end and 3/9 bar portion, and described 3/9 end has Kirschner wire entrance, and described 3/9 end sides is provided with positioning seat, and described positioning seat has directional hole;
Described ligament tibia end arc locating guider comprises guide part with fork-shaped band pointed tooth hook and connecting portion, described connecting portion side has service aisle, described service aisle is provided with the positioning and guiding screw hole of stationary positioned lock screw, and described connecting portion lower surface is respectively equipped with locating guider fixed via, anti-skidding lock screw and centre bore guide pin and takes out groove;
Described ligament tibia end centre bore locating guider comprises end and bar portion, described bar portion is provided with anti-skidding ratchet away from one end of end, described bar portion outer wall is provided with spacing adjustment chute, and described end sides is provided with Identification Division, and described end end face is provided with 2.4mm guide pin through hole;
Described ligament tibia end perforate guider comprises end and bar portion, and described end has Kirschner wire passage, is provided with the fixing guide groove in location outside described bar portion.
As preferably, the guide bar portion diameter of described positioning work access sheath guider is 9.8mm.
As preferably, the service aisle diameter of described ligament tibia end arc locating guider is 10mm.
As preferably, the locating guider fixed via of described ligament tibia end arc locating guider is two.
As preferably, the bar portion diameter of described ligament tibia end perforate guider is 9.8mm.
An application for orthopaedics knee joint ACL multi beam reconstruction technique, is applied to the position, hole making ACL femur end footmark district, comprises the following steps:
A, from medial approach, ACL femur end localizer is inserted articular cavity, and protruding limiting section is placed in condylus lateralis femoris trailing edge, insert 3.0mm Kirschner wire along localizer and after confirming 6 hole sites, Kirschner wire pierced in bone, wear out offside skin, select skin incision position, return Kirschner wire and be about 10mm to stock face, inner side;
B, by the installation site of steady job sleeve-assembled in gate guide housing upper ledge, to lock after adjustment direction.Gate guide housing lower frame is inserted in femur end localizer bar portion, assembles the top and the bottom of gate guider, and by screw locking;
C, by working column guider insert working column, cortical bone is arrived to through soft tissue along guide direction, adjustment gate guider direction of rotation also along femur end localizer slide downward, until steady job sleeve pipe teeth portion is stuck in femoral lateral condyle cortical bone, locks femur end localizer and gate frame;
D, take out working column guider, centre bore localizer is inserted working column, and adjustment direction uses 3mm Kirschner wire to position guiding to centre bore localizer, and centrally hole drill enters 2.4mm guide pin and is about 25mm, does not drill contralateral cortex bone;
E, use 8mm or 8 ~ 9mm core drill pierce along 2.4mm guide pin, stop to bore after entering spongy bone;
F, use spongy bone extractor pierce along 2.4mm guide pin, and be drilled into contralateral cortex bone and stop boring, takes out together with 2.4mm guide pin after rotating, the spongy bone in spongy bone extractor is for subsequent use;
H, 3/9 point location guider to be inserted along osseous tunnel, insertion depth is for arriving at tunnel bottom, maybe 25mm must be greater than, end projections orientation is to gate frame 3.0mm Kirschner wire direction, 4.0mm Kirschner wire is used to get out 3 spot hole and 9 spot hole respectively, after having holed, lead-in wire is inserted in articular cavity for subsequent use, take out 3/9 point location guider;
I, inserted along osseous tunnel by 12 point location guiders, insertion depth, for arriving at tunnel bottom, maybe must be greater than 25mm, end projections orientation is to gate frame 3.0mm Kirschner wire direction, use 3.0mm Kirschner wire to get out 12 spot hole, and guide wire is inserted articular cavity, take out locating guider;
J, 6 spot hole 3.0mm Kirschner wires are continued to pierce osseous tunnel, get out outside osseous tunnel, and guide wire is drawn;
K, remove all instruments, femur end tunnel completes.
An application for orthopaedics knee joint ACL multi beam reconstruction technique, is applied to make position, hole, ACL ligament tibia end footmark district, comprises the following steps:
A, ACL ligament tibia end arc locating guider is entered articular cavity from medial approach, front end fork-shaped band pointed tooth hook is fixed on ACL ligament tibia end footmark district center point, insert centre bore locating guider, adjust the position of localizer direction and centre bore locating guider ratchet according to tendon exit position and length of tunnel.Adjust rear locked-center hole locating guider, use 2.4mm guide pin to get out tibial tunnel center locating pin, do not drill contralateral cortex bone.Again 2 2.0mm Kirschner wires are pierced tibia along arc locating guider arched arm lock hole and be about 10mm, whole localizer is locked onto fixed position;
B, taking-up centre bore localizer;
C, suitable center locating pin are inserted 9mm drill bit, and are broken tibial medial cortical bone, stop to bore after entering spongy bone;
D, use spongy bone extractor pierce along 2.4mm guide pin, and be drilled into contralateral cortex bone and stop boring, takes out together with 2.4mm guide pin after rotating, in spongy bone extractor, spongy bone is for subsequent use;
E, ligament tibia end perforate guider is inserted osseous tunnel along localizer, lock after inserting tunnel bottom according to positioning and guiding direction, use 3.5mm Kirschner wire to pierce respectively, namely form the front hole of ligament tibia end;
F, taking-up Kirschner wire, rotate ligament tibia end perforate guider 180o, rotate to locating channel and lock, re-using 3.5mm Kirschner wire and pierce respectively, and confirm under arthroscope;
G, all instruments of dismounting ligament tibia end, use that 3mm is flat frustrates cutter or other instrument enters tunnel respectively by wrong a little flat for bone beam between two 3.5mm borings, form the oval osseous tunnel of former and later two about 7 × 3.5mm, in the middle of osseous tunnel, retain the cortical bone beam of >3mm; Tibial tunnel completes.
H, respectively 4 guide wires are introduced articular cavity from 4 holes of femoral bone tunnel, and according to 3 points, 6 go between into tibia metapore, 9 points, 12 go between into the front hole of tibia, by lead-in wire direction implantation graft ligament after having gone between, and modus operandi carries out tension-stretched routinely, femur end uses RIGIDFIX etc. to cross nail mode and is fixed, and ligament tibia end can use bone bridge and multiple squeezing screw mode to be fixed; After fixedly completing, the spongy bone got in bone object is backfilled into osseous tunnel, complete hands art;
Beneficial effect of the present invention is:
1. tool operation is convenient, and operating procedure is few, reduces operating time, reduces operation risk;
2. kit completes the perforate positioning function of the stock/each point of beam hole position, shin two ends of ACL;
3. the Kirschner wire that articular cavity inner cortex surface of bone perforate use operating room is standing, without the need to special expensive tool, operation cost is low;
4. instrument consumes low, meets and repeatedly uses, and reduces operation cost;
5. tool design realizes standardization operation, avoids because of medical technologies level or in problems such as the postoperative effect that operating-table error in judgement causes differ greatly;
6. the pith of operation completes under naked eyes direct-view, arthroscope is only as aid, doctor completes this type of operation without the need to good arthroscope specialty operation basis, therefore has universal, popularizing action, more doctor can be allowed to have grasped the technical ability of this type of operation in a short time;
7. perfection realizes the primary beam splitting Reconstruction of The Function of dissection of ACL;
8. embody the anatomical function structure of ACL truly, realize the full footmark district fiber distribution in two ends and the deflation arrangement of body fiber crossovers district.
Accompanying drawing explanation
Fig. 1 is femur end footmark district of the present invention locator structure schematic diagram;
Fig. 2 is gate guide housing structural representation of the present invention;
Fig. 3 is positioning work access sheath structural representation of the present invention;
Fig. 4 is positioning work access sheath guide structure schematic diagram of the present invention;
Fig. 5 is centre bore locator structure schematic diagram of the present invention;
Fig. 6 is spongy bone extractor structural representation of the present invention;
Fig. 7 is 12 point location guide structure schematic diagrams of the present invention;
Fig. 8 is 3/9 point location guide structure schematic diagram of the present invention;
Fig. 9 is ligament tibia end arc locating guider front view of the present invention;
Figure 10 is ligament tibia end arc locating guider top view of the present invention;
Figure 11 is ligament tibia end centre bore locating guider structural representation of the present invention;
Figure 12 is ligament tibia end perforate guide structure schematic diagram of the present invention.
In figure: 1, upper ledge; 2, lower frame; 3, positioning work access sheath passage; 4, fixed sleeving Kirschner wire guide-localization hole is located; 5, service aisle sleeve pipe set bolt; 6, upper depression; 7, lower convexity; 8, connecting bolt; 9, localizer guide rod passage; 10, femur end footmark district localizer set bolt; 11, protruding limiting section; 12, positioning needle preformed hole; 13, Kirschner wire outlet; 14, localizer end, footmark district; 15, Kirschner wire entrance; 16, Kirschner wire passage; 17, positioning work telescopic mast portion; 18, positioning work cannula tip; 19, fixed guide support arm; 20, the Kirschner wire passage of 3.0mm; 21, fixed screw draw-in groove; 22, guide bar portion; 23, guide end portion; 24, directional hole; 25, center positioning hole; 26, centre bore localizer bar portion; 27,12 point location guider Kirschner wire entrances; 28,12 point location guide bar portions; 29,3/9 point location guider Kirschner wire entrance; 30,3/9 point location guider point bar portion; 31, spongy bone extractor hands handle; 32, centre bore guid needle passage; 33, cutting head; 34, spongy bone filling area; 35, Fixed latches; 36, spongy bone automatic rebounding spring; 37, spongy bone baffle plate card; 38, observation port; 39, fork-shaped band pointed tooth hook; 40, service aisle; 41, positioning and guiding screw hole; 42, position and lock screw; 43, locating guider fixed via; 44, anti-skidding lock screw; 45, centre bore guide pin takes out groove; 46, anti-skidding ratchet; 47, spacing adjustment chute; 48, Identification Division; 49,2.4mm guide pin through hole; 50, Kirschner wire passage; 51, the fixing guide groove in location.
Detailed description of the invention
Below in conjunction with the accompanying drawings and the specific embodiments the present invention is described in further detail.
As shown in Figure 1, a kind of orthopaedics knee joint ACL multi beam reconstruction technique, comprises femur end footmark district localizer, gate guide housing, positioning work access sheath, positioning work access sheath guider, centre bore localizer, orthopaedics core drill, spongy bone extractor, 12 point location guiders, 3/9 point location guider, ligament tibia end arc locating guider, ligament tibia end centre bore locating guider and ligament tibia end perforate guider;
Described femur end footmark district localizer comprises localizer end, footmark district 14 and footmark district localizer body, described footmark district localizer body is provided with Kirschner wire entrance 15 away from the other end of localizer end, footmark district 14, the position corresponding with Kirschner wire entrance 15, localizer end, described footmark district 14 is provided with Kirschner wire and exports 13, described Kirschner wire entrance 15 and Kirschner wire are provided with Kirschner wire passage 16 between exporting 13, localizer end, described footmark district 14 is also provided with rear end 4mm positioning needle outlet preformed hole 12 and protruding limiting section 11, localizer end, described footmark district 14 and footmark district localizer body have certain angle,
Described gate guide housing comprises upper ledge 1 and lower frame 2, described upper ledge 1 is connected by connecting bolt 8 with lower frame 2, the face that described upper ledge 1 is relative with lower frame 2 is respectively equipped with upper depression 6 and lower convexity 7, described upper ledge 1 is respectively equipped with positioning work access sheath passage 3 and fixed sleeving Kirschner wire guide-localization hole 4, location away from one end of lower frame 2, lower frame 2 is provided with localizer guide rod passage 9 away from one end of upper ledge 1, described positioning work access sheath passage 3 is provided with service aisle sleeve pipe set bolt 5, described localizer guide rod passage 9 is provided with femur end footmark district localizer set bolt screw hole, described set bolt screw hole is provided with femur end footmark district localizer set bolt 10,
Described positioning work access sheath comprises cannula tip 18 and telescopic mast portion 17, described cannula tip 18 side is provided with fixed guide support arm 19, described fixed guide support arm 19 has the Kirschner wire passage 20 of 3.0mm, described cannula tip 18 also has fixed screw draw-in groove 21, and described telescopic mast portion 17 is zigzag away from one end of cannula tip 18;
The guide end portion 23 that described positioning work access sheath guider comprises guide bar portion 22 and is attached thereto;
Described centre bore localizer comprises centre bore localizer end and centre bore localizer bar portion 26, and described centre bore localizer end sides is provided with positioning seat, described positioning seat has directional hole 24, and described centre bore localizer end has center positioning hole 25;
The drilling rod that described orthopaedics core drill comprises drill bit and is attached thereto;
Described 12 point location guiders comprise 12 ends and 12 bar portions 28, and described 12 ends have 3.0mm Kirschner wire entrance 27, and described 12 end sides are provided with positioning seat, described positioning seat have directional hole 24;
Described 3/9 point location guider comprises 3/9 end and 3/9 bar portion 30, and described 3/9 end has 4.0mm Kirschner wire entrance 29, and described 3/9 end sides is provided with positioning seat, described positioning seat has directional hole 24;
Described spongy bone extractor comprises working beam and handle 31, described working beam is connected by Fixed latches 35 with handle 31, described handle 31 has centre bore guid needle passage 32, described working beam is hollow structure, spongy bone automatic rebounding spring 36 is provided with in described working beam, the position corresponding with spongy bone automatic rebounding spring 36, described working beam side is connected with spongy bone baffle plate card 37 by observation port 38, described spongy bone baffle plate card 37 has guide pin through hole, described working beam side also has spongy bone and takes out groove 34, described working beam is provided with cutting head 33 away from one end of handle 31,
Described ligament tibia end arc locating guider comprises guide part with fork-shaped band pointed tooth hook 39 and connecting portion, described connecting portion side has service aisle 40, described service aisle 40 is provided with the positioning and guiding screw hole 41 of stationary positioned lock screw 42, and described connecting portion side is respectively equipped with locating guider fixed via 43, anti-skidding lock screw 44 and centre bore guide pin and takes out groove 45;
Described ligament tibia end centre bore locating guider comprises end and bar portion, described bar portion is provided with anti-skidding ratchet 46 away from one end of end, described bar portion outer wall is provided with spacing adjustment chute 47, and described end sides is provided with Identification Division 48, and described end end face is provided with 2.4mm guide pin through hole;
Described ligament tibia end perforate guider comprises end and bar portion, and described end has Kirschner wire passage 50, and outside described bar portion, 50 are provided with the fixing guide groove 51 in location.
As preferably, guide bar portion 22 diameter of described positioning work access sheath guider is 9.8mm.
As preferably, service aisle 40 diameter of described ligament tibia end arc locating guider is 10mm.
As preferably, the locating guider fixed via 43 of described ligament tibia end arc locating guider is two.
As preferably, the bar portion diameter of described ligament tibia end perforate guider is 9.8mm.
An application for orthopaedics knee joint ACL multi beam reconstruction technique, is applied to the position, hole making ACL femur end footmark district, comprises the following steps:
Step one, from medial approach, ACL femur end localizer is inserted articular cavity, and protruding limiting section is placed in condylus lateralis femoris trailing edge, insert 3.0mm Kirschner wire along localizer and after confirming 6 hole sites, Kirschner wire pierced in bone, wear out offside skin, select skin incision position, return Kirschner wire and be about 10mm to stock face, inner side;
Step 2, by the installation site of steady job sleeve-assembled in gate guide housing upper ledge, to lock after adjustment direction.Gate guide housing lower frame is inserted in femur end localizer bar portion, assembles the top and the bottom of gate guider, and by screw locking;
Step 3, by working column guider insert working column, cortical bone is arrived to through soft tissue along guide direction, adjustment gate guider direction of rotation along femur end localizer slide downward, until steady job sleeve pipe teeth portion is stuck in femoral lateral condyle cortical bone, locking femur end localizer and gate frame;
Step 4, take out working column guider, centre bore localizer is inserted working column, and adjustment direction uses 3mm Kirschner wire to position guiding to centre bore localizer, and centrally hole drill enters 2.4mm guide pin and is about 25mm, does not drill contralateral cortex bone;
Step 5, use 8mm or 8 ~ 9mm core drill pierce along 2.4mm guide pin, stop to bore after entering spongy bone;
Step 6, use spongy bone extractor pierce along 2.4mm guide pin, and be drilled into contralateral cortex bone and stop boring, takes out together with 2.4mm guide pin after rotating, the spongy bone in spongy bone extractor is for subsequent use;
Step 7,3/9 point location guider to be inserted along osseous tunnel, insertion depth arrives at tunnel bottom, 25mm must be greater than, end projections orientation is to gate frame 3.0mm Kirschner wire direction, 4.0mm Kirschner wire is used to get out 3 spot hole and 9 spot hole respectively, after having holed, lead-in wire is inserted in articular cavity for subsequent use, take out 3/9 point location guider;
Step 8, inserted along osseous tunnel by 12 point location guiders, insertion depth arrives at tunnel bottom, must be greater than 25mm, end projections orientation is to gate frame 3.0mm Kirschner wire direction, use 3.0mm Kirschner wire to get out 12 spot hole, and guide wire is inserted articular cavity, take out locating guider;
Step 9,6 spot hole 3.0mm Kirschner wires are continued to pierce osseous tunnel, get out outside osseous tunnel, and guide wire is drawn;
Step 10, remove all instruments, femur end tunnel completes.
An application for orthopaedics knee joint ACL multi beam reconstruction technique, is applied to make position, hole, ACL ligament tibia end footmark district, comprises the following steps:
Step one, ACL ligament tibia end arc locating guider is entered articular cavity from medial approach, front end fork-shaped band pointed tooth hook is fixed on ACL ligament tibia end footmark district center point, insert centre bore locating guider, adjust the position of localizer direction and centre bore locating guider ratchet according to tendon exit position and length of tunnel.Adjust rear locked-center hole locating guider, use 2.4mm guide pin to get out tibial tunnel center locating pin, do not drill contralateral cortex bone.Again 2 2.0mm Kirschner wires are pierced tibia along arc locating guider arched arm lock hole and be about 10mm, whole localizer is locked onto fixed position;
Step 2, taking-up centre bore localizer;
Step 3, suitable center locating pin are inserted 9mm drill bit, and are broken tibial medial cortical bone, stop to bore after entering spongy bone;
Step 4, use spongy bone extractor pierce along 2.4mm guide pin, and be drilled into contralateral cortex bone and stop boring, takes out together with 2.4mm guide pin after rotating, in spongy bone extractor, spongy bone is for subsequent use;
Step 5, ligament tibia end perforate guider is inserted osseous tunnel along localizer, lock after inserting tunnel bottom according to positioning and guiding direction, use 3.5mm Kirschner wire to pierce respectively, namely form the front hole of ligament tibia end;
Step 6, taking-up Kirschner wire, rotate ligament tibia end perforate guider 180o, rotate to locating channel and lock, re-using 3.5mm Kirschner wire and pierce respectively, and confirm under arthroscope;
Step 7, all instruments of dismounting ligament tibia end, use that 3mm is flat frustrates cutter or other instrument enters tunnel respectively by wrong a little flat for bone beam between two 3.5mm borings, form the oval osseous tunnel of former and later two about 7 × 3.5mm, retain the cortical bone beam of >3mm in the middle of osseous tunnel, tibial tunnel completes;
Step 8, respectively 4 guide wires are introduced articular cavity from 4 holes of femoral bone tunnel, and according to 3 points, 6 go between into tibia metapore, 9 points, 12 go between into the front hole of tibia, by lead-in wire direction implantation graft ligament after having gone between, and modus operandi carries out tension-stretched routinely, femur end uses RIGIDFIX etc. to cross nail mode and is fixed, and ligament tibia end can use bone bridge and multiple squeezing screw mode to be fixed; After fixedly completing, the spongy bone got in bone object is backfilled into osseous tunnel, complete operation.
The above embodiment only have expressed the specific embodiment of the present invention, and it describes comparatively concrete and detailed, but therefore can not be interpreted as the restriction to the scope of the claims of the present invention.It should be pointed out that for the person of ordinary skill of the art, without departing from the inventive concept of the premise, can also make some distortion and improvement, these all belong to protection scope of the present invention.
Claims (7)
1. an orthopaedics knee joint ACL multi beam reconstruction technique, is characterized in that: comprise femur end footmark district localizer, gate guide housing, positioning work access sheath, positioning work access sheath guider, centre bore localizer, orthopaedics core drill, spongy bone extractor, 12 point location guiders, 3/9 point location guider, ligament tibia end arc locating guider, ligament tibia end centre bore locating guider and ligament tibia end perforate guider;
Described femur end footmark district localizer comprises localizer end, footmark district and footmark district localizer body, described footmark district localizer body is provided with Kirschner wire entrance away from one end of localizer end, footmark district, the position corresponding with Kirschner wire entrance, localizer end, described footmark district is provided with Kirschner wire and exports, Kirschner wire passage is provided with between described Kirschner wire entrance and Kirschner wire export, localizer end, described footmark district is also provided with positioning needle preformed hole and protruding limiting section, and localizer end, described footmark district and footmark district localizer body have certain angle;
Described gate guide housing comprises upper ledge and lower frame, described upper ledge is connected by connecting bolt with lower frame, the face that described upper ledge is relative with lower frame is respectively equipped with upper depression and lower convexity, described upper ledge is respectively equipped with positioning work access sheath passage and fixed sleeving Kirschner wire guide-localization hole, location away from one end of lower frame, lower frame is provided with localizer guide rod passage away from one end of upper ledge, described positioning work access sheath passage is provided with service aisle sleeve pipe set bolt, described localizer guide rod passage is provided with service aisle sleeve pipe set bolt, described localizer guide rod passage is provided with femur end footmark district localizer set bolt,
Described positioning work access sheath comprises cannula tip and telescopic mast portion, described cannula tip side is provided with fixed guide support arm, described fixed guide support arm has the Kirschner wire passage of 3.0mm, described cannula tip also has fixed screw draw-in groove, and described telescopic mast portion is zigzag away from one end of cannula tip;
The guide end portion that described positioning work access sheath guider comprises guide bar portion and is attached thereto;
Described centre bore localizer comprises centre bore localizer end and centre bore localizer bar portion, and described centre bore localizer end sides is provided with positioning seat, and described positioning seat has directional hole, and described centre bore localizer end has center positioning hole;
The drilling rod that described orthopaedics core drill comprises drill bit and is attached thereto;
Described spongy bone extractor comprises working beam and handle, described working beam is connected by Fixed latches with handle, described handle has centre bore guid needle passage, described working beam is hollow structure, spongy bone automatic rebounding spring is provided with in described working beam, the position corresponding with spongy bone automatic rebounding spring, described working beam side is connected with spongy bone baffle plate card by observation port, described spongy bone baffle plate card has guide pin through hole, described working beam side also has observation port, and described working beam is provided with cutting head away from one end of handle;
Described 12 point location guiders comprise 12 ends and 12 bar portions, and described 12 ends have Kirschner wire entrance, and described 12 end sides are provided with positioning seat, and described positioning seat has directional hole;
Described 3/9 point location guider comprises 3/9 end and 3/9 bar portion, and described 3/9 end has Kirschner wire entrance, and described 3/9 end sides is provided with positioning seat, and described positioning seat has directional hole;
Described ligament tibia end arc locating guider comprises guide part with fork-shaped band pointed tooth hook and connecting portion, described connecting portion side has service aisle, described service aisle is provided with the positioning and guiding screw hole of stationary positioned lock screw, and described connecting portion lower surface is respectively equipped with locating guider fixed via, anti-skidding lock screw and centre bore guide pin and takes out groove;
Described ligament tibia end centre bore locating guider comprises end and bar portion, described bar portion is provided with anti-skidding ratchet away from one end of end, described bar portion outer wall is provided with spacing adjustment chute, and described end sides is provided with Identification Division, and described end end face is provided with 2.4mm guide pin through hole;
Described ligament tibia end perforate guider comprises end and bar portion, and described end has Kirschner wire passage, is provided with the fixing guide groove in location outside described bar portion.
2. orthopaedics knee joint ACL multi beam reconstruction technique according to claim 1, is characterized in that: the guide bar portion diameter of described positioning work access sheath guider is 9.8mm.
3. orthopaedics knee joint ACL multi beam reconstruction technique according to claim 1 and 2, is characterized in that: the service aisle diameter of described ligament tibia end arc locating guider is 10mm.
4. orthopaedics knee joint ACL multi beam reconstruction technique according to claim 1 and 2, is characterized in that: the locating guider fixed via of described ligament tibia end arc locating guider is two.
5. orthopaedics knee joint ACL multi beam reconstruction technique according to claim 1 and 2, is characterized in that: the bar portion diameter of described ligament tibia end perforate guider is 9.8mm.
6. the application of an orthopaedics knee joint ACL multi beam reconstruction technique as claimed in claim 1, it is characterized in that, be applied to the position, hole making ACL femur end footmark district, comprise the following steps: a, from medial approach, ACL femur end localizer is inserted articular cavity, and protruding limiting section is placed in condylus lateralis femoris trailing edge, insert 3.0mm Kirschner wire along localizer and after confirming 6 hole sites, Kirschner wire pierced in bone, wear out offside skin, select skin incision position, return Kirschner wire and be about 10mm to inner side surface of bone;
B, by the installation site of steady job sleeve-assembled in gate guide housing upper ledge, to lock after adjustment direction; Gate guide housing lower frame is inserted in femur end localizer bar portion, assembles the top and the bottom of gate guider, and by screw locking;
C, by working column guider insert working column, cortical bone is arrived to through soft tissue along guide direction, adjustment gate guider direction of rotation also along femur end localizer slide downward, until steady job sleeve pipe teeth portion is stuck in femoral lateral condyle cortical bone, locks femur end localizer and gate frame;
D, take out working column guider, centre bore localizer is inserted working column, and adjustment direction uses 3mm Kirschner wire to position guiding to centre bore localizer, and centrally hole drill enters 2.4mm guide pin and is about 25mm, does not drill contralateral cortex bone;
E, use 8mm or 8 ~ 9mm core drill pierce along 2.4mm guide pin, stop to bore after entering spongy bone;
F, use spongy bone extractor pierce along 2.4mm guide pin, and be drilled into contralateral cortex bone and stop boring, takes out together with 2.4mm guide pin after rotating, the spongy bone in spongy bone extractor is for subsequent use;
H, 3/9 point location guider to be inserted along osseous tunnel, insertion depth is for arriving at tunnel bottom, maybe 25mm must be greater than, end projections orientation is to gate frame 3.0mm Kirschner wire direction, 4.0mm Kirschner wire is used to get out 3 spot hole and 9 spot hole respectively, after having holed, lead-in wire is inserted in articular cavity for subsequent use, take out 3/9 point location guider;
I, inserted along osseous tunnel by 12 point location guiders, insertion depth, for arriving at tunnel bottom, maybe must be greater than 25mm, end projections orientation is to gate frame 3.0mm Kirschner wire direction, use 3.0mm Kirschner wire to get out 12 spot hole, and guide wire is inserted articular cavity, take out 12 point location guiders;
J, 6 spot hole 3.0mm Kirschner wires are continued to pierce osseous tunnel, get out outside osseous tunnel, and guide wire is drawn;
K, remove all instruments, femur end tunnel completes.
7. an application for orthopaedics knee joint ACL multi beam reconstruction technique as claimed in claim 1, is characterized in that, is applied to make position, hole, ACL ligament tibia end footmark district, comprises the following steps:
A, ACL ligament tibia end arc locating guider is entered articular cavity from medial approach, front end fork-shaped band pointed tooth hook is fixed on ACL ligament tibia end footmark district center point, insert centre bore locating guider, the position of localizer direction and centre bore locating guider ratchet is adjusted according to tendon exit position and length of tunnel, adjust rear locked-center hole locating guider, 2.4mm guide pin is used to get out tibial tunnel center locating pin, do not drill contralateral cortex bone, again 2 2.0mm Kirschner wires are pierced tibia along arc locating guider arched arm lock hole and be about 10mm, whole localizer is locked onto fixed position,
B, taking-up centre bore localizer;
C, suitable center locating pin are inserted 9mm drill bit, and are broken tibial medial cortical bone, stop to bore after entering spongy bone;
D, use spongy bone extractor pierce along 2.4mm guide pin, and be drilled into contralateral cortex bone and stop boring, takes out together with 2.4mm guide pin after rotating, in spongy bone extractor, spongy bone is for subsequent use;
E, ligament tibia end perforate guider is inserted osseous tunnel along localizer, lock after inserting tunnel bottom according to positioning and guiding direction, use 3.5mm Kirschner wire to pierce respectively, namely form the front hole of ligament tibia end;
F, taking-up Kirschner wire, rotate ligament tibia end perforate guider 180o, rotate to locating channel and lock, re-using 3.5mm Kirschner wire and pierce respectively, and confirm under arthroscope;
G, all instruments of dismounting ligament tibia end, use that 3mm is flat frustrates cutter or other instrument enters tunnel respectively by wrong a little flat for bone beam between two 3.5mm borings, form the oval osseous tunnel of former and later two about 7 × 3.5mm, in the middle of osseous tunnel, retain the cortical bone beam of >3mm; Tibial tunnel completes;
H, respectively 4 guide wires are introduced articular cavity from 4 holes of femoral bone tunnel, and according to 3 points, 6 go between into tibia metapore, 9 points, 12 go between into the front hole of tibia, by lead-in wire direction implantation graft ligament after having gone between, and modus operandi carries out tension-stretched routinely, femur end uses RIGIDFIX etc. to cross nail mode and is fixed, and ligament tibia end can use bone bridge and multiple squeezing screw mode to be fixed; After fixedly completing, the spongy bone got in bone object is backfilled into osseous tunnel, complete operation.
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| Application Number | Priority Date | Filing Date | Title |
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| CN201510000742.9A CN104814786B (en) | 2015-01-04 | 2015-01-04 | Multi-beam reconstruction component for knee-joint ACL (anterior cruciate ligament) for department of orthopaedics |
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| CN201510000742.9A CN104814786B (en) | 2015-01-04 | 2015-01-04 | Multi-beam reconstruction component for knee-joint ACL (anterior cruciate ligament) for department of orthopaedics |
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| CN111700665A (en) * | 2020-06-29 | 2020-09-25 | 中国人民解放军总医院 | Kirschner wire positioning device for high tibial osteotomy |
| CN112690890A (en) * | 2020-12-28 | 2021-04-23 | 武汉大学 | Kirschner wire positioning and guiding device |
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| CN104814786B (en) | 2017-02-22 |
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