CN105212996B - Lumbar intervertebral aperture mirror and Thoracolumbar disk percutaneous cervical arc root screw puncture positioning guider and its Needle localization method - Google Patents
Lumbar intervertebral aperture mirror and Thoracolumbar disk percutaneous cervical arc root screw puncture positioning guider and its Needle localization method Download PDFInfo
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- CN105212996B CN105212996B CN201510663894.7A CN201510663894A CN105212996B CN 105212996 B CN105212996 B CN 105212996B CN 201510663894 A CN201510663894 A CN 201510663894A CN 105212996 B CN105212996 B CN 105212996B
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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
- A61B17/34—Trocars; Puncturing needles
- A61B17/3403—Needle locating or guiding means
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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
- A61B17/34—Trocars; Puncturing needles
- A61B17/3403—Needle locating or guiding means
- A61B2017/3405—Needle locating or guiding means using mechanical guide means
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Abstract
A kind of lumbar intervertebral aperture mirror and Thoracolumbar disk percutaneous cervical arc root screw puncture positioning guider and its Needle localization method, including sliding rail, puncture needle guide sleeve and angle indication dial disc, puncture needle guide sleeve is radially arranged and rotatable along angle indication dial disc, sliding rail side is provided with retention bar, it is slidably equipped with pedicle of vertebral arch body surface marking body between retention bar and angle indication dial disc, pedicle of vertebral arch body surface marking body has with pedicle of vertebral arch in the overlapping location reference point O of the summit progress of a side of body surface projection；Cross the axis L2 of puncture needle guide sleeve and plane Bs of the plane A parallel to graduation indication face with location reference point O excessively and parallel to graduation indication face is essentially coincided；Pedicle of vertebral arch body surface marking body with can locking mode be slidedly arranged on sliding rail；Angle indication dial disc and puncture needle guide sleeve with can locking mode be slidedly arranged on sliding rail.Its is simple in construction, easy to operate, applied widely, be greatly improved the security and success rate of operation.
Description
Technical field
The present invention relates to technical field of medical instruments, and in particular to a kind of lumbar intervertebral aperture mirror and Thoracolumbar disk percutaneous cervical arc root
Screw puncture positioning guider and its Needle localization method.
Background technology
The operation as two kinds of minimally invasive treatment Thoracolumbar disk diseases is fixed in foramen intervertebrale lens and micro-wound percutaneous pedicle screw
Mode, has the advantages that operation wound is small, patient recovers fast, spend few, carries out extensively in China in recent years.Carry out intervertebral foramen
The key of videoendoscopic surgery is in art that Needle localization Needle localization in the position of disc herniation, current art relies on doctor exactly
Clinical experience carries out free-hand puncture, and puncture accuracy influence by doctor's level and subjective factor, easily occur puncture it is inaccurate,
The problems such as being punctured repeatedly in art, causes to cause Surrounding muscles soft tissue unnecessary damage, and severe patient even damages abdominal cavity
The internal organs such as intestinal tube or the nerve root and dural sac at rear etc., cause abdominal cavity infection, lower limb paralysis and leakage of cerebrospinal etc. serious
Complication.Furthermore, it is that clear and definite puncture position need to carry out radioscopy repeatedly during puncturing repeatedly, to the health of patient
Also influence can be produced.
Key fixed in percutaneous cervical arc root screw is carried out to be to select suitable entry point and suitable leaning angle in art,
Entry point more options are located at the outer upper limb of pedicle of vertebral arch lateral wall under fluoroscopy during operation, and the inclined angle for entering nail exists according to different centrums
Between 10 ~ 20 degree.It is clinically at present to use free-hand puncture more, the quality of surgical quality depend critically upon doctor clinical experience and
Performance in art, the confirmation of entry point touches the heart according to the difference of different centrum screw entrance point anatomic landmarks by the hand of doctor
X-ray examination in meeting and art repeatedly determines that excessive perspective is all a kind of injury for patient or doctor；The determination of leaning angle
The range estimation in doctor's art is even more relied on, is exerted oneself due to patient posture difference, the difference of doctors experience and by harder sclerotin
, often there is leaning angle excessive or too small in the movement of centrum during puncture.Because pedicle diameter is limited, as first time wears
Thorn position is undesirable, and the difficulty of adjustment change screw way is larger again in art, and sclerotin successfully can be also reduced to screw even if changing its course
Hold, increases the postoperative risk for screw loosening displacement and operative failure occur.Such as puncture inaccurate, entry point partially in or it is interior
The inclination angle pedicle screw bigger than normal that is likely to occur damages dural sac and neural possible into canalis spinalis, causes serious complication.It is free-hand
Operation can not realize the standardization for putting nail, can be had differences in the entry point and leaning angle of the pedicle screw of different centrums,
The tail end of pedicle screw of the difference of screw end-position, i.e. the same side is in turn resulted in not point-blank, in long segment
Fixed operation in above-mentioned difference can significantly increase the difficulty that pitman between screw is placed.
The content of the invention
The technical problem to be solved in the present invention be overcome the shortcomings of prior art exist there is provided one kind it is simple in construction, operate
The percutaneous vertebral arch of lumbar intervertebral aperture mirror and Thoracolumbar disk of security and success rate convenient, applied widely, that be greatly improved operation
Root screw puncture positioning guider and its Needle localization method.
In order to solve the above technical problems, the present invention uses following technical scheme：
A kind of lumbar intervertebral aperture mirror and Thoracolumbar disk percutaneous cervical arc root screw puncture positioning guider, including have graduated cunning
Dynamic rail road, puncture needle guide sleeve and the angle indication dial disc being slidedly arranged on the sliding rail, puncture needle guide sleeve edge
The angle indication dial disc is radially arranged, and can be rotated on the angle indication dial disc, the puncture positioning guider
Also include the retention bar located at sliding rail side, the sliding rail between the retention bar and angle indication dial disc
On be also slidably equipped with a pedicle of vertebral arch body surface marking body, the pedicle of vertebral arch body surface marking body has with pedicle of vertebral arch in the side of body surface projection
The summit on side carries out overlapping location reference point O；The card and the scale of the sliding rail of the angle indication dial disc refer to
Show that face is parallel；And the axis L2 and plane A parallel to graduation indication face of puncture needle guide sleeve are crossed with crossing location reference point O simultaneously
Essentially coincided parallel to the plane B in graduation indication face；The pedicle of vertebral arch body surface marking body is by the first fixation kit can lock
Mode is slidedly arranged on sliding rail；The angle indication dial disc and puncture needle guide sleeve are by the second fixation kit can lock
Tight mode is slidedly arranged on sliding rail.
Above-mentioned puncture positioning guider, it is preferred that the pedicle of vertebral arch body surface marking body is that a cross section is oval
The axis of column, the minor axis L1 of the oval cross section of the pedicle of vertebral arch body surface marking body and the puncture needle guide sleeve
L2 is in the same plane；The location reference point O is external for the minor axis L1 and pedicle of vertebral arch body surface marking of oval cross section
The intersection point of side wall.
Above-mentioned puncture positioning guider, it is preferred that the centers of pedicle of vertebral arch body surface marking Ti Wei mono- offer vertical logical
The open column shape body in hole, and the cross section of through hole is ellipse；And open column shape body is in the ellipse projection and ellipse of body surface
Hot spot corresponds to projection of the different size pedicle of vertebral arch in body surface respectively.
Above-mentioned puncture positioning guider, it is preferred that the sliding rail offers the chute extended along its length, institute
The side for stating angle indication dial disc is connected with the first sliding block and is slidedly arranged on by the first sliding block in chute, the pedicle of vertebral arch body surface
Marked body is connected with the second sliding block and is slidedly arranged on by the second sliding block in chute.
Above-mentioned puncture positioning guider, it is preferred that first fixation kit includes the first locking nut and the first spiral shell
Bar, one end of first screw rod and the second sliding block are affixed, and the other end and the first locking nut are connected；Described second fixes
Component includes the second screw rod and the second locking nut, and one end of second screw rod and puncture needle guide sleeve are affixed, the other end
It is connected through angle indication dial disc and the first sliding block and the second locking nut.
Above-mentioned puncture positioning guider, it is preferred that set between the puncture needle guide sleeve and angle indication dial disc
There is a dismountable pad, the puncture needle guide sleeve can be by dismantling pad against angle indication dial disc.
Above-mentioned puncture positioning guider, it is preferred that the length that the retention bar stretches out to sliding rail both sides differs
Cause.
Above-mentioned puncture positioning guider, it is preferred that one end of the sliding rail, which is provided with to be used to paste, is fixed to patient
Fixation blade on skin.
Above-mentioned puncture positioning guider, it is preferred that the retention bar is set close to the fixed blade.
Present invention also offers a kind of method that foramen intervertebrale lens Needle localization is carried out using above-mentioned puncture positioning guider, bag
Include following steps：
A. by finding the target area of puncture in x-ray, CT and/or magnetic resonance imaging data, and puncture road is designed
Line, and then measure inserting needle puncture angle and skin surface entry point and open distance apart from the side of centrum spinous process line；
B. retention bar and patient spine spinous process line coincident, the retention bar are played into positioning action under having an X-rayed, to wear
The fixed position for piercing locating guider provides reference, is easy to the position of adjustment determination puncture needle guide sleeve in subsequent operation；
C. with operative incision diaphragm by sliding rail paste be fixed on the skin at patient back, according to entry point away from
From centrum spinous process line side open with a distance from, the relevant position of entry point is determined on sliding rail, then unclamp second fix
Component, makes puncture needle guide sleeve be close to angle indication dial disc, slides puncture needle guide sleeve to correct position；
D. the angle of puncture needle guide sleeve, puncture needle guide sleeve are regulated according to the scale of angle indication dial disc
Tail end alignment locks the second fixation kit after puncturing entry point, now puncture needle guide sleeve, angle indication dial disc and slip
The position of track is relatively fixed, and completes positioning action.
Above-mentioned puncture positioning guider is used to carry out percutaneous cervical arc root screw Needle localization present invention also offers a kind of
Method, comprises the following steps：
A. the introversion of the thickness and pedicle of vertebral arch of the skin soft tissue of patient is measured according to CT and/or MRI image data
Angle, and thickness and pedicle of vertebral arch leaning angle according to the skin soft tissue measured, calculate entry point and are thrown apart from pedicle of vertebral arch in body surface
Open distance in the side of the outer side edges of shadow；
B. during minimal invasion Pedicle Screw is oriented to, sliding rail is glued with operative incision diaphragm
Patch is fixed on the skin at patient back, unclamps the position of adjustment pedicle of vertebral arch body surface marking body under the first fixation kit, X perspectives,
Cross section is entered for the side wall and pedicle of vertebral arch of the open column shape pedicle of vertebral arch body surface marking body of ellipse in the outer side edges of body surface projection
Row is overlapping, locks the first fixation kit, and then determine the particular location for the outer side edges that pedicle of vertebral arch is projected in skin surface；
C. the second fixation kit is unclamped, distance is opened on the side of the outer side edges of body surface projection apart from pedicle of vertebral arch according to entry point,
The relevant position of entry point is determined on sliding rail, puncture needle guide sleeve so far position is slided；
D. according to the scale of angle indication dial disc, according to the leaning angle of preoperative determination, puncture needle guide sleeve is regulated
Angle, the alignment of puncture needle guide sleeve tail end locks the second fixation kit after puncturing entry point, now pedicle of vertebral arch body surface marking
Body, puncture needle guide sleeve, the position of angle indication dial disc and sliding rail are relatively fixed, and complete positioning action.
Compared with prior art, the advantage of the invention is that：The lumbar intervertebral aperture mirror and the percutaneous vertebral arch of Thoracolumbar disk of the present invention
Root screw puncture positioning guider, can realize that lumbar intervertebral aperture mirror Needle localization is punctured with Thoracolumbar disk percutaneous cervical arc root screw simultaneously
Positioning, can make retention bar with after the positioning of patient spine spinous process line coincident, entering further according to actual conditions under fluoroscopy during operation
Position and angle of inclination of the puncture needle guide sleeve on sliding rail are adjusted during row lumbar intervertebral aperture mirror Needle localization, is being entered
Pedicle of vertebral arch body surface marking body and puncture needle guide sleeve are adjusted during percutaneous pedicle screw Needle localization on sliding rail
Position and angle of inclination, so as to fast and accurately puncture puncture needle along puncture needle guide sleeve；In addition, horizontal using positioning
Bar is positioned with patient spine spinous process line coincident, determines that the position of puncture positioning guider is more simple when can operate Intraoperative position
Just, accurately, fast.The lumbar intervertebral aperture mirror of the present invention and its structure letter of Thoracolumbar disk percutaneous cervical arc root screw puncture positioning guider
It is single, easy to operate, applied widely, without determining puncture position by the clinical experience and X-ray examination repeatedly of doctor in art
And angle, it can be prevented effectively to puncture repeatedly in art and unnecessary damage and pain are caused to patient, it is to avoid occur clinical serious
Complication, substantially increase the security and success rate of operation.
Brief description of the drawings
Fig. 1 is the main structure diagram of puncture positioning guider of the present invention.
Fig. 2 is the overlooking the structure diagram of puncture positioning guider of the present invention.
Fig. 3 is the backsight structural representation of puncture positioning guider of the present invention.
Marginal data：
1st, sliding rail；11st, chute；2nd, pedicle of vertebral arch body surface marking body；3rd, angle indication dial disc；4th, puncture needle guide sleeves
Cylinder；5th, retention bar；6th, the first sliding block；7th, fixed blade；8th, pad；9th, the second sliding block；101st, the first screw rod；102nd, the first lock
Tight nut；201st, the second screw rod；202nd, the second locking nut.
Embodiment
The present invention is described in further detail below in conjunction with the drawings and specific embodiments.
As shown in Figure 1 to Figure 3, lumbar intervertebral aperture mirror of the invention and Thoracolumbar disk percutaneous cervical arc root screw Needle localization are oriented to
Device, including sliding rail 1, angle indication dial disc 3 and puncture needle guide sleeve 4, angle indication dial disc 3 are slidedly arranged on slip
On track 1, puncture needle guide sleeve 4 is radially arranged along angle indication dial disc 3, and can be turned on angle indication dial disc 3
Dynamic adjustment angle of inclination, angle indication dial disc 3 slides rail provided with the scale for indicating the angle of inclination of puncture needle guide sleeve 4
The retention bar 5 stretched out to the both sides of sliding rail 1, the cunning between retention bar 5 and angle indication dial disc 3 are additionally provided with road 1
A pedicle of vertebral arch body surface marking body 2 is slidably equipped with dynamic rail road 1, pedicle of vertebral arch body surface marking body 2 has with pedicle of vertebral arch in body surface projection
The summit of outer side edges carries out overlapping location reference point O, wherein, pedicle of vertebral arch is shaped as ellipse body surface projection, the summit
For the end points of the short axle of ellipse projection；The card of angle indication dial disc 3 is parallel with the graduation indication face of sliding rail 1；And
Cross the axis L2 of puncture needle guide sleeve 4 and plane A parallel to graduation indication face is with crossing location reference point O and parallel to scale
The plane B of index plane is essentially coincided；Pedicle of vertebral arch body surface marking body 2 by the first fixation kit with can locking mode be slidedly arranged on slip
On track 1, angle indication dial disc 3 and puncture needle guide sleeve 4 by the second fixation kit with can locking mode be slidedly arranged on cunning
On dynamic rail road 1.
The puncture positioning guider can be such that retention bar 5 is positioned with patient spine spinous process line coincident under fluoroscopy during operation
Afterwards, further according to actual conditions, when carrying out lumbar intervertebral aperture mirror Needle localization, regulation puncture needle guide sleeve 4 is in sliding rail 1
On position and angle of inclination, regulation pedicle of vertebral arch body surface marking body 2 and worn when carrying out percutaneous cervical arc root screw Needle localization
Position and angle of inclination of the pricker guide sleeve 4 on sliding rail 1, so as to fast and accurately by puncture needle along puncture needle
Guide sleeve 4 is punctured, and its is simple in construction, easy to operate, without the clinical experience and X-ray examination repeatedly in art by doctor
To determine puncture position and angle, it can be prevented effectively to puncture repeatedly in art and unnecessary damage and pain are caused to patient, keep away
Exempt from clinical serious complication occur, substantially increase the security and success rate of operation.
Because pedicle of vertebral arch body surface marking body 2 and puncture needle guide sleeve 4 can slide adjustment position, mistake along sliding rail 1
The axis L2 of puncture needle guide sleeve 4 and plane A parallel to graduation indication face and cross location reference point O and refer to parallel to scale
Show that the plane B in face is essentially coincided, make the location reference point O and pedicle of vertebral arch of pedicle of vertebral arch body surface marking body 2 in the outside of body surface projection
After the summit on side is overlapping, on the one hand, can be to adjust puncture needle guide sleeve 4 away from pedicle of vertebral arch on the side of the outer side edges of body surface projection
Open distance and reference is provided, on the other hand, after the sliding position and angle adjustment of puncture needle guide sleeve 4 are good, its axis is just right
Answer the medium position of pedicle of vertebral arch lateral wall, allow puncture needle be fast and accurately pierced into along puncture needle guide sleeve 4 pedicle of vertebral arch and
In centrum, and then ensure the accuracy of entry point position in subsequent procedures operating process, it is ensured that screw is located at most in pedicle of vertebral arch
At big transverse diameter, it is to avoid screw is on the upper side or sub- pedicle of vertebral arch on the lower side in cut out, and then cause neurotrosis.
In the present embodiment, pedicle of vertebral arch body surface marking body 2 is the column that a cross section is ellipse, pedicle of vertebral arch body surface marking
The minor axis L1 of the oval cross section of body 2 and the axis L2 of puncture needle guide sleeve 4 are in the same plane；Above-mentioned positioning ginseng
Examination point O is the minor axis L1 of oval cross section and the intersection point of the lateral wall of pedicle of vertebral arch body surface marking body 2.In Needle localization operation
When, make the column lateral wall of ellipse overlapping in the outer side edges of body surface projection with pedicle of vertebral arch, facilitate operating personnel to observe and fast
The minor axis L1 of the whole oval cross section of velocity modulation is with the intersection point of the lateral wall of pedicle of vertebral arch body surface marking body 2 with pedicle of vertebral arch in body surface projection
The summits of outer side edges essentially coincide.
Further, pedicle of vertebral arch body surface marking body 2 is preferably that a cross section is the open column shape body of ellipse, and open tubular column
The endoporus of shape body is ellipse；And open column shape body is in ellipse projection and the elliptical spot corresponding different size respectively of body surface
Projection of the pedicle of vertebral arch in body surface.The open column shape body of ellipse is easy to the outside of the observation pedicle of vertebral arch body surface marking body 2 in the case where X has an X-rayed
Whether wall is overlapping with the outer side edges of the projection of pedicle of vertebral arch；Also, the edge of the elliptical spot of open column shape body can be additionally used in
The relatively small pedicle of vertebral arch of size body surface projection outer side edges it is overlapping positioned, expand the scope of application.
In the present embodiment, as shown in Figures 2 and 3, sliding rail 1 offers the chute 11 extended along its length, angle
The side of degree indication dial disc 3 is connected with the first sliding block 6 and is slidedly arranged on by the first sliding block 6 in chute 11, pedicle of vertebral arch body surface mark
Note body 2 is connected with the second sliding block 9 and is slidedly arranged on by the second sliding block 9 in chute 11.First fixation kit includes the first screw rod 101
With the first locking nut 102, one end of the first screw rod 101 and pedicle of vertebral arch body surface marking body 2 be affixed, the other end and the first locking screw
Mother 102 is connected.First locking nut 102 and pedicle of vertebral arch body surface marking body 2 are divided into the both sides of sliding rail 1, are unscrewing
During the first locking nut 102, pedicle of vertebral arch body surface marking body 2, the first screw rod 101 and the first locking nut 102 can be slided along chute 11
Dynamic adjustment position, wherein, the scale on sliding rail 1 is easy to determine the sliding position of pedicle of vertebral arch body surface marking body 2；Tighten first
During locking nut 102, pedicle of vertebral arch body surface marking body 2 and the first locking nut 102 are fixedly clamped sliding rail 1, so as to make vertebra
The position of nut body surface marking body 2 keeps fixed.Second fixation kit includes the second screw rod 201 and the second locking nut 202,
One end of second screw rod 201 and puncture needle guide sleeve 4 are affixed, the other end through the sliding block 6 of angle indication dial disc 3 and first with
Second locking nut 202 is connected；Puncture needle guide sleeve 4 is articulated with by the second screw rod 201 and the second locking nut 202
On angle indication dial disc 3.When unscrewing the second locking nut 202, angle indication dial disc 3, puncture needle guide sleeve 4,
Two screw rods 201 and the second locking nut 202 can slide adjustment position along chute 11, while puncture needle guide sleeve 4 can be around second
Scale on the axis trimming angle of inclination of screw rod 201, sliding rail 1 and angle indication dial disc 3 is easy to determine that puncture needle draws
The sliding position of guide pin bushing cylinder 4 and angle of inclination, so that fast and accurately finding side opens distance and puncture angle；Tighten the second locking
During nut 202, the locking nut 202 of puncture needle guide sleeve 4 and second is fixedly clamped angle indication dial disc 3 and sliding rail 1,
So as to make the position of pedicle of vertebral arch body surface marking body 2 and angle indication dial disc 3 keep fixation.
In the present embodiment, one end of sliding rail 1, which is provided with, to be used to paste the fixation blade 7 being fixed on patient skin, should
Fixed blade 7 is in kidney ellipsoid.Fixed blade 7 can be pasted fixed on patient skin using operative incision diaphragm etc., so that
Puncture positioning guider is fixed, its fixing-stable is reliable, and ensure that the comfort level of patient.Above-mentioned retention bar 5 is close
Fixed blade 7 is set.In other embodiments, it can also be not provided with fixing blade 7, directly will using operative incision diaphragm etc.
The position that retention bar 5 is connected with sliding rail 1, which is pasted, to be fixed on patient skin.
In the present embodiment, the length that retention bar 5 stretches out to the both sides of sliding rail 1 is inconsistent, namely the both sides of sliding rail 1
Retention bar 5 one is long and the other is short, be easy to have an X-rayed the rostral and caudal that judge backbone and centrum.
In the present embodiment, dismountable pad 8, pad are provided between puncture needle guide sleeve 4 and angle indication dial disc 3
8 are sleeved on the second screw rod 201, and the pad 8 makes the minor axis of pedicle of vertebral arch body surface marking body 2 and the axle of puncture needle guide sleeve 4
Line is in the same plane, after the pad 8 between puncture needle guide sleeve 4 and angle indication dial disc 3 is removed, can make puncture
Pin guide sleeve 4 is close to angle indication dial disc 3, be easy to adjust in foramen intervertebrale lens operation technique puncture needle guide sleeve 4 to
Accurate guide position.
The puncture positioning guider of the present embodiment is preoperative common by x-ray, CT and/or magnetic when carrying out foramen intervertebrale lens puncture
Shake and find the target area of puncture on imaging data, and design puncture route, and then measure inserting needle puncture angle and skin
Surface entry point is apart from centrum spinous process line（That is centrum center line）Side open distance；By retention bar 5 and patient under fluoroscopy during operation
Spinous process line coincident（I.e. where the center line of cone）, the retention bar 5 plays positioning action, is puncture positioning guider
Fixed position provides reference, is easy to the position of adjustment determination puncture needle guide sleeve 4 in subsequent operation.Use operative incision diaphragm
Fixed blade 7 is pasted and is fixed on the skin at patient back, the side of preoperative measurement is determined according to the scale on sliding rail 1
Relevant position of the distance on skin is opened, the second locking nut 202, slip angle indication dial disc 3 to suitable position is then unclamped
The angle of puncture needle guide sleeve 4 is put and regulates, the alignment of the tail end of puncture needle guide sleeve 4 tightens the second lock after puncturing entry point
Tight nut 202, now the position of puncture needle guide sleeve 4, angle indication dial disc 3 and sliding rail 1 be relatively fixed, then will
Puncture needle is punctured along the row of set puncture needle guide sleeve 4.
When carrying out Pedicle Screw, the preoperative skin that can measure patient according to CT and/or MRI image data is soft
The length of the thickness of tissue, the leaning angle of pedicle of vertebral arch and screw used, and according to the thickness and vertebral arch of the skin soft tissue measured
Root leaning angle, calculates entry point and opens distance on the side of the outer side edges of body surface projection apart from pedicle of vertebral arch；In minimal invasion pedicle of vertebral arch
It is the open column shape pedicle of vertebral arch body surface marking body 2 of ellipse by cross section in advance under perspective during screw puts nail guiding
Lateral wall and pedicle of vertebral arch are overlapping in the outer side edges progress of body surface projection, and make location reference point O（The minor axis of oval cross section
L1 and the lateral wall of pedicle of vertebral arch body surface marking body 2 intersection point）It is substantially overlapping on the summit of the outer side edges of body surface projection with pedicle of vertebral arch, enter
And determine particular location of the pedicle of vertebral arch in the outer side edges of body surface projection, in order to determine that distance is opened on the preoperative side calculated
Initial calculation position, is easy to adjustment in subsequent operation to determine that the position of puncture needle guide sleeve 4 determines entry point；According to determination
The position that distance adjusts puncture needle guide sleeve 4 according to the scale on sliding rail 1 is opened on side, passes through elastic second locking nut
Open distance in the side of 202 adjustment puncture needle guide sleeves 4（1.0cm left and right）And inclined angle, along puncture needle guide sleeve 4 by screw
The through bony surface of skin soft tissue is pierced into, perspective is lower to confirm puncture needle tip in the position of pedicle of vertebral arch lateral wall, and such as position is good
It is good, then puncture needle is directly squeezed into pedicle of vertebral arch and centrum using hand drill or electric drill, by hollow reamer along puncture needle
Expand duct, be afterwards directly threaded into screw in pedicle of vertebral arch and centrum along puncture needle.Clinical experience hand without depending on doctor in art
Touch the heart and can determine whether entry point, as long as the tip of the lower guide pin of perspective is overlapping with the middle upper limb of pedicle of vertebral arch lateral wall, leaning angle without
The range estimation of doctor need to be leaned on, according to the difference of different centrum leaning angles, accurately regulation selection is suitable on angle indication dial disc 3
Angle, it is to avoid the difference between the different pedicle screws that hand operation is brought, realize the mark of Pedicle Screw
Standardization is operated.
Described above is only the preferred embodiment of the present invention, and protection scope of the present invention is not limited merely to above-mentioned implementation
Example.To those of ordinary skill in the art, the improvement and change resulting in the case where not departing from the technology of the present invention concept thereof
Change and also should be regarded as protection scope of the present invention.
Claims (10)
1. a kind of lumbar intervertebral aperture mirror and Thoracolumbar disk percutaneous cervical arc root screw puncture positioning guider, including have graduated slide
Track（1）, puncture needle guide sleeve（4）Be slidedly arranged on the sliding rail（1）On angle indication dial disc（3）, puncture needle
Guide sleeve（4）Along the angle indication dial disc（3）It is radially arranged, and can be in the angle indication dial disc（3）It is upper to rotate,
It is characterized in that：The puncture positioning guider also includes being located at sliding rail（1）The retention bar of side（5）, described fixed
Position cross bar（5）With angle indication dial disc（3）Between sliding rail（1）On be also slidably equipped with a pedicle of vertebral arch body surface marking body（2）,
The pedicle of vertebral arch body surface marking body（2）With the overlapping positioning reference of the summit progress with pedicle of vertebral arch in a side of body surface projection
Point O；The angle indication dial disc（3）Card and the sliding rail（1）Graduation indication face it is parallel；And puncture needle excessively draws
Guide pin bushing cylinder（4）Axis L2 and plane A parallel to graduation indication face with crossing location reference point O and parallel to graduation indication face
Plane B is essentially coincided；The pedicle of vertebral arch body surface marking body（2）By the first fixation kit with can locking mode be slidedly arranged on slip rail
Road（1）On；The angle indication dial disc（3）With puncture needle guide sleeve（4）By the second fixation kit with can locking mode
It is slidedly arranged on sliding rail（1）On.
2. puncture positioning guider according to claim 1, it is characterised in that：The pedicle of vertebral arch body surface marking body（2）For
One cross section is the column of ellipse, the pedicle of vertebral arch body surface marking body（2）Oval cross section minor axis L1 and institute
State puncture needle guide sleeve（4）Axis L2 it is in the same plane；The location reference point O is the short axle of oval cross section
Line L1 and pedicle of vertebral arch body surface marking body（2）The intersection point of lateral wall.
3. puncture positioning guider according to claim 2, it is characterised in that：The pedicle of vertebral arch body surface marking body（2）For
One center offers the open column shape body of vertical through hole, and the cross section of through hole is ellipse；And open column shape body is in body surface
Ellipse projection and elliptical spot projection of the corresponding different size pedicle of vertebral arch in body surface respectively.
4. puncture positioning guider according to any one of claim 1 to 3, it is characterised in that：The sliding rail（1）
Offer the chute extended along its length（11）, the angle indication dial disc（3）Side be connected with the first sliding block（6）And
Pass through the first sliding block（6）It is slidedly arranged on chute（11）In, the pedicle of vertebral arch body surface marking body（2）It is connected with the second sliding block（9）And lead to
Cross the second sliding block（9）It is slidedly arranged on chute（11）In.
5. puncture positioning guider according to claim 4, it is characterised in that：First fixation kit includes the first lock
Tight nut（102）With the first screw rod（101）, first screw rod（101）One end and the second sliding block（9）It is affixed, the other end with
First locking nut（102）It is connected；Second fixation kit includes the second screw rod（201）With the second locking nut
（202）, second screw rod（201）One end and puncture needle guide sleeve（4）Affixed, the other end runs through angle indication dial disc
（3）With the first sliding block（6）With the second locking nut（202）It is connected.
6. puncture positioning guider according to any one of claim 1 to 3, it is characterised in that：The puncture needle guiding
Sleeve（4）With angle indication dial disc（3）Between be provided with a dismountable pad（8）, the puncture needle guide sleeve（4）It can lead to
Cross dismounting pad（8）Against angle indication dial disc（3）.
7. puncture positioning guider according to any one of claim 1 to 3, it is characterised in that：The retention bar（5）
To sliding rail（1）The length that both sides are stretched out is inconsistent.
8. puncture positioning guider according to any one of claim 1 to 3, it is characterised in that：The sliding rail（1）
One end be provided be used for paste be fixed to patient skin on fixation blade（7）.
9. the puncture positioning guider any one of a kind of use claim 1 to 8 carries out foramen intervertebrale lens Needle localization
Method, it is characterised in that：Comprise the following steps：
A. by finding the target area of puncture in x-ray, CT and/or magnetic resonance imaging data, and puncture route is designed, entered
And measure inserting needle puncture angle and skin surface entry point and open distance apart from the side of centrum spinous process line；
B. by retention bar under having an X-rayed（5）With patient spine spinous process line coincident, the retention bar（5）Positioning action is played, is
The fixed position of puncture positioning guider provides reference, is easy to adjustment in subsequent operation to determine puncture needle guide sleeve（4）Position
Put；
C. operative incision diaphragm is used by sliding rail（1）Stickup is fixed on the skin at patient back, according to entry point distance
Distance is opened on the side of centrum spinous process line, in sliding rail（1）On determine the relevant position of entry point, then unclamp second and fix
Component, makes puncture needle guide sleeve（4）It is close to angle indication dial disc（3）, slide puncture needle guide sleeve（4）To suitable position
Put；
D. according to angle indication dial disc（3）Scale regulate puncture needle guide sleeve（4）Angle, puncture needle guide sleeves
Cylinder（4）Tail end alignment locks the second fixation kit after puncturing entry point, now puncture needle guide sleeve（4）, angle indicating graduation
Disk（3）And sliding rail（1）Position be relatively fixed, complete positioning action.
10. the puncture positioning guider any one of a kind of use claim 1 to 8 carries out percutaneous cervical arc root screw puncture
The method of positioning, it is characterised in that：Comprise the following steps：
A. the thickness and the leaning angle of pedicle of vertebral arch of the skin soft tissue of patient are measured according to CT and/or MRI image data, and
According to the thickness of the skin soft tissue measured and pedicle of vertebral arch leaning angle, entry point is calculated apart from pedicle of vertebral arch in the outer of body surface projection
Open distance in the side of side；
B. during minimal invasion Pedicle Screw is oriented to, with operative incision diaphragm by sliding rail（1）Paste
On the skin for being fixed on patient back, the first fixation kit, the lower adjustment pedicle of vertebral arch body surface marking body of X perspectives are unclamped（2）Position,
By open column shape pedicle of vertebral arch body surface marking body of the cross section for ellipse（2）Side wall and pedicle of vertebral arch body surface projection outer side edges
Overlapping, the first fixation kit of locking is carried out, and then determines the particular location for the outer side edges that pedicle of vertebral arch is projected in skin surface；
C. the second fixation kit is unclamped, distance is opened on the side of the outer side edges of body surface projection apart from pedicle of vertebral arch according to entry point, in cunning
Dynamic rail road（1）On determine the relevant position of entry point, slide puncture needle guide sleeve（4）So far position；
D. according to angle indication dial disc（3）Scale, according to the leaning angle of preoperative determination, regulate puncture needle guide sleeve
（4）Angle, puncture needle guide sleeve（4）Tail end alignment locks the second fixation kit after puncturing entry point, now pedicle of vertebral arch body
List notation body（2）, puncture needle guide sleeve（4）, angle indication dial disc（3）And sliding rail（1）Position be relatively fixed, it is complete
Into positioning action.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201510663894.7A CN105212996B (en) | 2015-10-15 | 2015-10-15 | Lumbar intervertebral aperture mirror and Thoracolumbar disk percutaneous cervical arc root screw puncture positioning guider and its Needle localization method |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201510663894.7A CN105212996B (en) | 2015-10-15 | 2015-10-15 | Lumbar intervertebral aperture mirror and Thoracolumbar disk percutaneous cervical arc root screw puncture positioning guider and its Needle localization method |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| CN105212996A CN105212996A (en) | 2016-01-06 |
| CN105212996B true CN105212996B (en) | 2017-10-24 |
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| CN201510663894.7A Expired - Fee Related CN105212996B (en) | 2015-10-15 | 2015-10-15 | Lumbar intervertebral aperture mirror and Thoracolumbar disk percutaneous cervical arc root screw puncture positioning guider and its Needle localization method |
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| Country | Link |
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| CN (1) | CN105212996B (en) |
Families Citing this family (13)
| Publication number | Priority date | Publication date | Assignee | Title |
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| CN106667555B (en) * | 2017-01-17 | 2023-06-16 | 山西医科大学 | Medical sacral nerve puncture positioning and guiding system |
| CN108969029B (en) * | 2017-06-01 | 2024-03-12 | 崔家鸣 | Bridge crossing device for shoulder arthroscopy operation |
| CN109199563B (en) * | 2018-11-26 | 2024-07-05 | 泗洪医院 | Spinal posterior operation positioning device capable of three-dimensionally adjusting |
| CN109692033B (en) * | 2019-03-07 | 2023-08-11 | 谢林 | Percutaneous lumbar intervertebral foramen mirror puncture auxiliary positioning ware |
| CN110279456B (en) * | 2019-07-25 | 2024-04-12 | 娄底市中心医院 | Puncture positioning guide device applied to intervertebral foramen mirror operation and application method thereof |
| CN110353779A (en) * | 2019-07-30 | 2019-10-22 | 南方医科大学深圳医院 | A kind of universal puncture navigator fix device of spinal pedicle |
| CN110731811B (en) * | 2019-11-25 | 2024-07-19 | 柳州市柳铁中心医院 | Spinal puncture positioning device |
| CN111035438A (en) * | 2019-12-16 | 2020-04-21 | 浙江省中医院 | Laparoscope cyst puncture anti-overflow positioning device |
| CN111134798A (en) * | 2020-02-12 | 2020-05-12 | 山东航维骨科医疗器械股份有限公司 | Spine minimally invasive guider |
| CN111134800A (en) * | 2020-02-24 | 2020-05-12 | 梧州市红十字会医院 | Intervertebral foramen mirror puncture positioning device |
| CN112890937A (en) * | 2021-01-15 | 2021-06-04 | 翟睿 | Orthopedic minimally invasive vertebral body shaping positioner |
| CN113693687B (en) * | 2021-08-13 | 2024-07-16 | 广东施泰宝医疗科技有限公司 | Detachable percutaneous puncture positioning tool |
| CN114869421A (en) * | 2022-05-06 | 2022-08-09 | 郑州市骨科医院 | Body surface positioning guider for transpedicular puncture operation |
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| Publication number | Priority date | Publication date | Assignee | Title |
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| EP2381858B1 (en) * | 2008-12-01 | 2018-11-07 | Mazor Robotics Ltd. | Robot guided oblique spinal stabilization |
| CN102614023B (en) * | 2012-04-20 | 2013-12-04 | 何世国 | Puncture positioning guide device for percutaneous nephrolithotomy |
| TWI481382B (en) * | 2012-08-31 | 2015-04-21 | Univ Nat Cheng Kung | Assistance device and guiding assembly for percutaneous surgery |
| CN103083092B (en) * | 2013-03-01 | 2015-06-17 | 张忠荣 | Three-dimensional positioning and guiding device for penetrating vertebral pedicle through skin |
| CN205072980U (en) * | 2015-10-15 | 2016-03-09 | 胡金玺 | Lumbar vertebrae intervertebral foramen mirror and chest lumbar vertebrae percutaneous pedicle of vertebral arch screw puncture clamping orient ware |
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