CN105395237A - Positioning device for mandibular ramus osteotomy - Google Patents
Positioning device for mandibular ramus osteotomy Download PDFInfo
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- CN105395237A CN105395237A CN201510918069.7A CN201510918069A CN105395237A CN 105395237 A CN105395237 A CN 105395237A CN 201510918069 A CN201510918069 A CN 201510918069A CN 105395237 A CN105395237 A CN 105395237A
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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
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/1657—Bone breaking devices
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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
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
- A61B17/1673—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the jaw
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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
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1732—Guides or aligning means for drills, mills, pins or wires for bone breaking devices
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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
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
- A61B17/176—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the jaw
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- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Dentistry (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Orthopedic Medicine & Surgery (AREA)
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- Surgical Instruments (AREA)
- Prostheses (AREA)
Abstract
The invention discloses a positioning device for a mandibular ramus osteotomy. The positioning device has two structures: according to the first structure, the positioning device comprises a first main rod, a subordinate rod, a first connector, a positioning rod, a first limiter and an intra-bone nail which takes a fixing effect during an operation; and according to the second structure, the positioning device comprises a second main rod, a guide plate, a first branch rod, a second branch rod, a second limiter, a third limiter, a second connector, a third connector and an intra-bone nail which takes a fixing effect during the operation. When the positioning device is used, an operation incision line can be kept away from mandibular nerve and mandibular nerve tube, and the location of an osteotomy line can be directly and accurately determined; and during the operation, injury of inferior alveolar nerve vessel bundles can be avoided, and a sufficient width with proximal segment can be guaranteed as well.
Description
Technical field
The invention belongs to medical assistance instrument field, particularly for the positioner of mandibular ramus bone cutting operation.
Background technology
Be adopt ascending branch leading edge mucoperiosteum otch through the vertical ramus (IVRO) of intraoral approach or diagonal sacrotomy (IORO), appear mandibular ramus lateral surface, downward from mandibular ramus simoid notch, ascending branch holostrome sclerotin is cut completely before foramen of mandibular nerve rear to angle of mandible, be widely used in a kind of art formula rescuing prognathism, the serious Asymmetry deformity of lower jaw, particularly can obvious mitigation symptoms for the preoperative patient that there is temporomandibular joint disturbance syndrome (TMJD).Applies this technology and only make single osteotomy line, therefore operation is relatively simple, consuming time short, go out insufficiency of blood, bone wound is little.But because this operative space is narrow, position exists deeply, limited view, thus operating difficulty is higher, even usually cause that osteotomy line is irregular may form two or more osteotomy lines, not only wastes operating time, too increase the damage to local organization, even likely form fracture etc.As improper in the design of bone cut-off lines in addition, easily damage IMA and inferior alveolar nerve vascular bundle, cause massive hemorrhage.Therefore, accurately preparing bone cut-off lines, is the key of successful surgery.
Still a kind of applicable measurable instrument is not had clinically to locate osteotomy line at present.The normal witness marker using external carina of ramus as operation bone cut-off lines clinically, but due to external carina of ramus relative to inner side foramen of mandibular nerve top to the front, position, the distinguishable rate of naked eyes is lower, and some patients there is no knuckle outside ramus of mandible, so the witness marker using it as operation bone cut-off lines has certain limitation.And in visual area narrow like this and space, index point is not easily recognized, patient's inconvenience is placed swing saw and is also carried out osteotomy by desired position, can only with the sensation of patient and experience, accuracy and efficiency lower.
Chen Xiayun etc. instruct osteotomy (see " computer-aided design individuation template study on accuracy and clinical practice in intraoral approach mandibular setback " by making the personalized osteotomy guide plate of the 3 D-printing holding ascending branch trailing edge, Chen Xiayun etc., China's stomatology research magazine (electronic edition), 2009, Vol.3, No.6), but described osteotomy guide plate is in place need peel off too much ascending branch trailing edge and lower edge muscle and surrounding tissue, not easily in place in art, and each patient needs custom-made osteotomy guide plate, increases the financial burden of patient.
Summary of the invention
The object of the invention is to for the deficiencies in the prior art, a kind of mandibular ramus bone cutting operation positioner is provided, accurately to determine that in art the position of osteotomy line and guides osteotomy, reduce operating time and complication, alleviate the financial burden of patient.
Mandibular ramus bone cutting operation positioner of the present invention, have two kinds of structures, they belong to a total inventive concept.
The first mandibular ramus bone cutting operation positioner of the present invention, structure is as follows:
This device plays the interior nail of bone of fixation when comprising the first mobile jib, secondary bar, the first adapter, locating rod, the first stop and perform the operation; The back side of described first mobile jib upper end is provided with the upper limb hook in Mandibular Rumas simoid notch location, and the first mobile jib front is provided with Length Indication mark, and lower section is provided with the hole for installing locating rod; Described secondary bar is screw rod, and the back side of secondary bar one end is provided with the trailing edge hook in mandibular bone trailing edge location, and secondary bar front is provided with Length Indication mark; Described locating rod one end is provided with the screw be connected with the first mobile jib, the other end be provided with bone in follow closely the hole of combination; Described first stop is made up of spacing section and fastening section, and spacing section be cylindrical, and external cylindrical surface is provided with stopper slot, and fastening section is prismatic, and spacing section has through screw with the centre of fastening section; The shape of described first adapter is cube, this cube is provided with the first jack combined with the first mobile jib, the second jack combined with the first stop and secondary bar, second jack is made up of stop construction section and secondary bar via segments, the axis of described first jack is mutually vertical but non-intersect with the axis of the second jack, the hole wall of described first jack is provided with the first screw combined with trip bolt, the stop construction section hole wall of described second jack is provided with the second screw combined with stop screw; The compound mode of each component: the first jack sleeve of the first mobile jib and the first adapter connects, and it is fixing on the first connector by trip bolt, spacing section of first stop is inserted the stop construction section in the second jack of the first adapter, located by stop screw and fix on the first connector, secondary bar is connected with the first stop screw, and locating rod is connected with the first mobile jib lower section by trip bolt.
In above-mentioned positioner, the first mobile jib lower section arrange for install the hole of locating rod be bar hole or multiple centrage point-blank and the equal circular hole of spacing.
In above-mentioned positioner, the Length Indication that the first mobile jib and secondary bar front are arranged is designated bright, secretly alternate wide strip mark, so that observe in operation.
In above-mentioned positioner, locating rod is arranged with bone in follow closely combination hole be the pure stress hole that semicircle orifice and semicircle taper hole form.
In above-mentioned positioner, the cross section of the first mobile jib and locating rod is rectangle, and the cross section of secondary bar is surrounded by the circular arc that the identical parallel lines of two length are identical with two sections of radiuses.
The second mandibular ramus bone cutting operation positioner of the present invention, structure is as follows:
This device plays the interior nail of bone of fixation when comprising the second mobile jib, guide plate, the first pole, the second pole, the second stop, the 3rd stop, the second adapter, the 3rd adapter and perform the operation; The back side of described second mobile jib upper end is provided with the upper limb hook in Mandibular Rumas simoid notch location, the second mobile jib lower end be provided with bone in follow closely the hole of combination, front is provided with Length Indication mark; Described guide plate is made up of location-plate and connecting plate, and the angle of location-plate and connecting plate is 90 °, described connecting plate is provided with for installing the first pole, the second pole hole; Described first pole, the second pole are that radial dimension is identical with structure, length is identical or not identical screw rod, their front is provided with Length Indication mark, left end end is provided with the screw combined with the connecting plate of guide plate, and the section start of Length Indication mark is positioned at the edge on the right side of described screw; The shape of described second stop and the 3rd stop is identical with structure, and by spacing section and fastening section of composition, spacing section is cylindrical, and external cylindrical surface is provided with stopper slot, and fastening section is prismatic, and spacing section has through screw with the centre of fastening section; Described second adapter is cube, this cube is provided with the first jack combined with the second mobile jib, the second jack combined with the second stop and the first pole, second jack is made up of stop construction section and the first pole via segments, the axis of described first jack is mutually vertical but non-intersect with the axis of the second jack, the hole wall of described first jack is provided with the first screw combined with trip bolt, the stop construction section hole wall of described second jack is provided with the second screw combined with stop screw; Described 3rd adapter is cube, this cube is provided with the first jack combined with the second mobile jib, the second jack combined with the 3rd stop and the second pole, second jack is made up of stop construction section and the second pole via segments, the axis of described first jack is mutually vertical but non-intersect with the axis of the second jack, the hole wall of described first jack is provided with the first screw combined with trip bolt, the stop construction section hole wall of described second jack is provided with the second screw combined with stop screw; The compound mode of each component: the top of the second mobile jib and the first jack sleeve of the second adapter connect and be fixed on the second adapter by trip bolt, the bottom of the second mobile jib and the first jack sleeve of the 3rd adapter connect and are fixed on the 3rd adapter by trip bolt; Spacing section of second stop is inserted the stop construction section in the second jack of the second adapter, located by stop screw and be fixed on the second adapter, the left end of the first pole is arranged on the connecting plate of guide plate by trip bolt, and right-hand member is connected with the second stop screw; Spacing section of 3rd stop is inserted the stop construction section in the second jack of the 3rd adapter, located by stop screw and be fixed on the 3rd adapter, the left end of the second pole is arranged on the connecting plate of guide plate by trip bolt, and right-hand member is connected with the 3rd stop screw.
In above-mentioned positioner, the connecting plate of guide plate is arranged for installing the first pole, the second pole hole be multiple centrage point-blank and the equal circular hole of spacing.
In above-mentioned positioner, the Length Indication that the second mobile jib, the first pole and the second pole front are arranged is designated bright, secretly alternate wide strip mark, so that observe in operation.
In above-mentioned positioner, the second mobile jib lower end arrange with bone in follow closely combination hole be the pure stress hole that semicircle orifice and semicircle taper hole form.
In above-mentioned positioner, the cross section of the second mobile jib is rectangle, and the cross section of the first pole and the second pole is surrounded by the circular arc that the identical parallel lines of two length are identical with two sections of radiuses.
Mandibular ramus bone cutting operation positioner of the present invention, makes by conventional machining method, and also make by rapid three dimensional printing forming method, material is implantable titanium, titanium alloy or rustless steel.
Compared with prior art, the present invention has following beneficial effect:
1, use positioner of the present invention, operation tangent line can be made to avoid foramen of mandibular nerve and mandible incisor, determine the position of osteotomy line intuitively, exactly, both can avoid damage inferior alveolar nerve vascular bundle in art, and also can ensure enough width of nearly heart bone section.
2, along the first mobile jib or guide plate edge osteotomy, the first mobile jib or guide plate can hold rock saw sawtooth, reduce vibration, make that sawtooth is convenient, reliable, safe carries out osteotomy, thus ensure that the neat of osteotomy line, and can reduce operating time.
3, the mandibular ramus anterolateral surface exposed in Rhizoma Atractylodis Macrocephalae put by the main member of positioner of the present invention, easily in place, do not need to peel off soft tissue too much, is conducive to the blood fortune of heart bone section near, far away and postoperative symphysis.
4, positioner of the present invention is adjustable structure, is applicable to different patients, thus can alleviate the financial burden of patient.
5, in positioner of the present invention, on locating rod and the second mobile jib with bone in follow closely combination hole be the pure stress hole that semicircle orifice and semicircle taper hole form, this kind of pure stress hole can apply an outside thrust to locating rod end or the second mobile jib end when performing the operation when following closely precession in patient's bone in bone, and thus the location of whole device is more firm.
6, the cross section of the first mobile jib and locating rod or the second mobile jib is rectangle, and the cross section of secondary bar or the first pole and the second pole is surrounded by the circular arc that the identical parallel lines of two length are identical with two sections of radiuses, and thus combined and instant is stable when device uses.
7, because Length Indication is designated bright, secretly alternate wide strip mark, thus need in operation to be convenient to during the position adjusting component in positioner observe and identify.
8, positioning device structure of the present invention is simple, is convenient to processing and fabricating, and easy to use, is thus conducive to promoting the use of.
Accompanying drawing explanation
Fig. 1 is a kind of structural representation of the first mandibular ramus bone cutting operation positioner of the present invention;
Fig. 2 is the rearview of Fig. 1;
Fig. 3 is another structural representation of the first mandibular ramus bone cutting operation positioner of the present invention;
Fig. 4 is the rearview of Fig. 3;
Fig. 5 is the structural representation of the second mandibular ramus bone cutting operation positioner of the present invention;
Fig. 6 is the rearview of Fig. 5;
Fig. 7 is the structural representation of the first adapter, the second adapter, the 3rd adapter;
Fig. 8 is the right view of Fig. 7;
Fig. 9 is the left view of Fig. 7;
Figure 10 is the top view of Fig. 7;
Figure 11 is the upward view of Fig. 7;
Figure 12 is the structural representation of the first stop, the second stop, the 3rd stop;
Figure 13 is the left view of Figure 12;
Figure 14 be with bone in follow closely the structural representation in the pure stress hole of combination;
Figure 15 is the top view of Figure 14;
Figure 16 is using state schematic diagram after the preoperative pre-adjustment of the bone of mandibular ramus shown in Fig. 1, Fig. 2 cutting operation positioner completes and in art;
Figure 17 is using state schematic diagram after the preoperative pre-adjustment of the bone of mandibular ramus shown in Fig. 3, Fig. 4 cutting operation positioner completes and in art;
Figure 18 is using state schematic diagram after the preoperative pre-adjustment of the bone of mandibular ramus shown in Fig. 5, Fig. 6 cutting operation positioner completes and in art.
In figure, the 1-the first mobile jib, 1-1-upper limb hook, the circular hole of 1-2-installation locating rod, 1-3-Length Indication mark, the bar hole of 1-4-installation locating rod, 2-the first adapter, 2-1-the first jack, 2-2-the second jack, 2-3-the first screw, 2-4-the second screw, 3-secondary bar, 3-1-trailing edge hook, 3-2-Length Indication mark, nail in 4-bone, 5-locating rod, 5-1-semicircle orifice, 5-2-semicircle taper hole, 6-the first stop, 6-1-spacing section, 6-2-fastening section, 6-3-stopper slot, the screw of 6-4-through, 7-trip bolt, 8-stop screw, 9-guide plate, 9-1-location-plate, 9-2-connecting plate, the hole of 9-3-install the first pole and the second pole, 10-the first pole, 10-1-Length Indication mark, 11-the second stop, 11-1-spacing section, 11-2-fastening section, 11-3-stopper slot, the screw of 11-4-through, 12-the second adapter, 12-1-the first jack, 12-2-the second jack, 12-3-the first screw, 12-4-the second screw, 13-the second pole, 13-1-Length Indication mark, 14-the three stop, 14-1-spacing section, 14-2-fastening section, 14-3-stopper slot, the screw of 14-4-through, 15-the three adapter, 15-1-the first jack, 15-2-the second jack, 15-3-the first screw, 15-4-the second screw, 16-mandibular bone, 16-1-angle of mandible, 16-2-foramen of mandibular nerve, 16-3-trailing edge, 16-4-condyle is dashed forward, 16-5-ascending branch simoid notch, 16-6-edge is dashed forward, 16-7-leading edge, 16-8-outer oblique ridge, 16-9-mandible incisor, 16-10-mental foramen, 16-11-operation tangent line, 17-the second mobile jib, 17-1-upper limb hook, 17-2-Length Indication mark, 17-3-semicircle orifice, 17-4-semicircle taper hole.
Detailed description of the invention
Below by embodiment, mandibular ramus bone cutting operation positioner of the present invention and using method thereof are described further.
Embodiment 1
Mandibular ramus bone cutting operation positioner described in the present embodiment as shown in Figure 1 and Figure 2, plays the interior nail 4 of bone of fixation when comprising the first mobile jib 1, secondary bar 3, first adapter 2, locating rod 5, first stop 6 and perform the operation.
Described first mobile jib 1 for cross section be rectangular rod member, the back side of the first mobile jib upper end is provided with the upper limb hook 1-1 located at Mandibular Rumas simoid notch 16-5, front is provided with Length Indication mark 1-3, lower section is provided with the hole for installing locating rod, described Length Indication is designated the wide strip mark of bright, secretly alternate 1mm, install the hole of locating rod be multiple centrage point-blank and the equal circular hole 1-2 of spacing; Described secondary bar 3 is screw rod, its cross section is surrounded by the circular arc that the identical parallel lines of two length are identical with two sections of radiuses, the circular arc that two sections of radiuses are identical is the projection that secondary bar arranges threaded two sides, article two, the parallel lines that length is identical are the projections at secondary bar front and the back side, the back side of secondary bar left end is provided with the trailing edge hook 3-1 located at mandibular bone trailing edge 16-3, secondary bar front is provided with Length Indication mark 3-2, and this Length Indication is designated the wide strip mark of bright, secretly alternate 1mm; Described locating rod 5 for cross section be rectangular rod member, locating rod left end is provided with the screw be connected with the first mobile jib, right-hand member be provided with bone in follow closely the hole of combination, described with bone in follow closely combination hole be the pure stress hole (see Figure 14, Figure 15) that semicircle orifice 5-1 and semicircle taper hole 5-2 form; Described first stop 6 as shown in Figure 12 and Figure 13, be made up of spacing section of 6-1 and fastening section of 6-2, spacing section is cylindrical, external cylindrical surface is provided with stopper slot 6-3, fastening section is prismatic, there is through screw 6-4 in the centre of spacing section and fastening section, and the screw thread of this screw and secondary bar matches; Described first adapter 2 is as shown in Fig. 7 to Figure 11, shape is cuboid, this cuboid is provided with the first jack 2-1 combined with the first mobile jib, the second jack 2-2 combined with the first stop 6 and secondary bar 3, second jack 2-2 is made up of stop construction section and secondary bar via segments, the axis of described first jack is mutually vertical but non-intersect with the axis of the second jack, the hole wall of described first jack is provided with the first screw 2-3 combined with trip bolt, the stop construction section hole wall of described second jack is provided with the second screw 2-4 combined with stop screw.
The compound mode of each component: the first jack 2-1 of the first mobile jib 1 and the first adapter overlaps and connects, and be fixed on the first adapter 2 by trip bolt 7, its two ends are all positioned at outside the first adapter, spacing section of 6-1 of the first stop 6 inserts the stop construction section in the second jack 2-2 of the first adapter, insert stopper slot 6-3 by stop screw 8 through the second screw 2-4 locate and be fixed on the first adapter 2, secondary bar 3 is threaded with the first stop 6, its two ends are all positioned at outside the first stop 6 and the first adapter 2, the left end of locating rod 5 is connected with the first mobile jib lower section by trip bolt 7.
Described in the present embodiment, the using method of positioner is as follows:
1, the three-dimensional reconstruction image of mandible, foramen of mandibular nerve and mandible incisor is obtained
Preoperative by CT scan and the three-dimensional reconstruction image (1:1 ratio) with the software acquisition mandible 16, foramen of mandibular nerve 16-2 and the mandible incisor 16-9 that CT data are carried out Digital Three-Dimensional Reconstruction of The Function, and determine tangent line of performing the operation, then this image is printed in 1:1 ratio;
2, the pre-adjustment of positioner
(1) positioner is placed on patient image that step 1 prints, then the trip bolt of connection first mobile jib 1 and the first adapter 2 is unclamped, respectively the upper limb of the first mobile jib upper end hook 1-1 is placed in the simoid notch of Mandibular Rumas shown in patient image lowest part, the trailing edge hook 3-1 of secondary bar is placed in the trailing edge of mandibular bone shown in patient image place, then unclamp stop screw 8 and rotate the first stop 6, make the outer rim of the first mobile jib parallel with the operation tangent line 16-11 on patient image and avoid foramen of mandibular nerve (see Figure 16), continue after tighten trip bolt 7 first mobile jib fixed, tighten stop screw 8 first stop is fixed,
(2) trip bolt 7 connecting locating rod 5 and the first mobile jib 1 is unclamped, the adjustment installation site of locating rod on the first mobile jib, make locating rod end with bone in follow closely the outer oblique ridge 16-8 place (see Figure 16) that 4 holes of combining are positioned at mandibular bone shown in patient image, then tighten trip bolt 7 and measure the distance to the first mobile jib outer rim in the middle part of the mandibular bone trailing edge on patient image;
3, use in art
(1) the little groove of an about 1mm is made at mandible ascending branch upper limb simoid notch 16-5 lowest part, in the positioner good by step 2 pre-adjustment, the upper limb hook 1-1 of the first mobile jib is placed on described little groove, the trailing edge of secondary bar hook 3-1 is placed in mandible trailing edge 16-3 place, then the thread segment following closely 4 in bone is passed on locating rod with bone in follow closely combination hole one end of locating rod is fixed on the outer oblique ridge 16-8 place (see Figure 16) of mandible;
(2) to measure in the middle part of mandible trailing edge to the distance of mobile jib outer rim and compare with the distance measured on patient image during pre-adjustment, if identical, then implementing otomy along the first mobile jib outer rim; If not identical, then unclamp stop screw 8 and take out nail 4 in bone, rotate the first stop 6 regulate in the middle part of the first mobile jib outer rim and mandibular bone trailing edge 16-3 between spacing, when tightening stop screw 8 after regulating and by following closely the outer oblique ridge 1--8 place that 4 are fixed on mandible again in bone, then implementing otomy along the first mobile jib outer rim.
Embodiment 2
Mandibular ramus bone cutting operation positioner described in the present embodiment as shown in Figure 3, Figure 4, plays the interior nail 4 of bone of fixation when comprising the first mobile jib 1, secondary bar 3, first adapter 2, locating rod 5, first stop 6 and perform the operation.Difference from Example 1 be first mobile jib lower section arrange be bar hole 1-4 for installing the hole of locating rod.
Described in the present embodiment, the using method of mandibular ramus bone cutting operation positioner is shown in Figure 17, identical with embodiment 1.
Embodiment 3
Mandibular ramus bone cutting operation positioner described in the present embodiment as shown in Figure 3, Figure 4, plays the interior nail 4 of bone of fixation when comprising the second mobile jib 17, guide plate 9, first pole 10, second pole 13, second stop 11, the 3rd stop 14, second adapter 12, the 3rd adapter 15 and perform the operation.
Described second mobile jib 17 for cross section be rectangular rod member, the back side of the second mobile jib upper end is provided with the upper limb hook 17-1 located at Mandibular Rumas simoid notch 16-5, lower end be provided with bone in follow closely the hole of combination, front is provided with Length Indication mark 17-2, described with bone in follow closely combination hole be the pure stress hole that semicircle orifice 17-3 and semicircle taper hole 17-4 form, described Length Indication is designated the wide strip mark of bright, secretly alternate 1.5mm, described guide plate 9 is made up of location-plate 9-1 and connecting plate 9-2, the angle of location-plate and connecting plate is 90 °, connecting plate 9-2 is provided with the hole 9-3 for installing the first pole 10, second pole 13, hole 9-3 be multiple centrage point-blank and the equal circular hole of spacing, described first pole 10 is screw rod, second pole 13 is that radial dimension is identical with the first pole with structure, length is longer than the screw rod of the first pole, the cross section of the first pole and the second pole surrounds by the circular arc that the identical parallel lines of two length are identical with two sections of radiuses, the circular arc that two sections of radiuses are identical is the first pole, second pole arranges the projection of threaded two sides, article two, the parallel lines that length is identical are first poles, the projection at the second pole front and the back side, the front of the first pole and the second pole is provided with Length Indication mark, left end end is provided with the screw combined with the connecting plate of guide plate, described Length Indication is designated bright, the strip mark that secretly alternate 1.5mm is wide, its section start is positioned at the edge on the right side of described screw, described second stop 11 as shown in Figure 12 and Figure 13, be made up of spacing section of 11-1 and fastening section of 11-2, spacing section is cylindrical, external cylindrical surface is provided with stopper slot 11-3, fastening section is prismatic, there is through screw in the centre of spacing section and fastening section, and the screw thread of this screw and the first pole matches, described 3rd stop 14 as shown in Figure 12 and Figure 13, be made up of spacing section of 14-1 and fastening section of 14-2, spacing section is cylindrical, external cylindrical surface is provided with stopper slot 14-3, fastening section is prismatic, there is through screw in the centre of spacing section and fastening section, and the screw thread of this screw and the second pole matches, described second adapter 12 is as shown in Fig. 7 to Figure 11, shape is cuboid, this cuboid is provided with the first jack 12-1 combined with the second mobile jib, the the second jack 12-2 combined with the second stop 11 and the first pole 10, second jack is made up of stop construction section and the first pole via segments, the axis of described first jack is mutually vertical but non-intersect with the axis of the second jack, the hole wall of described first jack is provided with the first screw 12-3 combined with trip bolt, the stop construction section hole wall of described second jack is provided with the second screw 12-4 combined with stop screw, described 3rd adapter 15 is as shown in Fig. 7 to Figure 11, shape is cuboid, this cuboid is provided with the first jack 15-1 combined with the second mobile jib, the the second jack 15-2 combined with the 3rd stop 14 and the second pole 13, second jack is made up of stop construction section and the second pole via segments, the axis of described first jack is mutually vertical but non-intersect with the axis of the second jack, the hole wall of described first jack is provided with the first screw 15-3 combined with trip bolt, the stop construction section hole wall of described second jack is provided with the second screw 15-4 combined with stop screw.
The compound mode of each component: the top of the second mobile jib 17 and the first jack sleeve of the second adapter 12 connect and be fixed on the second adapter by trip bolt 7, the bottom of the second mobile jib 17 and the first jack sleeve of the 3rd adapter 15 connect and are fixed on the 3rd adapter by trip bolt 7; Spacing section of second stop 11 is inserted the stop construction section in the second jack of the second adapter, located by stop screw 8 and be fixed on the second adapter 12, the left end of the first pole 10 is arranged on the connecting plate of guide plate by trip bolt, and right-hand member is threaded with the second stop 11; Spacing section of 3rd stop 14 is inserted the stop construction section in the second jack of the 3rd adapter, located by stop screw 8 and be fixed on the 3rd adapter 15, the left end of the second pole 13 is arranged on the connecting plate of guide plate by trip bolt, and right-hand member is threaded with the 3rd stop 14.
Described in the present embodiment, the using method of positioner is as follows:
1, the three-dimensional reconstruction image of mandible, foramen of mandibular nerve and mandible incisor is obtained
Preoperative by CT scan and the three-dimensional reconstruction image (1:1 ratio) with the software acquisition mandible, foramen of mandibular nerve and the mandible incisor that CT data are carried out Digital Three-Dimensional Reconstruction of The Function, and determine tangent line of performing the operation, then this image is printed in 1:1 ratio;
2, the pre-adjustment of positioner
(1) positioner is placed on patient image that step 1 prints, then make the upper limb of the second mobile jib 17 link up with 17-1 and be positioned at the simoid notch of Mandibular Rumas shown in patient image 16-5 lowest part, the second mobile jib 17 lower end arrange with bone in follow closely combination hole be positioned at the outer oblique ridge 16-8 place of mandibular bone shown in patient image and locate (see Figure 18);
(2) unclamp the stop screw fixing the 3rd stop 14 and rotate the 3rd stop, make the Length Indication of the second pole (stock) identify section start (for " zero " place) and be positioned at (see Figure 18) on the tangent line of foramen of mandibular nerve trailing edge, then tighten the stop screw fixing the 3rd stop;
(3) unclamp the stop screw fixing the second stop 11 and rotate the second stop, make the location-plate 9-1 lateral surface of guide plate parallel with the operation tangent line on patient image and avoid foramen of mandibular nerve (see Figure 18), then tightening the stop screw fixing the second stop and the distance measured to the location-plate 9-1 lateral surface of guide plate in the middle part of mandibular bone trailing edge;
3, use in art
(1) the little groove of an about 1mm is made at mandible ascending branch upper limb simoid notch 16-5 lowest part, in the positioner good by step 2 pre-adjustment, the upper limb hook 17-1 of the second mobile jib is placed on described little groove, and the second mobile jib lower end is fixed on the outer oblique ridge 16-8 place (see Figure 18) of mandible by the hole then thread segment following closely 4 in bone being passed the second mobile jib lower end;
(2) measuring in the middle part of mandible trailing edge 16-3 to the distance of the location-plate 9-1 lateral surface of guide plate and compare with the distance measured on patient image during pre-adjustment, if identical, then the location-plate lateral surface along guide plate implements otomy; If not identical, then unclamp the stop screw fixing the second stop 11, the 3rd stop 14, rotate the second stop, the 3rd stop regulates in the middle part of mandible trailing edge to the distance between the location-plate lateral surface of guide plate, after regulating, tighten stop screw, the location-plate 9-1 lateral surface then along guide plate implements otomy.
Claims (10)
1. a mandibular ramus bone cutting operation positioner, is characterized in that the interior nail (4) of bone of playing fixation when comprising the first mobile jib (1), secondary bar (3), the first adapter (2), locating rod (5), the first stop (6) and perform the operation, the back side of described first mobile jib (1) upper end is provided with upper limb hook (1-1) of locating at Mandibular Rumas simoid notch (16-5), first mobile jib front is provided with Length Indication mark (1-3), and lower section is provided with the hole for installing locating rod, described secondary bar (3) is screw rod, and the back side of secondary bar one end is provided with trailing edge hook (3-1) of locating at mandibular bone trailing edge (16-3), and secondary bar front is provided with Length Indication mark (3-2), described locating rod (5) one end is provided with the screw be connected with the first mobile jib, the other end be provided with bone in follow closely the hole of combination, described first stop (6) is made up of spacing section (6-1) and fastening section (6-2), spacing section is cylindrical, external cylindrical surface is provided with stopper slot (6-3), fastening section is prismatic, and there is through screw (6-4) in the centre of spacing section and fastening section, the shape of described first adapter (2) is cube, this cube is provided with the first jack (2-1) combined with the first mobile jib, the second jack (2-2) combined with the first stop (6) and secondary bar (3), second jack (2-2) is made up of stop construction section and secondary bar via segments, the axis of described first jack is mutually vertical but non-intersect with the axis of the second jack, the hole wall of described first jack is provided with the first screw (2-3) combined with trip bolt, the stop construction section hole wall of described second jack is provided with the second screw (2-4) combined with stop screw,
The compound mode of each component: the first mobile jib (1) overlaps with first jack (2-1) of the first adapter and connects, and it is fixing on the first connector by trip bolt (7), spacing section (6-1) of the first stop (6) inserts the stop construction section in second jack (2-2) of the first adapter, located by stop screw (8) and fix on the first connector, secondary bar (3) is threaded with the first stop (6), and locating rod (5) is connected with the first mobile jib lower section by trip bolt (7).
2. mandibular ramus bone cutting operation positioner according to claim 1, it is characterized in that the first mobile jib lower section arranges for install the hole of locating rod be bar hole (1-4) or multiple centrage point-blank and the equal circular hole (1-2) of spacing.
3. mandibular ramus bone cutting operation positioner according to claim 1 or 2, is characterized in that the Length Indication that the first mobile jib (1) and secondary bar (3) front are arranged is designated bright, secretly alternate wide strip mark.
4. mandibular ramus bone cutting operation positioner according to claim 1 or 2, it is characterized in that locating rod (5) upper that arrange with bone in follow closely combination hole be the pure stress hole that semicircle orifice (5-1) and semicircle taper hole (5-2) form.
5. mandibular ramus bone cutting operation positioner according to claim 1 or 2, it is characterized in that the cross section of the first mobile jib (1) and locating rod (5) is rectangle, the cross section of secondary bar (3) is surrounded by the circular arc that the identical parallel lines of two length are identical with two sections of radiuses.
6. a mandibular ramus bone cutting operation positioner, is characterized in that the interior nail (4) of bone of playing fixation when comprising the second mobile jib (17), guide plate (9), the first pole (10), the second pole (13), the second stop (11), the 3rd stop (14), the second adapter (12), the 3rd adapter (15) and perform the operation, the back side of described second mobile jib (17) upper end is provided with upper limb hook (17-1) of locating at Mandibular Rumas simoid notch (16-5), second mobile jib lower end be provided with bone in follow closely the hole of combination, front is provided with Length Indication mark (17-2), described guide plate (9) is made up of location-plate (9-1) and connecting plate (9-2), the angle of location-plate and connecting plate is 90 °, described connecting plate (9-2) is provided with the hole (9-3) for installing the first pole (10), the second pole (13), described first pole (10), the second pole (13) are for radial dimension is identical with structure, length is identical or not identical screw rod, their front is provided with Length Indication mark, left end end is provided with the screw combined with the connecting plate of guide plate, and the section start of Length Indication mark is positioned at the edge on the right side of described screw, described second stop (11) is identical with structure with the shape of the 3rd stop (14), by spacing section and fastening section of composition, spacing section is cylindrical, external cylindrical surface is provided with stopper slot, fastening section is prismatic, and there is through screw in the centre of spacing section and fastening section, described second adapter (12) is cube, this cube is provided with the first jack (12-1) combined with the second mobile jib, the second jack (12-2) combined with the second stop (11) and the first pole (10), second jack is made up of stop construction section and the first pole via segments, the axis of described first jack is mutually vertical but non-intersect with the axis of the second jack, the hole wall of described first jack is provided with the first screw (12-3) combined with trip bolt, the stop construction section hole wall of described second jack is provided with the second screw (12-4) combined with stop screw, described 3rd adapter (15) is cube, this cube is provided with the first jack (15-1) combined with the second mobile jib, the second jack (15-2) combined with the 3rd stop (14) and the second pole (13), second jack is made up of stop construction section and the second pole via segments, the axis of described first jack is mutually vertical but non-intersect with the axis of the second jack, the hole wall of described first jack is provided with the first screw (15-3) combined with trip bolt, the stop construction section hole wall of described second jack is provided with the second screw (15-4) combined with stop screw,
The compound mode of each component: the top of the second mobile jib (17) and the first jack sleeve of the second adapter (12) connect and be fixed on the second adapter by trip bolt, the bottom of the second mobile jib (17) and the first jack sleeve of the 3rd adapter (15) connect and are fixed on the 3rd adapter by trip bolt; Spacing section of second stop (11) is inserted the stop construction section in the second jack of the second adapter, located by stop screw (8) and be fixed on the second adapter (12), the left end of the first pole (10) is arranged on the connecting plate of guide plate by trip bolt, and right-hand member is threaded with the second stop (11); Spacing section of 3rd stop (14) is inserted the stop construction section in the second jack of the 3rd adapter, located by stop screw (8) and be fixed on the 3rd adapter (15), the left end of the second pole (13) is arranged on the connecting plate of guide plate by trip bolt, and right-hand member is threaded with the 3rd stop (14).
7. mandibular ramus bone cutting operation positioner according to claim 6, it is characterized in that the connecting plate (9-2) of guide plate upper arrange for installing the first pole (10), the second pole (11) hole be multiple centrage point-blank and the equal circular hole of spacing.
8. mandibular ramus bone cutting operation positioner according to claim 6 or 7, is characterized in that the Length Indication that the second mobile jib (17), the first pole (10) and the second pole (11) front are arranged is designated bright, secretly alternate wide strip mark.
9. according to claim 6 or 7 for the positioner of mandibular ramus bone cutting operation, it is characterized in that the second mobile jib (17) lower end arranges with bone in follow closely combination hole be the pure stress hole that semicircle orifice (17-3) and semicircle taper hole (17-4) form.
10. mandibular ramus bone cutting operation positioner according to claim 6 or 7, it is characterized in that the cross section of the second mobile jib (17) is rectangle, the cross section of the first pole (10) and the second pole (13) is surrounded by the circular arc that the identical parallel lines of two length are identical with two sections of radiuses.
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| Application Number | Priority Date | Filing Date | Title |
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| CN201510918069.7A CN105395237B (en) | 2015-12-10 | 2015-12-10 | Mandibular ramus bone cutting operation positioner |
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201510918069.7A CN105395237B (en) | 2015-12-10 | 2015-12-10 | Mandibular ramus bone cutting operation positioner |
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| CN105395237A true CN105395237A (en) | 2016-03-16 |
| CN105395237B CN105395237B (en) | 2017-10-20 |
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| CN107411811A (en) * | 2017-07-12 | 2017-12-01 | 中南大学湘雅医院 | Multifunctional guide device for sacral nail placement |
| CN107736914A (en) * | 2017-10-30 | 2018-02-27 | 吉林大学 | Maxilla moves precise localizer |
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| Publication number | Publication date |
|---|---|
| CN105395237B (en) | 2017-10-20 |
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