CN105596077A - Universal screw-setting device for pedicle screw - Google Patents
Universal screw-setting device for pedicle screw Download PDFInfo
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- CN105596077A CN105596077A CN201610082225.5A CN201610082225A CN105596077A CN 105596077 A CN105596077 A CN 105596077A CN 201610082225 A CN201610082225 A CN 201610082225A CN 105596077 A CN105596077 A CN 105596077A
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation 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
- A61B17/34—Trocars; Puncturing needles
- A61B17/3415—Trocars; Puncturing needles for introducing tubes or catheters, e.g. gastrostomy tubes, drain catheters
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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
- A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
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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
- A61B17/3468—Trocars; Puncturing needles for implanting or removing devices, e.g. prostheses, implants, seeds, wires
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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
- A61B17/3472—Trocars; Puncturing needles for bones, e.g. intraosseus injections
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
- A61B17/90—Guides therefor
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B2017/564—Methods for bone or joint treatment
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- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- General Health & Medical Sciences (AREA)
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- Orthopedic Medicine & Surgery (AREA)
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- Gastroenterology & Hepatology (AREA)
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Abstract
The invention provides a universal screw-setting device for a pedicle screw. The universal screw-setting device for the pedicle screw comprises a puncture cone, a guide needle, an expanding core, a screw-setting guide sleeve, a hollow flat file, a hollow screw tap and a nailing device, wherein the puncture cone comprises a puncture sleeve and a puncture cone needle; the puncture sleeve is a hollow pipe; the front end of the puncture sleeve is tapered; an expanded holding part is arranged at the rear end of the puncture needle; the hollow core of the holding part is expanded and is provided with an inner thread region; the puncture cone needle is needle-like; the front end of the puncture cone needle is tapered; the tail end is expanded and is provided with an outer thread; the puncture cone needle is inserted into the puncture sleeve; after the outer thread at the tail end of the puncture cone needle is matched and identical with the inner thread at the rear end of the puncture sleeve, the tapered tip at the front end of the puncture cone needle is exposed out of the front end of the puncture sleeve and is identical with the taper shape of the front end of the puncture sleeve; a scale is arranged on the surface of the puncture sleeve; the guide needle is needle-like and is used for being inserted into a vertebral pedicle inlet through the puncture sleeve to determine the screw-setting position; and the scale is arranged on the surface of the guide needle. According to the universal screw-setting device for the pedicle screw, the hollow or solid pedicle screw can be accurately set into a vertebral pedicle and a vertebral body.
Description
Technical field
The present invention relates to bone surgery medical instruments field, be specifically related to a kind of general spike devices of putting of pedicle screw.
Background technology
Pedicle screw instrumentation has the fixing advantage of three posts, is a kind of very ripe spinal surgery technology, is widely used.Conventional method is to adopt way of escape otch open surgery, need extensively peel off the structure such as paraspinal muscle, ligament, easily causes paraspinal muscle funeralDenervation, the sequelae such as patient easily leaves over pain in back and loin, stiff. And this operation wound is large, hemorrhage many, and the hospital stays is long,Patient's misery and financial burden are increased. Minimal invasion pedicle screw instrumentation was applied to clinically in recent years, and wound is little, loses bloodFew, recover fast, and obtained certain curative effect. Percutaneous cervical arc root nail system and corresponding Minimally Invasive Surgery apparatus mostly adopt sky at presentThe moving axis pedicle nail of being indecisive and changeable, default excellent length and radian, but the solid pedicle screw of strength ratio of hollow Pediculus arcus vertebrae screwStrength decreased 30%, movable axis pedicle screw is poorer than the reset capability of fixed axis pedicle screw, there is no solid fixed axis vertebraNut nail is put the related device of nail, is difficult to solid fixed axis Pedicle Screw position accurately to be controlled, and makes to put nail essenceSpend lowlyer, difficulty is large.
Summary of the invention
The technical problem to be solved in the present invention is to overcome the deficiency that prior art exists, provide a kind of simple to operation, put nail essenceAccurate, to can be used for hollow fixed axis or movable axis pedicle screw and solid fixed axis or movable axis Pedicle Screw pedicle of vertebral archThe general spike devices of putting of screw.
For solving the problems of the technologies described above, the present invention by the following technical solutions:
The general spike devices of putting of pedicle screw, comprises puncture awl, guide pin, expansion core, puts and follow closely pilot sleeve, hollow flatProminent file, hollow screw tap and upper nail device, described puncture awl comprises puncture cannula and puncture awl, puncture cannula is hollow pipe, punctureThe front end of sleeve pipe is taper, and the rear end of puncture cannula is provided with the hand grip portion expanding, and the interior hollow expansion of hand grip portion is also provided with internal thread,Puncture awl is needle-like, and the front end of puncture awl is taper, and the tail end of puncture awl expands and is provided with external screw thread, puncture awl cushionEnter in puncture cannula, when the external screw thread of puncture awl backshank end mates the awl front end of puncturing after coincideing with the internal thread of puncture cannula rear endConical points expose puncture cannula front end and coincide with the taper of puncture cannula front end, there is scale on puncture cannula surface; Described leadsPin is needle-like, and for insert the definite nail position of putting of pedicle of vertebral arch entrance through puncture cannula, there is scale on guide pin surface.
The above-mentioned general spike devices of putting, preferred, also comprise seal wire, described seal wire is elongated silk, its diameter is less than or equal to leadsPin diameter, length is greater than the length of guide pin.
The above-mentioned general spike devices of putting, preferred, described expansion core comprises along the cylinder on axis with guide pin through hole, cylinderThe external diameter of body is identical with the nail seat external diameter of pedicle screw; It is conical that cylindrical one end is, and the other end is Handheld Division.
The above-mentioned general spike devices of putting, preferred, described in put nail pilot sleeve and comprise along thering is pedicle screw through hole on axisCylinder, one end of cylinder is band saw dentation, and the other end is fixedly connected with the first hand-held horizontal handle, and the length of cylinder is less thanThe cylindrical length of expansion core, the length of cylinder is greater than the rivet nut of pedicle screw, nail seat and broken long-armed total length.
The above-mentioned general spike devices of putting, preferred, described hollow flat prominent file comprises along the file bar on axis with guide pin through hole,The file external diameter of bar is identical with the rivet nut external diameter of pedicle screw, files one end of bar and is fixedly connected with file head, and the other end is fixedly connected with theTwo hand-held horizontal handles, file end surface is provided with roll flute, and periphery is provided with and bores style screw thread; Described hollow screw tap comprises along having and lead on axisThe screw tap bar of pin through hole, the external diameter of screw tap bar is identical with the rivet nut external diameter of pedicle screw, and one end of screw tap bar is fixedly connected with silkTap holder, the other end is fixedly connected with the 3rd hand-held horizontal handle, and the periphery of tap holder is provided with the thread road mating with pedicle screw rivet nut.
The above-mentioned general spike devices of putting, preferred, described upper nail device comprises strut, is fixed in the chock plug of strut one end and is fixed inThe 4th hand-held horizontal handle of the strut other end, is arranged with rotating hammerlock pipe on strut, hammerlock pipe is near one end outer surface of chock plugHave the external screw thread mating with broken long-armed inner surface internal thread, the other end of hammerlock pipe is fixedly connected with and is useful on rotation lock arm pipeTurncap, on hammerlock pipe, be arranged with screw guide ring and rotary handle, screw guide ring is positioned near chock plug one side, rotation handHandle is positioned near the 4th hand-held horizontal handle one side, and the external diameter of screw guide ring is identical with the nail seat external diameter of pedicle screw, on hammerlock pipeAlso be provided with the rotation stopping screw that pushes against or unclamp strut by screwing, described upper nail device also has seal wire through hole, and seal wire through hole is along strutAxially run through chock plug, strut and the 4th hand-held horizontal handle.
The above-mentioned general spike devices of putting, preferred, on described chock plug, be also provided with projection, projection is used for inserting movable axis pedicle of vertebral arch screwThe rivet nut of tightening movable axis pedicle screw in the bulb of nail, described seal wire through hole connects described projection.
Compared with prior art, the invention has the advantages that: the general spike devices of putting of pedicle screw of the present invention, has solved existingIn technology, have the difficult and accurate low technical problem of solid fixed axis Pedicle Screw, it is common to hollow fixed axis or activityAxle pedicle screw and solid fixed axis or movable axis pedicle screw accurately put nail, have flexible operation, easy, quick,Advantage accurately.
Brief description of the drawings
Fig. 1 is the structural representation of puncture awl.
Fig. 2 is the sectional structure schematic diagram of puncture awl.
Fig. 3 is the structural representation of guide pin.
Fig. 4 is the perspective view of expansion core.
Fig. 5 is the sectional structure schematic diagram of expansion core.
Fig. 6 is the structural representation of putting nail pilot sleeve.
Fig. 7 is the structural representation of hollow flat prominent file.
Fig. 8 is the structural representation of hollow screw tap.
Fig. 9 is the structural representation without the hollow upper nail device of projection.
Figure 10 is the structural representation with the hollow upper nail device of projection.
Figure 11 is the structural representation of seal wire.
Figure 12 is the structural representation of fixed axis pedicle screw.
Figure 13 is the structural representation of movable axis pedicle screw.
Figure 14 is the rivet nut of movable axis pedicle screw and the schematic diagram of ball head structure.
Figure 15 is the structural representation of the plug screw of movable axis pedicle screw.
Figure 16 is the structural representation of the bulb pressure pad of movable axis pedicle screw.
Marginal data:
1, pedicle screw; 10, rivet nut; 11, nail seat; 12, broken long-armed; 13, plug screw; 14, U-shaped structure; 15,Bulb; 16, bulb pressure pad; 17, hold consent; 18, recessed incisura; 3, puncture awl; 31, puncture cannula; 32, puncture awl;33, hand grip portion; 4, guide pin; 5, expansion core; 51, cylinder; 6, put nail pilot sleeve; 61, cylinder; 62, firstHand-held horizontal handle; 7, upper nail device; 71, strut; 72, chock plug; 73, the 4th hand-held horizontal handle; 74, hammerlock pipe; 75, turncap;76, screw guide ring; 77, rotary handle; 78, rotation stopping screw; 79, projection; 9, seal wire; 100, hollow flat prominent file;101, file bar; 102, the second hand-held horizontal handle; 103, file head; 200, hollow screw tap; 201, screw tap bar; 202, the 3rd handHold horizontal handle; 203, tap holder.
Detailed description of the invention
Below in conjunction with the drawings and specific embodiments, the present invention is described in further detail.
As shown in Figure 12 to Figure 16, pedicle screw 1 comprises rivet nut 10, nail seat 11, two broken long-armed 12 and plug screw13, rivet nut 10 is connected with nail seat 11, and two broken long-armed 12 pairs are on the spot fixedly connected on and in nail seat 11, form U-shaped structure14, in U-shaped structure 14, for embedding the vertical rod that connects, plug screw 13 is for being screwed into the U-shaped structure 14 of two broken long-armed 12Compress the vertical rod that connects. Rivet nut 10 is solid or hollow, and hollow rivet nut 10 has guide pin 4 through holes vertically, and rivet nut 10 is provided with spiral shellLine.
Article two, broken long-armed 12 inner surface has internal thread, and as shown in figure 15, the outer surface of plug screw 13 has with brokenThe external screw thread of long-armed 12 inner surface internal threads couplings, it is broken long-armed 12 far away that one end of plug screw 13 has 17, two of the consents of holdingAfterbody from nail seat 11 is also provided with smooth section, and while insertion between plug screw 13 is along broken long-armed 12, smooth section is to plug screw 13Play the guiding role.
Pedicle screw 1 can be arranged to fixed axis pedicle screw 1 and/or movable axis pedicle screw 1, rivet nut 10 as requiredFor solid or hollow, hollow rivet nut 10 has guide pin 4 through holes vertically. For example, the structure of fixed axis pedicle screw 1 is as figureShown in 1, because rivet nut 10 is fixedly connected with nail seat 11, make rivet nut 10 relatively nail seat 11 move, therefore form solidDead axle pedicle screw 1. Nail seat 11 is short cylindrical shape, and two broken long-armed 12 are fixedly connected with nail seat 11.
As shown in Figure 2, nail seat 11 is hollow-core construction to the structure of movable axis pedicle screw 1, is built-in with bulb 15 and bulb and pressesPad 16. Wherein rivet nut 10 is fixedly connected with bulb 15, and bulb pressure pad 16 is positioned at the hollow structure of nail seat 11, and is pressed in ballOn 15. Bulb pressure pad 16 is also hollow structure, as shown in figure 16, makes the vertical rod that connects can embed in U-shaped structure 14 and pressOn bulb pressure pad 16. On bulb 15, there is polygon groove, as shown in figure 14. Between bulb 15 and nail seat 11, be flexibly connected.Vertical company under excellent pressure-acting in U-shaped structure 14, the position of rivet nut 10 and nail seat 11 is fixed. Movable axis pedicle of vertebral arch screwIn nail 1, because bulb 15 is flexibly connected with nail seat 11, make rivet nut 10 have certain mobility in all directions, be beneficial to three joint vertebrasMore than body fixing.
Compared with common fixed axis pedicle screw 1, fixed axis and movable axis pedicle screw 1 have short cylindrical shape nail seat 11, canThe smooth section of long-armed 12 tail ends of fractureing play the guiding role to plug screw 13, is convenient to be screwed into plug screw 13; Nail seat 11 is to pedicle of vertebral arch simultaneouslyScrew 1 plays direction control action in the time of the slip of putting in nail pilot sleeve 6; Rivet nut 10 is solid or hollow, and rivet nut 10 is solidMore hollow active force is strong, and hollow rivet nut 10 can be screwed into along seal wire 9, put nail accuracy rate high.
Under preferable case, be the long-armed of pedicle screw 1 that better fracture, on two broken long-armed 12 of pedicle screw 1One end place near nail seat 11 is provided with recessed incisura 18. A little less than recessed incisura 18 places are broken, can fracture herein broken long-armed 12.
The general spike devices of putting of pedicle screw of the present invention, comprise puncture awl 3, guide pin 4, expansion core 5, put nail pilot sleeve 6,Hollow flat prominent file 100, hollow screw tap 200 and upper nail device 7, wherein, puncture awl 3 and guide pin 4 are put nail position for determining. AsShown in Fig. 1 and Fig. 2, puncture awl 3 comprises puncture cannula 31 and puncture awl 32. Puncture cannula 31 is hollow pipe, and front end isTaper, rear end is provided with the hand grip portion 33 expanding, and the interior hollow expansion of hand grip portion 33 is also provided with internal thread, and puncture awl 32 is needle-like,The front end of puncture awl 32 is also taper, and the tail end of puncture awl 32 expands and is provided with external screw thread, and puncture awl 32 inserts punctureIn sleeve pipe 31, when the external screw thread of puncture awl 32 tail ends mate the awl that punctures after identical with the internal thread of puncture cannula 31 rear endsThe conical points of 32 front ends exposes puncture cannula 31 front ends and coincide with the taper of puncture cannula 31 front ends. Puncture cannula 31 surfacesThere is scale, can measure the insertion depth of puncture awl 3.
As shown in Figure 3, guide pin 4 is needle-like, for extract puncture awl 32 from puncture cannula 31, inserts again, determines and putsNail position. There is scale on the surface of guide pin 4. Guide pin 4 is inserted into behind centrum middle part from puncture cannula 31, extracts puncture cannula31, indwelling guide pin 4.
In the present embodiment, also comprise seal wire 9, as shown in figure 11, seal wire 9 is elongated silk, and its diameter is less than or equal to guide pin 4Diameter, length is greater than the length of guide pin 4.
In the present embodiment, expansion core 5 comprises along the cylinder 51 on axis with guide pin 4 through holes, as shown in Figure 4 and Figure 5.The external diameter of cylinder 51 is identical with nail seat 11 external diameters of pedicle screw 1. It is conical that one end of cylinder 51 is, and the other end isHandheld Division. Expansion core 5 screws in along guide pin 4, disposable expansion muscle passage, and head end arrives at pedicle of vertebral arch entrance surface of bone. Due to micro-Wound otch 1.5cm has cut skin, and deep fascia, therefore expands core 5 and be easy to expand spatium intermusculare, with tradition expanded phase step by stepRatio, simple to operate, fast save time.
In the present embodiment, put nail pilot sleeve 6 and comprise along the cylinder 61 on axis with pedicle screw 1 through hole, as Fig. 6Shown in. One end of cylinder 61 is band saw dentation, and the other end is fixedly connected with the first hand-held horizontal handle 62, and expansion core 5 is along leadingPin 4 inserts, then puts nail pilot sleeve 6 and insert along expansion cores 5, therefore the internal diameter of cylinder 61 and the external diameter of expansion core 5, withAnd equate with the external diameter three of pedicle screw 1 nail seat 11.
The length of the Length Ratio expansion core 5 of cylinder 61 is short, puts nail pilot sleeve 6 and inserts along expansion core 5, the tail of expansion core 5Expose outside the afterbody of putting nail pilot sleeve 6 end Handheld Division, operator hold put nail pilot sleeve 6 the first hand-held horizontal handle 62 and underThe sliding circular saw spine of putting nail pilot sleeve 6 that makes is at vertebral plate, articular process surface of bone, compresses and puts the first hand-held of nail pilot sleeve 6Horizontal handle 62, to keep the circular saw of putting nail pilot sleeve 6 not move, then extracts expansion core 5, retains and puts nail pilot sleeve6 and guide pin 4, now guide pin 4 is put the circular saw central point in putting nail pilot sleeve 6 to the marrow. The length of cylinder 61 is largeIn rivet nut 10, nail seat 11 and broken long-armed 12 the total length of pedicle screw 1. Therefore, when pedicle screw 1 insertsPut in nail pilot sleeve 6, the rivet nut of pedicle screw 1 10 points are just when the concordant circular saw of putting nail pilot sleeve 6, vertebral archTwo broken long-armed 12 cylinders 61 that submerge of root screw 1.
Change guide pin 4 into seal wire 9 with puncture awl 3, hollow Pediculus arcus vertebrae screw 1 can insert through putting nail pilot sleeve 6 along seal wire 9And be screwed into centrum. Put when nail pilot sleeve 6 is coaxial to be inserted on solid pedicle screw 1 edge, also can realize accurate location, has solvedIn prior art, can only in hollow screw, insert the accurately technical problem of location of seal wire 9. Therefore the present invention accurately completes solidPut nail with hollow Pediculus arcus vertebrae screw 1.
In open surgery, find, because articular process is uneven, pedicle screw 1 rivet nut 10 tips are difficult to insert little vertebra sometimesNut entrance, the easy kibe of cortex, displacement while twisting nail. Hollow flat prominent file 100 of the present invention for filing guide pin 4 to the marrow mouthfulCortex of bone, and pierce interior several millimeters of pedicle of vertebral arch, manufacture and have size to have the pedicle of vertebral arch bone entrance of the degree of depth.
As shown in Figure 7, hollow flat prominent file 100 is T shape structure, comprise along the file bar 101 on axis with guide pin 4 through holes,One end of file bar 101 is fixedly connected with file 103, and the other end is fixedly connected with the second hand-held horizontal handle 102. File 103 end face are provided withRoll flute, periphery is provided with and bores style gear screw thread. Hollow flat prominent file 100 inserts pedicle of vertebral arch entrance along guide pin 4, therefore hollow flat prominentFile 100 internal diameters and be a bit larger tham guide pin 4, the external diameter of its file bar 101 is less than the external diameter of pedicle screw 1 rivet nut 10.
In the present embodiment, hollow screw tap 200 carries out tapping for opposed nail position, facilitates inserting of pedicle screw 1. As figureShown in 8, hollow screw tap 200 is T shape structure, comprises along the screw tap bar 201 on axis with guide pin 4 through holes, screw tap bar 201One end be fixedly connected with tap holder 203, the other end is fixedly connected with the 3rd hand-held horizontal handle 202. The periphery of tap holder 203 be provided withThe thread road that pedicle screw 1 rivet nut 10 is mated. Hollow screw tap 200 inserts pedicle of vertebral arch entrance, therefore air silk along guide pin 4Attack 200 internal diameter and be a bit larger tham guide pin 4, the external diameter of its screw tap bar 201 is identical with the external diameter of pedicle screw 1 rivet nut 10. Screw tap203 thread road and the screw thread of pedicle screw 1 rivet nut 10 match. Hollow screw tap 200 along guide pin 4 to pedicle of vertebral arch vertebraBody carries out tapping, carries out tapping for 1 of the pedicle screw with self tapping ability without the hollow screw tap 200 of employing.
In the present embodiment, the structure of hollow upper nail device 7 as shown in Figure 9, comprises strut 71 and lays respectively at strut 71 two endsChock plug 72 and the 4th hand-held horizontal handle 73. On strut 71, be arranged with rotating hammerlock pipe 74, hammerlock pipe 74 is near chock plug 72One end outer surface has the external screw thread mating with broken long-armed 12 inner surface internal threads, and the other end of hammerlock pipe 74 is fixedly connected withThere is turncap 75, for rotating hammerlock pipe 74, on turncap 75, have lock nut. When hammerlock pipe 74 is rotated in place locking vertebral archWhen root screw 1, lock nut pins turncap 75, prevents that hammerlock pipe 74 from exiting, and is arranged with screw guide ring on hammerlock pipe 7476 and rotary handle 77, wherein, screw guide ring 76 is positioned near chock plug 72 1 sides, and rotary handle 77 is positioned near the 4thHand-held horizontal handle 73 1 sides. Screw guide ring 76 and rotary handle 77 are enclosed within on hammerlock pipe 74, can independently rotate separately. In addition,On hammerlock pipe 74, be also provided with the rotation stopping screw 78 that pushes against or unclamp strut 71 by screwing, upper nail device 7 also has seal wire 9 through holes,Seal wire 9 through holes axially run through chock plug 72, strut 71 and the 4th hand-held horizontal handle 73 along strut 71.
Chock plug 72 is directly inserted in U-shaped structure 14 bottoms of pedicle screw 1, and rotation turncap 75 makes the outer spiral shell of hammerlock pipe 74The internal thread interlock of line and broken long-armed 12 inner surfaces of pedicle screw 1 is tight, thus by pedicle screw 1 be fixed on hollow onOn nail device 7. The external diameter of screw guide ring 76 is with pedicle screw 1 nail seat 11 external diameters and put the internal diameter phase of following closely pilot sleeve 6Deng. When the pedicle screw 1 being connected with hollow upper nail device 7 is when putting nail pilot sleeve 6 and insert, screw guide ring 76 also entersPut in nail pilot sleeve 6, and coincide with the inwall of putting nail pilot sleeve 6. Therefore, have at the middle front end of putting nail pilot sleeve 6The nail seat 11 of pedicle screw 1, there is screw guide ring 76 rear end, and pedicle screw 1 is slided in pilot sleeve 6 putting nailTime guarantee that the tip of rivet nut 10 aims at the center position of putting nail pilot sleeve 6, thereby ensure the rivet nut of solid pedicle screw 1Pedicle of vertebral arch bone entrance is accurately inserted at 10 tip. The circular saw of putting nail pilot sleeve 6 stings in vertebral plate, articular process cortex bone,Keep center position not rotate, insert after pedicle of vertebral arch bone entrance when the tip of rivet nut 10, putting nail pilot sleeve 6 can be with upper nailDevice 7 directions change, and pedicle screw 1 is screwed into towards more definite direction, are similar to the open nail of putting.
In the time that pedicle screw 1 is movable axis pedicle screw 1, due to nail seat 11 with rivet nut 10 for being flexibly connected, only adoptChock plug 72 cannot complete the upper nail operation of movable axis pedicle screw 1. Therefore, upper nail device 7 also has another kind of preferably enforcement sideFormula, as shown in figure 10, is also provided with projection 79, for inserting movable axis pedicle screw 1 on the chock plug 72 of described upper nail device 7The groove of bulb 15 in, directly twist the rivet nut 10 of movable axis pedicle screw 1, meanwhile, above-mentioned seal wire 9 through holes connect protrudingPlay 79.
Taking the chest vertebra body fracture of lumbar vertedra as example, the course of work that pedicle screw of the present invention general put spike devices is as follows:
1, after anaesthetizing successfully, patient gets prone position, and belly is unsettled.
2, C arm X-ray machine Fluoroscopy location, mark is hindered the pedicle of vertebral arch body surface projection of vertebra and upper and lower vertebra, uses puncture awl 3 in pedicle of vertebral archOther the opening through skin of body surface projection outer rim penetrates, and needle point reaches 2 or 10 of the outer upper limbs of pedicle of vertebral arch bone projection " eyes " and locates to wear out cortexLayer, slowly pierces and reaches centrum middle part, extracts puncture awl 32, inserts guide pin 4 reach centrum middle part through puncture cannula 31, extractsPuncture cannula 31, retains guide pin 4, inserts guide pin 4 with method in other pedicles of vertebral arch through skin, and positive side position perspective is confirmed 4 of guide pinsPut appropriate.
3, centered by guide pin 4, do longitudinal skin incision of 1.5 centimetres, and cut deep fascia, with expanding core 5 along guide pin 4 oneInferior property expands passage, puts nail pilot sleeve 6 and inserts along expansion core 5, and hand-held the first hand-held horizontal handle 62 of operator compresses, and makes to put nailThe circular saw spine of pilot sleeve 6 front ends enters the surperficial cortex of vertebral plate, articular process, fixedly puts nail pilot sleeve 6 holding positionsDo not move, extract expansion core 5, retain and put nail pilot sleeve 6 and guide pin 4.
4, insert along guide pin 4 with hollow flat prominent file 100, polish guide pin 4 entrance cortexs of bone, and pierce a little degree of depth, extract skyThe flat prominent file 100 of the heart, carries out tapping along guide pin 4 to pedicle nail road with hollow screw tap 200, extracts guide pin 4.
5, after hollow upper nail device 7 is connected with pedicle screw 1, insert along putting nail pilot sleeve 6, the tip of rivet nut 10 is accurateInsert pedicle of vertebral arch entrance, rotate hollow upper nail device 7, be screwed into pedicle screw 1. Same method is inserted all the other pedicle screws 1,Hinder if desired vertebra and can insert one-sided or bilateral screw.
Other method is put hollow Pediculus arcus vertebrae screw 1, inserts in centrum with the puncture cannula 31 of puncture awl 3 along guide pin 4, extractsGuide pin 4 retains puncture cannula 31, and seal wire 9 is inserted to centrum along puncture cannula 31 holes, extracts puncture cannula 31, retains seal wire9, hollow Pediculus arcus vertebrae screw 1 inserts along seal wire 9 after being connected with hollow upper nail device 7, and is screwed into hollow Pediculus arcus vertebrae screw 1 to centrumIn.
The general spike devices of putting of the present invention has the following advantages:
1, the present invention, because the front end of puncture awl 32 is set to taper, makes it have from cone ability, and due to puncture cannula31 is hollow pipe, and its front end forms crown, not only plays sawtooth effect but also play fixation, works as puncture awl 32 and enter in the time of operationAfter cortex bone, exit puncture awl 32, puncture cannula 31 crowns thrust cortex bone makes it be difficult for displacement, guarantees guide pin 4Insert. When puncture awl 3 punctures, in puncture awl 3, puncture awl 32 and puncture cannula 31 all have the effect of boring in sclerotin, andParacentesis trocar of the prior art, because its puncture barrel forward end is circular, is not taper, himself does not bore broken skin mass-energy power,Only have puncture needle to have to bore into the effect in sclerotin, only depend on puncture needle taper hole, but puncture needle diameter is less than puncture cannula, puncture needle coneBehind hole, puncture cannula round end enters effort difficulty, and particularly harder cortex bone, so its effect only limits to insert and lead for puncturePin. In practical operation, in the time of spike pierces cortex backed off after random, the easy displacement of puncture cannula, position can cause inserting guide pin timeEasily change; Puncture awl 3 of the present invention also has two effects: one is adjusted guide pin 4 directions, works as guide pin 4 in operationAfter inserting, X-ray examination finds to lead the correct and poor direction of penetration when true, inserts with the puncture cannula 31 of puncture awl 3 through guide pin 4Enter, its sawtooth bore into cortex of bone a little and thrust sclerotin, guide pin 4 exits in surface of bone, but and not exclusively in puncture cannula 31, move backGo out, adjust puncture cannula 31 directions, then return and insert this guide pin 4, completed the adjustment of guide pin 4 directions. Its two conversions seal wire 9 is doneWith, after guide pin 4 positions are accurate, because guide pin 4 is thicker, general hollow pedicle through hole is thinner, so will convert to elongatedSeal wire 9. Insert along guide pin 4 with puncture cannula 31, its sawtooth is bored in sclerotin and is fixed, and extracts guide pin 4 out again, then by seal wire9 insert in the duct of sclerotin Central Plains guide pin along puncture cannula 31, then hollow pedicle nail and hollow upper nail device 7 are twisted along seal wire 9Enter, ensured that guide pin 4 changes seal wire 9 and invariant position.
2, expansion core 5 and put nail pilot sleeve 6 structures and using method all with minimal invasion pedicle screw-rod of the prior art inIn fixed system, expansion core 5 used is followed closely pilot sleeve 6 differences with putting. Structure difference: expansion core of the prior art is provided with handHandle, and the present invention expands core 5 to put nail pilot sleeve 6 long without handle and Length Ratio are set, growing part becomes Handheld Division,The nail pilot sleeve of putting of the prior art is provided with two U-lags parallel with putting the horizontal handle of nail pilot sleeve 6, and now puts nail guidingSleeve 6 is without arranging two U-lags, and handle is equal with sleeve entrance.
Using method difference: using method of the prior art is, expansion core inserts and expands soft tissue passage backed off after random along guide pin,Put nail pilot sleeve and insert fit along expansion core again and make to expand the horizontal handle of core and embed in the U-lag of putting nail pilot sleeve, be combined into one,Insert along guide pin through expansion core through hole again, after expansion core conflict surface of bone, press down and put nail pilot sleeve handle, make it continue lower insertion,Its crown stings surface of bone, then on draw horizontal handle to extract expansion core. Using method of the present invention is: expansion core 5 inserts and expands along guide pin 4Open soft tissue, conflict after surface of bone, put nail pilot sleeve 6 and directly insert along expansion core 5, its crown stings surface of bone, holds expansionOpen core 5 Handheld Divisions and extract expansion core 5. Obviously,, compared with using method of the prior art, have easy and simple to handle, efficientlyAdvantage. Compared with other sleeve type device in prior art, the tooth that barrel forward end arranges, is putting hollow nail process except playingMiddle obstruct also protects outer this crown of effect of soft tissue to sting in cortex, also can guarantee to put nail pilot sleeve 6 far-ends without displacement, reallyProtect guide pin inlet point and be positioned at center, in the time that hollow nail inserts through putting nail pilot sleeve 6, guarantee that nail tip enters to lead penetration.
3, the upper nail device structure in upper nail device 7 and minimal invasion pedicle screw-rod internal fixation system of the prior art and effect are notIdentical. The strut of upper nail device of the prior art is solid, can only put solid pedicle nail, on turncap, without lock nut, twistsWhen pedicle nail, easily exit, loosening. The strut 71 of the upper nail device 7 in the present invention is hollow, both can put hollow nail and also can put realityHeart nail, has lock nut on turncap 75, and lock nut locking turncap 75 has been locked hammerlock pipe 74 simultaneously, twists pedicle nailIn time, does not exit, non-loosening, and handling safety is stable.
To adopt the general data analysis of putting the 518 routine thoracolumbar fracture Minimally Invasive Surgeries that spike devices completes of the present invention, it is mid-Nail totally 3115 pieces, rate of accuracy reached 98.3%, and have compared with existing open surgery that operating time is short, hemorrhage less, the hospital staysThe advantage such as short, concrete correction data is as follows:
Operating time: open surgery is 60～180 minutes, average 91 minutes; Adopting Minimally Invasive Surgery of the present invention is 30～70 pointsClock, average 52 minutes.
Amount of bleeding: open surgery is 100～600ml, average 260ml; Adopting Minimally Invasive Surgery of the present invention is 15～30ml, average25ml。
Hospital stays: open surgery is 15～21 days, average 14 days; Adopting Minimally Invasive Surgery of the present invention is 6～14 days, average9 days.
The above is only the preferred embodiment of the present invention, and protection scope of the present invention is also not only confined to above-described embodiment. RightIn those skilled in the art, also should look not departing from the improvement and the conversion that obtain under the technology of the present invention design prerequisiteFor protection scope of the present invention.
Claims (7)
1. the general spike devices of putting of pedicle screw, comprises puncture awl, guide pin, expansion core, puts nail pilot sleeve, hollowFlat prominent file, hollow screw tap and upper nail device, is characterized in that: described puncture awl comprises puncture cannula and puncture awl, puncture cannulaFor hollow pipe, the front end of puncture cannula is taper, and the rear end of puncture cannula is provided with the hand grip portion expanding, hollow expansion in hand grip portionAnd be provided with internal thread, and puncture awl is needle-like, and the front end of puncture awl is taper, and the tail end of puncture awl expands and is provided with outer spiral shellLine, puncture awl pin inserts in puncture cannula, coincide when the external screw thread of puncture awl backshank end mates with the internal thread of puncture cannula rear endThe conical points of rear puncture awl front end exposes puncture cannula front end and coincide with the taper of puncture cannula front end, and puncture cannula surface hasScale; Described guide pin is needle-like, and for insert the definite nail position of putting of pedicle of vertebral arch entrance through puncture cannula, there is quarter on guide pin surfaceDegree.
2. the general spike devices of putting according to claim 1, is characterized in that: also comprise seal wire, described seal wire is elongatedSilk, its diameter is less than or equal to guide pin diameter, and length is greater than the length of guide pin.
3. the general spike devices of putting according to claim 1, is characterized in that: described expansion core comprises along having and lead on axisThe cylinder of pin through hole, cylindrical external diameter is identical with the nail seat external diameter of pedicle screw; It is conical that cylindrical one end is, anotherOne end is Handheld Division.
4. the general spike devices of putting according to claim 1, is characterized in that: described in put nail pilot sleeve comprise along on axisHave the cylinder of pedicle screw through hole, one end of cylinder is band saw dentation, and the other end is fixedly connected with the first hand-held horizontal strokeHandle, the length of cylinder is less than the cylindrical length of expanding core, and the length of cylinder is greater than the rivet nut of pedicle screw, nail seatWith broken long-armed total length.
5. the general spike devices of putting according to claim 1, is characterized in that: described hollow flat prominent file comprises along on axisHave the file bar of guide pin through hole, the file external diameter of bar is identical with the rivet nut external diameter of pedicle screw, and one end of file bar is fixedly connected with fileHead, the other end is fixedly connected with the second hand-held horizontal handle, and file end surface is provided with roll flute, and periphery is provided with and bores style screw thread; Described air silkAttack the screw tap bar comprising along having guide pin through hole on axis, the external diameter of screw tap bar is identical with the rivet nut external diameter of pedicle screw, screw tapOne end of bar is fixedly connected with tap holder, and the other end is fixedly connected with the 3rd hand-held horizontal handle, and the periphery of tap holder is provided with and pedicle of vertebral arch screwThe thread road of nail rivet nut coupling.
6. the general spike devices of putting according to claim 1, is characterized in that: described upper nail device comprises strut, is fixed in supportThe chock plug of bar one end and the 4th hand-held horizontal handle that is fixed in the strut other end, be arranged with rotating hammerlock pipe, hammerlock pipe on strutOne end outer surface near chock plug has the external screw thread mating with broken long-armed inner surface internal thread, and the other end of hammerlock pipe is fixedBe connected with the turncap for rotating hammerlock pipe, be arranged with screw guide ring and rotary handle on hammerlock pipe, screw guide ring is positioned atNear chock plug one side, rotary handle is positioned near the 4th hand-held horizontal handle one side, the external diameter of screw guide ring and the nail of pedicle screwSeat external diameter is identical, is also provided with the rotation stopping screw that pushes against or unclamp strut by screwing on hammerlock pipe, and described upper nail device also has seal wireThrough hole, seal wire through hole axially runs through chock plug, strut and the 4th hand-held horizontal handle along strut.
7. the general spike devices of putting according to claim 6, is characterized in that: on described chock plug, be also provided with projection, projection is usedThe rivet nut of tightening movable axis pedicle screw in inserting the bulb of movable axis pedicle screw, described seal wire through hole connects described protrudingRise.
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| CN201610082225.5A CN105596077A (en) | 2016-02-06 | 2016-02-06 | Universal screw-setting device for pedicle screw |
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| Application Number | Priority Date | Filing Date | Title |
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| CN201610082225.5A CN105596077A (en) | 2016-02-06 | 2016-02-06 | Universal screw-setting device for pedicle screw |
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| CN106137335A (en) * | 2016-07-15 | 2016-11-23 | 于海龙 | A kind of Thoracolumbar disk percutaneous puncture device and using method thereof |
| CN106725712A (en) * | 2016-12-23 | 2017-05-31 | 上海三友医疗器械股份有限公司 | Followed closely in articular process in apparatus and articular process and follow closely method |
| CN109998656A (en) * | 2019-04-10 | 2019-07-12 | 晏怡果 | Vertebral pedicle nail fixer for cervical vertebrae, fixed system and fixing means |
| CN109998655A (en) * | 2019-04-10 | 2019-07-12 | 晏怡果 | Thoracic and lumbar vertebral posterior is orthopedic to use vertebral pedicle nail fixing device and fixed system |
| CN110063783A (en) * | 2019-05-27 | 2019-07-30 | 吴溢峰 | Device is followed closely on a kind of pedicle nail with gravity needle protractor |
| CN111904574A (en) * | 2020-09-07 | 2020-11-10 | 郝定均 | Posterior atlantoaxial reposition fixing system |
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| CN110063783A (en) * | 2019-05-27 | 2019-07-30 | 吴溢峰 | Device is followed closely on a kind of pedicle nail with gravity needle protractor |
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