CN106137373A - Combination type spinal column puts nail guide plate and preparation method thereof - Google Patents
Combination type spinal column puts nail guide plate and preparation method thereof Download PDFInfo
- Publication number
- CN106137373A CN106137373A CN201610631834.1A CN201610631834A CN106137373A CN 106137373 A CN106137373 A CN 106137373A CN 201610631834 A CN201610631834 A CN 201610631834A CN 106137373 A CN106137373 A CN 106137373A
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- Prior art keywords
- screw
- substrate
- pilot sleeve
- guide plate
- spinal column
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Classifications
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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
-
- 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
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00526—Methods of manufacturing
-
- 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
Abstract
The invention discloses a kind of combination type spinal column and put nail guide plate and manufacture method thereof, put nail guide plate and include substrate, substrate is provided with the laminating locating surface for fitting with the spinous process and vertebral plate rear surface of bone of spinal column, substrate is provided with more than one group All-in-One guidance set, All-in-One guidance set includes the screw pilot sleeve being fixed on substrate and the guide pin pilot sleeve being sheathed in screw pilot sleeve, the axis of screw pilot sleeve and the dead in line of guide pin pilot sleeve.Manufacture method includes obtaining CT data, rebuilding spinal three-dimensional model, design substrate and All-in-One guidance set, the step of 3D printing processing.The present invention have simple in construction, be prone to make, easy to operate, put that nail accuracy is high, can shorten operating time, reduce fluoroscopy during operation frequency and radiation dose, and meet routine and put the advantages such as nail flow process.
Description
Technical field
The present invention relates to surgery assistor tool technical field, be specifically related to a kind of combination type spinal column and put nail guide plate and making thereof
Method.
Background technology
In Via Posterior Spinal Approach pedicle screw-rod internal fixation, be previously most frequently with is that naked eyes judge, free-hand put nail method,
The success of operation relies primarily on clinical experience and the subjective sensation of patient, the probability of nail position, road and anisotropy occurs relatively
Greatly.Along with the development of 3D printing technique and the application in Orthopedic Clinical works, occur in that for Via Posterior Spinal Approach pedicle screw-rod
The auxiliary of internal fixation puts nail guide plate so that the accuracy putting nail is greatly improved.But, at present in the guide plate of application, percutaneous is led
Plate is due to skin and hypodermic movable property so that its accuracy is the best；The guide plate of laminating bone surface requires tough on spine
Band, the stop of interspinal ligaments are all peeled off, then are inserted on spinous process by guide plate, on the one hand, its wound is big, on the other hand, is inserted in spine
Attach the best after Tu, affect accuracy.Additionally, nail road is simply set up in the effect of guide plate, actual enter pedicle of vertebral arch screw during nail
Occur side to move in Ding Keding road, also can affect accuracy.Therefore, prior art need to be improved.
Summary of the invention
The technical problem to be solved in the present invention is the deficiency overcoming prior art to exist, it is provided that a kind of simple in construction, be prone to
Make, easy to operate, put that nail accuracy is high, operating time can be shortened, reduce fluoroscopy during operation frequency and radiation dose and often meet
Rule are put the combination type spinal column of nail flow process and are put nail guide plate, correspondingly provide this combination type spinal column a kind of and put the manufacture method of nail guide plate.
For solve above-mentioned technical problem, the present invention by the following technical solutions:
A kind of combination type spinal column puts nail guide plate, including substrate, described substrate be provided with for the spinous process and vertebral plate of spinal column after quadrate bone
The laminating locating surface of face laminating, described substrate is provided with more than one group All-in-One guidance set, described All-in-One guidance set bag
Including the screw pilot sleeve being fixed on substrate and the guide pin pilot sleeve being sheathed in screw pilot sleeve, described screw is led
To axis and the dead in line of guide pin pilot sleeve of sleeve.
Combinations of the above formula spinal column puts nail guide plate, it is preferred that described screw pilot sleeve or screw pilot sleeve and base
Plate is provided with the lateral fluting removed for pedicle screw along screw pilot sleeve radial direction.
Combinations of the above formula spinal column puts nail guide plate, it is preferred that described guide pin pilot sleeve is provided with and is laterally recessed at described
The slide unit being slidably matched on screw pilot sleeve axial direction.
Combinations of the above formula spinal column puts nail guide plate, it is preferred that it is detachable that the outer cover of described screw pilot sleeve is provided with one
Outer sleeve.
Combinations of the above formula spinal column puts nail guide plate, it is preferred that be provided with between described screw pilot sleeve and substrate one with
Upper reinforcement strut.
Combinations of the above formula spinal column puts nail guide plate, it is preferred that treat operative region according to the laminating locating surface of described substrate
SCT data, use the curved surface of 3D printer printing shaping, described curved surface and spinal column plan to implement spinous process and the vertebra of operation vertebra
Plate rear surface of bone is fitted completely, and ensures that substrate can not slide on spinous process, vertebral plate when pressurization is fixing.
Combinations of the above formula spinal column puts nail guide plate, it is preferred that described substrate is provided with two groups and is respectively used to from vertebra both sides
Carry out putting the All-in-One guidance set of nail.
Combinations of the above formula spinal column puts nail guide plate, it is preferred that described substrate is provided with least one set for from vertebra side
Carry out putting the All-in-One guidance set of nail.
Combinations of the above formula spinal column puts nail guide plate, it is preferred that described substrate and/or screw pilot sleeve are provided with for kirschner
Pin through with combination type spinal column is put nail guide plate be fixed on epispinal auxiliary positioning hole.
A kind of combinations thereof formula spinal column puts the manufacture method of nail guide plate, comprises the following steps:
(A) treat operative site spinal segments and carry out three-D CT scanning, it is thus achieved that original CT data；
(B) use medical image processing software that original CT data is processed, reconstruct the spinal three-dimensional model of 1:1 size；
(C) on spinal three-dimensional model, pedicle screw or lateral mass screw are inserted in simulation, labelling entry point, screw orientation and
Screw length and diameter；
(D) design substrate, extracts and intends inserting pedicle screw or the spinous process of lateral mass screw and lamina surface outline data information,
Carry out surface fitting and obtain the laminating locating surface of substrate；
(E) according to entry point, screw orientation and screw length and the diameter information of step (C) institute labelling, substrate is designed
Comprise screw specification, direction, entry point, set up and expand the All-in-One guidance set that bone passage is integrated；
(F) 3D printing device is used to process substrate and All-in-One guidance set.
Compared with prior art, it is an advantage of the current invention that: combination type spinal column of the present invention puts nail guide plate in use, makes base
Plate laminating is fixed on the spinous process of patient's vertebra perform the operation and surface of bone formation in vertebral plate rear positions and fixes, and utilizes screw pilot sleeve
And the lateral fluting on substrate is accurately positioned entry point, and after break the cortical bone of entry point with Kirschner wire or open circuit device, will
Guide pin pilot sleeve is set in screw pilot sleeve and uses detatachable external sleeve ring to fix, and is directed to positioning needle and guides along guide pin
Sleeve uniform pressurization pierces pedicle of vertebral arch, sets up bone passage, exits guide location pin, then extract detatachable external sleeve ring, guide pin is led
To sleeve, pedicle screw is pierced in the bone passage that pedicle of vertebral arch has built up along screw pilot sleeve uniform pressurization, vertebral arch
After pedicle of vertebral arch certain depth inserted by root screw, be equivalent to screw cap close to after screw pilot sleeve upper limb, nail guide plate will be put overall
Take off, then pedicle screw screw hole in pedicle of vertebral arch is entirely within.Use this combination type spinal column to put nail guide plate to put
During nail, whole process need not multiple bearing, puts nail guide plate and only need to once fit and be positioned at spinous process and vertebral plate surface of bone, the most available
The guiding of guide pin pilot sleeve and screw pilot sleeve completes follow-up guide location pin and punctures and put nail, can avoid guide-localization
When pin inserts pedicle screw after extracting again, screw orientation is subjected to displacement on the basis of guide location pin direction, it is possible to significantly carry
Height puts the degree of accuracy of nail, and can shorten operating time, improves procedure efficiency, reduces unnecessary fluoroscopy during operation.This combination type
Spinal column put nail guide plate simple in construction, be prone to make, easy to operate.
Accompanying drawing explanation
Fig. 1 is that combination type spinal column is put nail guide plate laminating and is fixed on the structural representation on spinal column surface.
Fig. 2 is the perspective view that combination type spinal column puts nail guide plate.
Fig. 3 is the decomposition texture schematic diagram that combination type spinal column puts nail guide plate.
Fig. 4 is the perspective view that screw pilot sleeve is connected on substrate.
Marginal data:
1, substrate；2, screw pilot sleeve；21, laterally slot；3, guide pin pilot sleeve；31, slide unit；4, detatachable external sleeve ring；
5, strut is strengthened.
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 Figures 1 to 4, the combination type spinal column of the present embodiment puts nail guide plate, including substrate 1, substrate 1 be provided with for
The spinous process of spinal column and the laminating locating surface of vertebral plate rear surface of bone laminating, substrate 1 is provided with more than one group for setting up nail road and auxiliary
Helping the All-in-One guidance set inserting pedicle screw, All-in-One guidance set includes screw pilot sleeve 2 and guide pin fairlead
Cylinder 3, the internal diameter of screw pilot sleeve 2 is identical with the external diameter of the external diameter of guide pin pilot sleeve 3 and pedicle screw, guide pin fairlead
The internal diameter of cylinder 3 is identical with the diameter of guide pin, and screw pilot sleeve 2 is fixed on substrate 1, and guide pin pilot sleeve 3 is sheathed on screw
In pilot sleeve 2, it can slide axially and is inserted in screw pilot sleeve 2 or takes out from screw pilot sleeve 2, and guide pin guides
Sleeve 3 is sheathed on axis and the dead in line of guide pin pilot sleeve 3 of screw pilot sleeve 2 after screw pilot sleeve 2.This combination
Formula spinal column puts nail guide plate in use, makes substrate 1 laminating be fixed on the spinous process of patient's vertebra perform the operation and vertebral plate surface of bone is formed calmly
Position is also fixed, and utilizes the lateral fluting 21 on screw pilot sleeve 2 and substrate 1 to be accurately positioned entry point, and with Kirschner wire or
After open circuit device breaks the cortical bone of entry point, in guide pin pilot sleeve 3 is set in screw pilot sleeve 2 and outside employing detachably
The collar 4 is fixed, and is directed to positioning needle and pierces pedicle of vertebral arch along guide pin pilot sleeve 3 uniform pressurization, sets up bone passage, exit guiding
Positioning needle, then extract detatachable external sleeve ring 4, guide pin pilot sleeve 3, by pedicle screw along screw pilot sleeve 2 uniform pressurization
Pierce in the bone passage that pedicle of vertebral arch has built up, after pedicle screw inserts pedicle of vertebral arch certain depth, be equivalent to screw cap and connect
After nearly screw pilot sleeve 2 upper limb, nail guide plate entirety will be put and take off, then by whole for pedicle screw screw hole in pedicle of vertebral arch
Insert.Using this combination type spinal column to put nail guide plate when putting nail, whole process need not multiple bearing, puts nail guide plate and only needs one
Secondary laminating is positioned at spinous process and vertebral plate surface of bone, and the guiding that i.e. may utilize guide pin pilot sleeve 3 and screw pilot sleeve 2 completes follow-up
Guide location pin puncture and put nail, when guide location pin can be avoided to insert pedicle screw again after extracting screw orientation guide
Positioning needle is subjected to displacement on the basis of direction, it is possible to is greatly improved the degree of accuracy putting nail, and can shorten operating time, improves hands
Art efficiency, reduces unnecessary fluoroscopy during operation.This combination type spinal column put nail guide plate simple in construction, be prone to make, easy to operate.
Further, screw pilot sleeve 2 or screw pilot sleeve 2 and substrate 1 are provided with for pedicle screw along screw
The lateral fluting 21 of pilot sleeve 2 radial direction removal, by arranging this laterally fluting 21, guides along screw at pedicle screw
After pedicle of vertebral arch certain depth inserted by sleeve 2, nail guide plate entirety will be put and tear to side, pedicle screw can be made laterally to slot 21
Nail guide plate is put in abjection, it is achieved pedicle screw separates with putting nail guide plate, the most only need to put and follow closely guide plate entirety and take off, can be by
Pedicle screw is entirely within, and again inserts without after being taken out by pedicle screw, can not only save operating procedure, enter
One step shortens operating time, and pedicle screw once insert beneficially improve put nail precision and pedicle screw insert after firm
Property.
The screw pilot sleeve 2 of the present embodiment is connected to inside the edge of substrate 1, therefore at screw pilot sleeve 2 and base
On plate 1, fluting forms lateral fluting 21 simultaneously, so that pedicle screw can laterally be slotted and 21 be moved and put nail guide plate and separate.
In other embodiments, if screw pilot sleeve 2 is connected to the edge of substrate 1, then only to open lateral on screw pilot sleeve 2
Fluting 21.
In the present embodiment, guide pin pilot sleeve 3 is provided with and slides on screw pilot sleeve 2 axial direction with laterally fluting 21
The slide unit 31 coordinated, when guide pin pilot sleeve 3 is inserted in screw pilot sleeve 2, slide unit 31 inserts lateral fluting 21 and by lateral
Fluting 21 fills up, by slide unit 31 and the mutual restriction effect of lateral fluting 21, it is possible to strengthen guide pin pilot sleeve 3 and lead at screw
Location in sleeve 2, is beneficial to improve the accuracy that guide location pin punctures and puts nail.
Further, the outer cover of screw pilot sleeve 2 is provided with a detatachable external sleeve ring 4, can prevent from putting nail guide plate and bone
During the laminating of face, human muscular tissue promotes guide pin pilot sleeve 3 to deviate from screw pilot sleeve 2.
In the present embodiment, it is provided with one between screw pilot sleeve 2 and substrate 1 and strengthens strut 5, it is possible to strengthen screw and guide
The steadiness that sleeve 2 is connected with substrate 1, it is ensured that during use, screw pilot sleeve 2 does not rocks, also may be used additionally, strengthen strut 5
Avoid putting the nail guide plate strength of materials to deform not the problem of displacement.When substrate 1 is provided with two or more screw fairlead
During cylinder 2, it is also possible to connection reinforcement strut 5 between two adjacent screw pilot sleeves 2, enhancing can be played equally and connect steady
The effect of solidity.
The laminating locating surface of the present embodiment substrate 1 is to treat that the CT data acquisition 3D printer of operative region prints according to spinal column
The curved surface of molding, it is ensured that with spinal column, laminating locating surface treats that the spinous process of operative region and vertebral plate surface of bone are fitted completely, not by patient spine
Dash forward and the individuation differentia influence of lamina surface shape.
In the present embodiment, substrate 1 is provided with two groups of All-in-One guidance sets being respectively used to carry out putting nail from spinal column both sides.
In other embodiments, substrate 1 also can be provided with more than one group for the All-in-One guidance set carrying out putting nail from spinal column side.
Namely put nail guide plate and can be designed as bilateral and assist simultaneously and put nail, it is possible to it is designed as the single vertebral body of one side or multiple vertebral body simultaneously
Auxiliary puts nail.
In the present embodiment, substrate 1 and/or screw pilot sleeve 2 are provided with for Kirschner wire through to be put by combination type spinal column
Nail guide plate is fixed on epispinal auxiliary positioning hole, uses Kirschner wire to insert in vertebra through this auxiliary positioning hole, can make to put nail
Guide plate entirety secure fit is not moved in surface of bone.
A kind of combinations thereof formula spinal column puts the manufacture method of nail guide plate, comprises the following steps:
(A) treat operative site spinal segments and carry out three-D CT scanning, it is thus achieved that original CT data；
(B) use medical image processing software that original CT data is processed, reconstruct the spinal three-dimensional model of 1:1 size；
Above-mentioned medical image processing software is existing conventional software, such as, mimics.Spinal three-dimensional model is in this medical image processing
Can carry out 360 ° of rotations on software, tomography is observed, blur and the operation such as interpolation；
(C) use medical image processing software to simulate on spinal three-dimensional model and insert pedicle screw or lateral mass screw, from
All directions observe pedicle screw when being fully located in lateral mass, pedicle of vertebral arch and vertebral body, labelling entry point, screw orientation and spiral shell
Nail length and diameter；
(D) design substrate 1, extraction intends inserting pedicle screw or the spinous process of lateral mass screw and lamina surface number of contours it is believed that
Breath, carries out surface fitting and obtains the laminating locating surface of substrate 1, and this laminating locating surface is fitted completely with corresponding bone surface；
(E) according to entry point, screw orientation and screw length and the diameter information of step C institute labelling, design many on substrate 1
Unification guidance set, including the screw pilot sleeve 2 with lateral fluting 21, the guide pin pilot sleeve 3 of band slide unit 31；Redesign out
Strengthen strut 5 and auxiliary fixing hole；
(F) 3D printing device is used to process substrate 1 and All-in-One guidance set.
Putting nail guide plate due to combination type spinal column uses medical image processing software inversely to weigh according to patient spine anatomic landmark
Organizational system is made, and uses 3D printing technique to print machine-shaping, it is possible to accurately quickly determine pedicle screw or lateral mass spiral shell
Nail entry point and nail direction, road, and not by the individuation differentia influence of patient's spinous process and lamina surface shape, can guarantee that laminating is fixed
The accuracy of position, so that it is guaranteed that put the accuracy of nail.
The above is only the preferred embodiment of the present invention, and protection scope of the present invention is not limited merely to above-mentioned enforcement
Example.To those of ordinary skill in the art, the improvement obtained by under without departing from the technology of the present invention concept thereof and change
Change and also should be regarded as protection scope of the present invention.
Claims (10)
1. combination type spinal column puts a nail guide plate, and including substrate (1), described substrate (1) is provided with for the spinous process and vertebra with spinal column
The laminating locating surface of plate rear surface of bone laminating, it is characterised in that: described substrate (1) is provided with more than one group All-in-One guiding group
Part, described All-in-One guidance set includes the screw pilot sleeve (2) being fixed on substrate (1) and is sheathed on screw fairlead
Guide pin pilot sleeve (3) in cylinder (2), the axis of described screw pilot sleeve (2) and the axis weight of guide pin pilot sleeve (3)
Close.
Combination type spinal column the most according to claim 1 puts nail guide plate, it is characterised in that: described screw pilot sleeve (2) or
Person's screw pilot sleeve (2) and substrate (1) be provided with for pedicle screw along screw pilot sleeve (2) radial direction remove lateral
Fluting (21).
Combination type spinal column the most according to claim 2 puts nail guide plate, it is characterised in that: described guide pin pilot sleeve (3) sets
There is the slide unit (31) being slidably matched on screw pilot sleeve (2) axial direction with described lateral fluting (21).
Combination type spinal column the most according to claim 3 puts nail guide plate, it is characterised in that: described screw pilot sleeve (2)
Outer cover is provided with a detatachable external sleeve ring (4).
Combination type spinal column the most according to claim 1 puts nail guide plate, it is characterised in that: described screw pilot sleeve (2) with
It is provided with more than one between substrate (1) and strengthens strut (5).
Combination type spinal column the most according to claim 1 puts nail guide plate, it is characterised in that: the laminating location of described substrate (1)
Treating the SCT data of operative region according to face, use the curved surface of 3D printer printing shaping, described curved surface is planned to implement with spinal column
Spinous process and the vertebral plate rear surface of bone of operation vertebra are fitted completely, and ensure that substrate can not on spinous process, vertebral plate when pressurization is fixing
Slide.
Combination type spinal column the most according to claim 1 puts nail guide plate, it is characterised in that: described substrate (1) is provided with two groups
It is respectively used to carry out putting the All-in-One guidance set of nail from vertebra both sides.
Combination type spinal column the most according to claim 1 puts nail guide plate, it is characterised in that: described substrate (1) is provided with at least
One group for carrying out putting the All-in-One guidance set of nail from vertebra side.
Combination type spinal column the most according to claim 1 puts nail guide plate, it is characterised in that: described substrate (1) and/or screw are led
To sleeve (2) be provided with for Kirschner wire through with combination type spinal column is put nail guide plate be fixed on epispinal auxiliary positioning hole.
10. combination type spinal column described in a claim 1 puts the manufacture method of nail guide plate, it is characterised in that: comprise the following steps:
(A) treat operative site spinal segments and carry out three-D CT scanning, it is thus achieved that original CT data；
(B) use medical image processing software that original CT data is processed, reconstruct the spinal three-dimensional model of 1:1 size；
(C) on spinal three-dimensional model, pedicle screw or lateral mass screw are inserted in simulation, labelling entry point, screw orientation and
Screw length and diameter；
(D) design substrate (1), extraction intends inserting pedicle screw or the spinous process of lateral mass screw and lamina surface number of contours it is believed that
Breath, carries out surface fitting and obtains the laminating locating surface of substrate (1)；
(E) according to entry point, screw orientation and screw length and the diameter information of step (C) institute labelling, substrate is designed
Comprise screw specification, direction, entry point, set up and expand the All-in-One guidance set that bone passage is integrated；
(F) 3D printing device is used to process substrate (1) and All-in-One guidance set.
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| Application Number | Priority Date | Filing Date | Title |
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| CN201610631834.1A CN106137373A (en) | 2016-08-04 | 2016-08-04 | Combination type spinal column puts nail guide plate and preparation method thereof |
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| Application Number | Priority Date | Filing Date | Title |
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| CN201610631834.1A CN106137373A (en) | 2016-08-04 | 2016-08-04 | Combination type spinal column puts nail guide plate and preparation method thereof |
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Cited By (11)
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| CN107007344A (en) * | 2017-05-31 | 2017-08-04 | 上海光韵达数字医疗科技有限公司 | Percutaneously put nail guide plate |
| CN108652731A (en) * | 2017-03-29 | 2018-10-16 | 深圳市普天阳医疗科技股份有限公司 | A kind of backbone sets nail guide plate and production method |
| CN108888331A (en) * | 2018-07-24 | 2018-11-27 | 华中科技大学同济医学院附属协和医院 | A kind of lagging guide plate and its precise positioning method |
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| CN110251246A (en) * | 2019-07-19 | 2019-09-20 | 丁焕文 | A kind of scoliosis orthopedic Split Positioning device |
| CN110693551A (en) * | 2019-09-29 | 2020-01-17 | 中国医学科学院北京协和医院 | Dura mater suture pusher for simulating nerve endoscopic skull base operation |
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| US10869722B2 (en) | 2016-11-02 | 2020-12-22 | Rochester Institute Of Technology | Method and fixture for guided pedicle screw placement |
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Application publication date: 20161123 |