CN106175908B - A kind of minimally invasive pedicle screw navigation template of outer individuation of the skin for having an X-rayed auxiliary - Google Patents
A kind of minimally invasive pedicle screw navigation template of outer individuation of the skin for having an X-rayed auxiliary Download PDFInfo
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- CN106175908B CN106175908B CN201610506151.3A CN201610506151A CN106175908B CN 106175908 B CN106175908 B CN 106175908B CN 201610506151 A CN201610506151 A CN 201610506151A CN 106175908 B CN106175908 B CN 106175908B
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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
- A61B17/56—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
- A61B2017/00526—Methods of manufacturing
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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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Abstract
The invention belongs to technical field of medical instruments, more particularly to a kind of minimally invasive pedicle screw navigation template of outer individuation of the skin for having an X-rayed auxiliary, it is characterised in that：There is the template individuation pilot hole of the minimally invasive pedicle screw guide pin entrance of the guiding of perspective auxiliary, middle part to be bent to form a spill and are fixed on for template outside skin.Template in the present invention is fully seated in vitro, improves its accuracy by having an X-rayed auxiliary, template can be integral by Kirschner wire connection and improve its stability, appropriate in sagittal plain can also be adjusted, be adapted to different positions；While it is also smaller on the radiation exposure of reduction medical worker and patient, bed, with preferable replicability.
Description
Technical field
The invention belongs to technical field of medical instruments, more particularly to a kind of minimally invasive pedicle of vertebral arch of outer individuation of the skin for having an X-rayed auxiliary
Screw navigation template.
Background technology
Thoracolumbar disk vertebral compression and blow-out fracture are the common types of spine fracture, are through fixed in posterior Pedicle
System is the preferred measure for handling such damage.Because conventional open is put, tack operation wound is larger, tissue dissection scope is relatively wide, operation
In can to surrounding tissue for a long time pull, and influence patient's postoperative function recover, so recently as vertebral column minimally invasive surgery
Development, percutaneous cervical arc root screw technique for fixing is increasingly subject to pay attention to, the determination in pedicle screw entry point and screw way direction in art
It is the key of this technology, but Thoracolumbar disk anatomical structure is more complicated and variation is big, in conventional percutaneous cervical arc root operation often
Underlying nail need to be continuously had an X-rayed, causes medical worker and patient radiation dose to increase, leukaemia and cutaneum carcinoma can be caused for a long time
Occur, though the pedicle of vertebral arch of free-hand limited touch, which puts nail method, can reduce perspective, extend operating time, and be harder to meet same
Centrum bilateral Screw entrance point and the uniformity in direction, influence reset effect.
The outer individuation template of the skin that currently exists in addition, be using the form outside skin as template Individual design,
But skin soft tissue activity is big, the influence such as receptor site, and do not allow to be fixed easily, hence it is evident that the accuracy of influence positioning.
The content of the invention
In order to solve the above-mentioned technical problem, the present invention provides a kind of outer individuation of the skin for having an X-rayed auxiliary minimally invasive pedicle screw
Navigation template, makes percutaneous cervical arc root screw implantation in minimally invasive spine surgical accurate, while reducing the radiation of patient and medical personnel.
The outer minimally invasive pedicle screw of individuation of skin for solving a kind of perspective auxiliary in the present invention of above technical problem is led
Model plane plate, it is characterised in that：The individuation that there is the template the minimally invasive pedicle screw guide pin of guiding of perspective auxiliary to enter is led
Xiang Kong, middle part are bent to form a spill, and are fixed on for template outside skin.
The template both sides are horizontal link structure, sign and positioning；Fixed and attachment structure for navigation in the middle part of template, template two
Side is connected by template inclined portion structure；
The individuation pilot hole includes the lower sign pedicle of vertebral arch projection centre positioning of the lower sign spinous process positioning hole of perspective, perspective
Hole, the lower sign centrum upper limb Kirschner wire positioning hole of perspective and the lower pedicle of vertebral arch hollow screw pilot pin that can suitably adjust of perspective auxiliary
Pilot hole, has an X-rayed lower sign pedicle of vertebral arch projection centre positioning hole to the sign pedicle of vertebral arch projection centre pilot pin through under having an X-rayed,
The lower sign centrum upper limb Kirschner wire positioning hole of perspective is to through lower sign centrum upper limb pilot pin is had an X-rayed, perspective is lower to indicate spinous process
Positioning hole through perspective is lower to indicate spinous process pilot pin.
The positioning hole of the setting auxiliary perspective of some holes of this in the present invention, middle supraspinous hole is fixed template action.
It is 2 that pedicle of vertebral arch projection centre positioning hole is indicated under the perspective, is symmetrically positioned in the lower sign spinous process navigation hole of perspective
Both sides, the lower sign centrum upper limb Kirschner wire positioning hole of perspective is horizontal both sides insertion, is respectively arranged on left horizontal even sidepiece and right horizontal company
Sidepiece.
Spinous process positioning hole is indicated under the perspective and is located at bottom in the middle part of template, hole open at one end upside in the middle part of template
Face, one end is located at downside in the middle part of template；The lower sign pedicle of vertebral arch projection centre positioning hole of perspective is located at template inclined portion structure, hole
Open at one end is located at template inclined portion upper side, and the other end is located at downside in the middle part of template；The lower sign centrum upper limb Kirschner wire of perspective
Positioning hole open at one end is located at template inclined portion upper side and close to top end, and other end level is located at horizontal even end side surface；Perspective is auxiliary
The pedicle of vertebral arch hollow screw that helping down suitably to adjust positions needle guide hole and is located at fixed navigation and attachment structure and horizontal link structure
Junction, with the inclined angle of individuation athwart template upper surface and template lower surface.
The navigation is fixed and attachment structure bottom is provided with fixed spinous process positioning hole, passes perpendicularly through the fixed and connection knot that navigates
Structure upper surface and navigation are fixed and attachment structure lower surface, are fixed to strengthen positioning, are not involved in Fluoroscopy location.
The fixed spinous process positioning hole number 1-3.
The lower pedicle of vertebral arch hollow screw positioning needle guide hole number that can suitably adjust of the perspective auxiliary>=2.
The horizontal link structure upper surface is provided with instruction block.
The template thickness 14-16mm.
The lower sign pedicle of vertebral arch projection centre positioning hole of spinous process positioning hole, perspective, the lower sign vertebra of perspective are indicated under the perspective
The aperture of body upper limb Kirschner wire positioning hole and the lower pedicle of vertebral arch hollow screw positioning needle guide hole that can suitably adjust of perspective auxiliary is
2.1mm, fits in through 2mm diameter Kirschner wires.
In the present invention template edge can also Passivation Treatment, to avoid weighing skin wounded.
The individuation skin exterior sheathing of perspective auxiliary is combined in the present invention, by fluoroscopy during operation auxiliary positioning, template is solved
The problem of changing is moved with skin, the pilot pin for being fixed on spinous process is also increased in addition, movement is prevented.
Template in the present invention makes percutaneous accurate placement and easily fixed, and template is disposed entirely within outside skin, when in art not
Need otch to place, spinous process pilot pin is designed in addition and strengthens locating effect.
Template in the present invention be fully seated in vitro, by have an X-rayed auxiliary improve its accuracy, template can by gram
The connection of family name's pin, which is integral, improves its stability, appropriate in sagittal plain can also be adjusted, is adapted to different positions；Together
When reduce it is also smaller on the radiation exposure of medical worker and patient, bed, with preferable replicability.
Navigation template is suitable for needing the puncture pedicle of vertebral arch root of individuation in the present invention, single operation centrum, such as pvp or
Pkp performs the operation, and be particularly suitable for use in the elderly.
Brief description of the drawings
Fig. 1-2 is the three-dimensional structure diagram of navigation template in the present invention
Fig. 3 is the combination schematic diagram of navigation template and Kirschner wire in the present invention
Fig. 4 is the combination schematic diagram of navigation template and Thoracolumbar disk bone in the present invention
Being specifically identified wherein in figure is as follows:1. under the lower sign pedicle of vertebral arch projection centre positioning hole of perspective, 2. perspective auxiliary
The pedicle of vertebral arch hollow screw positioning needle guide hole that can suitably adjust, the lower sign spinous process positioning hole of 3. perspectives, the lower sign vertebra of 4. perspectives
Body upper limb Kirschner wire positioning hole, 5. fixation spinous process positioning holes, 6. instruction blocks, 7. horizontal link structures (left horizontal even 7-1, right horizontal even 7-2),
8. under template edge, the lower sign pedicle of vertebral arch projection centre pilot pin of 9. perspectives, the lower sign spinous process pilot pin of 10. perspectives, 11. perspectives
Centrum upper limb pilot pin is indicated, 12. navigation are fixed and attachment structure, 13. template inclined portion structures (template inclined portion upper side 13-1),
14. bottom (downside 14-2 in the middle part of upper side 14-1, template in the middle part of template), 15. template upper surfaces, 16. templates in the middle part of template
Lower surface, 17. Thoracolumbar disk bones, 18. enter nail pipe, 19. horizontal even end side surfaces
Embodiment
With specific embodiment, the present invention is further illustrated below：
Embodiment 1
Have an X-rayed the minimally invasive pedicle screw navigation template of the outer individuation of skin of auxiliary, the minimally invasive vertebral arch of guiding with perspective auxiliary
The individuation pilot hole of root screw guide pin entrance, middle part are bent to form a spill, and are fixed on for template outside skin.
Template both sides are horizontal link structure, sign and positioning；Fixed and attachment structure for navigation in the middle part of template, template both sides lead to
Template inclined portion structure is crossed to be connected.Wherein, individuation pilot hole includes the lower sign spinous process positioning hole of perspective, the lower sign vertebral arch of perspective
The lower sign centrum upper limb Kirschner wire positioning hole of root projection centre positioning hole, perspective and the lower pedicle of vertebral arch that can suitably adjust of perspective auxiliary
Hollow screw positions needle guide hole, and the lower sign pedicle of vertebral arch projection centre positioning hole of perspective through the lower sign pedicle of vertebral arch of perspective to throw
Centrum upper limb Kirschner wire positioning hole is indicated under shadow center locating pin, perspective to the sign centrum upper limb pilot pin through under having an X-rayed,
The lower sign spinous process positioning hole of perspective is to the sign spinous process pilot pin through under having an X-rayed.The setting auxiliary perspective of some holes of this in the present invention
Positioning hole, middle supraspinous hole is fixed template action.
The lower sign spinous process positioning hole of perspective coordinates Fluoroscopy location, disposes Fluoroscopy location Kirschner wire.
The lower sign pedicle of vertebral arch projection centre positioning hole of perspective is 2, is symmetrically positioned in the lower sign spinous process navigation hole both sides of perspective,
The lower sign centrum upper limb Kirschner wire positioning hole of perspective is horizontal both sides insertion, is respectively arranged on left horizontal even sidepiece and right horizontal even sidepiece.
The lower sign spinous process positioning hole of perspective is located at bottom in the middle part of template, and hole open at one end is located at upper side in the middle part of template, one
End is located at downside in the middle part of template；The lower sign pedicle of vertebral arch projection centre positioning hole of perspective is located at template inclined portion structure, hole opening
One end is located at template inclined portion upper side, and the other end is located at downside in the middle part of template；The lower sign centrum upper limb Kirschner wire positioning of perspective
Hole open at one end is located at template inclined portion upper side and close to top end, and other end level is located at horizontal even end side surface；Under perspective auxiliary
The pedicle of vertebral arch hollow screw positioning needle guide hole that can suitably adjust is located at fixed navigation and attachment structure and the connection of horizontal link structure
Place, with the inclined angle of individuation athwart template upper surface and template lower surface.
Navigation is fixed and attachment structure bottom is provided with fixed spinous process positioning hole, passes perpendicularly through and navigates in fixed and attachment structure
Surface and navigation are fixed and attachment structure lower surface, are fixed to strengthen positioning, are not involved in Fluoroscopy location.
Fixed spinous process navigation hole number 3, template thickness 14mm, the lower pedicle of vertebral arch hollow screw that can suitably adjust of perspective auxiliary
Position needle guide hole number 10, template thickness 14mm or 16mm.The lower pedicle of vertebral arch hollow screw that can suitably adjust of perspective auxiliary is determined
Position needle guide hole can also increase to more than 10, it is possible to reduce Fluoroscopy location number of times, directly can be adjusted in different ducts, more
It is convenient to operate in art.
Under perspective under the lower sign pedicle of vertebral arch projection centre positioning hole of sign spinous process positioning hole, perspective, perspective on sign centrum
The aperture of edge Kirschner wire positioning hole and the lower pedicle of vertebral arch hollow screw positioning needle guide hole that can suitably adjust of perspective auxiliary is
2.1mm, fits in through 2mm diameter Kirschner wires.Spinous process table is shallow, in pedicle of vertebral arch low level.Displacement can be avoided with Kirschner wire fixation.
Embodiment 2
Have an X-rayed the minimally invasive pedicle screw navigation template of the outer individuation of skin of auxiliary, the minimally invasive vertebral arch of guiding with perspective auxiliary
The individuation pilot hole of root screw guide pin entrance, middle part are bent to form a spill, and are fixed on for template outside skin.
Template both sides are horizontal link structure, sign and positioning；Fixed and attachment structure for navigation in the middle part of template, template both sides lead to
Template inclined portion structure is crossed to be connected.Wherein, individuation pilot hole includes the lower sign spinous process positioning hole of perspective, the lower sign vertebral arch of perspective
The lower sign centrum upper limb Kirschner wire positioning hole of root projection centre positioning hole, perspective and the lower pedicle of vertebral arch that can suitably adjust of perspective auxiliary
Hollow screw positions needle guide hole, and the lower sign pedicle of vertebral arch projection centre positioning hole of perspective through the lower sign pedicle of vertebral arch of perspective to throw
Centrum upper limb Kirschner wire positioning hole is indicated under shadow center locating pin, perspective to the sign centrum upper limb pilot pin through under having an X-rayed,
The lower sign spinous process positioning hole of perspective is to the sign spinous process pilot pin through under having an X-rayed.The setting auxiliary perspective of some holes of this in the present invention
Positioning hole, middle supraspinous hole is fixed template action.
The lower sign pedicle of vertebral arch projection centre positioning hole of perspective is 2, is symmetrically positioned in the lower sign spinous process navigation hole both sides of perspective,
The lower sign centrum upper limb Kirschner wire positioning hole of perspective is horizontal both sides insertion, is respectively arranged on left horizontal even sidepiece and right horizontal even sidepiece.
The lower sign spinous process positioning hole of perspective is located at bottom in the middle part of template, and hole open at one end is located at upper side in the middle part of template, one
End is located at downside in the middle part of template；The lower sign pedicle of vertebral arch projection centre positioning hole of perspective is located at template inclined portion structure, hole opening
One end is located at template inclined portion upper side, and the other end is located at downside in the middle part of template；The lower sign centrum upper limb Kirschner wire positioning of perspective
Hole open at one end is located at template inclined portion upper side and close to top end, and other end level is located at horizontal even end side surface；Under perspective auxiliary
The pedicle of vertebral arch hollow screw positioning needle guide hole that can suitably adjust is located at fixed navigation and attachment structure and the connection of horizontal link structure
Place, with the inclined angle of individuation athwart template upper surface and template lower surface.
Navigation is fixed and attachment structure bottom is provided with fixed spinous process positioning hole, passes perpendicularly through and navigates in fixed and attachment structure
Surface and navigation are fixed and attachment structure lower surface, are fixed to strengthen positioning, are not involved in Fluoroscopy location.The horizontal surface that connects is provided with
Indicate block.
Fixed spinous process navigation hole number 3, template thickness 15mm, the lower pedicle of vertebral arch hollow screw that can suitably adjust of perspective auxiliary
Position needle guide hole number 5.
Under perspective under the lower sign pedicle of vertebral arch projection centre positioning hole of sign spinous process positioning hole, perspective, perspective on sign centrum
The aperture of edge Kirschner wire positioning hole and the lower pedicle of vertebral arch hollow screw positioning needle guide hole that can suitably adjust of perspective auxiliary is
2.1mm, fits in through 2mm diameter Kirschner wires.Template edge can also Passivation Treatment, to avoid weighing skin wounded.
Beneficial effect in the present invention：
1. guiding minimally invasive can significantly reduce operating time, perspective number of times, the spoke for reducing medical worker and patient when putting nail
Dosage is penetrated, intraoperative hemorrhage is reduced；
2. the minimally invasive accuracy and uniformity for putting and following closely and pedicle screw being significantly improved compared with traditional operation is guided；Compared with optical navigation
The underlying nail of guiding also has more preferable uniformity.
3. nail is put in guiding has application and promotional value in minimally invasive spine surgical, it is easy to which basic hospital is promoted.
Method for preparing template is as follows in the present invention：
(1) segmentation and foundation of threedimensional model
The row CT of pre-operative patients row 64 (Siemens Company, Germany) scanning；The condition of scanning：Voltage 120kV, electric current 150mA, layer
Thick 0.625mm, matrix 512 512；The data of collection are stored in dicom format；In Mimics14.11, (Materialise is public
Department, Belgium) original Dicom formatted datas are imported in software.
By the way that " Crop project " instruments select required fixed-segment diminution modeling scope to improve desin speed；
" Thresholding " instrument obtains original cover of Thoracolumbar disk and covered；" Regiongrowing " instrument reduces and changes above-mentioned illiteracy cover (figure
4)；Cover on cover that " Calcuate 3D " instruments set up threedimensional model with this.
(2) design of the minimally invasive guide pin of standard
In Mimics softwares " Medcad " menu, diameter 2.1mm cylinder is inserted in simulation, and this cylinder is to represent empty
Intend the minimally invasive pedicle screw guide pin inserted.Virtual guide pin meets following condition in Mimics softwares：①“Online
Reslice " is in guide pin entry point horizontal resection, and standard anteroposterior position simulation X-ray film guide pin is located at pedicle of vertebral arch and projects outer ledge, left
The Screw entrance point distribution of 3 pieces of right side is on the same line；2. " Online Reslice " pass through pedicle of vertebral arch level completely in guide pin
Cutting, standard anteroposterior position simulation X-ray film guide pin is located at pedicle of vertebral arch and projects inside edge；3. observed in threedimensional model, sagittal plain spiral shell
Follow closely parallel into the upper soleplate of nail direction and centrum, same centrum pedicle screw entry point is symmetrical with entering to follow closely direction left and right sides.
(3) design of the lower pilot pin of perspective auxiliary and the optional minimally invasive guide pin of simulation
The outer individuation template of skin is not that, using the formalness of skin as template construct, therefore it is auxiliary to combine perspective
Help the position that just can determine that template in art, thus we devise pilot pin three parallel to centrum upper limb, by spinous process and
The pilot pin at bilateral pedicle of vertebral arch center three, altogether six roots of sensation Fluoroscopy location pin, pilot pin diameter 2.1mm；We also allow for not
Influence with position and skin thickness is so devise some screw ways parallel to the minimally invasive guide pin of standard, screw way diameter 2.1mm, on
Screw way is stated to preserve with stl file with pilot pin and the bit model of centrum three.
(3) design and printing of template
The design procedure of template is as follows：1. in the softwares of Geomagic Studio 2013 (Geomagic companies, the U.S.)
Import above-mentioned stl file simultaneously；2. it is close to the template of skin by Geomagic Studio Software for Design, template thickness 15mm,
It is boundary-passivated to avoid oppressing skin；3. " drawing a circle " instrument is used to delete virtual screw way 2.1mm inner core, this inner core is minimally invasive vertebra
The navigation passage of pedicle screw guide pin；4. " drawing a circle " instrument is used to delete Fluoroscopy location pin 2.1mm inner core simultaneously, this inner core is
For the kirschner needle passageway of auxiliary template Fluoroscopy location in art；5. for ease of fixed outside the skin of template, our individuations are devised
Puncture the Kirschner wire for entering spinous process；6. template becomes an entirety by the Kirschner wire of longitudinal direction, so can both reduce its rolling
It is dynamic to improve the degree of accuracy, while a range of regulation can also be carried out to minimally invasive guide pin in position chanP；7. in template surface
The name and section mark of upper design patient, is easy to distinguish in art.
Above-mentioned digital model is saved as into the incoming 3D printer of STL formatted files (3D SYSTEMS companies, the U.S.) to enter
Row 3D material object printings, printed material is resin material (3D SYSTEMS companies, the U.S.).
Process of the navigation template of the present invention in art：
In art in fixation be long-armed single pedicle screw system (Beijing City Fule Technology Development Co., Ltd, in
State), patient takes the prone position of hanging belly after general anesthesia.Using C-arm X-ray machine, standard normotopia takes the photograph piece centered on hindering vertebra, confirms
Spinous process is located at the center of left and right sides pedicle of vertebral arch projection join line.Body surface marking hinders vertebra and the adjacent upper limb of pleurocentrum end to end, each vertebra
The line of line and left and right sides the pedicle of vertebral arch projection of body spinous process.1 piece of diameter 2mm Kirschner wires are selected to respectively penetrate the horizontal stroke of above-mentioned each template
To Fluoroscopy location hole, then 3 pieces are selected to penetrate longitudinal Fluoroscopy location hole, standard normotopia takes the photograph piece and confirms that perspective Kirschner wire reaches Design
It is required that (laterally perspective Kirschner wire is located at each centrum upper limb, longitudinal direction perspective Kirschner wire and is located at spinous process line and both sides pedicle of vertebral arch respectively
Projection centre line), spinous process is driven into shorter diameter 2mm Kirschner wires and is fixed with the sticky pad pasting of operation.
By above-mentioned normotopia take the photograph piece on the basis of substantially suitable pilot hole is selected in template, diameter 2mm is percutaneously driven into successively
Kirschner wire amounts to 6 pieces, reaches after sclerotin, and piece is taken the photograph in row positive side position, and pilot hole adjustment positioning Kirschner wire is closed on according to X-ray film selection,
Until the Kirschner wire being driven into is adjusted to normotopia and reaches pedicle of vertebral arch projecting edge, side position is parallel (with Design with the upper soleplate of centrum
It is identical), continue to be driven into Kirschner wire, make its needlepoint side position when reaching centrum rear wall, normotopia is located at pedicle of vertebral arch and projects inner side, continues to hit
Enter kernig sign into before centrum 1/3.Expansion sleeve and protection sleeve are put into step by step along positioning Kirschner wire successively, with hollow screw tap edge
Position Kirschner wire and expand screw way, select suitable diameter and the long-armed single pedicle screw of length to be screwed into vertebra along positioning Kirschner wire
Body, inserts 6 pieces altogether, and the screw length for hindering vertebra selection is slightly shorter.The angle of appropriate adjustment operation table, vertebra is hindered by Postural reduction.
Pre-bending is carried out by the pitman of the superfine method choice appropriate length of Wu, pitman is percutaneously sequentially inserted into 3 pieces of long-armed singles by otch
Follow closely bottom.Screw tail cap is inserted, appropriate distraction reduction centrum is simultaneously locked, and fracture nail tail, art finishes.
The navigation template preparation used time in the present invention is not long, clinical operation requirement is disclosure satisfy that, with generalization.This group is suffered from
Person extracts data from being admitted to hospital and can completed to stencil marking in 12h.For the base without 3D printer and stencil design ability
Layer hospital can also upload initial data, outsourcing design template and 3D material object printings, then pass through logistics express delivery by interconnection path
It is sent to.With becoming increasingly popular for 3D printing, the printing cost of current template is not high, influences little to the financial burden of patient,
Application template can provide more technical guarantees for operative doctor on the contrary, gradually step up its technology, reduce complication for patients, make
Patient is benefited.
Effect example 1
Patient male, 55 years old, is chief complaint and is sought medical advice with " flank pain activity difficulty 3+ hours ".Before 3+ hours, patient Yin Che
Misfortune wound causes flank pain activity difficulty to be admitted to hospital.Regain consciousness after wound, no vomiting and chest and abdomen pain do not do double lower limb numbness powerless.Training is examined
Look into：Backbone kowtows tenderness substantially in chest waist section kyphosis deformity, and waist activity is substantially limited.The DR and CT that is admitted to hospital is pointed out：The centrum of waist 2 is quick-fried
Fragility is fractured.Admission diagnosis：The centrum bursting fracture of waist 2.
Correlation Preoperative Method is improved after being admitted to hospital, after definitely operation taboo, the minimally invasive pedicle screw fixation of the way of escape is planned to implement.
Preoperative to import patient's original CT data in Mimics softwares, make this patent introduction " has an X-rayed the outer individuation of the skin aided in micro-
Wound pedicle screw navigation template " simultaneously prints material object by 3D printer.This template, Fluoroscopy location rear pattern plate energy are applied in art
It is fixed on well outside skin, no movement；" have an X-rayed the lower pedicle of vertebral arch hollow screw that can suitably adjust of auxiliary to determine by template in art
Position needle guide hole ", can safety insert hollow screw pilot pin, and smoothly insert hollow Pediculus arcus vertebrae screw fix lesion vertebra
Body.Operating time 2.5 hours under optical navigation, is shorten to 1 hour or so compared with 2 hours positioned under conventional mammogram.Perspective time
Number and intraoperative hemorrhage are also significantly reduced compared with aforesaid way.Postoperative CT examination, screw does not break through pedicle of vertebral arch cortex, and all screws are once
Property is punctured successfully, sagittal plane screw placement angle, poor screw sagittal plane angle, Screw entrance point difference in height, screw leaning angle difference
Etc. being " excellent ".Postoperative 1 year check screw non-loosening, union is good, and patient does not tell special discomfort.
The foregoing is merely illustrative of the preferred embodiments of the present invention, is not intended to limit the invention, all essences in the present invention
Any modifications, equivalent substitutions and improvements made within refreshing and principle etc., should be included in the scope of the protection.
Claims (9)
1. a kind of minimally invasive pedicle screw navigation template of outer individuation of the skin for having an X-rayed auxiliary, it is characterised in that：The template has
The individuation pilot hole that the minimally invasive pedicle screw guide pin of guiding of perspective auxiliary enters, middle part is bent to form a spill, and mould
Plate is fixed on outside skin；
The template both sides are horizontal link structure（7）, indicate and position；Fixed and attachment structure for navigation in the middle part of template（12）, mould
Plate both sides pass through template inclined portion structure（13）It is connected；
The individuation pilot hole includes the lower sign spinous process positioning hole of perspective（3）, the lower sign pedicle of vertebral arch projection centre positioning of perspective
Hole（1）, the lower sign centrum upper limb Kirschner wire positioning hole of perspective（4）With the lower pedicle of vertebral arch hollow screw that can suitably adjust of perspective auxiliary
Position needle guide hole（2）, the lower sign pedicle of vertebral arch projection centre positioning hole of perspective（1）To be projected through the lower sign pedicle of vertebral arch of perspective
Center locating pin（9）, the lower sign centrum upper limb Kirschner wire positioning hole of perspective（4）To be positioned through the lower sign centrum upper limb of perspective
Pin（11）, the lower sign spinous process positioning hole of perspective（3）To indicate spinous process pilot pin through perspective is lower（10）；
Wherein, template edge Passivation Treatment.
2. a kind of minimally invasive pedicle screw navigation template of outer individuation of the skin for having an X-rayed auxiliary according to claim 1, it is special
Levy and be：Pedicle of vertebral arch projection centre positioning hole is indicated under the perspective（1）For 2, the lower sign spinous process positioning of perspective is symmetrically positioned in
Hole（3）Both sides, the lower sign centrum upper limb Kirschner wire positioning hole of perspective（4）For horizontal both sides insertion, left horizontal company is respectively arranged on（7-1）
Sidepiece and right horizontal company（7-2）Sidepiece.
3. a kind of minimally invasive pedicle screw navigation template of outer individuation of the skin for having an X-rayed auxiliary according to claim 2, it is special
Levy and be：Spinous process positioning hole is indicated under the perspective（3）Positioned at bottom in the middle part of template（14）, hole open at one end is in the middle part of template
Upper side（14-1）, one end is located at downside in the middle part of template（14-2）；The lower sign pedicle of vertebral arch projection centre positioning hole of perspective（1）Position
In template inclined portion structure（13）Place, hole open at one end is located at template inclined portion upper side（13-1）, under the other end is in the middle part of template
Sideways（14-2）；The lower sign centrum upper limb Kirschner wire positioning hole of perspective（4）Open at one end is located at template inclined portion upper side（13-1）
And close to top end, other end level is located at horizontal even end side surface（19）；The lower hollow spiral shell of pedicle of vertebral arch that can suitably adjust of perspective auxiliary
Nail positioning needle guide hole（2）Fixed positioned at navigation and attachment structure（12）With horizontal link structure（7）Junction, with individuation
Degree of tilt athwart template upper surface（15）With template lower surface（16）.
4. the minimally invasive pedicle screw navigation template of individuation outside a kind of skin of perspective auxiliary according to claim 2, it is special
Levy and be：The navigation is fixed and attachment structure（12）Bottom is provided with fixed spinous process positioning hole（5）, pass perpendicularly through navigation it is fixed and
Attachment structure（12）Upper surface and navigation are fixed and attachment structure（12）Lower surface.
5. a kind of minimally invasive pedicle screw navigation template of outer individuation of the skin for having an X-rayed auxiliary according to claim 4, it is special
Levy and be：The fixed spinous process positioning hole（5）Number 1-3.
6. a kind of minimally invasive pedicle screw navigation template of outer individuation of the skin for having an X-rayed auxiliary according to claim 2, it is special
Levy and be：The lower pedicle of vertebral arch hollow screw positioning needle guide hole that can suitably adjust of the perspective auxiliary（2）Number>=2.
7. a kind of minimally invasive pedicle screw navigation template of outer individuation of the skin for having an X-rayed auxiliary according to claim 1, it is special
Levy and be：The horizontal link structure（7）Upper surface is provided with instruction block（6）.
8. a kind of minimally invasive pedicle screw navigation template of outer individuation of the skin for having an X-rayed auxiliary according to claim 1, it is special
Levy and be：The template thickness 14-16mm.
9. a kind of minimally invasive pedicle screw navigation template of outer individuation of the skin for having an X-rayed auxiliary according to claim 1, it is special
Levy and be：Spinous process positioning hole is indicated under the perspective（3）, the lower sign pedicle of vertebral arch projection centre positioning hole of perspective（1）, perspective subscript
Show centrum upper limb Kirschner wire positioning hole（4）Needle guide hole is positioned with the lower pedicle of vertebral arch hollow screw that can suitably adjust of perspective auxiliary
（2）Aperture be 2.1mm.
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| CN201610506151.3A CN106175908B (en) | 2016-06-29 | 2016-06-29 | A kind of minimally invasive pedicle screw navigation template of outer individuation of the skin for having an X-rayed auxiliary |
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| CN201610506151.3A CN106175908B (en) | 2016-06-29 | 2016-06-29 | A kind of minimally invasive pedicle screw navigation template of outer individuation of the skin for having an X-rayed auxiliary |
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| CN106175908B true CN106175908B (en) | 2017-10-27 |
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| CN106037921B (en) * | 2016-06-29 | 2018-04-03 | 自贡市第四人民医院 | Have an X-rayed the minimally invasive pedicle screw navigation template device of the outer individuation of skin of auxiliary |
| CN108078622A (en) * | 2018-02-09 | 2018-05-29 | 陕西东望科技有限公司 | It is a kind of to take root in the percutaneous guide plate used nail art suitable for vertebral arch |
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| JP5935218B2 (en) * | 2010-08-12 | 2016-06-15 | 国立大学法人富山大学 | Three-dimensional guide for insertion hole preparation wire for pedicle screw |
| US20120245587A1 (en) * | 2011-03-25 | 2012-09-27 | Jing-Jing Fang | Method for spinal drilling operation and guiding assembly |
| ITPI20110040A1 (en) * | 2011-04-08 | 2012-10-09 | Univ Pisa | DRILLING MASK FOR PLANTING A TRANSPEDUNCULAR SCREW |
| US9763704B2 (en) * | 2011-08-31 | 2017-09-19 | DePuy Synthes Products, Inc. | System and method for cervical midline fixation |
| CN202515768U (en) * | 2011-11-27 | 2012-11-07 | 严丹 | Pedicle screw locator |
| JP6259513B2 (en) * | 2013-06-07 | 2018-01-10 | フライ, ジョージFREY, George | Patient-compatible instruments and methods for performing surgical procedures |
| US10105234B2 (en) * | 2014-03-13 | 2018-10-23 | Warsaw Orthopedic, Inc. | Spinal implant system and methods of use |
| CN204379422U (en) * | 2015-01-05 | 2015-06-10 | 刘融 | A kind of atlas and axis pedicle screw guider |
| CN104688323B (en) * | 2015-03-31 | 2017-01-18 | 首都医科大学附属北京友谊医院 | 3D-printing cervical vertebra side block screw guide embedded plate and manufacturing method thereof |
| CN105193492A (en) * | 2015-08-20 | 2015-12-30 | 首都医科大学附属北京友谊医院 | 3D printed percutaneous pedicle guide plate and preparation method thereof |
| CN105534588B (en) * | 2016-02-15 | 2018-02-13 | 自贡市第四人民医院 | A kind of percutaneous individuation pedicle screw navigation template of detachable bilateral type |
| CN205924155U (en) * | 2016-06-29 | 2017-02-08 | 自贡市第四人民医院 | Auxiliary pedicle of vertebral arch screw navigation template of skin external individuation wicresoft of perspective |
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