CN108836341B - Spinal column three-dimensional positioning ruler - Google Patents
Spinal column three-dimensional positioning ruler Download PDFInfo
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- CN108836341B CN108836341B CN201810841261.4A CN201810841261A CN108836341B CN 108836341 B CN108836341 B CN 108836341B CN 201810841261 A CN201810841261 A CN 201810841261A CN 108836341 B CN108836341 B CN 108836341B
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- 239000000463 material Substances 0.000 claims abstract description 8
- 239000002184 metal Substances 0.000 claims description 8
- 229910001220 stainless steel Inorganic materials 0.000 claims description 8
- 239000010935 stainless steel Substances 0.000 claims description 8
- 239000003973 paint Substances 0.000 claims description 3
- 238000000034 method Methods 0.000 description 13
- 238000010586 diagram Methods 0.000 description 8
- 210000000115 thoracic cavity Anatomy 0.000 description 2
- 206010010356 Congenital anomaly Diseases 0.000 description 1
- 208000028389 Nerve injury Diseases 0.000 description 1
- 206010064932 Sacralisation Diseases 0.000 description 1
- 239000002390 adhesive tape Substances 0.000 description 1
- 230000009286 beneficial effect Effects 0.000 description 1
- 230000000903 blocking effect Effects 0.000 description 1
- 238000010276 construction Methods 0.000 description 1
- 230000007850 degeneration Effects 0.000 description 1
- 230000003111 delayed effect Effects 0.000 description 1
- 238000004049 embossing Methods 0.000 description 1
- 238000005530 etching Methods 0.000 description 1
- 210000003608 fece Anatomy 0.000 description 1
- 230000000968 intestinal effect Effects 0.000 description 1
- 230000003902 lesion Effects 0.000 description 1
- 239000003550 marker Substances 0.000 description 1
- 238000012986 modification Methods 0.000 description 1
- 230000004048 modification Effects 0.000 description 1
- 230000008764 nerve damage Effects 0.000 description 1
- 239000002245 particle Substances 0.000 description 1
- 230000002035 prolonged effect Effects 0.000 description 1
- 210000001032 spinal nerve Anatomy 0.000 description 1
- 238000001356 surgical procedure Methods 0.000 description 1
- 230000009466 transformation Effects 0.000 description 1
- 238000003466 welding Methods 0.000 description 1
Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/103—Detecting, measuring or recording devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes
- A61B5/107—Measuring physical dimensions, e.g. size of the entire body or parts thereof
- A61B5/1072—Measuring physical dimensions, e.g. size of the entire body or parts thereof measuring distances on the body, e.g. measuring length, height or thickness
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
- A61B2090/3966—Radiopaque markers visible in an X-ray image
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- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- Veterinary Medicine (AREA)
- Pathology (AREA)
- Public Health (AREA)
- Biomedical Technology (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Heart & Thoracic Surgery (AREA)
- Engineering & Computer Science (AREA)
- General Health & Medical Sciences (AREA)
- Medical Informatics (AREA)
- Dentistry (AREA)
- Physics & Mathematics (AREA)
- Biophysics (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Apparatus For Radiation Diagnosis (AREA)
Abstract
The invention relates to a three-dimensional spinal positioning ruler, and belongs to the field of medical appliances. The spinal column three-dimensional positioning ruler consists of two positioning ruler units which are connected with each other in a perpendicular mode, wherein each positioning ruler unit is a cuboid made of materials which can be penetrated by X rays and is provided with four side faces and two bottom faces, and scale strips which are not penetrated by the X rays and are made of materials are arranged on two adjacent side faces. The invention has the advantages that: simple and reasonable structure and convenient use, and can realize the positioning function of all-around various angles. The positioning is quick and accurate, the operation time is shortened, and the perspective times are reduced. The invention can be used for the preoperative positioning of MED, foramen mirror operation, percutaneous pedicle screw internal fixation operation and vertebroplasty operation.
Description
Technical Field
The invention relates to a three-dimensional spinal positioning ruler, and belongs to the field of medical appliances.
Background
When the spine is operated in a posterior way, especially in operations of thoracic vertebrae and lumbar thoracic regions, repeated perspective is often caused by difficult determination of the puncture points of the diseased vertebrae and the pedicles, time is delayed, even positioning errors occur, operation incisions are required to be prolonged, the exposure range is increased, and complications such as spinal nerve injury are caused.
The traditional spine positioning methods are numerous and each has limitations: (1) The anterior superior iliac spine positioning method is low in accuracy rate depending on the experience of doctors and is rarely used clinically at present, and misjudgment is easily caused by the fact that the anterior superior iliac spine positioning method is fat or poor in spinous process clearance due to degeneration. (2) Rib positioning has high requirements on the definition of the perspective in preoperative X-ray tablet surgery, the judgment on the T12 ribs is affected by intestinal gas and feces, and in addition, some spines have congenital variation, such as sacral lumbar vertebra transformation, lumbar vertebra sacralization and the like, so that positioning errors are easy to cause, and the method is only an auxiliary means generally. (3) The skin marker positioning method is a positioning method which is relatively commonly used in clinic at present, but the positioning is quite inaccurate due to inconsistent positions of the photographic lens body or movement of the skin in operation, which causes the marks on the skin to move corresponding to the bony spinous processes, and particularly, the positioning error is larger for obese patients.
Chinese patent CN206587051U discloses a backbone body surface locator, including two first locating plates and two second locating plates, two first locating plate parallel arrangement, two second locating plate parallel arrangement, and the both ends of first locating plate are connected with the both ends of second locating plate, fixing screw's one end threaded connection has fixation nut, the cover is equipped with the clamp plate on the fixation screw, first spout has been seted up on the location montant, and is provided with the stopper in the first spout, the stopper passes through the positioning screw and is connected with the location horizontal pole, the second spout has been seted up on the location horizontal pole, the one end threaded connection that the stopper was kept away from to the positioning screw has the fixation nut, the both ends of positioning screw all are provided with the pointer, and pointer and second locating plate swing joint. The structure of the patent is complex, and the position data of the X-ray orthographic projection and the X-ray side projection cannot be obtained at the same time in use.
Chinese patent CN202801801U discloses a percutaneous puncture ct positioning net, which comprises a net body, wherein the net body is composed of an X-ray impermeable guide wire, and the grid in the net body is square. When in use, the CT percutaneous puncture positioning net is fixed on the skin of a patient focus by using the adhesive tape, and the body surface puncture point and the needle inserting direction can be accurately determined according to the distance between the focus displayed by scanning and the guide wire. The patent also obtains position data in only one X-ray projection direction.
In medical practice, the data of orthographic projection and lateral projection of the spine are usually required to be obtained to determine the lesion position, so that a method and a tool for three-dimensional positioning of the spine, which can obtain the position data under the two angles simultaneously, are simple in structure, convenient to use and accurate in data, are required.
Disclosure of Invention
The invention aims to solve the technical problem of providing the spine three-dimensional positioning ruler which is simple in structure, convenient to use and capable of simultaneously obtaining spine position data of X-ray positive positions and X-ray lateral positions.
In order to achieve the above purpose, the present invention adopts the following technical scheme:
a three-dimensional locating ruler for spinal column is composed of two locating ruler units which are mutually perpendicular and connected, wherein each locating ruler unit is a cuboid made of materials which can be penetrated by X rays and is provided with four side faces and two bottom faces, and scale strips which are not penetrated by X rays and are made of materials are arranged on two adjacent side faces.
The two adjacent side surfaces of each positioning ruler unit are in a vertical relationship, are not overlapped with each other and are not interfered when shooting, and can simultaneously display X-ray orthographic projection data and X-ray side projection data of the same shooting part on two X-ray films, so that X-ray photo data with multiple dimensions can be conveniently and rapidly obtained, and three-dimensional positioning is realized.
The connection is fixed connection, sliding connection or plug-in connection. The connection mode is not limited to these, and the purpose is to connect two positioning rule units into a whole in a mutually perpendicular manner, so that more positioning result data can be obtained in radiographs.
The scale strip is a metal scale strip. The metal scale strip comprises scale marks and can also comprise scale numbers. The metal scale bars may be formed by either an intaglio or an embossing process. The scale bars with different etching modes can display clear scales under X-ray shooting. The scale mark displayed on the X-ray film by the metal scale bar of the shade is transparent, and the scale mark displayed on the X-ray film by the metal scale bar of the anode is dark.
The metal scale strip is a stainless steel scale strip. The stainless steel scale strip can be inlaid and fixed, adhered and fixed, and fixedly connected with the corresponding surface of the positioning rule unit in a fixed screw fixing mode.
The opaque scale bar is sprayed, printed or stuck on the side surface of the three-dimensional positioning ruler unit by opaque paint. For example, the graduation mark and the graduation number are drawn and sprayed by using a paint containing lead particles capable of blocking X-rays, so that the graduation is displayed in an X-ray film.
A sliding groove is formed in the side face of the scale-free strip of one positioning ruler unit, a sliding block matched with the sliding groove is fixedly connected to the bottom face of the other positioning ruler unit, and the sliding block is arranged in the sliding groove so that the two positioning ruler units are in sliding connection. The sliding connection mode enables the two positioning ruler units to slide and adjust the position relationship conveniently according to the clinical actual conditions, and is beneficial to placement and shooting.
At least one concave hole is formed in the side face of the scale-free strip of one positioning ruler unit, a convex block matched with the clamping hole is fixedly connected to the bottom face of the other positioning ruler unit, and the convex block is inserted into the concave hole, so that the two positioning ruler units are spliced into a whole. The positioning mode can conveniently adjust the positions in use, so that the two positioning rule units are connected, when only one positioning rule is needed, the connection can be released, and in addition, the positioning rule is convenient to disassemble and then retract, thereby saving the space.
One positioning rule unit is fixedly connected with the other positioning rule unit or integrally formed, and is of an L-shaped or T-shaped structure. The L-shaped structure or the T-shaped structure can be integrally formed, or can be fixedly connected into a whole by means of bonding, welding, fixed connection by fixing pieces and the like.
The length of the positioning rule unit is 5-40cm. The preferred length is 15-30cm.
The width and height of the positioning rule unit are 1-5cm, and the preferred width is 2-4cm.
The two positioning rule units may be equal in length or unequal in length.
The application method of the invention is as follows: after the patient is anesthetized and the body position is put, the spine three-dimensional positioning ruler is placed on the back or the side face of the body of the patient, the back and forth position is used for perspective, and the specific position to be operated is marked on the body surface of the patient according to scales on perspective images.
The invention has the advantages that: simple and reasonable structure and convenient use, and can realize the positioning function of all-around various angles. The positioning is quick and accurate, the operation time is shortened, and the perspective times are reduced. The invention can be used for the preoperative positioning of MED, foramen mirror operation, percutaneous pedicle screw internal fixation operation and vertebroplasty operation.
The invention is further explained below with reference to the drawings and the detailed description, without limiting the invention. All equivalents in the art that come within the scope of the present disclosure are intended to be embraced therein.
Drawings
FIG. 1A is a block diagram of a tape unit according to embodiment 1
FIG. 1B is a diagram showing the structure of the scale bar of embodiment 1
FIG. 1C is a schematic view of a scale bar positive-tone construction of embodiment 1
FIG. 2A is a schematic overall structure of embodiment 2
FIG. 2B is a top view of embodiment 2
FIG. 3A is a schematic overall structure of embodiment 2
FIG. 3B is a schematic view illustrating the disassembly of the top structure of embodiment 3
FIG. 3C is a schematic diagram showing a top view of the structure of embodiment 3
FIG. 4A is a schematic overall structure of embodiment 4
FIG. 4B is a schematic diagram illustrating the disassembly of the top structure of embodiment 4
FIG. 4C is a schematic diagram showing a top view of the combination of the structures in embodiment 4
FIG. 5A is a first usage state reference diagram of embodiment 2
FIG. 5B is a second usage state reference diagram of embodiment 2
FIG. 5C is a third usage state reference diagram of embodiment 2
FIG. 6A is a schematic view of an orthographic projection X-ray photograph of the first usage state of embodiment 2
FIG. 6B is a schematic view of an X-ray side view of the first embodiment 2
FIG. 6C is a schematic view of an X-ray side view of the third embodiment 2
Detailed Description
Example 1, positioning ruler Unit
Referring to fig. 1A to 1C, the positioning rule unit 1 is a rectangular parallelepiped made of a material (plastic) that can be penetrated by X-rays, and includes four side surfaces 11 and two bottom surfaces 12, and the X-ray impermeable stainless steel scale bar 2 is fixed to two adjacent side surfaces 11. Two adjacent side surfaces are perpendicular to each other and are not shielded.
The stainless steel graduation strip 2 can be either negative (fig. 2A) or positive (fig. 2B), and corresponding graduation characters are left on the photo after the X-ray is taken. For easy reading, the scale bar is also provided with a scale number.
Example 2, fixedly connected L-shaped spinal column stereotactic ruler
Referring to fig. 2A and 2B, a three-dimensional positioning ruler for a spine is composed of two positioning ruler units 1 made of materials capable of being penetrated by X-rays, wherein each positioning ruler unit 1 is a cuboid and comprises four side faces and two bottom faces, and two stainless steel scale strips 2 which are not penetrated by the X-rays are fixed on two adjacent side faces.
The two positioning ruler units are fixedly connected at the edge by the fixing piece fixing 3 to form an L-shaped structure.
The lengths of the two positioning rule units 1 are 25cm and 35cm respectively, the lengths of scale bars arranged on the two positioning rule units are 20cm and 30cm respectively, and the widths and the heights of the positioning rule units are 4cm.
Example 3, sliding connection T-shaped spinal column stereotactic ruler
Referring to fig. 3A to 3C, a three-dimensional positioning ruler for a spine is composed of two positioning ruler units 1 perpendicular to each other, wherein each positioning ruler unit 1 is a cuboid and comprises four side faces and two bottom faces, and two adjacent side faces are provided with opaque stainless steel scale bars 2.
A sliding groove 13 is formed in the side face of the non-scale bar of one positioning ruler unit, a sliding block 14 matched with the sliding groove is fixedly connected to one bottom face of the other positioning ruler unit, and the sliding block 14 is arranged in the sliding groove 13, so that the two positioning ruler units are in sliding connection.
The length of one positioning rule unit is 25cm, the length of the scale bar on the positioning rule unit is 20cm, and the width and the height of the scale bar are 4cm; the other positioning rule unit is 35cm in length, and the length of the scale bar on the other positioning rule unit is 30cm and the width of the scale bar is 4cm.
Example 4 Detachable plug-in type spinal column stereotactic rule
Referring to fig. 3A to 3C, a three-dimensional spinal column positioning rule is composed of two positioning rule units 1 perpendicular to each other, wherein each positioning rule unit 1 is a cuboid, and comprises four side surfaces 11 and two bottom surfaces 12, and opaque stainless steel scale strips 2 are arranged on two adjacent side surfaces 11.
A plurality of concave holes 15 are formed in the side face of the scale-free strip of one positioning rule unit, a convex block 16 matched with the clamping hole is fixedly connected to one bottom face of the other positioning rule unit, and the convex block 16 is inserted into the concave holes 15, so that the two positioning rule units are spliced into a whole.
The length of one positioning rule unit is 25cm, the length of the scale bar on the positioning rule unit is 20cm, and the width and the height of the scale bar are 4cm; the other positioning rule unit has a length of 35cm, and the length of the scale bar on the other positioning rule unit is 30cm, and the width and the height of the scale bar are 4cm.
The application method of the invention
Referring to fig. 5A to 5C, taking the L-shaped spinal stereotactic rule of embodiment 2 as an example, the present invention has a plurality of methods of use, including but not limited to any of the following:
1. the patient is prone, the spinal stereotactic rule of example 2 is placed on the back of the patient near the point a where the operation is to be performed (fig. 5A), an X-ray orthographic projection view is taken in the X-direction (fig. 6A), and an X-ray lateral projection view is taken in the Y-direction (fig. 6B). The scales on the two photos are positioned at the same time and space position, and scale value images of the spine three-dimensional positioning ruler under different shooting angles are displayed at the same time. The accurate position of the point A can be accurately displayed through the reading values on different photos, and three-dimensional positioning is realized.
2. The patient is prone, the spinal column stereotactic rule of example 2 is placed on the back of the patient near the point a where the operation is to be performed, one of the rule units is placed on the back plane, the other rule unit is placed on the side of the body (fig. 5B), the X-ray orthographic projection is taken along the X-direction, and the X-ray lateral projection is taken along the Y-direction. And determining the spatial position of the point A according to the position information in the photo.
3. The patient is prone, the spinal stereotactic rule of example 2 is placed upright on the side of the patient's body, near the point a where the operation is to be performed (fig. 5C), an X-ray orthographic projection is taken in the X-direction, and an X-ray lateral projection is taken in the Y-direction (fig. 6C). And determining the spatial position of the point A according to the position information in the photo.
The graduation lines and graduation values of the spinal column three-dimensional positioning ruler are made of opaque materials, so that the graduation lines and graduation values are clearly visible in a photo. The exact value of the position of a certain diseased site a on two perpendicular projection planes (orthographic and sideways) is measured on radiographs. According to the reading value in the photo, the actual reading is carried out through the spine three-dimensional positioning ruler placed on the body of the patient, and the marking pen is used for marking the corresponding position of the body surface of the patient.
In use, a plurality of spinal stereotactic rules can be placed at different parts of the patient's body as required, thereby acquiring more relevant position information.
While the basic principles and main features of the present invention and advantages of the present invention have been shown and described, it will be understood by those skilled in the art that the present invention is not limited by the foregoing embodiments, which are described in the foregoing specification merely illustrate the principles of the present invention, and various changes and modifications may be made therein without departing from the spirit and scope of the invention, which is defined in the appended claims and their equivalents.
Claims (7)
1. Spinal column three-dimensional positioning chi, its characterized in that: the X-ray positioning ruler consists of two positioning ruler units which are mutually and vertically connected, wherein each positioning ruler unit is a cuboid made of a material which can be penetrated by X-rays and is provided with four side surfaces and two bottom surfaces, and two adjacent side surfaces are provided with scale strips which are not penetrated by the X-rays; the connection is fixed connection, sliding connection or plug connection; when in use, the spine position data of the X-ray positive position and the X-ray lateral position can be obtained simultaneously; a sliding groove is formed in the side face of the scale-free strip of one positioning rule unit, a sliding block matched with the sliding groove is fixedly connected to one bottom face of the other positioning rule unit, and the sliding block is arranged in the sliding groove so that the two positioning rule units are in sliding connection; at least one concave hole is formed in the side face of the scale-free strip of one positioning ruler unit, a convex block matched with the clamping hole is fixedly connected to the bottom face of the other positioning ruler unit, and the convex block is inserted into the concave hole, so that the two positioning ruler units are spliced into a whole.
2. A spinal stereotactic rule as recited in claim 1, wherein: the scale strip is a metal scale strip.
3. A spinal stereotactic rule as recited in claim 2, wherein: the metal scale strip is a stainless steel scale strip.
4. A spinal stereotactic rule as recited in claim 1, wherein: the opaque graduation strip is sprayed, printed or stuck on the side surface of the three-dimensional positioning ruler unit by opaque paint.
5. A spinal stereotactic rule as recited in claim 1, wherein: one positioning rule unit is fixedly connected with the other positioning rule unit or integrally formed, and is of an L-shaped or T-shaped structure.
6. A spinal stereotactic ruler as claimed in any one of claims 1 to 5, wherein: the length of the positioning rule unit is 5-50cm, and the width and the height are 1-5cm.
7. A spinal stereotactic ruler as recited in claim 6, wherein: the two positioning rule units are unequal in length.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201810841261.4A CN108836341B (en) | 2018-07-26 | 2018-07-26 | Spinal column three-dimensional positioning ruler |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201810841261.4A CN108836341B (en) | 2018-07-26 | 2018-07-26 | Spinal column three-dimensional positioning ruler |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| CN108836341A CN108836341A (en) | 2018-11-20 |
| CN108836341B true CN108836341B (en) | 2024-03-19 |
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| Application Number | Title | Priority Date | Filing Date |
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| CN201810841261.4A Active CN108836341B (en) | 2018-07-26 | 2018-07-26 | Spinal column three-dimensional positioning ruler |
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Families Citing this family (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN110279456B (en) * | 2019-07-25 | 2024-04-12 | 娄底市中心医院 | Puncture positioning guide device applied to intervertebral foramen mirror operation and application method thereof |
Citations (6)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN2688245Y (en) * | 2004-03-08 | 2005-03-30 | 景桂霞 | Medical puncture positioning ruler pyramidal checking for vertebra |
| JP2008026091A (en) * | 2006-07-20 | 2008-02-07 | Toru Takami | Marking ruler |
| CN202437359U (en) * | 2012-02-15 | 2012-09-19 | 张湘鲁 | Positioning ruler for interventional therapy |
| CN204709010U (en) * | 2015-06-19 | 2015-10-21 | 姚翔 | A kind of guider measured for posterior cervical |
| CN205198161U (en) * | 2015-12-10 | 2016-05-04 | 周军 | Head -mounted locater |
| CN209122237U (en) * | 2018-07-26 | 2019-07-19 | 北京医院 | Backbone stereoscopic localized ruler |
Family Cites Families (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US7662112B2 (en) * | 2005-05-13 | 2010-02-16 | Kci Licensing, Inc. | Medical measuring device and method |
| WO2014205112A1 (en) * | 2013-06-21 | 2014-12-24 | Quantronix, Inc. | Object dimensioning apparatus, systems and related methods |
| US9498351B2 (en) * | 2014-06-04 | 2016-11-22 | Spine Wave, Inc. | Apparatus for locating the position of a spinal implant during surgery |
-
2018
- 2018-07-26 CN CN201810841261.4A patent/CN108836341B/en active Active
Patent Citations (6)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN2688245Y (en) * | 2004-03-08 | 2005-03-30 | 景桂霞 | Medical puncture positioning ruler pyramidal checking for vertebra |
| JP2008026091A (en) * | 2006-07-20 | 2008-02-07 | Toru Takami | Marking ruler |
| CN202437359U (en) * | 2012-02-15 | 2012-09-19 | 张湘鲁 | Positioning ruler for interventional therapy |
| CN204709010U (en) * | 2015-06-19 | 2015-10-21 | 姚翔 | A kind of guider measured for posterior cervical |
| CN205198161U (en) * | 2015-12-10 | 2016-05-04 | 周军 | Head -mounted locater |
| CN209122237U (en) * | 2018-07-26 | 2019-07-19 | 北京医院 | Backbone stereoscopic localized ruler |
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| Publication number | Publication date |
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| CN108836341A (en) | 2018-11-20 |
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