Intramedullary nail sleeve device for patellar access tibia
Technical Field
The invention relates to the field of medical equipment, in particular to a sleeve device for a tibia intramedullary nail of a patella upper access.
Background
In recent years, because the intramedullary nail of the tibia has the advantages of being minimally invasive, high in fixing strength, capable of moving immediately after operation and the like, the application of the intramedullary nail to treat the fracture of the shank shaft becomes the preferred scheme of orthopedics doctors. The current operation access for fixing and treating tibia fracture by intramedullary nails mainly comprises a patella lower access and a patella upper access. The patella lower approach has the advantages of small wound, simple operation, easy acceptance by patients and the like, has wide clinical application, is difficult to maintain an ideal position in operation, has certain deformity, is difficult to perspective in operation, and is more common in postoperative knee pain. The patellar access is used as a novel operation access, and has the advantages of being beneficial to fracture reduction and maintenance, convenient in perspective in operation, low in incidence rate of postoperative gonalgia and the like. The patient is in supine position during the patellar access operation, the affected limb is in semi-straightened position, the operation incision is generally a longitudinal incision which is about 3-4cm long and is made from the upper pole of the patella to the proximal end of the limb on the median line of the patella, the femoral quadriceps tendon is separated in a sharp way after that, the joint capsule is opened from above the patella, a special hollow sleeve for the patellar access is inserted, and the protective sleeve is used for ensuring that the proximal end of the tibia reaches the optimal needle insertion point along the trochanter groove of the femur.
In actual clinical practice, patellar access tools present some problems. (1) Existing patellar access tools on the market are designed with western anatomy. Because the Chinese physique is smaller, the patella space is smaller, and the patient can encounter larger resistance when the protective jacket is inserted in the operation, the risk of iatrogenic injury to the intra-articular structure exists, the implantation of the positioning guide needle is influenced, and the operation time is prolonged. (2) The existing protective jackets on the market are round, while the patellofemoral joint is V-shaped, which are not well matched in shape. When the pressure of the patellofemoral joint is high, the patella slides to one side, and the sleeve slides to the opposite side. (3) The opening and reaming can produce a significant amount of debris that remains in the joint cavity with serious consequences such as knee pain, cross-locking, and even destruction of intra-articular structures, so thorough post-operative cleaning is necessary. But the operation channel of the access on the patella is a relatively closed environment, and the operation channel can not be thoroughly washed like the open operation such as knee joint replacement operation and the like. How to wash the scraps clean and reduce the foreign matter residues in the joint cavity becomes a relatively troublesome but non-negligible problem for the upper patellar approach.
Disclosure of Invention
Aiming at the defects existing in the prior art, the main purpose of the invention is to overcome the defects of the prior art, and discloses a sleeve device for a patellar access tibia intramedullary nail, which comprises a guide pin protective sleeve, a positioning guide sleeve, a connector and a flushing pipe, wherein,
the guide pin protection sleeve is of a cylindrical structure with a smooth surface;
the positioning guide sleeve comprises a sleeve body, and a connecting locking mechanism is arranged at the tail part of the sleeve body and used for being fixed with the connector;
the connector is radially provided with a through hole, and the front end of the connector is provided with a clamping groove matched with the connecting locking mechanism;
the flushing pipe is connected with the through hole of the connector.
Further, a guide cone is arranged at the front end of the positioning guide sleeve.
Further, an included angle alpha between the back side surfaces of the sleeve body is 120-160 degrees; the included angle between the ventral surfaces of the sleeve body is 120-150 degrees.
Further, an included angle alpha between the back side surfaces of the sleeve body is 135-150 degrees; the included angle between the ventral surfaces of the sleeve body is 130-140 degrees.
Further, the two sides of the sleeve body are provided with side wings, and the side wings are formed by extending and intersecting the ventral surface and the lateral surface.
Further, the connecting and locking mechanism comprises a clamping tongue, and the axial direction of the clamping tongue is of an inclined cone structure.
Further, one end of the clamping tongue is provided with a limiting block.
Further, the flushing pipe is arranged in an interference mode with the through hole.
Further, the outer diameter of the guide needle protection sleeve is the same as the outer diameter of the flushing pipe.
Further, the positioning guide sleeve is made of a soft medical grade plastic material, and the connector and the guide needle protection sleeve are made of a hard medical grade plastic material.
The invention has the beneficial effects that:
(1) By the arrangement of the device, the intramedullary nail can be conveniently, rapidly and accurately placed, the operation time is reduced, and the needle insertion point can be accurately found.
(2) The positioning guide sleeve is made of soft medical grade plastic materials, and the front end of the positioning guide sleeve is provided with the guide cone, so that the positioning guide sleeve plays a guiding role when being inserted into a patellofemoral joint gap, the resistance is reduced, the damage or the damage to human tissues is avoided, and the risk of iatrogenic damage is reduced.
(3) The sleeve body is provided with included angles alpha and beta, and the two sides of the sleeve body are provided with lateral wings, so that the sleeve body has a positioning function between the patella and the femur, and is prevented from sideslip and displacement offset.
(4) The sleeve body afterbody sets up and connects locking mechanism to its block tongue is axial oblique cone structure, can be with the connector quick installation when guaranteeing leakproofness and inseparable formula, and cooperation wash pipe and its through-hole interference setting, guarantees that the joint chamber has certain pressure, in order to reach the effect of clean joint chamber.
Drawings
FIG. 1 is a schematic view of a sleeve device for a patellar access tibial intramedullary nail according to the present invention;
FIG. 2 is a perspective view of a positioning guide sleeve;
FIG. 3 is a front view of the positioning guide housing;
FIG. 4 is a view of the use of the positioning guide sheath;
fig. 5 is a perspective view of the connector;
fig. 6 is a radial cross-sectional view of the connector;
FIG. 7 is a schematic view of a guide pin protection sleeve inserted into the patellofemoral joint space;
FIG. 8 is a schematic illustration of a guide pin insertion;
FIG. 9 is a schematic view of the insertion of the positioning guide sleeve into the patellofemoral joint space;
FIG. 10 is a schematic illustration of a rinse;
the reference numerals are as follows:
1. the guide pin protection sleeve comprises a guide pin protection sleeve body 2, a positioning guide sleeve, a guide pin 3, a connector 4, a flushing pipe 6, a guide pin 21, a sleeve body 22, a tail part 23, a connecting locking mechanism 24, a limiting block 25, a guide cone 26, a flank 31, a through hole 32, a clamping groove 51, a femur 52, a patella 53, a tibia 211, a dorsal surface 212, a ventral surface 213 and a lateral surface.
Detailed Description
The present invention will be described in further detail with reference to the drawings and examples, in order to make the objects, technical solutions and advantages of the present invention more apparent. It should be understood that the specific embodiments described herein are for purposes of illustration only and are not intended to limit the scope of the invention.
The invention relates to a sleeve device for a patellar upper approach tibia intramedullary nail, which comprises a guide pin protective sleeve 1, a positioning guide sleeve 2, a connector 3 and a flushing pipe 4, wherein,
as shown in fig. 1, the guide pin protective sleeve 1 is of a cylindrical structure with a smooth surface; is made of hard medical grade plastic material, has smooth surface, is used for guiding the guide needle and protecting human tissues, and prevents the guide needle from damaging peripheral tissues when being guided.
As shown in fig. 2-4, the positioning guide sleeve 2 comprises a sleeve body 21, and a tail 22 of the sleeve body 21 is provided with a connecting locking mechanism 23 for fixing with the connector 3, and can also be used for clamping and fixing with a handle for placing the positioning guide sleeve 2 into a joint; the connecting and locking mechanism 23 comprises a clamping tongue, and the axial direction of the clamping tongue is of an inclined cone structure; in one embodiment, a stopper 24 is disposed at one end of the latch to prevent excessive rotation and loosening. The positioning guide sleeve 2 is made of soft medical grade plastic material, so that the damage or the damage to human tissues is avoided.
As shown in fig. 5 to 6, the connector 3 is provided with a through hole 31 in the radial direction, and a snap groove 32 matching with the connection locking mechanism 23 is provided at the front end; the clamping tongues are arranged between the adjacent clamping grooves 32, and the clamping tongues are screwed into the clamping grooves 32 through the rotary connector 3, so that the connector 3 is connected with the positioning guide sleeve 2. Through the arrangement of the latch inclined cone structure, the connector 3 is ensured to be tightly attached to the positioning guide sleeve 2, and the locking and sealing functions are achieved. The connector 3 is made of a hard medical grade plastic material.
As shown in fig. 10, the flushing pipe 4 is connected to the through hole of the joint head 3. Preferably, the flushing pipe 4 and the through hole 31 of the connector 3 are arranged in an interference mode, so that a certain pressure is ensured in the joint cavity, and the effect of cleaning the joint cavity is achieved.
In one embodiment, as shown in fig. 2, the front end of the positioning guide sheath 2 is provided with a guide cone 25. The diameter of the end of the guide cone 25 is smaller than the diameter of the end of the guide cone connected with the sleeve body 21, so that the guide cone plays a guiding role when being inserted into the patellofemoral joint space, the resistance is reduced, and the risk of iatrogenic injury is reduced.
In one embodiment, as shown in fig. 3 and 4, the included angle α between the back sides 211 of the cartridge body 21 is 120-160 °; the angle beta between the ventral surfaces 212 of the sleeve body 21 is 120-150 deg.. Preferably, the included angle α between the back sides 211 of the sleeve body 21 is 135-150 °; the included angle beta between the ventral surfaces 212 of the sleeve body 21 is 130-140 deg.. In one embodiment, the included angle α between the back sides 211 of the sleeve body 21 is 142 °; the included angle beta between the ventral surfaces 212 of the sleeve body 21 is 135 deg.. By arranging the included angle alpha on the sleeve body 21, the positioning and guiding functions are realized in the direction of the pulley groove angle gamma of the femur 51, sideslip is prevented, and the positioning functions are realized; the included angle beta is arranged, so that the patella 52 has a positioning and guiding function in the direction of the patella face angle theta, and can prevent sideslip and have a positioning function.
In one embodiment, the sleeve body 21 is provided with wings 26 on both sides, the wings 26 being formed by the intersection of the extension of the ventral surface 212 and the lateral surface 213. Further preventing the sleeve body 21 from being shifted or rotated, the shoulder 26 lifts the patella 52,
in one embodiment, the outer diameter of the guide pin protection sleeve is the same as the outer diameter of the flush tube.
The method of use of the present invention is described below with reference to FIGS. 1-10, and comprises the following steps:
step 1, selecting a proper preoperative position, taking a supine position of a patient, and placing a knee pillow at the affected popliteal fossa to be in a semi-straightened position (buckling 10-20 degrees). The lower limb on the healthy side is lowered to facilitate the rear perspective. If the operator is right-handed, the operator recommends to stand on the left side of the patient all the time, and the C-arm X-ray machine is positioned on the right side of the patient all the time, so that the operation at the back is convenient. If the operator is left-handed, the reverse is true.
And 2, making a longitudinal incision with the length of about 3-4cm from the upper pole of the patella to the proximal end of the limb on the median line of the patella, and cutting off subcutaneous soft tissues of the skin.
Step 3, acutely incising the quadriceps femoris tendon, and further opening the joint capsule from above the patella. One finger may be inserted into the joint capsule for initial separation of soft tissue.
Step 4, as shown in fig. 7, after the joint capsule is opened, gently inserting the guide needle protection sleeve 1 along the pulley groove of the femur 51 to the vicinity of the needle insertion point of the tibia 53; then, as shown in FIG. 8, a 3.2mm guide pin 6 is drilled, after which an intraoperative perspective is performed to determine that the guide pin is at the optimal needle insertion point. The nail feeding point is positioned at the inner side edge of the intercondylar spine of the tibia, the lateral X-ray sheet is positioned at the intersection boundary edge of the anterior cortex and the joint surface, and the needle feeding direction is kept consistent with the tibial stem direction.
And 5, pulling out the guide pin protective sleeve 1, and inserting the positioning guide sleeve 2 along the guide pin 6. As shown in fig. 9.
Step 6, opening along the direction of the guide pin 6; the marrow is expanded after the guide pin 6 is put in; inserting a suitable intramedullary nail; the far and near end locking nails are fixed; and placing a tail cap.
Step 7, as shown in fig. 10, the connector 3 is mounted, and the pulse flushing nozzle 4 is inserted along the through hole 31 of the connector 3 to perform pulse flushing.
And 8, closing the incision.
The invention has the beneficial effects that:
(1) By the arrangement of the device, the intramedullary nail can be conveniently, rapidly and accurately placed, the operation time is reduced, and the needle insertion point can be accurately found.
(2) The positioning guide sleeve is made of soft medical grade plastic materials, and the front end of the positioning guide sleeve is provided with the guide cone, so that the positioning guide sleeve plays a guiding role when being inserted into a patellofemoral joint gap, the resistance is reduced, the damage or the damage to human tissues is avoided, and the risk of iatrogenic damage is reduced.
(3) The sleeve body is provided with included angles alpha and beta, and the two sides of the sleeve body are provided with lateral wings, so that the sleeve body has a positioning function between the patella and the femur, and is prevented from sideslip and displacement offset.
(4) The sleeve body afterbody sets up and connects locking mechanism to its block tongue is axial oblique cone structure, can be with the connector quick installation when guaranteeing leakproofness and inseparable formula, and cooperation wash pipe and its through-hole interference setting, guarantees that the joint chamber has certain pressure, in order to reach the effect of clean joint chamber.
The foregoing is merely a preferred embodiment of the present invention and is not intended to limit the scope of the present invention; modifications and equivalent substitutions are intended to be included in the scope of the claims without departing from the spirit and scope of the present invention.