CN110215270B - Orthopedic director of hoof varus foot osteotomy - Google Patents

Orthopedic director of hoof varus foot osteotomy Download PDF

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Publication number
CN110215270B
CN110215270B CN201910486110.6A CN201910486110A CN110215270B CN 110215270 B CN110215270 B CN 110215270B CN 201910486110 A CN201910486110 A CN 201910486110A CN 110215270 B CN110215270 B CN 110215270B
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plate
scale
orthopedic
fixing ring
feeding block
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Expired - Fee Related
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CN201910486110.6A
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Chinese (zh)
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CN110215270A (en
Inventor
赛佳明
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Qilu Hospital of Shandong University Qingdao
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Qilu Hospital of Shandong University Qingdao
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17Guides or aligning means for drills, mills, pins or wires
    • A61B17/1732Guides or aligning means for drills, mills, pins or wires for bone breaking devices
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/1775Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the foot or ankle
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical 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
    • A61B17/88Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical 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
    • A61B17/88Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/90Guides therefor

Abstract

The invention discloses a talipes equinovarus osteotomy orthopedic guide. Comprises an inner foot-turning orthopedic device and a sole detection flat plate position calibration and measurement device; the varus foot orthopedic device comprises a thimble, a connecting plate, a scale, a connecting column, a lower cutter feeding block, an arc-shaped track and an upper cutter feeding block, wherein the thimble is connected with the scale through the connecting plate, the scale is provided with a vernier, and the vernier is provided with a positioning rod; the sole detection flat plate position calibration and measurement device comprises a rear heel plate, a front sole plate, three height difference measurement scales and a shank fixing mechanism, wherein the rear heel plate is fixedly connected with a lower cutter feeding block through a rear heel connecting plate, and the front sole plate is fixedly connected with an upper cutter feeding block through a front sole connecting plate. The invention can accurately find the position of the osteotomy surface and the position of the driven screw, accurately select the angle of the osteotomy surface, improve the accuracy of determining the soft tissue loosening length and provide more scientific basis for clinic.

Description

Orthopedic director of hoof varus foot osteotomy
Technical Field
The invention relates to the field of medical instruments, in particular to a water chestnut varus osteotomy orthopedic guide device.
Background
Talipes equinovarus (equinovarus) refers to a horseshoe-shaped varus, which is classified into congenital deformity and acquired varus, and is the most common foot deformity. The formation of talipes equinovarus is mainly caused by unbalanced muscle force of feet, and bone joint deformity is formed after muscle imbalance is long, so that the deformity is more serious due to load bearing on the basis of the deformity. Equinovarus deformity consists of three factors, foot drop, varus and adduction. The aim of the equinovarus orthopaedics is to establish a painless and weight-bearing metatarsal walking foot, the force line between the foot and the lower leg is very critical, and the ideal force line is that the foot is in a flexion-extension neutral position, 5 degrees of external rotation and 5 degrees of eversion relative to the lower leg after the orthopaedics. The operation is usually wedge osteotomy of calcaneus, followed by calcaneal tendon elongation (multi-level section cutting off the achilles tendon to correct foot drop deformity caused by achilles tendon contracture), and metatarsal aponeurosis cutting off (cutting off the tense section of the metatarsal aponeurosis to correct plantarflexion and adduction of the forefoot) according to the force distribution of plantar surface in neutral position.
The accuracy of the calcaneus eversion osteotomy determines the effect of calcaneus correction after the osteotomy is everted and the treatment of later calcaneus healing. The operation steps are as follows: (1) an arc incision was made parallel to the fibula longissimus tendon at the posterior and inferior aspect of the tendon, exposing the lateral aspect of the foot. Retracting the upper edge of the incision to expose the tendon sheath of the long fibula, and peeling the calcaneal periosteum from the upper side, the lateral side and the lower side of the superior part; (2) the wedge-shaped osteotomy is performed in parallel to the fibula long tendon at the rear lower part close to the fibula long tendon, and the bone wedge is removed; (3) the inner cortex is fractured by manual force, and the wedge-shaped osteotomy gap is closed; further enabling the foot dorsiflexion to resist the tension of the achilles tendon and enabling the osteotomy area to be sealed; (4) two 6-7mm hollow compression screws are arranged in the bone cutting surface to be fixed. The key points of the operation include: (1) the angle of the osteotomy wedge is based on the orthopedic angle measured before the operation; (2) the bone wedge must reach the medial cortex of the calcaneus but not penetrate; (3) the osteotomy surface is smooth so as to be closed stably; (4) the two screws are perpendicular to the osteotomy surface and are evenly distributed. The technical points fail to satisfy the condition that the effect of osteotomy and orthopedic treatment and the healing of the osteotomy face bone are influenced.
At present, in clinical application, the calcaneus osteotomy level and the inner side intersection position of the osteotomy level can be estimated only by means of visual inspection and operation experience, the screw is placed and temporarily fixed by a Kirschner wire, and the position is fixed by implanting a hollow screw after the position is confirmed to be satisfied by repeated adjustment of perspective. Therefore, the deviation of the calcaneus osteotomy level and the defect of the calcaneus fusion line and the position of the screw are inevitably caused, the operation time is prolonged, and the operation treatment effect is poor, and even the calcaneus fusion operation fails.
The calcaneal tendon lengthening operation and the metatarsal aponeurosis cutting operation are soft tissue loosening operations, and the correction of residual foot drop deformity and plantarflexion and adduction deformity of the forefoot after the calcaneal eversion osteotomy fusion is mostly achieved by partially cutting off the achilles tendon or the metatarsal aponeurosis. The operation difficulty is relatively small, but the degree of the loosening and whether the stress condition of the sole can be evenly distributed when the sole is in the bending and stretching neutral position, the outward rotation of 5 degrees and the outward rotation of 5 degrees relative to the crus when the weight is loaded after the loosening determine the effect of the operation and the rehabilitation of the patient. In the current clinical application, the correction effect of the foot bottom loading plane after the operation can be estimated only according to the visual inspection and the hand feeling of an operator, so that the operation treatment effect is poor, the gait is abnormal and the local soft tissue is abraded due to the large local stress of the foot bottom when the patient walks after the operation, and the rehabilitation of the patient is finally influenced.
Disclosure of Invention
To address the equinovarus deformity mentioned in the background, the present invention presents a water chestnut varus osteotomy orthopedic guide.
In order to achieve the above purpose, the following technical solutions are provided:
a water chestnut varus osteotomy orthopedic guider comprises a varus orthopedic device and a sole detection flat plate position calibration measuring device; the varus foot orthopedic device comprises an ejector pin, a connecting plate, a scale, a connecting column, a lower cutter feeding block, an arc-shaped track and an upper cutter feeding block, wherein the ejector pin is connected with the scale through the connecting plate, the scale is provided with a vernier, the vernier is provided with a positioning rod, the bottom of the scale is provided with a row of through holes I, the scale is connected with the lower cutter feeding block through the connecting column, the arc-shaped track is fixedly connected to the upper part of the lower cutter feeding block, the upper cutter feeding block is penetrated through by the arc-shaped track, the side surfaces of the lower cutter feeding block and the upper cutter feeding block are respectively provided with a through hole II and a through hole III, the upper surface of the lower cutter feeding block and the lower surface of the upper cutter feeding block are superposed at a zero scale line; the sole detection flat plate position calibration and measurement device comprises a rear heel plate, a front sole plate, three height difference measuring scales and a shank fixing mechanism, wherein the rear heel plate is fixedly connected with a lower feed block through a rear heel connecting plate, the front sole plate is fixedly connected with an upper cutter block through a front sole connecting plate, one height difference measuring scale is arranged at the heel stress point of the rear heel plate, the two height difference measuring scales are arranged at the front sole stress point of the front sole plate, each height difference measuring scale comprises a graduated scale, an elastic element and a shell, the graduated scale penetrates through the elastic element and the shell, the elastic element is arranged in the shell, the three shells are respectively and fixedly connected with the rear heel plate and the front sole plate, one end of the graduated scale extends out of the rear heel plate and the front sole plate, and the shank fixing mechanism comprises a instep fixing ring, a connecting long rod and a shank fixing mechanism, The shank fixing ring is connected with earrings of the front foot sole plate, one end of the long connecting rod is connected with the shank fixing ring, and the other end of the long connecting rod is connected with the shank fixing ring.
Further, the scale is made of triangular steel.
Further the vernier is provided with a set screw.
Furthermore, the arc tracks are two parallel arc tracks, the interval between the two parallel arc tracks is 60mm, and two circle centers of the two arc tracks are positioned on a horizontal line where the needle point of the thimble is positioned.
Furthermore, the diameter of the first through hole, the diameter of the second through hole and the diameter of the third through hole are 2 mm.
Further, the elastic element is a compression spring.
Furthermore, the instep fixing ring is connected with the earrings of the front sole plate through hinges.
Furthermore, the instep fixing ring is connected with the connecting long rod through a hinge.
Furthermore, the shank fixing ring is of a split structure.
Furthermore, a soft cushion is arranged on the inner side of the shank fixing ring, the earrings of the instep fixing ring and the front foot sole plate are respectively provided with scale marks, the earrings of the front foot sole plate and the instep fixing ring are positioned through a first set screw, and the instep fixing ring and the long connecting rod are positioned through a second set screw.
The invention has the beneficial effects that:
1. the invention discloses a water chestnut varus osteotomy orthopedic guider which can accurately find the position of an osteotomy surface and the position of a driven screw and accurately select the angle of the osteotomy surface.
2. The water chestnut varus osteotomy orthopedic guide designed by the invention can improve the accuracy of determining the soft tissue loosening length and provides a more scientific basis for clinic.
3. The invention designs a water chestnut varus osteotomy orthopedic guide, which reduces the secondary injury to a patient caused by insufficient experience during traditional osteotomy.
4. The water chestnut varus osteotomy orthopedic guide designed by the invention improves the operation efficiency and ensures that the operation quality is better guaranteed.
Drawings
FIG. 1 is a perspective view of a water chestnut varus osteotomy orthopedic guide;
FIG. 2 is a schematic view of the upper and lower surfaces of a water chestnut varus osteotomy orthopedic guide shown in an angled configuration;
FIG. 3 is a perspective view of an varus orthotic device of a water-chestnut varus osteotomy orthopedic guide;
FIG. 4 is an enlarged view of the elevational difference side gauge structure of the varus orthotic device of the water chestnut varus osteotomy orthopedic guide;
fig. 5 is an enlarged view of a portion of the adjustment assembly of the varus orthotic device of the water-chestnut varus osteotomy guide.
Detailed Description
In order to make the technical solution of the present invention more clear and definite for those skilled in the art, the technical solution of the present invention is described in detail below with reference to the accompanying drawings, but the embodiments of the present invention are not limited thereto.
1-5, a water-chestnut varus osteotomy orthopedic guide comprises an varus orthopedic device 11, a sole detection plate position calibration measuring device 12; the varus foot orthopedic device comprises an ejector pin 11, a connecting plate 12, a scale 13, a connecting column 14, a lower feeding block 15, an arc-shaped track 17 and an upper feeding block 16, wherein the ejector pin 11 is connected with the scale 13 through the connecting plate 12, the scale 13 is provided with a cursor 132, a through hole 131 is formed in the bottom of the scale 13, the scale 13 is connected with the lower feeding block 15 through the connecting column 14, the arc-shaped track 17 is fixedly connected to the upper portion of the lower feeding block 15, the upper feeding block 16 is penetrated through by the arc-shaped track 17, a through hole two 151 and a through hole three 161 are formed in the side faces of the lower feeding block 15 and the upper feeding block 16, the upper surface 152 of the lower feeding block is coincided with the lower surface 162 of the upper feeding block at the zero scale line of the arc-shaped track 17, and the needle tip of the ejector pin. The sole detection plate position calibration and measurement device 2 comprises a rear heel plate 21, a front sole plate 22, three height difference measuring scales 24 and a lower leg fixing mechanism 23, wherein the rear heel plate 21 is fixedly connected with a lower feed block 15 through a rear heel connecting plate 211, the front sole plate 22 is fixedly connected with an upper cutter block 16 through a front sole connecting plate 221, one height difference measuring scale 24 is arranged at a heel stress point of the rear heel plate 21, the two height difference measuring scales 24 are arranged at a front sole stress point of the front sole plate 22, the height difference measuring scale 24 comprises a graduated scale 241, an elastic element 243 and a shell 242, the graduated scale 241 penetrates through the elastic element 243 and the shell 242, the elastic element 243 is arranged in the shell 242, the three shells 242 are respectively fixedly connected with the rear heel plate 21 and the front sole plate 22, one end of the graduated scale 242 extends out of the rear heel plate 21 and the front sole plate 22, the shank fixing mechanism 23 comprises a instep fixing ring 231, a connecting long rod 232 and a shank fixing ring 233, the instep fixing ring 231 is connected with the earrings 222 of the front foot sole plate 22, one end of the connecting long rod 232 is connected with the instep fixing ring 231, and the other end of the connecting long rod 232 is connected with the shank fixing ring 233.
The scale 13 is triangular steel to define 132 the radial degrees of freedom of the cursor. The cursor 132 is provided with a set screw 133 for positioning the cursor 132. The arc-shaped tracks 17 are two parallel arc-shaped tracks 17, so that the movement of the upper cutter feeding block 16 on the arc-shaped tracks 17 is more stable, two circle centers of the two arc-shaped tracks 17 are positioned on a horizontal line where the needle point of the thimble 11 is positioned, so that a crossing line of two times of cutting is positioned on the horizontal line, and the interval between the two parallel tracks is 60mm, so that the wide saw can be inserted. The diameter of the first through hole 131, the diameter of the second through hole 151 and the diameter of the third through hole 161 are 2mm, and the hollow nail guide pin is used for being placed in. The elastic member 243 is a compression spring. The connection between the instep fixing ring 231 and the earring 222 of the front sole plate 22 is a hinge connection, so that the sole of a foot can be conveniently put in. The connection between the instep fixing ring 231 and the long connecting rod 232 is a hinge connection. The lower leg fixing ring 233 has a split structure, so that the lower leg can be fixed conveniently. The inner side of the shank fixing ring 233 is provided with a cushion 234, so that the device can not scratch the skin. The instep fixing ring 231 and the earrings 222 of the front foot sole plate are respectively provided with scale marks, the earrings 222 of the front foot sole plate and the instep fixing ring 231 are positioned through a first set screw 223, and the instep fixing ring and the long connecting rod are positioned through a second set screw 233.
In the process of performing the varus foot orthosis, the foot part is inserted into the lower leg fixing ring 233, the heel of the foot faces the varus foot orthosis 11, the instep of the foot is inserted into the instep fixing ring 231, the angle of the instep fixing ring 231 is adjusted, and the first set screw 223 and the second set screw 233 are respectively fixed. An arc incision was made parallel to the fibula longissimus tendon at the posterior and inferior aspect of the tendon, exposing the lateral aspect of the foot. The upper edge of the incision is retracted, the tendon sheaths of the long fibular muscles are exposed, the calcaneal periosteum is peeled from the upper side, the lateral side and the lower side of the posterior part of the incision, and the thimble 11 abuts against the inner calcaneal periosteum. The point where the needle point of the thimble 11 is located is the coincident line of the two knife feeding surfaces, the coincident line passes through the circle centers of the two arc-shaped tracks 17, the lower surface 162 of the upper knife block 16 aligns with the position line of the first knife feeding, the set screw 163 of the upper knife block 16 is locked, and then a hollow nail guide pin of 2mm is driven into the through hole three 161 to fix the upper knife block 16. The heel is attached to the height difference measuring scale 21 of the heel plate 21, the forefoot is attached to the height difference measuring scale 24 of the forefoot plate 22, and the lower leg fixing ring 233 fixes the lower leg. Use the needle point of thimble 11 as the centre of a circle, rotate arc track 17 and need pivoted angle to the measurement before the art, back heel board 21 also can follow synchronous rotation simultaneously, and preceding sole board 22 is motionless, and back heel board 21 forms certain angle with preceding sole board 22, squeezes into 2 mm's hollow nail guide pin in two 151 departments of through-hole after that, fixes. After fixation is finished, wedge-shaped osteotomy is respectively performed on the lower surface 162 of the upper cutter block 16 and the upper surface 152 of the lower cutter block 15 in parallel to the fibula long tendon at the rear lower part close to the fibula long tendon, the two cutters are intersected at the needle point of the 11 thimble, the bone wedge is removed, the osteotomy is finished, the wedge-shaped osteotomy gap is closed, meanwhile, the heel plate 21 and the front sole plate 22 are closed, and further, the dorsiflexion of the foot is enabled to resist the pulling force of the heel tendon, so that the osteotomy area is closed; moving a cursor 132 to enable a positioning rod 134 to abut against the osteotomy closed region, screwing a positioning screw 133, measuring the width of the calcaneus after the osteotomy is closed, placing two hollow nail guide pins along a first through hole 131 at 1/3 and 2/3 of the width, after confirming an ideal position through perspective, detaching the hollow nail guide pin at the first through hole 131, detaching the hollow nail guide pins at a second through hole 151 and a third through hole 161, placing two hollow compression screws along the path of the two hollow nail guide pins at the first through hole 131, and finishing the calcaneus osteotomy orthopedic fusion operation. Then, soft tissue loosening operation is carried out, the heel plate 21 and the forefoot plate are closed, the difference value of the three height difference measuring scales 24 is observed and recorded through adjusting the assembly to an ideal position where the orthopedic rear foot is needed, the length of the achilles tendon or the plantar aponeurosis and the like which needs to be extended is calculated, the sutured achilles tendon or the plantar aponeurosis is loosened or prolonged to carry out correction on residual foot drop deformity and plantarflexion and adduction deformity after the calcaneus valgus closed osteotomy orthopedic, until the adjustment assembly is in the ideal position, the three height difference measuring scales 24 are equal in height. Finishing the operation of the talipes equinovarus osteotomy orthopedic.
While the invention has been described with respect to the preferred embodiments, it will be understood by those skilled in the art that various changes in form and details may be made therein without departing from the spirit and scope of the invention as defined by the appended claims.

Claims (10)

1. An orthopedic director of horse hoof varus osteotomy characterized in that: comprises an inner foot-turning orthopedic device and a sole detection flat plate position calibration and measurement device; the varus foot orthopedic device comprises an ejector pin, a connecting plate, a scale, a connecting column, a lower cutter feeding block, an arc-shaped track and an upper cutter feeding block, wherein the ejector pin is connected with the scale through the connecting plate, the scale is provided with a vernier, the vernier is provided with a positioning rod, the bottom of the scale is provided with a row of through holes I, the scale is connected with the lower cutter feeding block through the connecting column, the arc-shaped track is fixedly connected to the upper part of the lower cutter feeding block, the upper cutter feeding block is penetrated through by the arc-shaped track, the side surfaces of the lower cutter feeding block and the upper cutter feeding block are respectively provided with a through hole II and a through hole III, the upper surface of the lower cutter feeding block and the lower surface of the upper cutter feeding block are superposed at a zero scale line; the sole detection flat plate position calibration and measurement device comprises a rear heel plate, a front sole plate, three height difference measuring scales and a shank fixing mechanism, wherein the rear heel plate is fixedly connected with a lower feed block through a rear heel connecting plate, the front sole plate is fixedly connected with an upper cutter block through a front sole connecting plate, one height difference measuring scale is arranged at the heel stress point of the rear heel plate, the two height difference measuring scales are arranged at the front sole stress point of the front sole plate, each height difference measuring scale comprises a graduated scale, an elastic element and a shell, the graduated scale penetrates through the elastic element and the shell, the elastic element is arranged in the shell, the three shells are respectively and fixedly connected with the rear heel plate and the front sole plate, one end of the graduated scale extends out of the rear heel plate and the front sole plate, and the shank fixing mechanism comprises a instep fixing ring, a connecting long rod and a shank fixing mechanism, The shank fixing ring is connected with earrings of the front foot sole plate, one end of the long connecting rod is connected with the shank fixing ring, and the other end of the long connecting rod is connected with the shank fixing ring.
2. The orthopedic water-chestnut-varus osteotomy guide of claim 1, wherein: the scale is made of triangular steel.
3. The orthopedic water-chestnut-varus osteotomy guide of claim 1, wherein: the vernier is provided with a positioning screw.
4. The orthopedic water-chestnut-varus osteotomy guide of claim 1, wherein: the arc-shaped rails are two parallel arc-shaped rails, the interval between the two parallel arc-shaped rails is 60mm, and two circle centers of the two arc-shaped rails are positioned on a horizontal line where the needle point of the thimble is positioned.
5. The orthopedic water-chestnut-varus osteotomy guide of claim 1, wherein: the diameters of the first through hole, the second through hole and the third through hole are 2 mm.
6. The orthopedic water-chestnut-varus osteotomy guide of claim 1, wherein: the elastic element is a compression spring.
7. The orthopedic water-chestnut-varus osteotomy guide of claim 1, wherein: the instep fixing ring is connected with the earrings of the front sole plate through hinges.
8. The orthopedic water-chestnut-varus osteotomy guide of claim 1, wherein: the connection of the instep fixing ring and the connecting long rod is hinged.
9. The orthopedic water-chestnut-varus osteotomy guide of claim 1, wherein: the shank fixing ring is of a split structure.
10. The orthopedic water-chestnut-varus osteotomy guide of claim 1, wherein: the inner side of the shank fixing ring is provided with a cushion, the earrings of the instep fixing ring and the front foot sole plate are respectively provided with scale marks, the earrings of the front foot sole plate and the instep fixing ring are positioned through a first set screw, and the instep fixing ring and the long connecting rod are positioned through a second set screw.
CN201910486110.6A 2019-06-05 2019-06-05 Orthopedic director of hoof varus foot osteotomy Expired - Fee Related CN110215270B (en)

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SU477724A1 (en) * 1973-12-24 1975-07-25 Device for treating deformities of the feet
CN2254730Y (en) * 1996-04-13 1997-05-28 沈忠良 Orthopaedic device for treating congenital equinovarus
CN201469469U (en) * 2009-08-11 2010-05-19 北京积水潭新兴医疗科技公司伤残人用品用具服务部 Horseshoe varus orthotic device
CN101999970B (en) * 2010-12-24 2013-01-30 上海电机学院 Parallel multi-degree-of-freedom ankle joint rehabilitation trainer
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CN202821742U (en) * 2012-07-19 2013-03-27 Unfo麦德有限公司 Appliance for clubfoot
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CN109223098A (en) * 2018-09-20 2019-01-18 上海昕健医疗技术有限公司 The orthopedic guide assembly of osteotomy on ankle

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