CN110693599A - Circle-center-fixed rotation radius offset-minimally invasive sacroiliac screw positioning guider - Google Patents
Circle-center-fixed rotation radius offset-minimally invasive sacroiliac screw positioning guider Download PDFInfo
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- CN110693599A CN110693599A CN201911046485.7A CN201911046485A CN110693599A CN 110693599 A CN110693599 A CN 110693599A CN 201911046485 A CN201911046485 A CN 201911046485A CN 110693599 A CN110693599 A CN 110693599A
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- 210000003692 ilium Anatomy 0.000 claims abstract description 52
- 230000000149 penetrating effect Effects 0.000 claims description 15
- 210000000988 bone and bone Anatomy 0.000 description 17
- 238000000034 method Methods 0.000 description 13
- 230000001054 cortical effect Effects 0.000 description 11
- 210000003131 sacroiliac joint Anatomy 0.000 description 6
- 230000006378 damage Effects 0.000 description 5
- 238000003780 insertion Methods 0.000 description 5
- 230000037431 insertion Effects 0.000 description 5
- 238000002513 implantation Methods 0.000 description 4
- 230000000994 depressogenic effect Effects 0.000 description 3
- 238000010586 diagram Methods 0.000 description 3
- 201000010099 disease Diseases 0.000 description 3
- 208000037265 diseases, disorders, signs and symptoms Diseases 0.000 description 3
- 206010017076 Fracture Diseases 0.000 description 2
- 230000007547 defect Effects 0.000 description 2
- 230000000694 effects Effects 0.000 description 2
- 238000002594 fluoroscopy Methods 0.000 description 2
- 208000014674 injury Diseases 0.000 description 2
- 210000001696 pelvic girdle Anatomy 0.000 description 2
- 210000004197 pelvis Anatomy 0.000 description 2
- 230000000087 stabilizing effect Effects 0.000 description 2
- 206010017308 Fractured sacrum Diseases 0.000 description 1
- 206010071229 Procedural haemorrhage Diseases 0.000 description 1
- 208000027418 Wounds and injury Diseases 0.000 description 1
- 238000013459 approach Methods 0.000 description 1
- 230000009286 beneficial effect Effects 0.000 description 1
- 210000003164 cauda equina Anatomy 0.000 description 1
- 238000005553 drilling Methods 0.000 description 1
- 239000007943 implant Substances 0.000 description 1
- 238000005259 measurement Methods 0.000 description 1
- 238000012986 modification Methods 0.000 description 1
- 230000004048 modification Effects 0.000 description 1
- 210000005036 nerve Anatomy 0.000 description 1
- 230000000399 orthopedic effect Effects 0.000 description 1
- 230000001105 regulatory effect Effects 0.000 description 1
- 230000008733 trauma Effects 0.000 description 1
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- 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
- A61B17/8897—Guide wires or guide pins
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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
- 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
- A61B90/10—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 for stereotaxic surgery, e.g. frame-based stereotaxis
- A61B90/11—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 for stereotaxic surgery, e.g. frame-based stereotaxis with guides for needles or instruments, e.g. arcuate slides or ball joints
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- 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
- A61B90/10—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 for stereotaxic surgery, e.g. frame-based stereotaxis
- A61B2090/101—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 for stereotaxic surgery, e.g. frame-based stereotaxis for stereotaxic radiosurgery
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Abstract
The invention discloses a circle-center-fixed rotation radius offset-minimally invasive sacroiliac screw positioning guider which comprises a rectangular main positioner, a hollow positioning rod, a transverse arc-shaped adjuster and a hollow sleeve, wherein the rectangular main positioner comprises a positioner body and a transverse arc-shaped sleeve arranged at the front end of the positioner body, the positioner body is provided with a sacrum positioning hole and an ilium fixing hole which are through up and down, the transverse arc-shaped adjuster comprises a rectangular guide block and an arc-shaped scale rod arranged on the rectangular guide block, and the rectangular guide block is provided with an opening sliding groove which is through front and back and is open downwards. The sacroiliac screw track external inclination angle positioning device is simple in structure, low in cost and convenient to use, a doctor can determine different external inclination angle angles between the sacroiliac screw track and the sagittal plane of a human body in a mode of transversely adjusting the arc-shaped scale rod by taking the O point in the sacrum as a virtual circle center according to the condition of a patient, the positioning is accurate, the stability is high, and the screw placement can be successful at one time.
Description
Technical Field
The invention belongs to the technical field of medical instruments, and relates to a circle-center-fixed rotation radius offset-minimally invasive sacroiliac screw positioning guider.
Background
The injury of the posterior pelvic ring such as the dislocation of the sacroiliac joint and the fracture around the sacroiliac joint can cause the rotational instability and the vertical instability of the pelvis, and the superior method for realizing the fixation of the posterior pelvic ring is to implant sacroiliac screws in a patient body. In recent years, both clinical and biomechanical studies of pelvic fixation have demonstrated: the sacroiliac screw enters from the posterior lateral aspect of the ilium ala, passes through the sacroiliac joint and enters the middle upper part of the sacrum 1 or sacrum 2 vertebral body, and is a good internal fixation type. The percutaneous minimally invasive sacroiliac screw implantation can effectively reduce intraoperative hemorrhage, operative trauma and various complications, and becomes the first choice of clinical orthopedics doctors.
The technical difficulty of the sacroiliac joint screw is the implantation of a guide pin and a screw, the implantation of the prior sacroiliac joint screw is mostly finished by bare hands under the perspective of a C-arm X-ray machine, and the sacroiliac joint screw has the following defects: 1. in the process of nail placement, multi-angle X-ray repeated perspective is needed, the positioning is inaccurate, the stability is poor, and if a satisfactory fixed position cannot be achieved after multiple attempts, the fixed holding force is greatly reduced due to the damage of the guide pin to the bone structure. 2. Since the screw is fixed across the joint and needs to pass through 3 layers of cortical bone, accurate positioning of the point of insertion is extremely difficult. 3. The sacrum is anatomically tilted backwards, the sacroiliac screw has a certain angle in the transverse plane and the sagittal plane, and the individual difference is large, so the running direction of the screw is difficult to be accurately determined. 4. The length of the screw is preferably such that it does not break through the cortical bone of the contralateral sacrum, which is difficult to determine accurately by fluoroscopy. 5. The anterior part of the screw is adjacent to the iliac vessels, the posterior part of the screw is the cauda equina nerve in the vertebral canal, and the upper part of the screw is the intervertebral disc, so that the screw has slight deviation, not only can not achieve effective fixation, but also is easy to damage important nerves and vessels, and even endangers life. In summary, the insertion of the screw lacks objective criteria in determining the point of insertion, the direction of travel, the length of the screw, etc., and is not possible to succeed at one time, thus being technically very difficult and challenging.
In the existing sacroiliac screw guiding device, a pedicle screw guiding needle must be firstly drilled into a sacral 1 vertebral body, and then the guiding needle of the sacroiliac screw is drilled into the sacroiliac screw in a point-to-point aiming mode through a connecting rod with the radian of pi/2. The device improves the accuracy and the safety of nail placement to a certain extent, but has the following defects: 1. the guide pin of the sacrum 1 pedicle screw must be accurately placed, so that the technical threshold is greatly improved, and the damage to the fractured sacrum is aggravated; if the sacrum 1 pedicle guide needle can not be accurately placed in one time, the fixing strength of the sacrum iliac screw can be greatly reduced by repeated operation. 2. Because the guide pin of the sacroiliac screw takes the direction of the guide pin of the pedicle screw as reference, and the guide pin of the sacroiliac screw has included angles with the sagittal plane and the upper transverse plane of the sacrum and has large individual difference, the included angle between the guide pin of the sacroiliac screw and the guide pin of the pedicle screw is difficult to select before and during the operation; thus, the sacroiliac screw can enter the sacrum, but the direction is not necessarily optimal, nor is the length and fixation strength of the screw necessarily optimal. 3. In the case of sacral pedicle fractures, it cannot be used. 4. Sacroiliac screws cannot be used for sacral 2 and other segments.
In the prior art, a sighting device which only depends on anatomical marks of lumbar vertebrae and pelvis, has no obvious damage to vertebral pedicle, has low technical threshold, can randomly adjust the angle according to individual difference of patients, is simple and convenient to operate and can accurately place the sacroiliac screw guide pin at one time is lacked.
Disclosure of Invention
The invention aims to provide a circle-center-fixed rotation radius offset-minimally invasive sacroiliac screw positioning guider, which combines a rectangular main positioner with a transverse arc-shaped adjuster, can realize the functions of determining a screw feeding point according to different disease conditions of a patient, adjusting the inserting direction of sacroiliac screws and accurately inserting the sacroiliac screws at one time, and solves the problems in the prior art. The use of a transverse arc adjuster allows the operator to select different sacroiliac screw approach angles depending on the patient's condition.
In order to achieve the purpose, the technical scheme adopted by the invention is as follows:
a circle-center-fixed rotation radius offset-minimally invasive sacroiliac screw positioning guider comprises a rectangular main positioner, a hollow positioning rod, a transverse arc-shaped adjuster and a hollow sleeve.
The rectangular main positioner comprises a positioner body and a transverse arc-shaped sleeve arranged at the front end of the positioner body, wherein a sacrum positioning hole and an ilium fixing hole which are through up and down are arranged on the positioner body, the sacrum positioning hole is used for being inserted by the guide pin and plays a guiding role on the guide pin, and the rectangular main positioner can be fixed on the ilium through a threaded nail by the ilium fixing hole. Locking members are arranged on the sacrum positioning hole and the ilium fixing hole, a left and right through arc-shaped slide way is arranged on the transverse arc-shaped sleeve, and the locking members are arranged on the arc-shaped slide way.
The upper part and the lower part of the hollow positioning rod are both cylindrical, the diameter of the lower part of the hollow positioning rod is smaller than that of the upper part of the hollow positioning rod, a detachable connected threaded guide pin is arranged in the hollow positioning rod, the top of the threaded guide pin is a cylinder, threads are arranged below the cylinder and on the outer side of the guide pin, and the hollow positioning rod can be movably inserted into the sacrum positioning hole and can be locked by a locking component on the sacrum positioning hole. The hollow positioning rod is matched with the thread guide pin to be inserted into a sacrum positioning hole in the rectangular main positioning block body to penetrate into the skin, the tip end of the hollow positioning rod is tightly attached to the outer side of an upper articular process of a first sacrum, which is sunken on the cortical bone surface (the point where the hollow positioning rod is tightly attached is A point) or the bone surface of other key anatomical marks, and the thread guide pin can be screwed into the sacrum to stabilize the hollow positioning rod and can also not be screwed into the sacrum. Avoiding cumbersome and risky procedures that must rely on pedicle screws of the sacrum as a reference. A virtual straight line which is parallel to the sagittal plane and vertically enters the sacrum downwards is made through the point A, the point O (the point O is the center of a rotating circle) is selected at a certain distance below the point A on the virtual straight line, the distance from the point A to the point O is the offset distance, and the offset distance can be set by adjusting the scale on the hollow positioning rod inserted into the sacrum positioning hole during the operation.
The horizontal arc regulator includes rectangle guide block and the arc scale rod of setting on the rectangle guide block, penetrating and open-ended opening spout around being equipped with on the rectangle guide block, be equipped with locking member on the opening spout, hollow sleeve can move about and insert the opening spout and can be fastened by the locking member on the opening spout, be equipped with the scale on the arc scale rod, the arc scale rod can move about and insert in the arc slide and can be fastened by the locking member on the arc slide, the arc scale rod is unanimous with the radian of arc slide, can adjust the scale on the arc scale rod that inserts the arc slide according to patient's different state of an illness in order to confirm the camber angle of different sacroiliac screw nail ways and human sagittal plane, so that confirm the direction of putting into of sacroiliac screw.
The upper part of the hollow sleeve is cylindrical, the lower part of the hollow sleeve is conical, the hollow sleeve is used for being inserted into the opening sliding groove to reach the rear outer side of the iliac wing to play a role in positioning and guiding, and the extension line of the insertion direction of the hollow sleeve passes through the rotating sphere center O point.
The sacrum positioning holes on the positioner body are positioned on the inner side of the ilium fixing holes, the number of the ilium fixing holes is four, the ilium fixing holes are longitudinally arranged, only one sacrum positioning hole is arranged, the four ilium fixing holes are designed to use the ilium fixing holes in different positions according to different disease conditions of patients, and one sacrum positioning hole is designed to use the depressed cortical bone or other key anatomical marks on the outer side of the superior articular process of the first sacrum as a reference point for positioning.
The technical scheme is that the radian of the arc-shaped scale rod has various specifications for selection.
The technical scheme is that the locator body is further provided with a left square connecting hole and a right square connecting hole which are through, and the square connecting holes are provided with locking components.
The technical scheme is that the inner surface of the cylindrical upper part of the hollow positioning rod is provided with internal threads, and the outer surface of the hollow positioning rod is provided with scales; the top of the threaded guide pin is a cylinder, external threads are arranged below the cylinder and outside the guide pin, and the external threads of the guide pin are matched with the internal threads of the hollow positioning rod.
The technical scheme is that the device further comprises an opposite side fixing device, and the opposite side fixing device comprises a fixing block and a threaded nail. The fixing block is divided into a single-hole fixing block and a double-hole fixing block, a square connecting hole which is through from left to right and an ilium fixing hole which is through from top to bottom are arranged on the single-hole fixing block, locking members are arranged on the square connecting hole and the ilium fixing hole, two square connecting holes which are through from left to right and through from front to back are arranged on the double-hole fixing block, and the locking members are arranged on the two square connecting holes which are through from left to right and through from front to back.
The further technical scheme is that the number of the single-hole fixing blocks is two, the number of the double-hole fixing blocks is one, the number of the threaded nails is two, the threaded nails can penetrate through the ilium fixing holes in the single-hole fixing blocks, drill into the opposite ilium and are locked by the locking members in the ilium fixing holes, and the function of fixing the opposite side fixing device is achieved.
The technical scheme is that the positioner comprises a positioner body, and is characterized by further comprising a transverse square connecting rod and a longitudinal square connecting rod, wherein one end of the transverse square connecting rod is connected with a square connecting hole in the positioner body, the other end of the transverse square connecting rod penetrates through the square connecting hole in the first single-hole fixing block to be connected with left and right through square connecting holes in the double-hole fixing block and is locked by a locking component in the three square connecting holes, one end of the longitudinal square connecting rod is connected with the front and back through square connecting holes in the double-hole fixing block, the other end of the longitudinal square connecting rod is connected with the square connecting hole in. The transverse and longitudinal square connecting rods are used for connecting the positioner body and the opposite side fixing device, and the function of stabilizing the rectangular main positioner is achieved.
The further technical scheme is that the included angle between the transverse square connecting rod and the longitudinal square connecting rod is 90 degrees.
The further technical scheme is that the locking component is divided into a locking hole and a locking bolt detachably connected with the locking hole.
Compared with the prior art, the invention has the beneficial effects that:
1. the invention has simple structure, low cost and convenient use,
2. the invention does not need multi-angle X-ray repeated fluoroscopy and does not need to puncture into the bone, has accurate positioning and strong stability, and ensures the one-time success of the safe implantation of the guide pin and the screw.
3. The hollow positioning rod is matched with the thread guide pin to penetrate into skin, the tip end of the hollow positioning rod is tightly attached to the outer side of the upper articular process of the first sacrum and is sunken on cortical bone or the surface of bone of other key anatomical marks, and the thread guide pin can be screwed into the sacrum to stabilize the hollow positioning rod and can also not be screwed into the sacrum. Avoiding cumbersome and risky procedures that must rely on pedicle screws of the sacrum as a reference.
4. The use of the transverse arc regulator enables a doctor to determine different external inclination angles of the sacroiliac screw nail track and the human sagittal plane in a mode of transversely regulating the arc scale rod by taking the O point in the sacrum as a virtual circle center according to the condition of a patient.
Drawings
FIG. 1 is a schematic view of the combination of a rectangular main positioner and a transverse arc adjuster according to the present invention.
FIG. 2 is a schematic structural diagram of a rectangular primary locator according to the present invention.
Fig. 3 is a schematic view of the structure of the lateral arc adjuster of the present invention.
FIG. 4 is a schematic view of the contralateral fixation device.
FIG. 5 is a schematic structural diagram of the hollow positioning rod, the threaded guide pin and the hollow sleeve of the present invention.
Fig. 6 is a state diagram of the present invention in use.
Fig. 7 is a partially enlarged view of region B in fig. 6.
In the figure: 1. a locator body; 2. a sacral locating hole; 3. a hollow positioning rod; 4. a threaded guide pin; 5. an ilium fixation hole; 6. a threaded nail; 7. locking the bolt; 8. a transverse arcuate sleeve; 9. an arc-shaped scale rod; 10. a locking hole; 11. a hollow sleeve; 12. an open chute; 13. a rectangular guide block; 14. the ilium; 15. a sacrum; 16. a square connecting hole; 17. a transverse square connecting rod; 18. a double-hole fixing block; 19. a single-hole fixing block; 20. a longitudinal square connecting rod; 21. an arc-shaped slideway.
Detailed Description
In order to better understand the technical content of the invention, specific embodiments are provided below, and the invention is further described with reference to the accompanying drawings.
As shown in fig. 1 to 7, the centering and rotating radius offset-minimally invasive sacroiliac screw positioning guide provided by the invention comprises a rectangular main positioner, a transverse arc-shaped adjuster, a hollow positioning rod 3 and a hollow sleeve 11.
The rectangular main positioner comprises a positioner body 1 and a transverse arc-shaped sleeve 8 arranged at the front end of the positioner body 1, wherein a sacrum positioning hole 2 and an ilium fixing hole 5 which are through up and down are arranged on the positioner body 1, the sacrum positioning hole 2 is used for being inserted by a guide pin and plays a guiding role for the guide pin, and the ilium fixing hole 5 can be used for fixing the rectangular main positioner to an ilium 14 through a threaded nail 6. The sacrum positioning holes 2 on the positioner body 1 are positioned at the inner side of the ilium fixing holes 5, the number of the ilium fixing holes 5 is four, the ilium fixing holes are longitudinally arranged, only one sacrum positioning hole 2 is provided, the four ilium fixing holes 5 are designed to use the ilium fixing holes 5 at different positions according to different disease conditions of patients, and one sacrum positioning hole 2 is designed to use the depressed cortical bone or other key anatomical marks at the outer side of the upper articular process of the first sacrum 15 as a positioning reference point. Locking components are arranged on the sacrum positioning hole 2 and the ilium fixing hole 5, and the locking components are divided into a locking hole 10 and a locking bolt 7 detachably connected with the locking hole 10. Locking holes 10 on the sacrum positioning hole 2 and the ilium fixing hole 5 are located on the positioner body 1, two locking holes 10 are arranged on each sacrum positioning hole 2 and each ilium fixing hole 5, the locking holes 10 of the sacrum positioning hole 2 are located on the right side of the positioner body 1, the locking holes 10 of the ilium fixing hole 5 are located on the left side of the positioner body 1, and the guide pin can be locked by screwing the locking bolts 7 from the outside during use. The transverse arc-shaped sleeve 8 is provided with a left-right through arc-shaped slideway 21, the arc-shaped slideway 21 is provided with a locking component, and a locking hole 10 of the locking component is positioned on the transverse arc-shaped sleeve 8 and can be screwed in from the outside by using a locking bolt 7 for locking when in use. The positioner body 1 is also provided with a left and right through square connecting hole 16, and the square connecting hole 16 is provided with a locking component.
The upper portion and the lower part of hollow locating lever 3 are cylindricly and the lower part diameter is less than the upper portion diameter, are equipped with detachable connected screw thread guide pin 4 in hollow locating lever 3, and the cylindric upper portion internal surface of hollow locating lever 3 is equipped with the screw thread, and the surface is equipped with the scale, and 4 tops of screw thread guide pin are the cylinder, and the lower part is the guide pin, is equipped with the screw thread in the below of cylinder, the outside of guide pin, and hollow locating lever 3 can the activity insert sacrum locating hole 2 and can be locked by the locking component on the sacrum locating hole 2. The hollow positioning rod 3 is inserted into the sacrum positioning hole 2 on the positioner body 1 to penetrate into the skin in cooperation with the threaded guide pin 4, the tip of the hollow positioning rod 3 is clung to the cortical bone surface (the point where the hollow positioning rod 3 is clung to is point A) or the bone surface of other key anatomical signs on the outer side of the upper articular process of the first sacrum 15, and the threaded guide pin 4 can be screwed into the sacrum 15 to stabilize the hollow positioning rod and can also be not screwed into the sacrum 15. Cumbersome and risky procedures that must rely on pedicle screws of the sacrum 15 as a reference are avoided. A virtual straight line which is parallel to the sagittal plane and vertically enters the sacrum 15 downwards is made through the point A, a certain distance below the point A is selected to be a point O (the point O is the center of a rotating circle) on the virtual straight line, the distance from the point A to the point O is a stagger distance, and the stagger distance can be set by adjusting the scales on the hollow positioning rod 3 inserted into the sacrum positioning hole 2 during the operation.
The horizontal arc regulator comprises a rectangular guide block 13 and an arc scale rod 9 arranged on the rectangular guide block 13, wherein an opening sliding groove 12 which is through from front to back and is opened downwards is formed in the rectangular guide block 13, a locking component is arranged on the opening sliding groove 12, a locking hole 10 of the locking component is formed in the rectangular guide block 13, the radian of the arc scale rod 9 is provided with multiple specifications for selection, and scales are arranged on the rod. The arc-shaped scale rod 9 can be movably inserted into the arc-shaped slideway 21 and can be fastened by a locking component on the arc-shaped slideway 21, the radians of the arc-shaped scale rod 9 and the arc-shaped slideway 21 are consistent, and the scales on the arc-shaped scale rod 9 inserted into the arc-shaped slideway 21 can be adjusted according to different illness states of patients so as to determine different external inclination angles of the sacroiliac screw nail way and the sagittal plane of a human body.
The upper part of the hollow sleeve 11 is cylindrical, the lower part is conical, and the hollow sleeve 11 can be movably inserted into the open sliding groove 12 and can be locked by a locking component on the open sliding groove 12. The hollow sleeve 11 is used for being inserted into the opening sliding groove 12 to reach the rear outer side of the ilium 14 wing to play a role in positioning and guiding, and the extension line of the insertion direction of the hollow sleeve passes through a point O.
The fixing device comprises a fixing block and a threaded nail 6, and the fixing block is divided into a single-hole fixing block 19 and a double-hole fixing block 18. The number of the single-hole fixing blocks 19 is two, the number of the double-hole fixing blocks 18 is one, and the number of the screw nails 6 is two. Be equipped with on haplopore fixed block 19 about penetrating square connecting hole 16 and upper and lower penetrating ilium fixed orifices 5, all be equipped with locking member on square connecting hole 16 and ilium fixed orifices 5, the locking hole 10 of two locking member all establishes on haplopore fixed block 19, be equipped with on diplopore fixed block 18 about penetrating and front and back penetrating two square connecting hole 16, it is penetrating about, be equipped with locking member on two front and back penetrating square connecting holes 16, the locking hole 10 of two locking member all establishes on diplopore fixed block 18, screw 6 can pass ilium fixed orifices 5 on haplopore fixed block 19 and bore on contralateral ilium 14 and be locked by the locking member of ilium fixed orifices 5, play fixed contralateral fixing device's effect.
Still include horizontal square connecting rod 17 and vertical square connecting rod 20, the contained angle of horizontal square connecting rod 17 and vertical square connecting rod 20 becomes 90 contained angles, the one end of horizontal square connecting rod 17 is connected with square connecting hole 16 on the locator body 1, the other end passes square connecting hole 16 of first piece single-hole fixed block 19 and is connected with the left and right sides through square connecting hole 16 of double-hole fixed block 18, and be locked by the locking member on three square connecting hole 16, vertical square connecting rod 20 one end is connected with the front and back through square connecting hole 16 of double-hole fixed block 18, the other end is connected with square connecting hole 16 of second piece single-hole fixed block 19, and be locked by the locking member on two square connecting hole 16. The transverse and longitudinal square connecting rods are used for connecting the positioner body 1 and the opposite side fixing device, and the function of stabilizing the rectangular main positioner is achieved.
The working principle of the invention is as follows:
before an operation, a patient is in a prone position, the upper surface of a sacrum 15 is perpendicular to the ground, a grid-shaped positioner is placed at the lumbosacral part, the sacrum 15 is positioned in a perspective mode, a point on the surface of a depressed bone on the outer side of an articular process on the sacrum 15 is determined and called as an A point, a virtual straight line which is parallel to a sagittal plane and vertically enters the sacrum downwards is made through the A point, a certain distance below the A point is selected to be an O point on the virtual straight line (the distance from the A point to the O point is an offset distance, the distance can be determined through CT measured data before the operation and is realized by adjusting scales on a hollow positioning rod 3), the O point is used as a virtual circle center, and a proper rotation radius is selected on a backward extension line of an OA connecting line. And determining the included angle alpha between the nail path and the sagittal plane according to CT measurement data.
In the operation process, puncture is carried out in a vertical horizontal plane, a hollow positioning rod 3 reaches cortical bone at the point A, a thread guide pin 4 is inserted into the hollow positioning rod 3 and is screwed into cortical bone at the point A of a sacrum 15, a sacrum positioning hole 2 of a rectangular main positioner is sleeved on the hollow positioning rod 3, the hollow positioning rod 3 is locked by a locking hole 10 and a locking bolt 7 on the sacrum positioning hole 2 to fix the rectangular main positioner, different ilium fixing holes 5 on a positioner body 1 are selected according to different illness states of a patient, a screw 6 is inserted into the ilium fixing hole 5 and is drilled into an ilium 14, a locking component on the ilium fixing hole 5 is used for locking the screw 6 to stabilize the rectangular main positioner, and finally, the rectangular main positioner and an opposite side fixing device are connected by a transverse square connecting rod 17 through a square connecting hole 16 on the positioner body 1 and a square connecting hole 16 of the opposite side fixing device, the stability of the rectangular main positioner is improved.
Since the rotation offset (i.e. the distance from the rotation center O point to the cortical surface of the bone at the point a) and the included angle α between the nail track and the sagittal plane are determined before the operation, the arc-shaped scale rod 9 of the transverse arc-shaped adjuster is inserted into the arc-shaped slide way 21 of the transverse arc-shaped sleeve 8, the abduction angle of the transverse arc-shaped adjuster is adjusted to α according to the scale on the arc-shaped scale rod 9, and the transverse arc-shaped adjuster is locked by the locking member of the arc-shaped slide way 21 positioned on the transverse arc-shaped sleeve 8.
Inserting the hollow sleeve 11 into an opening sliding groove 12 of a rectangular guide block 13 of the transverse arc-shaped adjuster, enabling the tip of the hollow sleeve 11 to reach cortex outside the rear of an ilium 14 wing, enabling the extension line of the tip to pass through a point O, locking the hollow sleeve 11 by a locking component on the opening sliding groove 12, inserting a guide pin into the hollow sleeve 11, confirming the guide pin again through the perspective of a C-arm X-ray machine, drilling the guide pin into the outer cortex of the ilium 14 and the sacrum 15 through the hollow sleeve 11, maintaining the position of the hollow sleeve 11 after the guide pin enters 30-40mm, withdrawing the guide pin, and replacing the guide pin with a channel opener.
And (3) continuously opening the way by using the opener, selecting a proper limit resistance gear, enabling the opener to advance in the sacrum 15 and pass through the point O in the advancing process until reaching the opposite cortical bone of the sacrum 15, namely, observing the right side of the sacrum 15, measuring the depth and screwing in a sacroiliac screw with proper length and diameter.
The above description is only for the purpose of illustrating the preferred embodiments of the present invention and is not to be construed as limiting the invention, and any modifications, equivalents, improvements and the like that fall within the spirit and principle of the present invention are intended to be included therein.
Claims (10)
1. A circle-center-fixed rotation radius offset-minimally invasive sacroiliac screw positioning guider is characterized in that: the device comprises a rectangular main positioner, a hollow positioning rod, a transverse arc regulator and a hollow sleeve;
the rectangular main positioner comprises a positioner body and a transverse arc-shaped sleeve arranged at the front end of the positioner body, wherein a sacrum positioning hole and an ilium fixing hole which are through up and down are arranged on the positioner body, locking members are arranged on the sacrum positioning hole and the ilium fixing hole, an arc-shaped slideway which is through left and right is arranged on the transverse arc-shaped sleeve, and the arc-shaped slideway is provided with the locking members;
the upper part and the lower part of the hollow positioning rod are both cylindrical, the diameter of the lower part is smaller than that of the upper part, a detachably connected threaded guide pin is arranged in the hollow positioning rod, and the hollow positioning rod can be movably inserted into the sacrum positioning hole and can be locked by a locking component on the sacrum positioning hole;
the transverse arc regulator comprises a rectangular guide block and an arc scale rod arranged on the rectangular guide block, an opening sliding groove which is through from front to back and is opened downwards is formed in the rectangular guide block, a locking component is arranged on the opening sliding groove, scales are arranged on the arc scale rod, and the arc scale rod can be movably inserted into the arc slide way and can be fastened by the locking component on the arc slide way;
the upper part of the hollow sleeve is cylindrical, the lower part of the hollow sleeve is conical, and the hollow sleeve can be movably inserted into the opening sliding groove and can be fastened by a locking component on the opening sliding groove.
2. The centered radius of rotation offset-minimally invasive sacroiliac screw positioning guide as defined in claim 1, wherein: the sacrum positioning holes on the positioner body are positioned on the inner side of the ilium fixing holes, the number of the ilium fixing holes is four, the ilium fixing holes are longitudinally arranged, and only one sacrum positioning hole is arranged.
3. The centered radius of rotation offset-minimally invasive sacroiliac screw positioning guide as defined in claim 1, wherein: the radian of the arc-shaped scale rod has various specifications for selection.
4. The centered radius of rotation offset-minimally invasive sacroiliac screw positioning guide as defined in claim 1, wherein: the locator body is also provided with a square connecting hole which is through from left to right, and the square connecting hole is provided with a locking component.
5. The centered radius of rotation offset-minimally invasive sacroiliac screw positioning guide as defined in claim 1, wherein: the inner surface of the cylindrical upper part of the hollow positioning rod is provided with an internal thread, and the outer surface of the hollow positioning rod is provided with scales; the top of the threaded guide pin is a cylinder, external threads are arranged below the cylinder and outside the guide pin, and the external threads of the guide pin are matched with the internal threads of the hollow positioning rod.
6. The centered radius of rotation offset-minimally invasive sacroiliac screw positioning guide as defined in claim 1, wherein: still include offside fixing device, offside fixing device includes fixed block and screw thread nail, and the fixed block divide into haplopore fixed block and diplopore fixed block, is equipped with about on the haplopore fixed block penetrating square connecting hole and upper and lower penetrating ilium fixed orifices, all is equipped with locking member on square connecting hole and ilium fixed orifices, controls penetrating and two front and back penetrating square connecting holes about being equipped with on the diplopore fixed block, all is equipped with locking member on controlling penetrating, front and back penetrating two square connecting holes.
7. The centered radius of rotation offset-minimally invasive sacroiliac screw positioning guide as defined in claim 6, wherein: the single-hole fixing blocks are two, the double-hole fixing blocks are one, the threaded nails are two, and the threaded nails can penetrate through the ilium fixing holes in the single-hole fixing blocks, drill into the opposite ilium and are locked by the locking members in the ilium fixing holes.
8. The centered radius of rotation offset-minimally invasive sacroiliac screw positioning guide as defined in claim 1, wherein: still include horizontal square connecting rod and vertical square connecting rod, the one end of horizontal square connecting rod is connected with the square connecting hole on the locator body, the other end passes the square connecting hole of first haplopore fixed block and the penetrating square connecting hole of controlling of diplopore fixed block is connected, and by the locking member locking on the three square connecting hole, vertical square connecting rod one end is connected with the penetrating square connecting hole around the diplopore fixed block, the other end is connected with the square connecting hole of second haplopore fixed block, and by the locking member locking on two square connecting holes.
9. The centered radius of rotation offset-minimally invasive sacroiliac screw positioning guide as defined in claim 1, wherein: the included angle between the transverse square connecting rod and the longitudinal square connecting rod is 90 degrees.
10. The centered radius of rotation offset-minimally invasive sacroiliac screw positioning guide as defined in claim 1, wherein: the locking member is divided into a locking hole and a locking bolt detachably connected with the locking hole.
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| CN110693599B (en) | 2024-07-23 |
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