CN111067587B - Children DDH femur near-end osteotomy guide plate and use method thereof - Google Patents

Children DDH femur near-end osteotomy guide plate and use method thereof Download PDF

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CN111067587B
CN111067587B CN201911322777.9A CN201911322777A CN111067587B CN 111067587 B CN111067587 B CN 111067587B CN 201911322777 A CN201911322777 A CN 201911322777A CN 111067587 B CN111067587 B CN 111067587B
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femur
osteotomy
kirschner wire
groove
ddh
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CN111067587A (en
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连峰
崔勇
曲敬
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Harbin Medical University
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Harbin Medical University
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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
    • A61B17/1742Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the hip
    • 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
    • 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
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/74Devices for the head or neck or trochanter of the femur
    • A61B17/742Devices for the head or neck or trochanter of the femur having one or more longitudinal elements oriented along or parallel to the axis of the neck
    • A61B17/746Devices for the head or neck or trochanter of the femur having one or more longitudinal elements oriented along or parallel to the axis of the neck the longitudinal elements coupled to a plate opposite the femoral head
    • 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
    • A61B2017/568Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor produced with shape and dimensions specific for an individual patient
    • YGENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y02TECHNOLOGIES OR APPLICATIONS FOR MITIGATION OR ADAPTATION AGAINST CLIMATE CHANGE
    • Y02PCLIMATE CHANGE MITIGATION TECHNOLOGIES IN THE PRODUCTION OR PROCESSING OF GOODS
    • Y02P10/00Technologies related to metal processing
    • Y02P10/25Process efficiency

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Biomedical Technology (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Engineering & Computer Science (AREA)
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  • Oral & Maxillofacial Surgery (AREA)
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  • Surgical Instruments (AREA)

Abstract

The invention provides a child DDH femur near-end osteotomy guide plate and a use method thereof, wherein two femur plates which follow the femur are arranged up and down, a gap is arranged between the two femur plates, the two femur plates are connected by a connecting part at the gap, a first osteotomy groove which is perpendicular to the axis of a femur shaft is arranged on the femur plate positioned above, an inclined second osteotomy groove is arranged on the femur plate positioned below, and a plurality of Kirschner wire positioning holes are respectively arranged on the two femur plates. The orthopedic osteotomy plate integrates positioning, guiding and distance measuring, can improve the safety and accuracy of operation, shortens the operation time, can avoid excessive X-ray radiation, provides more accurate osteotomy guiding for clinicians, achieves the aim of personalized treatment of children DDH, improves the hip joint function of patients, promotes the acetabulum to develop again, cures hip joint deformity or delays the occurrence of hip joint osteoarthritis, and reduces the patient disability rate.

Description

Children DDH femur near-end osteotomy guide plate and use method thereof
Technical Field
The invention relates to the technical field of medical equipment, in particular to a 3D printing guide plate device for accurate osteotomy of proximal femur caused by developmental hip joint dysplasia of children.
Background
Developmental hip dysplasia (developmental dysplasia of the hip, DDH) is a hip disorder that occurs in childhood or childhood, with an incidence of about one thousandth of a surviving neonate. Many reports indicate that DDH osteotomies are complex to operate, learning curves are long, the success of the surgery is closely related to reasonable choices of the surgery and the experience of the doctor of the main doctor, and errors in assessing the deformity are easy to generate.
Among the various pelvic osteotomies of DDH, the most frequently used are the modified Pemberton and Dega periacetabular osteotomies. However, no matter what operation type, the doctor of the main knife needs to cut bones by hands according to experience, and the disadvantage of the operation is that the bare-hand bone cutting is used for complex orthopedic operation, the error is large, the operation is inconvenient and the efficiency is low. Therefore, in order to improve the safety and accuracy of the operation, and simultaneously shorten the operation time and avoid excessive X-ray radiation, a medical instrument capable of providing accurate osteotomy positioning and guiding for the DDH pelvis and femur of children is urgently needed to be developed and applied.
Disclosure of Invention
The invention provides a child DDH femur proximal end osteotomy guide plate and a use method thereof, and aims to overcome the defects in the prior art, provide an orthopedic osteotomy plate integrating positioning, guiding and distance measurement for completing osteotomy operation in orthopedic surgery, and provide more accurate osteotomy guiding for clinicians.
In order to achieve the above purpose, the invention adopts the following technical scheme:
the utility model provides a children DDH thighbone near-end cuts bone baffle, two with femur along with the femur board upper and lower arrangement of shape to have a clearance between two bone boards, two bone boards are in the clearance department is connected by connecting portion, and the outside upper side wall irregular bone face laminating of the femur board that is located the top and the thighbone tuberosity has first osteotomy groove on the femur board that is located the top, has the second osteotomy groove on the femur board that is located the below, two respectively be equipped with the locating hole of several kirschner wire on the femur board.
The proximal bone cutting guide plate of the DDH femur of the child comprises: the femur plate positioned above is provided with 4 Kirschner wire positioning holes, and the 4 Kirschner wire positioning holes are arranged in a diamond shape and can enable the Kirschner wire to be nailed into the femoral shaft in a first direction; the femur plate positioned below is provided with 3 Kirschner wire positioning holes, and the 3 Kirschner wire positioning holes are arranged in a longitudinal straight shape and can enable the Kirschner wire to be nailed into the femoral shaft in a second direction;
the proximal bone cutting guide plate of the DDH femur of the child comprises: the positions of the Kirschner wire positioning holes are matched with the positions of screw holes of the locking steel plate.
The proximal bone cutting guide plate of the DDH femur of the child comprises: the connecting line of two longitudinally arranged kirschner wires in the 4 kirschner wires locating holes at the upper part and the axis of the femoral shaft form a first kirschner wire plane, the connecting line of the 3 kirschner wires locating holes at the lower part and the axis of the femoral shaft form a second kirschner wire plane, and the included angle between the first kirschner wire plane and the second kirschner wire plane is the pre-correction angle of the pre-dip angle of the femur
The proximal bone cutting guide plate of the DDH femur of the child comprises: the notch connecting line of the first osteotomy groove vertically passes through the first Kirschner wire plane, and the groove bottom connecting line of the first osteotomy groove and the notch connecting line form a first osteotomy plane; the notch connecting line of the second osteotomy groove vertically passes through the second Kirschner wire plane, and the groove bottom connecting line of the second osteotomy groove and the notch connecting line form a second osteotomy plane; the first osteotomy plane is perpendicular to the femoral shaft, and an included angle between the second osteotomy plane and the first osteotomy plane is a femoral neck angle predistortion angle.
The proximal bone cutting guide plate of the DDH femur of the child comprises: the distance between the lowest points of the first osteotomy groove and the second osteotomy groove is the femur shortening length.
The connecting part is provided with a plurality of strips or other structures which are convenient for cutting.
The proximal bone cutting guide plate of the DDH femur of the child comprises: is manufactured by a 3D printing technology.
The application method of the DDH femur near-end osteotomy guide plate for children comprises the following steps,
a. fitting the femoral plate to the proximal femur of the patient on the patient's affected side;
b. at least 2 Kirschner wires are respectively drilled into the Kirschner wire positioning holes of the upper femur plate and the lower femur plate so as to fix the femur plates;
c. the pendulum saw cuts bones through the first bone cutting groove and the second bone cutting groove;
d. cutting off the connecting part and taking down the femur plate;
e. rotating the femur to enable the corresponding nail hole of the locking steel plate to be sleeved on the Kirschner wire;
f. and screws with predicted lengths are screwed in sequence to fix the locking steel plate.
Compared with the prior art, the invention has the beneficial effects that:
1. the outer upper side wall of part of the femur greater trochanter is selected as a guide plate attaching part, so that the accuracy of guide plate positioning can be remarkably improved;
2. the fractured ends of the osteotomies are anastomosed face to face, the contact area is increased, and the risk of fracture nonunion is reduced;
3. the stability of the osteotomy after the osteotomy is closed is enhanced, and the loosening probability of the steel plate screw is reduced;
4. the operation is simple and convenient, and the operation efficiency is improved;
5. the learning cost is low, and the popularization is easier.
Drawings
FIG. 1 is a front view of a child DDH femoral proximal osteotomy guide provided by the present invention;
FIG. 2 is a top view of a child DDH femoral proximal osteotomy guide provided by the present invention;
fig. 3 is a left side view of a child DDH femoral proximal osteotomy guide provided by the present invention.
Reference numerals illustrate: 1-a femoral plate; a 2-connection; 3-Kirschner wire positioning holes; 4-a first osteotomy groove; 5-a second osteotomy groove; 6-pre-correcting the pre-inclination angle of the femur; 7, pre-correcting the angle of the neck shaft of the femur; 8-femur shortening length.
Detailed Description
Some specific embodiments of the invention will now be described in detail, by way of example and not by way of limitation, with reference to the accompanying drawings. The same reference numbers will be used throughout the drawings to refer to the same or like parts or portions. It will be appreciated by those skilled in the art that the drawings are not necessarily drawn to true scale.
Referring to fig. 1, the present invention provides a proximal femoral resection guide for a child DDH, which includes two femoral plates 1 following the femur and a connecting portion 2 connecting the femoral plates 1 together. Two of the femoral plates 1 are arranged one above the other with a gap between the two bone plates 1. The two femur plates 1 extend outwards at the tail ends of the gaps and are connected into a whole to form a connecting part 2. The upper side of the connecting part 2 is provided with a first osteotomy groove 4 on the upper femur plate 1, and the lower side of the connecting part 2 is provided with a second osteotomy groove 5 on the lower femur plate 1. The upper femur plate 1 is attached to the irregular bone surface of the outer upper side wall of the femur greater tuberosity, so that the function of increasing positioning accuracy can be achieved, and on the basis of guaranteeing overall strength and positioning accuracy, the lower end of the upper femur plate 1 can be properly narrowed according to an operation incision, but cannot be narrowed to ensure enough attaching area, and positioning accuracy is guaranteed. The lower femoral plate 1 can be shortened and narrowed on the basis of ensuring the overall strength. Preferably, the connecting part is a plurality of strips arranged in parallel or other structures convenient for cutting.
The upper femur plate 1 is provided with 4 k-wire positioning holes 3, and the 4 k-wire positioning holes are arranged in a diamond shape. The femur plate 1 positioned below is provided with 3 Kirschner wire positioning holes 3, and the 3 Kirschner wire positioning holes 3 are arranged in a longitudinal straight shape.
Referring to fig. 2, the 4 k-wire positioning holes 3 of the upper femoral plate 1 and the 3 k-wire positioning holes 3 of the lower femoral plate 1 are not in the same plane, and as seen from a top view, a first k-wire plane is formed by connecting two longitudinally arranged k-wire pinholes 3 of the 4 k-wire positioning holes 3 of the upper femoral plate 1 with the axis of the femoral shaft, a second k-wire plane is formed by connecting the 3 k-wire positioning holes 3 of the lower and the axis of the femoral shaft, and an included angle is formed between the first k-wire plane and the second k-wire plane, and is the pre-correction angle 6 of the antefemoral angle.
The notch connecting line of the first osteotomy groove 4 vertically passes through the first kirschner wire plane, and the notch connecting line of the second osteotomy groove 5 vertically passes through the second kirschner wire plane, that is, when the bone cutting is performed by extending into the first osteotomy groove 4 and the second osteotomy groove 5, the two bone cutting planes are at a certain angle in the overlooking direction.
Referring to fig. 3, 4 k-wire positioning holes 3 on the upper femoral plate 1 enable the k-wires to be nailed into the femoral shaft in a first direction, and 3 k-wire positioning holes on the lower femoral plate 1 enable the k-wires to be nailed into the femoral shaft in a second direction. The first direction and the second direction are arranged to be consistent with the screw-in direction of the locking steel plate, so that the femoral shaft after operation can be conveniently fixed. The Kirschner wire positioning hole 3 has the rotation removing function of correcting the excessive forward inclination besides fixing the guide plate, assisting the positioning of the screw and the locking steel plate.
The connecting line of the groove bottom of the first osteotomy groove 4 and the connecting line of the groove opening form a first osteotomy plane, the connecting line of the groove bottom of the second osteotomy groove and the connecting line of the groove opening form a second osteotomy plane, the first osteotomy plane is perpendicular to the femoral shaft, and the included angle between the second osteotomy plane and the first osteotomy plane is the femoral neck angle predistortion angle 7. The distance between the lowest point of the first osteotomy groove 4 and the second osteotomy groove 5 is the femur shortening length 8. It should be noted that the present invention is manufactured by 3D printing technology. Before processing and manufacturing, DICOM data of the pelvis and the bilateral femur of the patient are obtained in advance through three-dimensional CT scanning, and then the data are imported into the mimics software to carry out three-dimensional reconstruction on the pelvis and the bilateral femur of the patient. And measuring the neck shaft angle, the anteversion angle and the length required to be shortened of the femur in the three-dimensional model, so as to calculate the varus angle, the rotation angle and the length required to be corrected.
The invention comprises the following specific steps when in use:
1. the invention is attached to the proximal femur of the affected side of a patient, and the outer upper side wall of the greater trochanter is taken as an attachment point, so that the tight attachment can be realized;
2. at least 2 Kirschner wires are respectively drilled into the Kirschner wire positioning holes at the upper end of the first osteotomy groove and the lower end of the second osteotomy groove to fix the femur plate;
3. the pendulum saw cuts bones through the first bone cutting groove and the second bone cutting groove;
4. cutting off the connecting part and taking down the guide plate;
5. the femur is rotated, so that the corresponding nail holes of the locking steel plate are sleeved on the positioning Kirschner wire, and the two sides of the bone end are involuted, thereby realizing the shortening, the rotation removal and the correction of varus deformity of the proximal femur;
6. and screws with predicted lengths are screwed in sequence to fix the locking steel plate.
It should be noted that the locking plate is used in conjunction with the present invention to secure the patient's femur after the correction, and serves to provide firm support during healing of the patient's femur. The locking steel plate has an appearance which is fit with the femur of a patient, and the screw holes on the locking steel plate are consistent with the positions of the Kirschner wire positioning holes on the femur plate in the same direction.
The invention has the advantages that:
the invention provides an orthopedic osteotomy plate system integrating positioning, guiding and distance measurement for finishing osteotomy operation in orthopedic surgery and an operation method, which can improve the safety and accuracy of surgery, shorten the surgery time, avoid excessive X-ray radiation, provide more accurate osteotomy guiding for clinicians, achieve the aim of personalized treatment of children DDH, improve the hip joint function of patients, promote the secondary development of acetabulum, cure hip joint deformity or delay the occurrence of hip joint osteoarthritis, and reduce the patient disease residue rate.
The above description is illustrative of the invention and is not to be construed as limiting, and it will be understood by those skilled in the art that many modifications, variations or equivalents may be made without departing from the spirit and scope of the invention as defined in the appended claims.

Claims (6)

1. A child DDH femur proximal osteotomy guide plate, characterized in that: the two femur plates which are in shape with the femur are arranged up and down, a gap is formed between the two femur plates, the two femur plates are connected by a connecting part at the gap, the femur plate positioned above is attached to the irregular bone surface of the outer upper side wall of the femur greater tuberosity, the femur plate positioned above is provided with a first osteotomy groove, the femur plate positioned below is provided with a second osteotomy groove, and a plurality of Kirschner wire positioning holes are respectively arranged on the two femur plates;
the connecting line of two longitudinally arranged kirschner wires in the 4 kirschner wires locating holes above and the axis of the femoral shaft form a first kirschner wire plane, the connecting line of the 3 kirschner wires locating holes below and the axis of the femoral shaft form a second kirschner wire plane, and the included angle between the first kirschner wire plane and the second kirschner wire plane is a pre-correction angle of the anteversion angle of the femur;
the notch connecting line of the first osteotomy groove vertically passes through the first Kirschner wire plane, and the groove bottom connecting line of the first osteotomy groove and the notch connecting line form a first osteotomy plane;
the notch connecting line of the second osteotomy groove vertically passes through the second Kirschner wire plane, and the groove bottom connecting line of the second osteotomy groove and the notch connecting line form a second osteotomy plane;
the first osteotomy plane is perpendicular to the femoral shaft, and the included angle between the second osteotomy plane and the first osteotomy plane is a femoral neck angle predistortion angle;
the femur plate is attached to the proximal femur of the patient, the outer upper side wall of the greater trochanter is used as an attachment point for achieving tight attachment, at least 2 Kirschner wires are drilled in the Kirschner wire positioning holes at the upper end of the first osteotomy groove and the lower end of the second osteotomy groove respectively for fixing the femur plate, the pendulum saw is used for osteotomy through the first osteotomy groove and the second osteotomy groove, the connecting part is cut off, the guide plate is taken down, and the guide plate is used for enabling the corresponding nail holes of the locking steel plate to be sleeved on the positioning Kirschner wires to enable the bone ends at two sides to be closed, so that the shortening, the rotation removal and the correction of varus deformity of the proximal femur are achieved.
2. The child DDH femoral proximal osteotomy guide of claim 1, wherein:
the femur plate positioned above is provided with 4 Kirschner wire positioning holes, and the 4 Kirschner wire positioning holes are arranged in a diamond shape and can enable the Kirschner wire to be nailed into the femoral shaft in a first direction;
the femur plate positioned below is provided with 3 Kirschner wire positioning holes, and the 3 Kirschner wire positioning holes are arranged in a longitudinal straight shape and can enable the Kirschner wire to be nailed into the femoral shaft in a second direction.
3. The child DDH femoral proximal osteotomy guide of claim 2, wherein: the positions of the Kirschner wire positioning holes are matched with the positions of screw holes of the locking steel plate.
4. The child DDH femoral proximal osteotomy guide of claim 1, wherein: the distance between the lowest points of the first osteotomy groove and the second osteotomy groove is the femur shortening length.
5. The child DDH femoral proximal osteotomy guide of claim 1, wherein: the connecting part is provided with a plurality of strip-shaped bodies which are arranged in parallel.
6. The child DDH femoral proximal osteotomy guide of claim 1, wherein: is manufactured by a 3D printing technology.
CN201911322777.9A 2019-12-20 2019-12-20 Children DDH femur near-end osteotomy guide plate and use method thereof Active CN111067587B (en)

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CN111803175B (en) * 2020-08-10 2022-03-29 经纬医疗器材制造(深圳)有限公司 Osteotomy positioning tool
CN114129259B (en) * 2021-11-05 2024-10-01 刘逸夫 Preparation method of osteotomy guide plate and clamping locking sleeve based on digital medicine and 3D printing technology
CN118633997B (en) * 2024-08-16 2024-11-01 北京爱康宜诚医疗器材有限公司 Orthopedic osteotomy guide plate

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RU2355347C1 (en) * 2007-10-25 2009-05-20 Государственное учреждение "Научно-исследовательский центр Татарстана "Восстановительная травматология и ортопедия" Femoral neck varus treatment method
CN104840240B (en) * 2015-05-21 2017-07-14 南方医科大学第三附属医院 A kind of femur osteotomy assistor
CN105266868B (en) * 2015-10-09 2017-11-10 郝明仲 One kind realizes pinpoint Limb bone osteotomy guider
CN105434009B (en) * 2015-11-26 2019-05-17 南京医科大学附属南京儿童医院 For the navigation template of femoral osteotomies, application method and production method
CN205924106U (en) * 2016-06-27 2017-02-08 湖南华翔增量制造股份有限公司 Cut orthopedic baffle of bone based on 3D prints
CN207055523U (en) * 2017-03-01 2018-03-02 湖南华翔增量制造股份有限公司 A kind of osteotomy guide plate
CN108294805B (en) * 2018-03-22 2020-06-12 中国人民解放军总医院 Universal femur osteotomy guider for congenital acetabular dysplasia

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