CN111195157B - Guiding device for brain surgery positioning - Google Patents
Guiding device for brain surgery positioning Download PDFInfo
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- CN111195157B CN111195157B CN202010128730.5A CN202010128730A CN111195157B CN 111195157 B CN111195157 B CN 111195157B CN 202010128730 A CN202010128730 A CN 202010128730A CN 111195157 B CN111195157 B CN 111195157B
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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
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- B—PERFORMING OPERATIONS; TRANSPORTING
- B33—ADDITIVE MANUFACTURING TECHNOLOGY
- B33Y—ADDITIVE MANUFACTURING, i.e. MANUFACTURING OF THREE-DIMENSIONAL [3-D] OBJECTS BY ADDITIVE DEPOSITION, ADDITIVE AGGLOMERATION OR ADDITIVE LAYERING, e.g. BY 3-D PRINTING, STEREOLITHOGRAPHY OR SELECTIVE LASER SINTERING
- B33Y80/00—Products made by additive manufacturing
Abstract
The invention relates to a guiding device for brain surgery positioning, belongs to the technical field of brain minimally invasive surgery equipment, and solves the problem that the existing device is easy to damage brain tissues of a patient. The guide device includes: a mask guide plate and a guide bracket; the mask guide plate can be attached and fixed to the skin of the head of a patient, the guide bracket is mounted on the mask guide plate, and the mask guide plate is detachably and fixedly connected with the guide bracket; the guide device is used for guiding the guide needle, the guide needle can enter the brain according to the guide direction of the guide support, and the retraction catheter can enter a preset position in the brain along the guide needle. The invention prevents the swing of the retracting catheter in the process of entering the brain, can reduce the damage degree of the retracting catheter to the brain tissue in the process of inserting the retracting catheter, and can further improve the accuracy of the retracting catheter in the position of the brain; meanwhile, the conical design of the front end of the tube core of the retracting catheter further reduces the damage to brain tissue in the retracting catheter entering process, and the position is more accurate.
Description
Technical Field
The invention relates to the technical field of brain deep minimally invasive surgery equipment, in particular to a guiding device for brain surgery positioning.
Background
Compared with the neural navigation technology and the robot brain positioning technology, the 3D printing guide plate brain positioning technology is a brain positioning technology with lower cost. The existing clinical 3D printing guide plate brain positioning technology requires that a designed mask guide plate and an operation access are jointed on the scalp, namely the scalp cannot be displaced in the operation, so the positioning technology can only be used for intracranial cannulation operation, and most brain operations requiring bone window craniotomy cannot use the technology because the scalp is necessarily displaced due to the exposure of an incision.
For example, cerebral hemorrhage is a common clinical disease, most of which is located in deep brain, and the minimally invasive endoscopic technique of bone window craniotomy has clinical significance in clearing intracerebral hematoma. However, the cerebral hemorrhage surgery without the positioning technology has a large trauma, the positioning technologies such as nerve navigation and the like have high cost, and the existing 3D printing guide plate brain positioning technology with low cost cannot be used for the bone window craniotomy needing scalp retraction.
Therefore, the development of a 3D printing guide plate brain positioning technology suitable for the bone window craniotomy (scalp displacement near the incision) is very significant.
When minimally invasive surgery is performed in deep brain, brain retraction devices are frequently used, and the existing deep brain retraction devices mainly comprise two types.
One type is known as disposable tissue expanders (e.g., manufactured by Peking Tianxinfu). The design of two-chamber, the scope relatively fixed (having restricted the nimble application of scope) that the operation was used, the design of pipe straight tube type (depth diameter unanimity) (and by shallow to the tapering design of dark pipe diameter, more be convenient for the cooperation of two apparatus in the operation to use than this kind of design), the cross section is circular (compare the ellipse design and has pushed away more two apparatus operation originally need not push away the brain tissue of pushing away), the tube core cavity is nevertheless not directly leading to the front end (the front end does not have straight hole, the directional guide needle of usefulness of brain location can not pass through).
In another class, they are called single use brain retraction guide catheters (e.g., manufactured by vinpocetine). The most slender specification of the catheter is LW120807, the elliptic caliber at the front end of the catheter is 12 multiplied by 8mm, and the catheter with the caliber is used for carrying out intracerebral hemorrhage endoscope minimally invasive surgery, and is too thick (can be thinner) and has too large wound; in addition, the maximum length is only 7cm, and many cerebral hemorrhage operation positions are deep, and the length can not reach hematoma; in addition, the tube core (inner tube) of the catheter is in a thin-wall tubular shape with an oval cross section, although the front end opening is narrowed, the space in the tube core is large, the front end opening is still in an oval shape with a large area, and if a guide needle for positioning is used for introducing the catheter into a brain through the opening, the catheter is large in swing amplitude in the process of entering the brain, inaccurate in access and large in brain tissue damage. In actual use, when the brain retraction catheter is pushed into the brain, the retraction catheter cannot be fixed, so that the possibility of dislocation and deviation of the retraction catheter exists, and the risk of deep brain surgery is greatly increased.
Disclosure of Invention
In view of the above analysis, the present invention aims to provide a guiding device for brain surgery positioning, which is used to solve the problem that the 3D printing guide plate brain positioning technology cannot be applied to frontal craniotomy with deformed incised scalp after retraction; the guide bracket is prefabricated, so that immediate printing is not needed, the time for operation preparation is greatly shortened, and the emergency rescue opportunity is won; the prefabricated guide support can be subjected to reliable sterilization in advance, emergency sterilization after printing with the guide plate is not needed, and the operation infection rate is reduced.
The purpose of the invention is mainly realized by the following technical scheme:
in the technical scheme of the invention, the guiding device for positioning the brain surgery comprises: a mask guide plate and a guide bracket; the mask guide plate can be attached and fixed on the skin of the head of a patient, the guide bracket is arranged on the mask guide plate, and the mask guide plate is detachably and fixedly connected with the guide bracket;
the guide device is used for guiding the guide needle, the guide needle can enter the brain according to the guide direction of the guide support, and the retraction catheter can enter a preset position in the brain along the guide needle.
In the technical scheme of the invention, the guide bracket comprises: the mounting head, the guide arm and the guide head; the guide arm is of a rigid structure and comprises a mounting end and a guide end, the mounting end is arranged at the mounting end of the guide arm, and the guide end of the guide arm is arranged at the guide head; the guide head is provided with a cylinder accommodating cavity, the cylinder accommodating cavity is axially extended to form an infinite-length cylinder space, and the guide support and the infinite-length cylinder space have no public part.
In the technical scheme of the invention, the guide arm is a bent rod or a straight rod, and the cross section of the guide arm is rectangular.
In the technical scheme of the invention, the guide head is a cylindrical barrel with an opening on the side wall, the cylindrical accommodating cavity is positioned in the cylindrical barrel, the opening on the side wall of the guide head is an axial opening, and the corresponding central angle is 30-120 degrees.
According to the technical scheme, the guide arm is fixedly connected with the side wall of the guide head, the guide arm is fixedly connected with the guide head along the radial direction of the guide head, and the openings of the side wall are symmetrical to the guide arm along the circumferential direction of the guide head.
In the technical scheme of the invention, the mask guide plate is a frontal mask guide plate or a mask guide plate wound on an auricle.
In the technical scheme of the invention, the mask guide plate is provided with a mounting seat; the mounting seat is provided with a mounting hole, the mounting head of the guide support can be inserted into the mounting hole of the mask guide plate, the shape and the size of the cross section of the mounting hole are the same as those of the cross section of the mounting head, and the depth of the mounting hole is larger than the length of the mounting head.
According to the technical scheme, a limiting ring is arranged at the joint of the mounting head of the guide support and the guide arm.
In the technical scheme of the invention, the limiting ring is a frustum pyramid, the shape and the size of the top surface of the frustum pyramid are the same as those of the cross section of the guide arm, and the shape and the size of the bottom surface of the frustum pyramid are the same as those of the cross section of the mounting head.
In the technical scheme of the invention, the length multiplied by the width of the cross section of the guide arm is 8mm multiplied by 6mm, and the length of the guide arm along the axial direction of the cylindrical accommodating cavity is 52.7 mm;
the distance between the axis of the cylindrical accommodating cavity and the axis of the mounting head is 54 mm;
the length of the guide head is 30mm, and the diameter of the cylindrical accommodating cavity is 16.3 mm;
the height of the limiting ring is 7.3 mm;
the mounting head length is 10 mm.
In the technical scheme of the invention, the manufacturing method of the guiding device for the department surgery positioning is used for manufacturing the guiding device for the department surgery positioning, and the manufacturing method adopts a 3D printing technology.
The technical scheme of the invention can at least realize one of the following effects:
1. the invention can fix the guide needle on a specific posture through the mask guide plate which is designed and printed in real time and the guide bracket with a specific structure, ensures that surgical instruments such as a retracting catheter and the like can be accurately inserted into a target focus in the brain along the guide needle and across the retracted and deformed scalp near the lower incision of the bracket through the guide bracket, and realizes the positioning and guiding of the bone window craniotomy;
2. the mask guide plate and the guide support can be printed by adopting a 3D printing technology, and the mask guide plate and the guide support are designed separately, so that the guide support does not need to be printed in a 3D way and can be prefabricated into disposable consumables, the guide support does not need to be printed in each operation, the mask guide plate is only printed by the 3D printing technology, the operation preparation time is greatly shortened, and precious rescue time is won for emergency operations such as cerebral hemorrhage and the like; the two are designed separately, the guide support can be reliably sterilized in advance, so that surgical instruments entering brain tissues are sterilized by the guide support which is reliably sterilized, and the surgical instruments (mask guide plates) are not immediately 3D printed and can only be soaked and sterilized by common iodophors, so that the surgical operation is safer;
3. the device has the advantages of simple structure, low processing cost, simple method steps, simple and convenient operation and no need of special professional training for medical care personnel.
In the invention, the technical schemes can be combined with each other to realize more preferable combination schemes. Additional features and advantages of the invention will be set forth in the description which follows, and in part will be obvious from the description, or may be learned by practice of the invention. The objectives and other advantages of the invention will be realized and attained by the structure particularly pointed out in the written description and drawings.
Drawings
The drawings are only for purposes of illustrating particular embodiments and are not to be construed as limiting the invention, wherein like reference numerals are used to designate like parts throughout.
FIG. 1 is a schematic view of a guide bracket without reinforcing bars according to an embodiment of the invention;
FIG. 2 is a schematic view of a guide bracket with reinforcing bars according to an embodiment of the present invention;
FIG. 3 is a schematic view of a frontal face mask guide of an embodiment of the present invention;
FIG. 4 is a schematic view of a circumaural mask guide according to an embodiment of the present invention;
FIG. 5 is a schematic view of the mounting of a frontal face mask guide and guide bracket according to an embodiment of the present invention;
FIG. 6 is a schematic view of the installation of a guide plate and guide bracket around an auricle mask in accordance with an embodiment of the present invention;
figure 7 is a schematic view of a retracting catheter according to an embodiment of the present invention.
Reference numerals:
1-a guide bracket; 2-frontal face mask guide plate; 3-mask guide plate around auricle; 4-inner tube; 5-an outer tube; 6-a guide hole;
Detailed Description
The preferred embodiments of the present invention will now be described in detail with reference to the accompanying drawings, which form a part hereof, and which together with the embodiments of the invention serve to explain the principles of the invention and not to limit its scope.
In the description of the embodiments of the present invention, it should be noted that, unless otherwise explicitly stated or limited, the term "connected" should be interpreted broadly, and may be, for example, a fixed connection, a detachable connection, or an integral connection, which may be a mechanical connection, an electrical connection, which may be a direct connection, or an indirect connection via an intermediate medium. The specific meanings of the above terms in the present invention can be understood by those skilled in the art according to specific situations.
The terms "top," "bottom," "above … …," "below," and "on … …" as used throughout the description are relative positions with respect to components of the device, such as the relative positions of the top and bottom substrates inside the device. It will be appreciated that the devices are multifunctional, regardless of their orientation in space.
Example 1
The embodiment of the invention provides a guiding device for deep brain minimally invasive surgery, which comprises: the mask comprises a guide bracket 1, a mask guide plate, a guide needle and a retraction catheter; the guide bracket 1 is arranged on the mask guide plate; the guide needle can be inserted into a retracting catheter, and the retracting catheter is detachably and fixedly connected with the guide support 1; the mask guide plate is attached to the skin of the head of the patient, and the guide needle and the retraction catheter can be inserted into the brain of the patient. In practical use, the embodiment of the invention also uses a guide clamp and a positioning needle adaptive pipe, which can be fixed on the guide bracket 1 and used for fixing the guide needle and the guide bracket 1 relatively.
As shown in fig. 1, a guide bracket 1 is a guide bracket 1 of a retracting catheter for minimally invasive brain surgery, and the guide bracket 1 includes: the mounting head, the guide arm and the guide head; the guide arm is of a rigid structure and comprises a mounting end and a guide end, the mounting end is arranged at the mounting end of the guide arm, and the guide end of the guide arm is arranged at the guide head; the guide head is provided with a cylindrical accommodating cavity which is used for accommodating the guide clamp and the positioning needle adaptive pipe and fixing the position of the guide needle through the guide clamp and the positioning needle adaptive pipe; can also be used for placing surgical instruments such as a drainage tube and the like. The axial extension of cylinder accommodation chamber forms infinitely long cylinder space, and guide bracket 1 does not have the public part with infinitely long cylinder space. The mounting head of guide bracket 1 is pegged graft in the mounting hole of mask baffle, and the axis that the cylinder held the chamber coincides with the axis of leading out the pipe, can fix the gesture and the direction of guide needle through guide bracket 1, can keep the pointed end of guide needle to be located patient's focus department in the brain all the time. Because the guide support 1 abduces the infinite cylinder space, the scalp deformed in a certain range around the incision is prevented from being covered by the guide plate, and the accurate approach direction of the retracting catheter is ensured.
In order to reduce the manufacturing cost of the embodiment of the invention on the premise of not influencing the structural strength, in the embodiment of the invention, the guide arm is a bent rod or a straight rod, and the cross section of the guide arm is rectangular, so that the structural strength of the guide arm can be ensured, the material consumption can be reduced to the maximum extent, the regular cross section is convenient to produce and process, and the manufacturing cost of the embodiment of the invention can be greatly saved.
In the embodiment of the invention, the cross section of the mounting head is rectangular, the mounting head can be inserted into the mounting hole of the mask guide plate, and the rectangular shape and the interface shape can form circumferential limit fixation for the mounting of the guide support 1 and the mask guide plate.
In order to further stably determine the spatial position of the guide bracket, in the embodiment of the invention, a limiting ring is arranged at the joint of the mounting head of the guide bracket and the guide arm, and is used for limiting the depth of the mounting head inserted into the mounting hole of the mask guide plate.
Meanwhile, in order to prevent the limiting ring from being cut and rubbed or colliding with other articles, the limiting ring is a prismatic table, the shape and the size of the top surface of the prismatic table are the same as those of the cross section of the guide arm, and the shape and the size of the bottom surface of the prismatic table are the same as those of the cross section of the mounting head. The transition of the prismatic table can prevent the limiting ring from being scraped or collided with other articles.
In the embodiment of the invention, the guide head is a cylindrical barrel with an opening on the side wall, and when a drainage tube is placed by the split guide clamp in the guide head in an operation, the drainage tube inserted into the brain can be separated from the guide head and the guide clamp through the opening on the side wall of the guide head, so that the operation of placing the drainage tube to a focus in the brain is completed. The side wall opening of the guide head is an axial opening, and the corresponding central angle is 30-120 degrees, preferably 60-90 degrees.
The guide arm is fixedly connected with the side wall of the guide head, so that the guide arm can be prevented from causing spatial interference to an infinite-length cylindrical space. In order to facilitate the processing of the embodiment of the invention, the guide arm is fixedly connected with the guide head along the radial direction of the guide head, and the openings of the side walls are symmetrical to the guide arm along the circumferential direction of the guide head. Furthermore, to facilitate the mounting of the guide bracket 1, the axis of the cylindrical accommodation chamber is parallel to the axis of the mounting head.
In the embodiment of the present invention, as shown in fig. 2, a reinforcing rib is provided at the joint of the guide arm and the guide head.
In consideration of the actual use case, the dimensions of the embodiment of the present invention are as follows:
the length multiplied by the width of the cross section of the guide arm is 8mm multiplied by 6mm, and the length of the guide arm along the axial direction of the cylindrical accommodating cavity is 52.7 mm;
the distance between the axis of the cylindrical accommodating cavity and the axis of the mounting head is 54 mm;
the length of the guide head is 30mm, and the diameter of the cylindrical accommodating cavity is 16.3 mm;
the height of the limiting ring is 7.3 mm;
the mounting head length is 10 mm.
As shown in fig. 3 and 5, the mask guide is a frontal mask guide 2 for positioning a brain surgery or a circumaural mask guide 3 for positioning a brain surgery.
And designing and obtaining the frontal face mask guide plate 2 by adopting a 3D printing technology. The frontal face mask guide plate 2 is designed on the basis of dissecting hard-texture bilateral eyebrow arches of the skull of a patient and nasal bridge and nasal root, and comprises a frontal plate, a nasal bridge plate and a mounting seat; the nose bridge plate is arranged in the center of the lower part of the forehead plate, and the nose bridge plate and the forehead plate form a T-shaped curved plate; the mounting seat is arranged on the forehead plate; the forehead plate, the nose bridge plate and the mounting seat are of an integrated structure. The outer edges of the two sides of the forehead plate respectively reach the outer edges of the two eyebrow arches, wrap the eyebrow arches and the eyebrows, and can also wrap part of the eyelids as required; grin-through from both sides continues down to the root of the two side nosewings.
The forehead plate has a height of 2-3 cm. The frontal and facial mask guide plate 2 is printed, and the frontal and facial mask guide plate 2 for positioning the brain operation can be attached and fixed at the corresponding position of the frontal and facial part of the patient through the attachment of the frontal plate and the eyebrow arch and the attachment of the nose bridge plate and the nose bridge.
The mounting seat is provided with a mounting hole, the mounting head can be inserted into the mounting hole, the shape and the size of the cross section of the mounting hole are the same as those of the cross section of the mounting head, and the depth of the mounting hole is larger than the length of the mounting head.
As shown in fig. 4 and 6, the auricle-surrounding mask guide plate 3 for positioning the brain in the surgical operation is designed on the basis of the anatomy of the auricle with determined space shape and position and the skin reverse fold of the auricle base part with fixed position connected with the skull, and comprises a skull plate, an auricle-surrounding plate and a mounting seat; the ear-winding plate can be attached to the back of an auricle in a three-dimensional manner, the skull plate is a convex polygonal curved plate, the joint of the ear-winding plate and the skull plate can be attached to the ear root of a patient, and the mounting seat is arranged on the outer side of the ear-winding plate; the surrounding ear contour plate and the mounting seat are of an integrated structure.
For example, for the surgical guidance of cerebellar hemispheres and brainstem, the guide plate needs to extend towards the back of the pillow by 8cm behind the external auditory canal and 2cm above the external auditory canal on the basis of the ear root; while the common top-rear approach mainly extends upwards, 2cm behind and 10cm above the external auditory meatus are needed.
Too large a tragus mask guide 3 will prolong the printing time, too small a tragus mask guide 3 will be unstable or it will be difficult to include guide bracket landing feet, the guide bracket mounting head will engage with the guide plate mounting holes, so it will be elaborated in 3D printing software.
The circumaural mask guide plate 3 is designed and obtained by adopting a 3D printing technology. The ear-winding mask guide plate 3 for positioning the brain operation can be fixed at the position of the patient around the auricle part by the attachment of the ear-winding plate and the auricle.
The mounting seat is provided with a mounting hole, the mounting head of the guide support can be inserted into the mounting hole of the mask guide plate, the shape and the size of the cross section of the mounting hole are the same as those of the cross section of the mounting head, and the depth of the mounting hole is larger than the length of the mounting head.
When the embodiment of the invention is actually used, medical staff select the frontal face mask guide plate 2 or the auricle-surrounding mask guide plate 3 according to actual requirements. Fix the mask baffle at patient's head skin, install guide bracket 1 in the mount pad, realize that guide bracket 1's cylinder holds the fixed of axis relative patient's head in chamber to make the guide needle can insert patient's focus department smoothly. When the mask guide plate is designed by 3D printing, the CT image information of the brain of a patient needs to be input into computer software, and the insertion direction, the target point and the posture of a guide needle are designed in the software. The area range of the mask guide plate and the position and the posture of the mounting seat on the mask guide plate can be determined by determining the insertion direction, the target point and the posture of the guide pin. It should be noted that the frontal face mask guide plate 2 for positioning the brain surgery and the circumaural face mask guide plate 3 for positioning the brain surgery can cover all requirements for positioning the brain deep minimally invasive surgery: the frontal face mask guide plate 2 can meet the positioning requirements of operations of bilateral frontal lobes and deep brain tissues thereof, namely, the forehead approach; the guide plate 3 of the mask around the auricle can meet the design requirements of the approach of all brain surgeries on the same side except the frontal lobe and the deep part thereof, namely the temporal lobe, the parietal lobe, the occipital lobe, the basal ganglia, the thalamus and cerebellum and the brainstem on the same side.
As shown in fig. 7, the retracting catheter is a transparent retracting catheter for operation, comprising: an outer tube 5 and an inner tube 4; the cross sections of the outer tube 5 and the inner tube 4 are both oblong or elliptical and are both tubular structures with thin and shallow deep parts and thick parts, so that the retraction catheter can be more easily inserted into the brain of a patient, and the damage to the brain tissue of the patient in the insertion process is reduced; the inner tube 4 is provided with a guide hole 6 arranged along the axis of the inner tube 4. When the embodiment of the invention is used, the guiding needle is fixed, the guiding needle is inserted into the guiding hole 6, the retracting catheter is inserted into the preset position, and the deep part of the retracting catheter is inserted into the focus of the brain of the patient.
In order to reduce the injury of the retraction catheter to the brain tissue of the patient, in the embodiment of the invention, the inner tube 4 and the outer tube 5, and the guide needle and the guide hole 6 are connected in a seamless sleeved mode, so that the axial gap of the retraction catheter is reduced to the maximum extent, and when the retraction catheter is inserted into the brain tissue of the patient, the brain tissue is prevented from being immersed into the gap. It should be noted that in order to reduce damage to the brain tissue of the patient, the guide needle has a diameter not exceeding 2 mm.
The shallow portion of outer tube 5 is equipped with spacing fender ring, and inner tube 4 is equipped with spacing snap ring, and spacing fender ring and spacing snap ring form limit structure, and the diameter of spacing snap ring is more than or equal to spacing fender ring, and after accomplishing the insertion of leading out the pipe, inner tube 4 need take out, and the size of spacing snap ring is not less than the size of spacing fender ring and makes things convenient for taking out of inner tube 4.
In the embodiment of the invention, the limit baffle ring is provided with the baffle ring holding part, and the limit clamp ring is provided with the clamp ring holding part, so that medical personnel can hold and fix the retracting catheter conveniently.
In order to guarantee the relatively fixed between inner tube 4 and the outer tube 5, keep off that ring portion and snap ring portion of holding all follow the radial setting of drawing the pipe, keep off that ring portion and snap ring portion of holding between the contact surface is equipped with location structure, and location structure includes the same locating hole of shape and size and locating piece, through the block of locating hole and locating piece, forms the circumferential relatively fixed between inner tube 4 and the outer tube 5. Also, the size of the retainer ring holding portion is not smaller than that of the retainer ring holding portion in order to facilitate removal of the inner tube 4.
In the embodiment of the invention, the retaining ring holding part and the snap ring holding part are also provided with a buckle structure, and the buckle structure can relatively fix the inner pipe 4 and the outer pipe 5 along the axial direction.
After the retracting catheter is inserted into a focus in the brain of a patient, the inner tube 4 is taken down, the outer tube 5 is left in the brain of the patient and serves as a retractor for minimally invasive surgery, and the outer tube 5 is a transparent tube in the embodiment of the invention in order to facilitate observation of the focus by an endoscope or a microscope.
In order to conveniently know the insertion depth of the retraction catheter, the outer surface of the outer tube 5 of the retraction catheter is provided with scale marks so as to know the insertion depth of the retraction catheter and ensure that the tip of the retraction catheter is accurately inserted into a focus of a patient.
Example 2
The embodiment of the invention provides a guiding method for deep brain minimally invasive surgery, which uses the guiding device for deep brain minimally invasive surgery in the embodiment 1.
The guiding method comprises the following steps:
s1, manufacturing a mask guide plate through a 3D printing technology;
inputting the head CT image data of the patient into the 3D printing software. According to the details of a case, determining and designing an operation access, namely the insertion direction, the target point and the posture of the guide needle; and designing a head mask guide plate in 3D printing software according to the set surgical access, namely determining the positions of the frontal mask guide plate 2 or the circumaural mask guide plate 3 and the mounting seat, and performing 3D printing to obtain the mask guide plate.
S2, mounting the guide bracket (1) on the mask guide plate;
the guide clamp and the positioning needle adaptive pipe are inserted into a guide head of the guide support, then the guide support is installed on the mask guide plate, and the guide support 1 is manufactured in a prefabricated mode in batches in advance or can be manufactured in advance by adopting a 3D printing technology.
S3, attaching and fixing the mask guide plate on the corresponding part of the skin of the head of the patient;
the frontal and facial mask guide plate 2 for positioning the brain operation can be fixed on the frontal and facial part of the patient through the joint of the frontal plate and the eyebrow arch and the joint of the nose bridge plate and the nose bridge; or, the auricle-wound mask guide plate 3 for positioning the brain operation can be fixed at the position of the patient around the auricle part by the attachment of the auricle-wound plate and the auricle. In actual operation, because the use time is short, the mask guide plate can be temporarily attached and fixed to the corresponding part of the skull of a patient in a manual attaching and fixing mode.
S4, inserting the guide needle into the brain of the patient through the guide bracket 1 until the tip of the guide needle is inserted into the focus of the patient;
it should be noted that, because the guiding needle is inserted into the brain of the patient, before the guiding method of the embodiment of the present invention is performed, the minimally invasive craniotomy of the patient is required, which includes: incise and retract the scalp, mill a small area of the bone flap, incise the dura mater, treat the cerebral cortex, and the like.
The guide needle is a metal long straight needle with two ends round and blunt and the diameter of the metal long straight needle is 2 mm.
S5, keeping the space position of the guide needle still, and removing the guide bracket 1 and the mask guide plate;
s6, inserting the retraction catheter into the brain of the patient through the guide needle until the tip of the retraction catheter is inserted into the focus of the patient;
the guide needle is inserted into the guide hole 6 of the inner tube 4, the position of the guide needle is kept still, and the retraction catheter is inserted into the brain of the patient.
S7, keeping the outer tube 5 still, taking out the inner tubes 4 of the guide needle and the retracting catheter from the outer tube 5 step by step, and realizing instrument entry and operation part of the deep brain minimally invasive surgery through the inner space of the outer tube (5) of the retracting catheter which is dynamically fixed;
the buckling structure between the inner tube 4 and the outer tube 5 is unfastened, the inner tube 4 of the guide needle and the retracting catheter is removed step by step, and medical personnel can use an endoscope or other instruments to perform minimally invasive surgery in the outer tube 5 of the retracting catheter.
In summary, the embodiment of the invention provides a guiding device for brain surgery positioning, which can fix a guiding needle at a specific posture through a mask guide plate with a specific structure and a guiding bracket with a specific structure, ensure that surgical instruments such as a retracting catheter and the like can cross a retracted and deformed scalp near a lower incision of the bracket along the guiding needle through the guiding bracket to be accurately inserted into a target focus in the brain, and realize positioning and guiding of a bone window craniotomy; the invention prevents the shake of the retraction catheter by the seamless matching between the inner tube and the outer tube of the retraction catheter, the guide hole and the guide needle, thereby reducing the damage to brain tissue in the process of feeding the retraction catheter into the brain, simultaneously further improving the accuracy of the insertion position of the retraction catheter, reducing the damage to the brain tissue expansion in the process of feeding the retraction catheter into the brain, and protecting the body cutting benefit of a patient; the mask guide plate is printed by adopting a 3D printing technology, and the mask guide plate and the guide bracket are separately designed, so that the guide bracket can be prefabricated into a disposable consumable, the guide bracket is not required to be printed in each operation, the mask guide plate is only printed by the 3D printing technology, the operation preparation time is greatly shortened (within 30 minutes), and the precious rescue time is won for emergency operations such as cerebral hemorrhage and the like; the two are designed separately, the prefabricated guide support can be reliably sterilized in advance, so that surgical instruments entering brain tissues are treated by the guide support with reliable sterilization and disinfection, but not the instant 3D printing instruments (mask guide plates) which can only be soaked and disinfected by common iodophors, and the surgical operation is safer; the device has the advantages of simple structure, low processing cost, simple method steps, simple and convenient operation and no need of special professional training for medical care personnel.
The above description is only for the preferred embodiment of the present invention, but the scope of the present invention is not limited thereto, and any changes or substitutions that can be easily conceived by those skilled in the art within the technical scope of the present invention are included in the scope of the present invention.
Claims (4)
1. The guiding device for brain surgery positioning is characterized by comprising a mask guide plate, a guiding bracket (1) and a retracting catheter; the retracting guide pipe is detachably and fixedly connected with the guide support (1), the mask guide plate can be attached and fixed to the skin of the head of a patient, the guide support (1) is installed on the mask guide plate, and the mask guide plate is detachably and fixedly connected with the guide support (1);
the guide device is used for guiding the guide needle, the guide needle can enter the brain according to the guide direction of the guide support, and the retraction catheter can enter a preset position in the brain along the guide needle;
the retracting catheter comprises an outer tube (5) and an inner tube (4), wherein the cross sections of the outer tube (5) and the inner tube (4) are both oblong or elliptical and are both tubular structures with deep thin parts and deep shallow parts; the inner pipe (4) is provided with a guide hole arranged along the axis of the inner pipe (4);
the outer pipe (5) and the inner pipe (4) and the guide needle and the guide hole (6) are connected in a seamless sleeved mode;
the shallow part of the outer pipe (5) is provided with a limiting stop ring, the inner pipe (4) is provided with a limiting snap ring, the limiting stop ring and the limiting snap ring form a limiting structure, and the diameter of the limiting snap ring is larger than or equal to that of the limiting stop ring;
the guide bracket (1) consists of an installation head, a guide arm and a guide head; the guide arm is of a rigid structure and comprises a mounting end and a guide end, the mounting end is arranged at the mounting end of the guide arm, and the guide end of the guide arm is arranged at the guide head; the guide head is provided with a cylindrical accommodating cavity, the cylindrical accommodating cavity is axially extended to form an infinite-length cylindrical space, and the guide support (1) and the infinite-length cylindrical space have no public part;
the mask guide plate is designed and obtained by adopting a 3D printing technology, and the guide support (1) is manufactured in a prefabricated mode in batches in advance;
the mask guide plate comprises a forehead mask guide plate (2) and an auricle-wound mask guide plate (3); when in use, medical care personnel select a frontal mask guide plate (2) or a circumaural mask guide plate (3) according to actual requirements; the guide head is a cylindrical barrel with an opening on the side wall, the cylindrical containing cavity is positioned in the cylindrical barrel, the opening on the side wall of the guide head is an axial opening, and the corresponding central angle is 30-120 degrees;
the guide arm is fixedly connected with the side wall of the guide head, the guide arm is fixedly connected with the guide head along the radial direction of the guide head, and the opening of the side wall and the guide arm are symmetrical along the circumferential direction of the guide head;
the mask guide plate is provided with a mounting seat; the mounting seat is provided with a mounting hole, the mounting head of the guide bracket can be inserted into the mounting hole of the mask guide plate, the shape and the size of the cross section of the mounting hole are the same as those of the cross section of the mounting head, and the depth of the mounting hole is greater than the length of the mounting head;
the axis of the cylindrical accommodating cavity is parallel to the axis of the mounting head.
2. The guide device of claim 1, wherein the guide arm is a bent or straight rod and the cross-sectional shape of the guide arm is rectangular.
3. The guide device of claim 2, wherein a stop ring is provided at the connection between the mounting head and the guide arm of the guide bracket.
4. The guide device of claim 3, wherein the limiting ring is a frustum of a pyramid, the shape and the size of the top surface of the frustum of a pyramid are the same as the cross section of the guide arm, and the shape and the size of the bottom surface of the frustum of a pyramid are the same as the cross section of the mounting head;
the length multiplied by the width of the cross section of the guide arm is 8mm multiplied by 6mm, and the length of the guide arm along the axial direction of the cylindrical accommodating cavity is 52.7 mm;
the distance between the axis of the cylindrical accommodating cavity and the axis of the mounting head is 54 mm;
the length of the guide head is 30mm, and the diameter of the cylindrical accommodating cavity is 16.3 mm;
the height of the limiting ring is 7.3 mm;
the length of the mounting head is 10 mm.
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN202010128730.5A CN111195157B (en) | 2020-02-28 | 2020-02-28 | Guiding device for brain surgery positioning |
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN202010128730.5A CN111195157B (en) | 2020-02-28 | 2020-02-28 | Guiding device for brain surgery positioning |
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| CN111195157B true CN111195157B (en) | 2021-11-16 |
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| Publication number | Priority date | Publication date | Assignee | Title |
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| CN111887959A (en) * | 2020-08-26 | 2020-11-06 | 杭州市第一人民医院 | Cerebral hemorrhage minimally invasive surgery positioning device |
Citations (3)
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| CN208404842U (en) * | 2017-12-26 | 2019-01-22 | 北京天智航医疗科技股份有限公司 | A kind of guider |
| CN110584755A (en) * | 2019-10-24 | 2019-12-20 | 山西雅韵雕医疗科技有限公司 | Operation positioner of pathological change in brain |
| CN110664444A (en) * | 2019-09-12 | 2020-01-10 | 济南科众医疗科技有限公司 | Soft tissue expander |
Family Cites Families (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN203885617U (en) * | 2014-02-19 | 2014-10-22 | 北京天智航医疗科技股份有限公司 | Orthopaedic robot guide needle locator and navigation device |
| CN209437336U (en) * | 2018-08-01 | 2019-09-27 | 娄国峰 | A kind of cephalophyma minimal invasion puncture drainage guiding die plate |
| CN109893223A (en) * | 2019-02-28 | 2019-06-18 | 成都真实维度科技有限公司 | A kind of 3D printing cerebral hemorrhage puncture drainage path orientation device and preparation method thereof |
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Patent Citations (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN208404842U (en) * | 2017-12-26 | 2019-01-22 | 北京天智航医疗科技股份有限公司 | A kind of guider |
| CN110664444A (en) * | 2019-09-12 | 2020-01-10 | 济南科众医疗科技有限公司 | Soft tissue expander |
| CN110584755A (en) * | 2019-10-24 | 2019-12-20 | 山西雅韵雕医疗科技有限公司 | Operation positioner of pathological change in brain |
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