CN111227921A - Pelvis fracture reduction device and operation method - Google Patents
Pelvis fracture reduction device and operation method Download PDFInfo
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- CN111227921A CN111227921A CN202010121026.7A CN202010121026A CN111227921A CN 111227921 A CN111227921 A CN 111227921A CN 202010121026 A CN202010121026 A CN 202010121026A CN 111227921 A CN111227921 A CN 111227921A
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- 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
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Abstract
A pelvis fracture reduction device and an operation method thereof comprise a near-end reduction mechanism, a far-end reduction mechanism and a connecting rod; the near-end resetting mechanism comprises a first frame body and a first positioning assembly which is arranged on the first frame body and used for fixing the near-end skeleton of the affected side; the far-end resetting mechanism comprises a second frame body, an adjusting frame body hinged with the second frame body, a second positioning assembly arranged on the second frame body and used for fixing the far-end skeleton at the affected side, and a third positioning assembly arranged on the adjusting frame body and used for fixing the far-end skeleton at the affected side; the first frame body is connected with the second frame body through a connecting rod. After the pelvis fracture is realized and the pelvis is displaced, the far-end skeleton at the affected side and the near-end skeleton at the affected side are reset and closed through the in-vitro resetting device. And the reduction precision is high, so that the recovery speed of the patient is high, and the bone recovery effect is better. Meanwhile, the large-scale scar left at the fracture part is avoided.
Description
Technical Field
The invention belongs to the field of medical instruments, and particularly relates to a pelvic fracture reduction device and an operation method. The pelvis fracture reduction device is applied to fracture reduction of pelvis suprapubic fossa or acetabulum anterior column.
Background
The fracture of pelvis pubic suprapubic branch and acetabular anterior column is clinical common, can take different treatment modes according to whether the broken bone takes place the displacement, specifically includes:
1. percutaneously closing the through-nail with the aid of an X-ray or surgical robot; the percutaneous nail penetration treatment mode is non-invasive and is an ideal fixing mode for fixing pelvis suprapubic fracture or acetabulum anterior column fracture.
2. Cutting a reset steel plate and fixing the steel plate; the fracture part is cut open, and after reduction, the internal fixation is carried out by a steel plate.
In both of the above two treatment methods, the broken bone is mostly displaced due to the pelvis suprapubic fracture and the acetabulum anterior column fracture which are usually caused by high energy injury. And because abundant muscles, nerves and blood vessels are wrapped and wound around, the broken bone is difficult to be closed and reset. The existing surgical robot can only assist in nail placement and cannot reset the fracture. Therefore, percutaneous transfixion is only applicable to non-displaced pelvic suprapubic/acetabular anterior column fractures. The mode of internal fixation in incision reduction can cause larger wound and leave obvious scar.
Therefore, it is highly desirable to develop an auxiliary positioning device which can reposition a fractured bone without cutting the fractured bone and has high accuracy of repositioning the fractured bone.
Disclosure of Invention
The invention aims to provide a pelvis reduction device arranged outside a body, which realizes the fixed connection between the reduction device and a fractured and displaced bone through a Kirschner wire nailed into the fractured part, and corrects the posture of the fractured and displaced bone and resets the fractured and displaced bone by matching with X-ray or other medical perspective equipment. The device has the linear resetting function and the rotary resetting function, and can enable the bone resetting posture to be more accurate.
For the convenience of distinction and description, in the present invention, a bone portion normally connected to a bone of a body is named as an affected proximal bone; the bone portion broken off the body bone was named affected distal bone. During the treatment process, the displaced far-end bone on the affected side needs to be adjusted for reduction.
The invention is realized by the following technical scheme:
a pelvis fracture reduction device comprises a near-end reduction mechanism, a far-end reduction mechanism and a connecting rod; the near-end resetting mechanism comprises a first frame body and a first positioning assembly which is arranged on the first frame body and used for fixing the near-end skeleton of the affected side; the far-end resetting mechanism comprises a second frame body, an adjusting frame body hinged with the second frame body, a second positioning assembly arranged on the second frame body and used for fixing the far-end skeleton at the affected side, and a third positioning assembly arranged on the adjusting frame body and used for fixing the far-end skeleton at the affected side; the first frame body is connected with the second frame body through a connecting rod.
Through the scheme, the invention at least obtains the following technical effects: the proximal bone of the affected side is fixed by the first positioning component on the first support body, the distal bone of the affected side is fixed by the second positioning component on the second support body, the first support body is connected with the second support body by the connecting rod, and the distal bone of the affected side and the proximal bone of the affected side are reset along the axial alignment of the connecting rod. Because the adjusting frame body is hinged with the second frame body, the adjusting frame body can move by taking a hinged point as a center, the third positioning assembly and the second positioning assembly which are arranged on the adjusting frame body form two points for fixing the far-end skeleton of the affected side, and the position of one of the two points is changed by the rotation of the adjusting frame body, so that the far-end skeleton of the affected side is driven to rotate to adjust the posture, and the more accurate angle and position correspond to the fracture of the near-end skeleton of the affected side. After the adjustment is finished, the affected side far-end skeleton and the affected side near-end skeleton are pushed to be close to each other by applying pressure to the near-end resetting mechanism and the far-end resetting mechanism, finally, after the pelvis and pubic upper limb fracture occurs and displacement occurs, the affected side far-end skeleton and the affected side near-end skeleton are reset and closed through an external resetting device. And the reduction precision is high, so that the recovery speed of the patient is high, and the bone recovery effect is better. Meanwhile, the large-scale scar left at the fracture part is avoided.
Preferably, the first positioning assembly comprises a first positioning seat and a plurality of fixing bolts, the first positioning seat is connected with the first frame body, the first positioning seat is provided with a plurality of first positioning holes, any one first positioning hole is matched with a first positioning piece, and the first positioning seat fixes the first positioning piece through the plurality of fixing bolts; the first positioning piece comprises a Kirschner wire, a combined structure of the Kirschner wire and a hollow screw, an LC-2 screw or a shanz screw.
The first positioning component is used for being fixed with the affected side near-end skeleton to serve as a supporting main body of the resetting device, the stability of the near-end resetting mechanism can be enhanced through multi-point fixation, and the situation that the far-end resetting mechanism deviates due to instable installation of the near-end resetting mechanism and finally inaccurate resetting is caused is avoided.
Preferably, the second positioning assembly comprises a second positioning seat and a plurality of fixing bolts, the second positioning seat is connected with the second frame body, the second positioning seat is provided with a second positioning hole, the second positioning hole is matched with a second positioning piece, and the second positioning seat fixes the second positioning piece through the plurality of fixing bolts; the second positioning piece comprises a combined structure of a kirschner wire and a hollow screw, an LC-2 screw or a shanz screw.
The second positioning assembly is used for fixing the affected side far-end skeleton, and the second positioning assembly and the third positioning assembly form two points for fixing the affected side far-end skeleton, so that only one second positioning hole is formed in the second positioning seat. When the affected side far-end bone is rotated and reset, the joint of the second positioning component and the affected side far-end bone is taken as a base point to rotate. Meanwhile, the second positioning component and the first positioning component form a fixing point for aligning and resetting the far-end bone of the affected side and the near-end bone of the affected side along the direction of the connecting rod.
Preferably, the third positioning assembly comprises a third positioning seat and a plurality of fixing bolts, the third positioning seat is connected with the adjusting frame body, a third positioning hole is formed in the third positioning seat, a third positioning part is matched with the third positioning hole, and the third positioning seat fixes the third positioning part through the plurality of fixing bolts; the third positioning piece comprises a Kirschner wire, a combined structure of the Kirschner wire and a hollow screw, an LC-2 screw or a shanz screw.
The third positioning assembly is used for fixing the affected side far-end skeleton, and the third positioning assembly and the second positioning assembly form two points for fixing the affected side far-end skeleton, so that only one third positioning hole is formed in the third positioning seat. When the affected side far-end bone is rotated and reset, the joint of the second positioning component and the affected side far-end bone is used as a base point for rotating, and meanwhile, the joint of the third positioning component and the affected side far-end bone rotates along with the change of the rotating angle, so that the affected side far-end bone is prevented from being stressed and aggravated to be damaged.
In the above scheme, the positioning piece can be selected for use according to different instruments according to the condition of a patient. The combination of the Kirschner wire and the hollow screw is that the Kirschner wire is used as a pre-positioning and guiding needle, and after the posture adjustment and the reset are completed, the hollow screw is placed into a bone fracture part along the track of the Kirschner wire to be connected and fixed. And the LC-2 screw and the shanz screw can be directly used for bone fixation and can be clinically selected according to the size and the condition of an affected part.
Preferably, the second positioning piece matched with the second positioning hole is a combined structure of a kirschner wire and a hollow screw; the Kirschner wire penetrates through the second positioning hole and is used for being nailed into a bone, and the hollow screw is slidably sleeved on the Kirschner wire and is used for being nailed into the bone along the axial direction of the needle body of the Kirschner wire.
In the scheme, the first positioning piece and the third positioning piece adopt Kirschner wires as positioning structures; the second positioning piece adopts a combined structure of a Kirschner wire and a hollow screw. Because the Kirschner wire has a small diameter, the drill hole left on the far-end bone at the affected side has a small diameter when the Kirschner wire is used, and the Kirschner wire can be suitable for a case with a small volume of the far-end bone at the affected side. Meanwhile, the drill hole diameter caused by the Kirschner wire is small, so that the drill hole can be repositioned once the positioning misalignment occurs due to misoperation, the influence of the abandoned drill hole on the bone is reduced to the maximum extent, and the problem that the nail cannot be replaced once the positioning misalignment occurs due to the small size of the far-end bone at the affected side is solved.
Preferably, the kirschner wire is matched with a limiting sleeve, the limiting sleeve is slidably sleeved on the needle body of the kirschner wire, and the limiting sleeve is detachably embedded in the first positioning hole, the second positioning hole or the third positioning hole.
When needing to carry out accurate location to the ke shi needle, the ke shi needle can match the use of spacing sleeve. At the moment, the outer diameter of the limiting sleeve is matched with the inner diameter of the first positioning hole, the second positioning hole or the third positioning hole, and the hole diameter of the Kirschner wire is matched with that of the through hole of the limiting sleeve. After the limiting sleeve is fixed, the kirschner wire penetrates through the through hole of the sleeve and is placed into the bone. The problem of inaccurate positioning caused by the fact that the inner diameter of the first positioning hole, the second positioning hole or the third positioning hole is larger than that of the Kirschner wire can be solved. The reason why the inner diameter of the first positioning hole, the second positioning hole or the third positioning hole is larger than the diameter of the Kirschner wire is that after the Kirschner wire is positioned, the hollow screw needs to be placed into the bone through the first positioning hole, the second positioning hole or the third positioning hole, so that the inner diameter of the first positioning hole, the second positioning hole or the third positioning hole needs to meet the requirement of passing the hollow screw.
Preferably, the rod body of the connecting rod is of a prism structure; the first frame body is provided with a first limiting piece; the first limiting part comprises a first limiting frame fixedly arranged on the first frame body and a plurality of limiting bolts, and an inner cavity of the first limiting frame is a prismatic cavity matched with the shape of the connecting rod; the first frame body is provided with a first through hole communicated with the inner cavity of the first limiting frame, and one end of the connecting rod penetrates through the inner cavity and/or the first through hole of the first limiting frame; the connecting rod is fixed on the first limiting frame through a plurality of limiting bolts.
For making near-end canceling release mechanical system can slide along the connecting rod, make to reset more accurately, produce the skew when avoiding the afterburning to near-end canceling release mechanical system, set up first spacing subassembly at first support body, thereby first support body passes through first spacing subassembly and slides on the connecting rod and restrict near-end canceling release mechanical system's displacement direction. After the bone is reset, the closed state of the bone needs to be kept for a period of time according to clinical treatment experience, so that the proximal resetting device and the connecting rod are fixed through the limiting bolt in order to fix the relative position of the proximal resetting mechanism on the connecting rod. The rod body of the connecting rod adopts a prism structure, namely the shapes of a triangular prism, a quadrangular prism, an irregular prism and the like. The inner cavity of the first limit frame is matched with the rod body of the connecting rod in shape, so that the near-end reset mechanism and the far-end reset mechanism do not rotate and deviate in the sliding process along the connecting rod, and the rotation and deviation of the far-end bone on the affected side in the resetting process are avoided.
Preferably, the second frame body is provided with a second limiting piece; the second limiting part comprises a second limiting frame fixedly arranged on the second frame body and a plurality of limiting bolts, and an inner cavity of the second limiting frame is a prismatic cavity body matched with the shape of the connecting rod; the second frame body is provided with a second through hole communicated with the inner cavity of the second limiting frame, one end of the connecting rod penetrates through the inner cavity of the second limiting frame and/or the second through hole, and the connecting rod is fixed on the second limiting frame through a plurality of limiting bolts. The inner cavity of the second limit frame is matched with the rod body shape of the connecting rod, so that the near-end reset mechanism and the far-end reset mechanism do not rotate and deviate in the sliding process along the connecting rod, and the rotation and deviation of the far-end bone at the affected side in the resetting process are avoided.
For making distal end canceling release mechanical system can slide along the connecting rod, make to reset more accurately, produce the skew when avoiding afterburning to distal end canceling release mechanical system, set up the spacing subassembly of second at the second support body, thereby the second support body passes through the spacing subassembly of second and slides on the connecting rod and restrict distal end canceling release mechanical system's displacement direction. After the bone is reset, the closed state of the bone needs to be kept for a period of time according to clinical treatment experience, so that the far-end resetting device and the connecting rod are fixed through the limiting bolt in order to fix the relative position of the far-end resetting mechanism on the connecting rod.
Preferably, the second frame body is hinged to the adjusting frame body through a universal shaft, a hinge or a pin.
The moving range of adjusting the support body receives the influence of articulated form, if the second support body with adjust the support body and adopt the cardan shaft to articulate, then adjust the support body and can rotate to arbitrary direction, have higher operability when making the distal end skeleton of affected side carry out the gesture and reset. Under the condition of hinge or pin joint, the moving range of the adjusting frame body is relatively limited, and the adjusting frame body can only move in a limited direction, but the adjusting frame body is more stable and accurate in the moving process. Therefore, the above solutions can be selected as alternatives according to the condition of the patient.
The invention also provides an operation method of the pelvis fracture reduction device, which comprises the pelvis fracture reduction device, and comprises the following steps:
s1: positioning by X-ray or surgical robot, and respectively placing a Kirschner wire in the far-end skeleton at the affected side and the near-end skeleton at the affected side of the pelvic fracture;
s2: mounting a proximal resetting mechanism to ensure that a first positioning hole on the first positioning seat is matched with the Kirschner wire placed in the proximal bone of the affected side;
s3: placing a Kirschner wire into the proximal bone of the affected side along the rest at least one first positioning hole on the first positioning seat, and fixing the Kirschner wire in the corresponding first positioning hole through a fixing bolt so as to fixedly connect the proximal resetting mechanism with the proximal bone of the affected side;
s4: installing a distal resetting mechanism to enable a limiting sleeve in a second positioning hole on the second positioning seat to be matched with the Kirschner wire placed into the distal bone of the affected side;
s5: placing a Kirschner wire in a third positioning hole of the third positioning seat, and fixing the Kirschner wire matched with the second positioning hole and the third positioning hole through a fixing bolt so as to fixedly connect the distal resetting mechanism with the distal skeleton of the affected side;
s6: the connecting rod is sequentially arranged in the second through hole, the inner cavity of the second limiting frame, the inner cavity of the first limiting frame and the first through hole in a penetrating manner, so that the far-end resetting mechanism is connected with the near-end resetting mechanism, and the alignment and the pair-line resetting of the far-end skeleton at the affected side and the near-end skeleton at the affected side at the fracture position are realized;
s7: moving the adjusting frame body to rotatably reset the far-end skeleton at the affected side;
s8: reducing the distance between the distal reduction mechanism and the proximal reduction mechanism to enable the affected side distal skeleton and the affected side proximal skeleton after the operation of the step S7 to be close and finally closed, thereby realizing the reduction of the separation and displacement of the pelvic fracture;
s9: taking out the Kirschner wire which is arranged in the proximal bone of the affected side in the step S1;
s10: jacking the kirschner wire in the step S1 to insert the kirschner wire into the affected side far-end bone and the affected side near-end bone;
s11: taking out the limiting sleeve in the second positioning hole, placing a hollow screw in the second positioning hole, and placing the hollow screw along the Kirschner wire placed in the far-end bone of the affected side and the near-end bone of the affected side, so that the far-end bone of the affected side and the near-end bone of the affected side are connected and fixed through the hollow screw;
s12: the reduction device is removed to complete reduction and fixation of the pelvic fracture.
Through the scheme, the invention at least obtains the following technical effects: after the pelvis fracture is realized and the pelvis is displaced, the far-end skeleton at the affected side and the near-end skeleton at the affected side are reset and closed through the in-vitro resetting device. And the reduction precision is high, so that the recovery speed of the patient is high, and the bone recovery effect is better. Meanwhile, the large-scale scar left at the fracture part is avoided.
Drawings
Fig. 1 is a schematic diagram illustrating pre-positioning of a k-wire according to an embodiment of the present invention.
FIG. 2 is a schematic view of a mounted proximal reset mechanism provided in one embodiment of the present invention.
Fig. 3 is a schematic view of a fixed proximal reduction mechanism provided in one embodiment of the present invention.
Fig. 4 is a schematic view of an installed distal reset mechanism provided in one embodiment of the present invention.
Fig. 5 is a schematic view of a fixed distal reduction mechanism provided in one embodiment of the present invention.
FIG. 6 is a schematic view of a mounting link provided in an embodiment of the present invention.
Fig. 7 is a schematic view illustrating a rotation adjustment frame body provided in an embodiment of the present invention performing a rotation reset operation.
Fig. 8 is a schematic view of a complete suprapubic reduction of the pelvis provided by an embodiment of the present invention.
Fig. 9 is a schematic view of the proximal reduction mechanism extraction k-wire provided in one embodiment of the present invention.
Fig. 10 is a schematic view of a k-wire penetrating bone of a distal reduction mechanism provided in one embodiment of the present invention.
Fig. 11 is a schematic view of a removal limiting sleeve according to an embodiment of the present invention.
FIG. 12 is a schematic view of a cannulated screw according to an embodiment of the present invention.
Fig. 13 is a schematic view of the invention in one embodiment to accomplish suprapubic reduction of the pelvis.
Legend:
1 a near-end reset mechanism; 2, a distal reset mechanism; 3 connecting the rods; 5 fixing the bolt; 6, a limit bolt;
11 a first frame body; 12 a first positioning assembly;
21 a second frame body; 22 a second positioning assembly; 23 adjusting the frame body; 24 a third positioning assembly;
41 a first positioning member; 42 a second positioning member; 43 a third positioning element;
111 a first stop assembly; 112 a first spacing frame; 113 a first via hole;
121 a first positioning seat; 122 a first locating hole;
211 a second stop assembly; 212 a second spacing frame; 213 second via holes;
221 a second positioning seat; 222 second positioning holes;
241 a third positioning seat; 242 a third positioning hole;
411 a limit sleeve; 412 k-wire; 413 hollow screw
Detailed Description
The invention is further illustrated by the following figures and examples.
Please refer to fig. 1-13.
Example 1:
a pelvis fracture reduction device comprises a near-end reduction mechanism 1, a far-end reduction mechanism 2 and a connecting rod 3; the proximal end resetting mechanism 1 comprises a first frame body 11 and a first positioning component 12 which is arranged on the first frame body 11 and is used for fixing proximal bones of an affected side; the distal reduction mechanism 2 comprises a second frame body 21, an adjusting frame body 23 hinged to the second frame body 21, a second positioning assembly 22 mounted on the second frame body 21 and used for fixing the distal bone of the affected side, and a third positioning assembly 24 arranged on the adjusting frame body 23 and used for fixing the distal bone of the affected side; the first frame body 11 is connected with the second frame body 21 through a connecting rod 3.
It should be noted that the pelvic fracture reduction device of the present invention can be applied to fracture reduction of the suprapubic pelvis or the anterior acetabular column. Wherein, utilize pelvis fracture resetting means realizes the in-process that the fracture of pelvis pubic bone goes up resets, by the fixed near-end skeleton of affected side of first locating component 12 on the first support body 11, the fixed far-end skeleton of affected side of second locating component 22 on the second support body 21, connecting rod 3 is connected first support body 11 and second support body 21, realizes that the near-end skeleton of affected side and the near-end skeleton of affected side are along the 3 axial alignments of connecting rod and reset. Because the adjusting frame body 23 is hinged with the second frame body 21, the adjusting frame body 23 can move by taking a hinged point as a center, the third positioning component 24 and the second positioning component 22 which are arranged on the adjusting frame body 23 form two points for fixing the far-end skeleton of the affected side, and the position of one of the two points is changed by the rotation of the adjusting frame body 23, so that the far-end skeleton of the affected side is driven to rotate to adjust the posture, and the more accurate angle and position correspond to the fracture of the near-end skeleton of the affected side. After the adjustment is finished, the pressure is applied to the near-end resetting mechanism 1 and the far-end resetting mechanism 2 to push the far-end skeleton at the affected side and the near-end skeleton at the affected side to be close to each other, and finally, after the pelvis and pubic upper fracture occurs and displacement occurs, the far-end skeleton at the affected side and the near-end skeleton at the affected side are reset and closed through an external resetting device. And the reduction precision is high, so that the recovery speed of the patient is high, and the bone recovery effect is better. Meanwhile, the large-scale scar left at the fracture part is avoided.
In addition, the principle of using the pelvis fracture reduction device to realize reduction of fracture of the acetabulum anterior column can be referred to the process of realizing reduction of fracture of pelvis suprapubic fracture, which is not described herein again.
Example 2:
on the basis of the embodiment 1, the technical scheme is improved as follows:
in an embodiment, to realize the fixed mounting of the proximal reduction mechanism 1 and the affected proximal bone, the first positioning component 12 includes a first positioning seat 121 connected to the first frame 11 and a plurality of fixing bolts 5, the first positioning seat 121 is provided with a plurality of first positioning holes 122, any one of the first positioning holes 122 is matched with the first positioning element 41, and the first positioning seat 121 fixes the first positioning element 41 through the plurality of fixing bolts 5. The first positioning member 41 comprises a kirschner wire, a combination structure of the kirschner wire and a hollow screw, an LC-2 screw or a shanz screw. The first positioning component 12 is used for fixing the affected side proximal bone as a supporting main body of the reduction device, and the multi-point fixation can enhance the stability of the proximal reduction mechanism 1, and avoid the displacement of the distal reduction mechanism 2 caused by the instable installation of the proximal reduction mechanism 1, which finally results in inaccurate reduction.
In an embodiment, in order to realize the installation of the distal reduction mechanism 2 and the affected distal bone and the rotational reduction effect, the second positioning assembly 22 includes a second positioning seat 221 connected to the second frame 21 and a plurality of fixing bolts 5, the second positioning seat 221 is provided with a second positioning hole 222, the second positioning hole 222 is matched with the second positioning element 42, and the second positioning seat 221 fixes the second positioning element 42 through the plurality of fixing bolts 5. The second positioning member 42 comprises a combination of a k-wire and cannulated screw, an LC-2 screw, or a shanz screw. The second positioning assembly 22 is used for fixing the affected side distal bone, and since the second positioning assembly 22 and the third positioning assembly 24 need to form two points for fixing the affected side distal bone, only one second positioning hole 222 is formed on the second positioning seat 221. When the affected side distal bone is rotated and reset, the joint of the second positioning component 22 and the affected side distal bone is used as the base point for rotation. Meanwhile, the second positioning component 22 and the first positioning component 12 form a fixing point for aligning and resetting the affected side far-end bone and the affected side near-end bone along the direction of the connecting rod 3.
In an embodiment, in order to realize the installation of the distal reduction mechanism 2 and the affected distal bone and the rotational reduction effect, the third positioning assembly 24 includes a third positioning seat 241 connected to the adjusting frame body 23 and a plurality of fixing bolts 5, the third positioning seat 241 is provided with a third positioning hole 242, the third positioning hole 242 is matched with the third positioning element 43, and the third positioning seat 241 fixes the third positioning element 43 through the plurality of fixing bolts 5. The third positioning member 43 comprises a k-wire, a combination of a k-wire and a cannulated screw, an LC-2 screw, or a shanz screw. The third positioning element 24 is used for fixing the affected side distal bone, and since the third positioning element 24 and the second positioning element 22 need to form two points for fixing the affected side distal bone, only one third positioning hole 242 is formed on the third positioning seat 241. When the affected side distal bone is rotated and repositioned, the joint between the second positioning element 22 and the affected side distal bone is rotated as the base point, and the joint between the third positioning element 24 and the affected side distal bone is rotated according to the change of the rotation angle, thereby preventing the affected side distal bone from being stressed and further damaged.
In the above embodiments, the positioning members may be selected according to the patient's condition, for example, in one example, the first positioning member 41 and the third positioning member 43 may be a kirschner wire, and the second positioning member 42 may be a combination of a kirschner wire and a cannulated screw 413, as shown in fig. 12. Wherein the combination of the kirschner wire and the hollow screw 413 is: the Kirschner wire is used as a pre-positioning and guiding wire, and after the posture adjustment and the reset are finished, the hollow screw 413 is placed into a bone fracture part along the track of the Kirschner wire for connection and fixation. While the LC-2 screw and the shanz screw enable direct bone fixation, in other instances, clinical choice may be made depending on the size of the affected area and the condition of the disease.
In an embodiment, to achieve the precise positioning effect, as shown in fig. 10 and 12, the second positioning element 42 engaged with the second positioning hole 222 is a combination structure of the k-wire 412 and the hollow screw 413; the kirschner wire 412 is inserted into the second positioning hole 222 for being driven into the bone, and the hollow screw 413 is slidably sleeved on the kirschner wire 412 for being driven into the bone along the axial direction of the needle body of the kirschner wire 412. In this embodiment, a combination structure of the kirschner wire 412 and the hollow screw 413 is selected as the second positioning element 42. Because the Kirschner wire 412 has a small diameter, the drill hole left on the affected side far-end bone during use has a small diameter, and the Kirschner wire can be suitable for a case with a small volume of the affected side far-end bone. Meanwhile, the drill hole diameter caused by the Kirschner wire 412 is small, so that the drill hole can be repositioned once the positioning misalignment occurs due to misoperation, the influence of the abandoned drill hole on the bone is reduced to the maximum extent, and the problem that the nail cannot be replaced once the positioning misalignment occurs due to the small size of the far-end bone at the affected side is solved.
In this embodiment, the hollow screw 413 is disposed in the second positioning hole 222 of the second frame 21. The second positioning hole 222 is therefore larger in diameter than the outer diameter of cannulated screw 413, such that cannulated screw 413 is placed into the bone through second positioning hole 222 along the intended path of k-wire 412. It should be noted that, for the positioning holes other than the second positioning hole, the aperture may be the same as or smaller than that of the second positioning hole.
In one embodiment, in order to enhance the precise positioning effect of the k-wire, any one of the k-wires is matched with a limiting sleeve 411, the limiting sleeve 411 is slidably sleeved on the body of the k-wire, and the limiting sleeve 411 is detachably embedded in the first positioning hole 122, the second positioning hole 222 or the third positioning hole 242. When the kirschner wire needs to be accurately positioned, the kirschner wire can be matched with the limiting sleeve 411 for use. At this time, the outer diameter of the limiting sleeve 411 is matched with the inner diameter of the first positioning hole 122, the second positioning hole 222 or the third positioning hole 242, and the hole diameter of the kirschner wire is matched with that of the through hole of the limiting sleeve. After the retaining sleeve 411 is secured, the k-wire 412 is inserted through the sleeve through the hole and into the bone, as shown in fig. 10. The problem of inaccurate positioning caused by the fact that the inner diameter of the first positioning hole 122, the second positioning hole 222 or the third positioning hole 242 is larger than that of the kirschner wire 412 can be avoided. The reason why the inner diameter of the first positioning hole 122, the second positioning hole 222 or the third positioning hole 242 is larger than the diameter of the k-wire 412 is that after the k-wire 412 is positioned, the hollow screw 413 needs to be inserted into the bone through the first positioning hole 122, the second positioning hole 222 or the third positioning hole 242, and therefore the inner diameter of the first positioning hole 122, the second positioning hole 222 or the third positioning hole 242 needs to meet the requirement of allowing the hollow screw 413 to pass through.
Example 3:
on the basis of the embodiment 1 or the embodiment 2, the technical scheme is improved as follows:
in one embodiment, in order to limit the moving direction of the proximal and distal reset mechanisms 1 and 2, the rod body of the connecting rod 3 is prism-structured; the first frame 11 is provided with a first limiting member 111; the first limiting member 111 includes a first limiting frame 112 fixedly disposed on the first frame 11 and a plurality of limiting bolts 6, and an inner cavity of the first limiting frame 112 is a prismatic cavity matching the shape of the connecting rod 3; first through-hole 113 with the inner chamber intercommunication of first spacing frame 112 is seted up on the first support body 11, the one end of connecting rod 3 is worn to locate the inner chamber and/or the first through-hole 113 of first spacing frame 112, first spacing frame 112 through a plurality of spacing bolts 6 with connecting rod 3 is connected. For making near-end canceling release mechanical system 1 can slide along connecting rod 3, make to reset more accurately, produce the skew when avoiding 1 afterburning to near-end canceling release mechanical system, set up first spacing subassembly at first support body 11, thereby first support body 11 passes through first spacing subassembly and slides on connecting rod 3 and restrict near-end canceling release mechanical system 1's displacement direction. After the bone reduction is completed, the bone closing state is required to be kept for a period of time according to clinical treatment experience, so that the proximal reduction device and the connecting rod 3 are fixed by the limiting bolt 6 penetrating through a screw hole formed in the side wall of the first limiting frame 112 so as to fix the relative position of the proximal reduction mechanism 1 on the connecting rod 3. The rod body of the connecting rod 3 adopts a prism structure, namely the shapes of a triangular prism, a quadrangular prism, an irregular prism and the like. The inner cavity of the first limit frame 112 is matched with the rod body shape of the connecting rod 3, so that the near-end resetting mechanism 1 and the far-end resetting mechanism 2 do not generate rotary deviation in the sliding process along the connecting rod 3, and the rotary deviation of the far-end bone at the affected side in the resetting process is avoided.
In one embodiment, in order to further limit the moving directions of the proximal resetting mechanism 1 and the distal resetting mechanism 2, the second frame body 21 is provided with a second limiting member 211; the second limiting member 211 comprises a second limiting frame 212 fixedly arranged on the second frame body 21 and a plurality of limiting bolts 6, and an inner cavity of the second limiting frame 212 is a prismatic cavity body matched with the shape of the connecting rod 3; the second frame body 21 is provided with a second through hole 213 communicated with the inner cavity of the second limit frame 212, one end of the connecting rod 3 penetrates through the inner cavity of the second limit frame 212 and/or the second through hole 213, and the second limit frame 212 is connected with the connecting rod 3 through a plurality of limit bolts 6. For making distal end canceling release mechanical system 2 can slide along connecting rod 3, make to reset more accurately, produce the skew when avoiding 2 afterburning to distal end canceling release mechanical system, set up the spacing subassembly of second at second support body 21, thereby second support body 21 passes through the spacing subassembly of second and slides on connecting rod 3 and restrict distal end canceling release mechanical system 2's displacement direction. After the bone reduction is completed, the bone closing state is required to be kept for a period of time according to clinical treatment experience, so that in order to fix the relative position of the distal reduction mechanism 2 on the connecting rod 3, the distal reduction device and the connecting rod 3 are fixed through the limiting bolt 6 penetrating through the screw hole formed in the side wall of the second limiting frame 212. The inner cavity of the second limiting frame 212 is matched with the rod body shape of the connecting rod 3, so that the near-end resetting mechanism 1 and the far-end resetting mechanism 2 do not rotate and deviate in the sliding process along the connecting rod 3, and the rotation and deviation of the far-end bone at the affected side in the resetting process are avoided.
In one embodiment, in order to enable the adjusting frame body 23 to select an appropriate hinge structure according to the patient's condition to achieve a desired rotation adjusting angle, the second frame body 21 is hinged to the adjusting frame body 23 through a universal shaft, a hinge or a pin. The moving range of the adjusting frame body 23 is influenced by the hinge type, if the second frame body 21 is hinged to the adjusting frame body 23 by a universal shaft, the adjusting frame body 23 can rotate in any direction, and the far-end bone on the affected side has higher operability when being reset in posture. In the case of the hinge or the pin joint, the moving range of the adjusting frame body 23 is relatively limited, and the adjusting frame body 23 can only move in a limited direction, but the adjusting frame body 23 is more stable and accurate in the moving process. Therefore, the above solutions can be selected as alternatives according to the condition of the patient.
Example 4:
the invention also provides an operation method of the pelvis fracture reduction device, which comprises the pelvis fracture reduction device, and comprises the following steps:
s1: positioning by X-ray or surgical robot, and respectively placing a Kirschner wire in the far-end skeleton at the affected side and the near-end skeleton at the affected side of the pelvic fracture;
s2: mounting the proximal reduction mechanism 1 to ensure that the first positioning hole 122 on the first positioning seat 121 is matched with the Kirschner wire placed in the proximal bone of the affected side;
s3: placing a kirschner wire into the proximal bone of the affected side along at least one of the remaining first positioning holes 122 on the first positioning seat 121, and fixing the kirschner wire in the corresponding first positioning hole 122 through the fixing bolt 5, so that the proximal reduction mechanism 1 is fixedly connected with the proximal bone of the affected side;
s4: installing the distal reduction mechanism 2, so that the limiting sleeve 411 in the second positioning hole 222 on the second positioning seat 221 is matched with the kirschner wire placed in the affected side distal bone;
s5: placing a kirschner wire into the third positioning hole 242 of the third positioning seat 241, and fixing the kirschner wire matched with the second positioning hole 222 and the third positioning hole 242 through the fixing bolt 5, so that the distal reduction mechanism 2 is fixedly connected with the distal bone of the affected side;
s6: the connecting rod 3 is sequentially arranged in the second through hole 213, the inner cavity of the second limit frame 212, the inner cavity of the first limit frame 112 and the first through hole 113 in a penetrating manner, so that the distal end resetting mechanism 2 is connected with the proximal end resetting mechanism 1, and the alignment and the paired resetting of the distal end skeleton at the affected side and the proximal end skeleton at the affected side at the fracture position are realized;
s7: the adjusting frame body 23 is moved to lead the far-end skeleton at the affected side to rotate and reset;
s8: reducing the distance between the distal reduction mechanism 2 and the proximal reduction mechanism 1 to enable the affected side distal bone and the affected side proximal bone after the operation of the step S7 to be close and finally closed, thereby realizing the reduction of the separation and displacement of the pelvic fracture;
s9: taking out the Kirschner wire which is arranged in the proximal bone of the affected side in the step S1;
s10: jacking the kirschner wire in the step S1 to insert the kirschner wire into the affected side far-end bone and the affected side near-end bone;
s11: taking out the limiting sleeve 411 in the second positioning hole 222, placing a hollow screw 413 in the second positioning hole 222, and placing the hollow screw 413 along the Kirschner wire placed in the affected side far-end bone and the affected side near-end bone, so that the affected side far-end bone and the affected side near-end bone are connected and fixed through the hollow screw 413;
s12: the reduction device is removed to complete reduction and fixation of the pelvic fracture.
After the pelvis fracture is realized and the pelvis is displaced, the far-end skeleton at the affected side and the near-end skeleton at the affected side are reset and closed through the in-vitro resetting device. And the reduction precision is high, so that the recovery speed of the patient is high, and the bone recovery effect is better. Meanwhile, the large-scale scar left at the fracture part is avoided.
Various technical features in the above embodiments may be arbitrarily combined as long as there is no conflict or contradiction in the combination between the features, but is limited to the space and is not described one by one.
The present invention is not limited to the above-described embodiments, and various changes and modifications of the present invention are intended to be included within the scope of the claims and the equivalent technology of the present invention if they do not depart from the spirit and scope of the present invention.
Claims (10)
1. A pelvis fracture reduction device is characterized by comprising a near-end reduction mechanism, a far-end reduction mechanism and a connecting rod; the near-end resetting mechanism comprises a first frame body and a first positioning assembly which is arranged on the first frame body and used for fixing the near-end skeleton of the affected side; the far-end resetting mechanism comprises a second frame body, an adjusting frame body hinged with the second frame body, a second positioning assembly arranged on the second frame body and used for fixing the far-end skeleton at the affected side, and a third positioning assembly arranged on the adjusting frame body and used for fixing the far-end skeleton at the affected side; the first frame body is connected with the second frame body through a connecting rod.
2. The pelvic fracture reduction device according to claim 1, wherein the first positioning assembly comprises a first positioning seat and a plurality of fixing bolts, the first positioning seat is connected with the first frame body, the first positioning seat is provided with a plurality of first positioning holes, any first positioning hole is matched with a first positioning piece, and the first positioning seat fixes the first positioning piece through the plurality of fixing bolts; the first positioning piece comprises a Kirschner wire, a combined structure of the Kirschner wire and a hollow screw, an LC-2 screw or a shanz screw.
3. The pelvic fracture reduction device according to claim 2, wherein the second positioning assembly comprises a second positioning seat and a plurality of fixing bolts, the second positioning seat is connected to the second frame body, the second positioning seat is provided with a second positioning hole, the second positioning hole is matched with a second positioning element, and the second positioning seat fixes the second positioning element through the plurality of fixing bolts; the second positioning piece comprises a combined structure of a kirschner wire and a hollow screw, an LC-2 screw or a shanz screw.
4. The pelvic fracture reduction device according to claim 3, wherein the third positioning assembly comprises a third positioning seat and a plurality of fixing bolts, the third positioning seat is connected with the adjustment frame body, the third positioning seat is provided with a third positioning hole, the third positioning hole is matched with a third positioning element, and the third positioning seat fixes the third positioning element through the plurality of fixing bolts; the third positioning piece comprises a Kirschner wire, a combined structure of the Kirschner wire and a hollow screw, an LC-2 screw or a shanz screw.
5. The pelvic fracture reduction apparatus of claim 4, wherein the second positioning member is a combination of a k-wire and a cannulated screw; the Kirschner wire penetrates through the second positioning hole and is used for being nailed into the bone; the hollow screw is sleeved on the Kirschner wire in a sliding manner and is used for being driven into a bone along the axial direction of the needle body of the Kirschner wire.
6. The pelvic fracture reduction device of claim 5, wherein the k-wire is matched with a limiting sleeve, the limiting sleeve is slidably sleeved on the needle body of the k-wire, and the limiting sleeve is detachably embedded in the first positioning hole, the second positioning hole or the third positioning hole.
7. The pelvic fracture reduction apparatus of claim 6, wherein the rod body of the connecting rod is of a prismatic structure; the first frame body is provided with a first limiting piece; the first limiting part comprises a first limiting frame fixedly arranged on the first frame body and a plurality of limiting bolts, and an inner cavity of the first limiting frame is a prismatic cavity matched with the shape of the connecting rod; the first frame body is provided with a first through hole communicated with the inner cavity of the first limiting frame, and one end of the connecting rod penetrates through the inner cavity and/or the first through hole of the first limiting frame; the connecting rod is fixed on the first limiting frame through a plurality of limiting bolts.
8. The pelvic fracture reduction apparatus of claim 7, wherein the second frame body is provided with a second stop; the second limiting part comprises a second limiting frame fixedly arranged on the second frame body and a plurality of limiting bolts, and an inner cavity of the second limiting frame is a prismatic cavity body matched with the shape of the connecting rod; the second frame body is provided with a second through hole communicated with the inner cavity of the second limiting frame, one end of the connecting rod penetrates through the inner cavity of the second limiting frame and/or the second through hole, and the connecting rod is fixed on the second limiting frame through a plurality of limiting bolts.
9. The pelvic fracture reduction apparatus of claim 8, wherein the second frame is hinged to the adjustment frame by a cardan shaft, a hinge, or a pin.
10. A method of operating a pelvic fracture reduction apparatus, comprising the pelvic fracture reduction apparatus of claim 9, comprising the steps of:
s1: positioning by X-ray or surgical robot, and respectively placing a Kirschner wire in the far-end skeleton at the affected side and the near-end skeleton at the affected side of the pelvic fracture;
s2: mounting a proximal resetting mechanism to ensure that a first positioning hole on the first positioning seat is matched with the Kirschner wire placed in the proximal bone of the affected side;
s3: placing a Kirschner wire into the proximal bone of the affected side along the rest at least one first positioning hole on the first positioning seat, and fixing the Kirschner wire in the corresponding first positioning hole through a fixing bolt so as to fixedly connect the proximal resetting mechanism with the proximal bone of the affected side;
s4: installing a distal resetting mechanism to enable a limiting sleeve in a second positioning hole on the second positioning seat to be matched with the Kirschner wire placed into the distal bone of the affected side;
s5: placing a Kirschner wire in a third positioning hole of the third positioning seat, and fixing the Kirschner wire matched with the second positioning hole and the third positioning hole through a fixing bolt so as to fixedly connect the distal resetting mechanism with the distal skeleton of the affected side;
s6: the connecting rod is sequentially arranged in the second through hole, the inner cavity of the second limiting frame, the inner cavity of the first limiting frame and the first through hole in a penetrating manner, so that the far-end resetting mechanism is connected with the near-end resetting mechanism, and the alignment and the pair-line resetting of the far-end skeleton at the affected side and the near-end skeleton at the affected side at the fracture position are realized;
s7: moving the adjusting frame body to rotatably reset the far-end skeleton at the affected side;
s8: reducing the distance between the distal reduction mechanism and the proximal reduction mechanism to enable the affected side distal skeleton and the affected side proximal skeleton after the operation of the step S7 to be close and finally closed, thereby realizing the reduction of the separation and displacement of the pelvic fracture;
s9: taking out the Kirschner wire which is arranged in the proximal bone of the affected side in the step S1;
s10: jacking the kirschner wire in the step S1 to insert the kirschner wire into the affected side far-end bone and the affected side near-end bone;
s11: taking out the limiting sleeve in the second positioning hole, placing a hollow screw in the second positioning hole, and placing the hollow screw along the Kirschner wire placed in the far-end bone of the affected side and the near-end bone of the affected side, so that the far-end bone of the affected side and the near-end bone of the affected side are connected and fixed through the hollow screw;
s12: the reduction device is removed to complete reduction and fixation of the pelvic fracture.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN202010121026.7A CN111227921A (en) | 2020-02-26 | 2020-02-26 | Pelvis fracture reduction device and operation method |
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| Application Number | Priority Date | Filing Date | Title |
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| CN202010121026.7A CN111227921A (en) | 2020-02-26 | 2020-02-26 | Pelvis fracture reduction device and operation method |
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| CN111227921A true CN111227921A (en) | 2020-06-05 |
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Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN112137703A (en) * | 2020-09-27 | 2020-12-29 | 西安市红会医院 | Pelvis fracture reduction device and using method thereof |
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Cited By (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN112137703A (en) * | 2020-09-27 | 2020-12-29 | 西安市红会医院 | Pelvis fracture reduction device and using method thereof |
| CN112137703B (en) * | 2020-09-27 | 2022-03-25 | 西安市红会医院 | Pelvis fracture reduction device and using method thereof |
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