CN111329571B - A lower extremity fracture reduction system - Google Patents
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- 210000003141 lower extremity Anatomy 0.000 title claims abstract description 22
- 238000011156 evaluation Methods 0.000 claims abstract description 13
- 210000000988 bone and bone Anatomy 0.000 claims description 155
- 208000010392 Bone Fractures Diseases 0.000 claims description 80
- 206010017076 Fracture Diseases 0.000 claims description 57
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- 206010061599 Lower limb fracture Diseases 0.000 claims description 7
- 238000011867 re-evaluation Methods 0.000 claims description 7
- 238000012274 Preoperative evaluation Methods 0.000 claims description 5
- 210000000544 articulatio talocruralis Anatomy 0.000 claims description 5
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- 208000006670 Multiple fractures Diseases 0.000 claims description 3
- 230000002159 abnormal effect Effects 0.000 claims description 3
- 210000003127 knee Anatomy 0.000 claims description 3
- 210000000629 knee joint Anatomy 0.000 claims description 3
- 210000003414 extremity Anatomy 0.000 abstract description 16
- 238000011084 recovery Methods 0.000 abstract description 5
- 238000001356 surgical procedure Methods 0.000 abstract description 3
- 238000004458 analytical method Methods 0.000 abstract description 2
- 238000004364 calculation method Methods 0.000 abstract description 2
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- 230000000740 bleeding effect Effects 0.000 description 1
- 230000017531 blood circulation Effects 0.000 description 1
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- 230000036244 malformation Effects 0.000 description 1
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Abstract
本发明公开了一种下肢骨折复位系统，在评估骨折畸形时利用患者健侧影像建立对照标准，逆向评估骨折畸形，不设定统一的参考标准，而是以患者自身的健侧作为参考标准，因人而异，更复合每一名患者的自身情况，不受X射线影像的拍摄角度、拍摄距离和患者肢体摆放等因素的影响，并通过计算机进行计算分析评估，进一步提高了评估及复位的准确性，能够保证术后肢体具有良好的恢复，两侧肢体对称。The invention discloses a lower extremity fracture reduction system. When evaluating fracture deformity, a control standard is established by using the image of the patient's healthy side, and the fracture deformity is evaluated in reverse. Instead of setting a unified reference standard, the patient's own healthy side is used as the reference standard. It varies from person to person, and is more complex with each patient's own situation. It is not affected by factors such as the shooting angle of X-ray images, shooting distance, and the placement of the patient's limbs. The computer is used for calculation and analysis, which further improves the evaluation and reset. The accuracy can ensure that the limbs have a good recovery after surgery, and the limbs on both sides are symmetrical.
Description
Technical Field
The invention relates to the technical field of fracture treatment, in particular to a lower limb fracture reduction system.
Background
Fracture is a common disease in orthopedic surgery, and before the fracture part is permanently fixed, the fracture part needs to be reset, the length of the lower limb needs to be recovered, and the correction of anterior-posterior angulation deformity, lateral angulation deformity and rotation deformity needs to be performed.
The traditional long bone fracture reduction method is that under the direct vision environment, doctors open and reduce through experience and skill, but the open and reduction method is easy to destroy blood circulation and soft tissues around the fracture, the operation time is long, bleeding is much, and infection is easy.
The fracture reduction methods proposed in patents US 9524587, US5728095 and EP2767252 can be embodied as the following procedure: firstly, shooting an X-ray positive piece and a side piece of a fracture part containing a complete external fixation bracket; secondly, manually measuring pose parameters between the bone fracture ends and installation parameters between the bone blocks and the external fixed support on the X-ray image, and reading the length of each branched chain of the external fixed support; then, inputting the data into a computer system, and solving the adjustment scheme of each branched chain driving joint by using a certain algorithm to form an electronic prescription; and finally, adjusting the lengths of six branched chains of the external fixing bracket according to the electronic prescription to realize the reduction of the fracture broken end.
The reset method has the following defects: 1) the factors such as the shooting angle, the shooting distance and the patient limb placement of the X-ray image cannot be standardized, the evaluation result has errors, and the resetting effect is not ideal; 2) when the X-ray image is measured manually, various subjective and objective errors exist; 3) the X-ray positive plate and the X-ray lateral plate can not reflect the rotation deformity of the broken end of the fracture around the axis, and the operation is carried out by the experience of a doctor, otherwise, the reduction is incomplete, and the limb movement is blocked after the recovery.
Disclosure of Invention
The invention aims to provide a lower limb fracture reduction system, which utilizes a healthy side image as a reference to reversely evaluate fracture deformity so as to improve the accuracy of evaluation and reduction and ensure good recovery of postoperative limbs.
In order to solve the technical problems, the technical scheme adopted by the invention is as follows:
a lower limb fracture reduction system, comprising:
c-arm machine and computer for preoperative assessment
The patient lies down upwards, the C-arm machine perspectives the operation section positioning sheet and the positioning sheet on the healthy side symmetrical to the operation section, and transmits the positioning sheet to the computer operation interface to define four directions of front, back, inner and outer;
computer start-of-form parameter evaluation
(1) Assessment of bone fragment length shift
(1.1) according to the determined factor A, a computer evaluates whether the two sections of fractured bones have displacement in the length direction on the operation section positioning sheet;
(2) assessment of lateral deformity of fractured bones
(2.1) establishing a reference standard on the healthy side, and acquiring a reference value K1 capable of evaluating whether the fractured bone has lateral angular deformity and a reference value K2 capable of evaluating whether the fractured bone has lateral displacement on a normal position sheet on the healthy side by a computer according to the established element B;
(2.2) according to the determined element B, the computer obtains actual values K1 ', K2' on the surgical segment normal sheet relative to the reference values K1, K2;
(2.3) comparing the actual value with the reference value in the computer operation interface and generating a result, if the difference between K1 'and K1 is greater than the allowable error value, then assessing that the fractured bone has lateral angular deformity, if the difference between K2' and K2 is greater than the allowable error value, then assessing that the fractured bone has lateral displacement, otherwise, no lateral deformity exists;
(2.4) if there is a lateral angulation deformity and/or lateral displacement, computer evaluating the inward or outward angulation and/or displacement according to a given factor B1;
the system also comprises a lower limb traction device for intraoperative reduction;
(1.2) if the fractured bone is displaced in the length direction, the lower limb traction device performs traction reduction operation;
(2.5) if the fractured bone has lateral deformity, the lower limb traction device performs reduction operation on the fractured bone lateral deformity;
reevaluation by C-arm machine, computer and lower extremity traction device
And (3) repeating the pre-operation evaluation (1) and (2), re-evaluating whether the reduced operation section has broken bone length displacement and broken bone lateral deformity, and if so, repeating the operation of the reduction (1.2) and (2.5) in the operation until the length of the lower limb is recovered and the medial or lateral deformity is corrected.
The further technical solution is that the preoperative assessment further comprises:
the patient lies down upwards, the C-arm machine perspectives the side sheet of the operation section and the side sheet of the healthy side symmetrical to the operation section, and transmits the side sheets to the computer operation interface to define four directions of front, back, inner and outer;
(3) assessment of deformity around fractured bone
(3.1) establishing a reference standard on the healthy side, and acquiring a reference value K3 capable of evaluating whether the fractured bone is in anterior-posterior angulation deformity and a reference value K4 capable of evaluating whether the fractured bone is in anterior-posterior displacement on a lateral position sheet on the healthy side by using a computer according to the established element C;
(3.2) according to the determined element C, the computer acquires actual values K3 'and K4' corresponding to the reference values K3 and K4 on the lateral position sheet of the operation section;
(3.3) comparing the actual value with the reference value in the computer operation interface and generating a result, if the difference value between K3 'and K3 is greater than the allowable error value, evaluating the presence of anterior-posterior angulation deformity of the fractured bone, if the difference value between K4' and K4 is greater than the allowable error value, evaluating the presence of anterior-posterior displacement of the fractured bone, otherwise, not evaluating the presence of anterior-posterior deformity;
(3.4) if there is anterior-posterior angulation deformity and/or anterior-posterior displacement, computer evaluating the anterior or posterior angulation and/or displacement according to a given factor C1;
the intraoperative reduction further comprises:
(3.5) if the fractured bone has front and back deformity, performing reduction operation on the front and back deformity of the fractured bone;
the re-evaluation further comprises:
and (4) repeating the preoperative evaluation (3), re-evaluating whether the operation section after reduction has front and back deformities, and repeating the operation of intraoperative reduction (3.5) until the front or back deformities are corrected.
The further technical solution is that the preoperative assessment further comprises:
(4) assessment of bone fracture rotation deformity
(4.1) establishing a reference standard at the healthy side, and acquiring at least one reference value K5 capable of evaluating whether the fractured bone is in the rotational deformity on the orthostatic sheet at the healthy side by the computer according to the established element D;
(4.2) according to the determined element D, the computer acquires an actual value K5' corresponding to the reference value K5 on the surgical segment positive position sheet;
(4.3) comparing the actual value with the reference value in the computer operation interface and generating a result, if the difference between K5' and K5 is greater than an allowable error value, assessing that the fractured bone has rotational deformity, otherwise, not;
(4.4) if the rotation deformity exists, the rotation deformity exists at the far end can be defaulted, and the inward rotation or outward rotation deformity is judged according to the pointing direction of the tiptoe;
the intraoperative reduction further comprises:
(4.5) if the fractured bone has the rotational deformity, carrying out the reduction operation of the internal rotation or the external rotation deformity;
the re-evaluation further comprises:
and repeating the preoperative assessment (4), re-assessing whether the reduced operation section has rotational deformity, and repeating the operation of intraoperative reduction (4.5) until the internal rotation or external rotation displacement is corrected.
The further technical scheme is that the method for evaluating the fractured bone rotation deformity further comprises or is replaced by the following steps:
obtaining a distance value L between the inner side end point of the fracture line at the proximal end of the fractured bone and the inner side end point of the fracture line at the distal end of the fractured bone on the C-arm machine perspective operation segment correction sheetInner partObtaining the distance value L between the outer side end point of the fracture line at the proximal end of the fractured bone and the outer side end point of the fracture line at the distal end of the fractured boneOuter coverAnd generating a result when LInner part≠LOuter coverIf so, evaluating that the fractured bone has rotational deformity, otherwise, evaluating that the fractured bone does not exist.
A further technical solution is that the method for evaluating the displacement of two broken bones in the longitudinal direction, which is included in the predetermined element a, includes:
whether a fracture exists between the far end of the near-end fractured bone and the near end of the far-end fractured bone; and
whether the distal end of the proximal fractured bone is distal to the proximal end of the distal fractured bone.
The further technical scheme is that the method for acquiring the reference values K1 and K2 contained in the given element B comprises the following steps:
on a healthy side positioning sheet which is symmetrical with the operation section in C-arm machine perspective, a central axis L of the healthy side near-end bone in the positive direction is made1And the central axis L of the healthy distal bone in the normal direction2,L1And L2The intersection angle alpha is recorded as a reference value K1, L1And L2Distance L between two points intersecting the fracture lineABReference value K2;
the method for obtaining the actual values K1 'and K2' included in the predetermined element B comprises the following steps:
making a central axis L of the operative side near-end bone in the positive direction on a C-arm machine perspective operation segment positioning sheet1', and axial line L of the distal bone at the operative side2’,L1' and L2Angle of intersectionAlpha 'is recorded as the actual value K1', L1' and L2' distance L between two points intersecting the fracture lineAB'note as actual value K2'; wherein
The central axis is obtained by the following method:
on the healthy side, two marking lines for connecting the edges of the two sides of each end bone are transversely made in the positive direction of each end bone, and the middle points of the two marking lines are connected to obtain the central axis of the end bone; and on the operation side, the healthy side is mirrored to the operative side, and the healthy side healthy sheet is rotated for the first time to make the healthy side near end coincide with the operative side near end, at this time L1Is at the position of L1' then, the healthy side orthotopic piece is rotated a second time so that the healthy side distal end coincides with the operative side distal end, at which time L2Is at the position of L2’。
The further technical proposal is that in the generated result, when K1' -K1 is more than 2 degrees, the lateral angulation deformity of the fractured bone is evaluated; when K2' -K2 > 2mm, the presence of lateral displacement of the fractured bone is assessed.
A further technical solution is that the determination criterion of the predetermined element B1 is, for example, the distal central axis L2The proximal end of' is located at L1The medial aspect of the' is then inwardly angled or displaced, e.g., about the central distal axis L2The proximal end of' is located at L1The outer side of' is then angled or displaced outwardly.
The further technical scheme is that the method for acquiring the reference values K3 and K4 included in the established element C comprises the following steps:
on the side position sheet of the healthy side which is symmetrical with the operation section in the C-arm machine perspective, the central axis L of the healthy side near-end bone side direction is made3And a medial axis L lateral to the healthy distal bone4,L3And L4The intersection angle beta is recorded as a reference value K3, L3And L4Distance L between two points intersecting the fracture lineCDReference value K4;
the method for acquiring the actual values K3 'and K4' included in the predetermined element C includes:
making a medial axis L of the lateral direction of the proximal bone of the operation side on a C-arm machine perspective operation section lateral position sheet3', and the distal end of the operation sideMedial axis L of the lateral direction of the bone4', L3' and L4The ' intersection angle β ' is recorded as the actual value K3 ', L3' and L4' distance L between two points intersecting the fracture lineCD'note as actual value K4'; wherein
The central axis is obtained by the following method:
on the healthy side, two marking lines for connecting the edges of the two sides of each end bone are transversely made in the lateral direction of each end bone, and the middle points of the two marking lines are connected to obtain the central axis of the end bone; and is
In the art side, will be good for the side position piece mirror image that the side mark axis is to the side position piece of art side to carry out the rotation for the first time to good for side position piece, make good for the side near-end and art side near-end coincidence, L this moment3Is at the position of L3' then, the side healthy slice is rotated for the second time to make the distal healthy end coincide with the distal operative end, at this time, L4Is at the position of L4’。
The further technical proposal is that in the generated result, when K3' -K3 is more than 2 degrees, the presence of angulation deformity before and after the fractured bone is evaluated; when K4' -K4 > 2mm, the presence of bone fragments was assessed for anteroposterior displacement.
A further technical solution is that the criterion of the predetermined element C1 is, for example, the central axis L of the distal end4The proximal end of' is located at L3The anterior aspect of the' is then angled or shifted anteriorly, e.g., in the direction of the central distal axis L4The proximal end of' is located at L3The posterior side of' is then angled or displaced posteriorly.
The further technical scheme is that the method for acquiring the reference value K5 for evaluating whether the fractured bone is in rotational deformity, which is included in the established element D, comprises the following steps:
obtaining the maximum value L of the width of the knee joint on the healthy side on a healthy side orthotopic sheet which is symmetrical with the operation segment through C-arm machine perspectiveKneeAnd the maximum value L of the ankle joint widthAnkle joint；
The method for obtaining the actual value K5' relative to the reference value, which is contained in the given element D, comprises the following steps:
on a C-arm machine perspective operation segment side position sheet, obtaining the maximum value L of the width of the operation side knee jointKnee' and width of ankle jointMaximum value LAnkle joint’；
In the generated result, when L isKnee’≠LKneeWhen the bone is abnormal, the proximal broken bone has a rotation deformity, when L isAnkle joint’≠LAnkle jointWhen the bone is broken, the distal broken bone has rotational deformity.
Adopt the produced beneficial effect of above-mentioned technical scheme to lie in:
this low limbs fracture system that resets utilizes patient's side of health image to establish contrast standard when aassessment fracture deformity, the reverse aassessment fracture deformity, do not set for unified reference standard, but use patient's side of health as reference standard, vary from person to person, more compound each patient's self condition, do not receive the shooting angle of X ray image, the influence of factors such as shooting distance and patient's limbs are put, and carry out computational analysis aassessment through the computer, further improved aassessment and the accuracy that resets, can guarantee that the postoperative limbs have good recovery, bilateral limbs are symmetrical.
Drawings
FIG. 1 is a perspective view of a side healthy tab of a C-arm machine symmetrical to a surgical segment;
FIG. 2 is an elevational view of the C-arm machine perspective surgical segment;
FIG. 3 is a perspective of a side blade of the side of the C-arm machine symmetrical to the surgical segment;
FIG. 4 is an elevational view of the C-arm machine perspective surgical segment;
fig. 5 is a schematic view of a portion of a fracture line in an orthostatic sheet of a surgical level.
Detailed Description
The technical solutions in the embodiments of the present invention are clearly and completely described below with reference to the drawings in the embodiments of the present invention, and it is obvious that the described embodiments are some, not all, embodiments of the present invention. All other embodiments, which can be derived by a person skilled in the art from the embodiments given herein without making any creative effort, shall fall within the protection scope of the present invention.
In the following description, numerous specific details are set forth in order to provide a thorough understanding of the present invention, but the present invention may be practiced in other ways than those specifically described and will be readily apparent to those of ordinary skill in the art without departing from the spirit of the present invention, and therefore the present invention is not limited to the specific embodiments disclosed below.
Example one
Referring to fig. 1-5, a lower limb fracture reduction system is disclosed, which can be used for the early reduction of the length of a limb and the reduction of a lateral deformity, and the operation method comprises pre-operation evaluation, intra-operation reduction and re-evaluation correction after reduction.
The patient lies down upwards, the C-arm machine perspectives the operation section positioning sheet and the positioning sheet on the healthy side symmetrical to the operation section, and transmits the positioning sheet to the computer operation interface to define four directions of front, back, inner and outer.
Assessment of bone length displacement before surgery
(1.1) according to the determined element A, the computer evaluates whether the two sections of fractured bones have displacement in the length direction on the operative section correction sheet.
The method for evaluating the displacement of two broken bones in the length direction, which is included in the predetermined element A, comprises the following steps:
whether a fracture exists between the far end of the near-end fractured bone and the near end of the far-end fractured bone; and
whether the distal end of the proximal fractured bone is distal to the proximal end of the distal fractured bone.
Preoperative assessment of lateral deformity of fractured bones, including assessment of lateral angulation deformity and lateral displacement:
(2.1) establishing a reference standard on the healthy side, and acquiring a reference value K1 capable of evaluating whether the fractured bone has lateral angular deformity and a reference value K2 capable of evaluating whether the fractured bone has lateral displacement on a normal position sheet on the healthy side by a computer according to the established element B;
(2.2) according to the determined element B, the computer obtains actual values K1 ', K2' on the surgical segment normal sheet relative to the reference values K1, K2;
(2.3) comparing the actual value with the reference value in the computer operation interface and generating a result, if the difference between K1 'and K1 is greater than the allowable error value, then assessing that the fractured bone has lateral angular deformity, if the difference between K2' and K2 is greater than the allowable error value, then assessing that the fractured bone has lateral displacement, otherwise, no lateral deformity exists;
(2.4) if there is a lateral angulation deformity and/or lateral displacement, the computer evaluates the angulation and/or displacement either inward or outward according to a given factor B1.
The method for obtaining the reference values K1 and K2 included in the given element B comprises the following steps:
on a healthy side positioning sheet which is symmetrical with the operation section in C-arm machine perspective, a central axis L of the healthy side near-end bone in the positive direction is made1And the central axis L of the healthy distal bone in the normal direction2,L1And L2The intersection angle alpha is recorded as a reference value K1, L1And L2Distance L between two points intersecting the fracture lineABIs noted as reference K2.
The method for obtaining the actual values K1 'and K2' included in the predetermined element B comprises the following steps:
making a central axis L of the operative side near-end bone in the positive direction on a C-arm machine perspective operation segment positioning sheet1', and axial line L of the distal bone at the operative side2’,L1' and L2The angle of intersection α 'is recorded as the actual value K1', L1' and L2' distance L between two points intersecting the fracture lineAB'to be recorded as the actual value K2'.
The central axis is obtained by the following method:
on the healthy side, two marking lines for connecting the edges of the two sides of each end bone are transversely made in the positive direction of each end bone, and the middle points of the two marking lines are connected to obtain the central axis of the end bone; and on the operation side, the healthy side is mirrored to the operative side, and the healthy side healthy sheet is rotated for the first time to make the healthy side near end coincide with the operative side near end, at this time L1Is at the position of L1' then, the healthy side orthotopic piece is rotated a second time so that the healthy side distal end coincides with the operative side distal end, at which time L2Is at the position of L2’。
The central axis of the operation side is made at the same position of the operation side by using the image of the central axis of the healthy side, so that the positions of the central axes made twice on the bone are the same, and the feasibility of comparison is ensured.
In the result generated in the step (2.3), when K1' -K1 is more than 2 degrees, the fractured bone is evaluated to have lateral angulation deformity; when K2' -K2 > 2mm, the presence of lateral displacement of the fractured bone is assessed.
The determination criteria for the given element B1 are, for example, the central axis L of the distal end2The proximal end of' is located at L1The medial aspect of the' is then inwardly angled or displaced, e.g., about the central distal axis L2The proximal end of' is located at L1The outer side of' is then angled or displaced outwardly.
The intraoperative reduction comprises the following operations:
(1.2) if the fractured bone has displacement in the length direction, performing traction reduction operation;
and (2.5) if the fractured bone has the lateral deformity, performing reduction operation on the lateral deformity of the fractured bone. When the reduction is carried out, the far end of the broken bone is reduced, and if the reduction is unsuccessful, the near end of the broken bone is reduced.
And (3) repeating the pre-operation evaluation (1) and (2), re-evaluating whether the reduced operation section has broken bone length displacement and broken bone lateral deformity, and if so, repeating the operation of the reduction (1.2) and (2.5) in the operation until the length of the lower limb is recovered and the medial or lateral deformity is corrected.
According to the lower limb fracture reduction method, when the fracture deformity is evaluated, the contrast standard is established by using the healthy side image of the patient, the fracture deformity is evaluated reversely, the unified reference standard is not set, but the healthy side of the patient is used as the reference standard, the conditions of each patient are compounded according to different people, the influences of factors such as the shooting angle and shooting distance of an X-ray image and the placement of the limbs of the patient are avoided, the evaluation and reduction accuracy is further improved by performing calculation analysis and evaluation through a computer, the postoperative limbs can be guaranteed to have good recovery, and the limbs on both sides are symmetrical.
Example two
There may also be a posterior-anterior deformity following a fracture of a limb, and thus the fracture reduction system also includes the assessment and correction of the anterior-posterior deformity of the fractured bone. The method also includes pre-operative assessment, intra-operative reduction, and post-reduction re-assessment correction.
The preoperative evaluation comprises evaluation on malformation around fractured bones, specifically comprises evaluation on angulation deformity around fractured bones and displacement around fractured bones, and the operation steps comprise:
the patient lies down upwards, the C-arm machine perspectives the side sheet of the operation section and the side sheet of the healthy side symmetrical to the operation section, and transmits the side sheets to the computer operation interface to define four directions of front, back, inner and outer;
(3) assessment of deformity around fractured bone
(3.1) establishing a reference standard on the healthy side, and acquiring a reference value K3 capable of evaluating whether the fractured bone is in anterior-posterior angulation deformity and a reference value K4 capable of evaluating whether the fractured bone is in anterior-posterior displacement on a lateral position sheet on the healthy side by using a computer according to the established element C;
(3.2) according to the determined element C, the computer acquires actual values K3 'and K4' corresponding to the reference values K3 and K4 on the lateral position sheet of the operation section;
(3.3) comparing the actual value with the reference value in the computer operation interface and generating a result, if the difference value between K3 'and K3 is greater than the allowable error value, evaluating the presence of anterior-posterior angulation deformity of the fractured bone, if the difference value between K4' and K4 is greater than the allowable error value, evaluating the presence of anterior-posterior displacement of the fractured bone, otherwise, not evaluating the presence of anterior-posterior deformity;
(3.4) if there is anterior-posterior angulation deformity and/or anterior-posterior displacement, the computer evaluates the anterior or posterior angulation and/or displacement according to a given factor C1.
The method for obtaining the reference values K3 and K4 included in the given element C comprises the following steps:
on the side position sheet of the healthy side which is symmetrical with the operation section in the C-arm machine perspective, the central axis L of the healthy side near-end bone side direction is made3And a medial axis L lateral to the healthy distal bone4,L3And L4The intersection angle beta is recorded as a reference value K3, L3And L4Distance L between two points intersecting the fracture lineCDIs noted as reference K4.
The method for acquiring the actual values K3 'and K4' included in the predetermined element C includes:
making a medial axis L of the lateral direction of the proximal bone of the operation side on a C-arm machine perspective operation section lateral position sheet3', and medial axis L lateral to the distal bone4', L3' and L4The ' intersection angle β ' is recorded as the actual value K3 ', L3' and L4' distance L between two points intersecting the fracture lineCD'to be recorded as the actual value K4'.
The central axis is obtained by the following method:
on the healthy side, two marking lines for connecting the edges of the two sides of each end bone are transversely made in the lateral direction of each end bone, and the middle points of the two marking lines are connected to obtain the central axis of the end bone; and is
In the art side, will be good for the side position piece mirror image that the side mark axis is to the side position piece of art side to carry out the rotation for the first time to good for side position piece, make good for the side near-end and art side near-end coincidence, L this moment3Is at the position of L3' then, the side healthy slice is rotated for the second time to make the distal healthy end coincide with the distal operative end, at this time, L4Is at the position of L4’。
In the results generated in the step (3.3), when K3' -K3 is more than 2 degrees, the fractured bone is evaluated to have anterior and posterior angulation deformity; when K4' -K4 > 2mm, the presence of bone fragments was assessed for anteroposterior displacement.
The determination criteria for the given element C1 are, for example, the central axis L of the distal end4The proximal end of' is located at L3The anterior aspect of the' is then angled or shifted anteriorly, e.g., in the direction of the central distal axis L4The proximal end of' is located at L3The posterior side of' is then angled or displaced posteriorly.
The intraoperative reduction comprises the following steps:
and (3.5) if the fractured bone has the front and back deformity, performing reduction operation on the front and back deformity of the fractured bone. When the reduction is carried out, the far end of the broken bone is reduced, and if the reduction is unsuccessful, the near end is reduced.
The re-evaluation includes:
and (4) repeating the preoperative evaluation (3), re-evaluating whether the operation section after reduction has front and back deformities, and repeating the operation of intraoperative reduction (3.5) until the front or back deformities are corrected.
EXAMPLE III
Rotational deformities may also exist after a limb fracture, and therefore the fracture reduction system also includes the assessment and correction of rotational deformities of the fractured bone. The method also includes pre-operative assessment, intra-operative reduction, and post-reduction re-assessment correction.
The preoperative evaluation comprises the evaluation of the deformity of the fractured bone rotation, and the operation steps comprise:
(4.1) establishing a reference standard at the healthy side, and acquiring at least one reference value K5 capable of evaluating whether the fractured bone is in the rotational deformity on the orthostatic sheet at the healthy side by the computer according to the established element D;
(4.2) according to the determined element D, the computer acquires an actual value K5' corresponding to the reference value K5 on the surgical segment positive position sheet;
(4.3) comparing the actual value with the reference value in the computer operation interface and generating a result, if the difference between K5' and K5 is greater than an allowable error value, assessing that the fractured bone has rotational deformity, otherwise, not;
and (4.4) if the rotation deformity exists, the rotation deformity exists at the far end can be defaulted, and the pronation or the supination deformity is judged according to the pointing direction of the tiptoe.
The method for obtaining the reference value for evaluating whether the fractured bone is in the rotational deformity, which is included in the given element D, comprises the following steps:
obtaining the maximum value L of the width of the knee joint on the healthy side on a healthy side orthotopic sheet which is symmetrical with the operation segment through C-arm machine perspectiveKneeAnd the maximum value L of the ankle joint widthAnkle joint；
The method for acquiring the actual value relative to the reference value, which is contained in the given element D, comprises the following steps:
on a C-arm machine perspective operation segment side position sheet, obtaining the maximum value L of the width of the operation side knee jointKnee' and maximum value of ankle joint width LAnkle joint’；
In the generated result, when L isKnee’≠LKneeWhen the bone is abnormal, the proximal broken bone has a rotation deformity, when L isAnkle joint’≠LAnkle jointWhen the bone is broken, the distal broken bone has rotational deformity.
The intraoperative reduction comprises the following steps:
and (4.5) if the fractured bone has the rotational deformity, performing the reduction operation of the internal rotation or the external rotation deformity. When the reduction is carried out, the far end of the broken bone is reduced, and if the reduction is unsuccessful, the near end is reduced.
The re-evaluation includes:
and repeating the preoperative assessment (4), re-assessing whether the reduced surgical segment has anterior-posterior angular deformities, and repeating the operation of intraoperative reduction (4.5) until the pronation or supination displacement is corrected.
Example four
Based on the third embodiment, the method for evaluating the rotation deformity of the fractured bone further comprises or is replaced by:
the computer obtains the distance value L between the inner side end point of the fracture line at the proximal end of the fractured bone and the inner side end point of the fracture line at the distal end of the fractured bone on the C-arm fluoroscopy operation segment correction sheetInner partObtaining the distance value L between the outer side end point of the fracture line at the proximal end of the fractured bone and the outer side end point of the fracture line at the distal end of the fractured boneOuter coverAnd generating a result when LInner part≠LOuter coverIf so, evaluating that the fractured bone has rotational deformity, otherwise, evaluating that the fractured bone does not exist.
According to any of the disclosed embodiments, during the reduction during the operation, the lower limb traction device described in the chinese patent application CN201910832613.4 by the applicant can be used for traction reduction, pushing reduction, and the like. And during reduction, the healthy side image is used for reversely reducing the fracture far end, if the reverse reduction of the fracture far end is unsuccessful, then the fracture near end is reversely reduced.
The above is only a preferred embodiment of the invention, and any simple modifications, variations and equivalents of the invention may be made by anyone in light of the above teachings and fall within the scope of the invention.
Claims (8)
1. A lower limb fracture reduction system, comprising:
a C-arm machine and computer for pre-operative assessment;
the patient lies down upwards, the C-arm machine perspectives the operation section positioning sheet and the positioning sheet on the healthy side symmetrical to the operation section, and transmits the positioning sheet to the computer operation interface to define four directions of front, back, inner and outer;
the computer begins to evaluate each parameter
(1) Assessment of bone fragment length shift
(1.1) according to the determined factor A, a computer evaluates whether the two sections of fractured bones have displacement in the length direction on the operation section positioning sheet;
wherein,
the method for evaluating the displacement of two broken bones in the length direction, which is included in the predetermined element A, comprises the following steps:
whether a fracture exists between the far end of the near-end fractured bone and the near end of the far-end fractured bone; and
whether the distal end of the proximal fractured bone is distal to the proximal end of the distal fractured bone;
(2) assessment of lateral deformity of fractured bones
(2.1) establishing a reference standard on the healthy side, and acquiring a reference value K1 capable of evaluating whether the fractured bone is laterally angulated and malformed and a reference value K2 capable of evaluating whether the fractured bone is laterally displaced on a normal position sheet on the healthy side by a computer according to the established element B;
(2.2) according to the determined element B, the computer obtains actual values K1 ', K2' on the surgical segment normal sheet relative to the reference values K1, K2;
(2.3) comparing the actual value with the reference value in the computer operation interface and generating a result, if the difference between K1 'and K1 is greater than the allowable error value, then assessing that the fractured bone has lateral angular deformity, if the difference between K2' and K2 is greater than the allowable error value, then assessing that the fractured bone has lateral displacement, otherwise, no lateral deformity exists;
(2.4) if there is a lateral angulation deformity and/or lateral displacement, computer evaluating the inward or outward angulation and/or displacement according to a given factor B1;
wherein,
the method for obtaining the reference values K1 and K2 included in the given element B comprises the following steps:
on a healthy side positioning sheet which is symmetrical with the operation section in C-arm machine perspective, a central axis L of the healthy side near-end bone in the positive direction is made1And the central axis L of the healthy distal bone in the normal direction2,L1And L2The intersection angle alpha is recorded as a reference value K1, L1And L2Distance L between two points intersecting the fracture lineABReference value K2;
the method for obtaining the actual values K1 'and K2' included in the predetermined element B comprises the following steps:
making a central axis L of the operative side near-end bone in the positive direction on a C-arm machine perspective operation segment positioning sheet1', and axial line L of the distal bone at the operative side2’,L1' and L2The angle of intersection α 'is recorded as the actual value K1', L1' and L2' distance L between two points intersecting the fracture lineAB'note as actual value K2';
the determination criteria for the given element B1 are, for example, the central axis L of the distal end2The proximal end of' is located at L1The medial aspect of the' is then inwardly angled or displaced, e.g., about the central distal axis L2The proximal end of' is located at L1The outer side of' is then angled or displaced outwardly;
the system also comprises a lower limb traction device for intraoperative reduction;
(1.2) if the fractured bone is displaced in the length direction, the lower limb traction device performs traction reduction operation;
(2.5) if the fractured bone has lateral deformity, the lower limb traction device performs reduction operation on the fractured bone lateral deformity;
reevaluation by C-arm machine, computer and lower extremity traction device
And (3) repeating the pre-operation evaluation (1) and (2), re-evaluating whether the reduced operation section has broken bone length displacement and broken bone lateral deformity, and if so, repeating the operation of the reduction (1.2) and (2.5) in the operation until the length of the lower limb is recovered and the medial or lateral deformity is corrected.
2. The lower extremity fracture reduction system of claim 1,
the preoperative assessment also included:
the patient lies down upwards, the C-arm machine perspectives the side sheet of the operation section and the side sheet of the healthy side symmetrical to the operation section, and transmits the side sheets to the computer operation interface to define four directions of front, back, inner and outer;
(3) assessment of deformity around fractured bone
(3.1) establishing a reference standard on the healthy side, and acquiring a reference value K3 capable of evaluating whether the fractured bone is in anterior-posterior angulation deformity and a reference value K4 capable of evaluating whether the fractured bone is in anterior-posterior displacement on a lateral position sheet on the healthy side by using a computer according to the established element C;
(3.2) according to the determined element C, the computer acquires actual values K3 'and K4' corresponding to the reference values K3 and K4 on the lateral position sheet of the operation section;
(3.3) comparing the actual value with the reference value in the computer operation interface and generating a result, if the difference value between K3 'and K3 is greater than the allowable error value, evaluating the presence of anterior-posterior angulation deformity of the fractured bone, if the difference value between K4' and K4 is greater than the allowable error value, evaluating the presence of anterior-posterior displacement of the fractured bone, otherwise, not evaluating the presence of anterior-posterior deformity;
(3.4) if there is anterior-posterior angulation deformity and/or anterior-posterior displacement, computer evaluating the anterior or posterior angulation and/or displacement according to a given factor C1;
wherein,
the method for obtaining the reference values K3 and K4 included in the given element C comprises the following steps:
on the side position sheet of the healthy side which is symmetrical with the operation section in the C-arm machine perspective, the central axis L of the healthy side near-end bone side direction is made3And a medial axis L lateral to the healthy distal bone4，L3And L4The intersection angle beta is recorded as a reference value K3, L3And L4Distance L between two points intersecting the fracture lineCDReference value K4;
the method for acquiring the actual values K3 'and K4' included in the predetermined element C includes:
making a medial axis L of the lateral direction of the proximal bone of the operation side on a C-arm machine perspective operation section lateral position sheet3', and medial axis L lateral to the distal bone4', L3' and L4The ' intersection angle β ' is recorded as the actual value K3 ', L3' and L4' distance L between two points intersecting the fracture lineCD'note as actual value K4';
the determination criteria for the given element C1 are, for example, the central axis L of the distal end4The proximal end of' is located at L3The anterior aspect of the' is then angled or shifted anteriorly, e.g., in the direction of the central distal axis L4The proximal end of' is located at L3The posterior side of' is then angled or displaced posteriorly;
the intraoperative reduction further comprises:
(3.5) if the fractured bone has front and back deformity, performing reduction operation on the front and back deformity of the fractured bone;
the re-evaluation further comprises:
and (4) repeating the preoperative evaluation (3), re-evaluating whether the operation section after reduction has front and back deformities, and repeating the operation of intraoperative reduction (3.5) until the front or back deformities are corrected.
3. The lower extremity fracture reduction system of claim 1,
the preoperative assessment also included:
(4) assessment of bone fracture rotation deformity
(4.1) establishing a reference standard at the healthy side, and acquiring at least one reference value K5 capable of evaluating whether the fractured bone is in the rotational deformity on the orthostatic sheet at the healthy side by the computer according to the established element D;
(4.2) according to the determined element D, the computer acquires an actual value K5' corresponding to the reference value K5 on the surgical segment positive position sheet;
(4.3) comparing the actual value with the reference value in the computer operation interface and generating a result, if the difference between K5' and K5 is greater than an allowable error value, assessing that the fractured bone has rotational deformity, otherwise, not;
(4.4) if the rotation deformity exists, the rotation deformity exists at the far end can be defaulted, and the inward rotation or outward rotation deformity is judged according to the pointing direction of the tiptoe;
wherein,
the method for obtaining the reference value K5 for evaluating whether the fractured bone is in the rotational deformity, which is included in the given element D, comprises the following steps:
obtaining the maximum value L of the width of the knee joint on the healthy side on a healthy side orthotopic sheet which is symmetrical with the operation segment through C-arm machine perspectiveKneeAnd the maximum value L of the ankle joint widthAnkle joint；
The method for obtaining the actual value K5' relative to the reference value, which is contained in the given element D, comprises the following steps:
on a C-arm machine perspective operation segment side position sheet, obtaining the maximum value L of the width of the operation side knee jointKnee' and maximum value of ankle joint width LAnkle joint’；
In the generated result, when L isKnee’≠LKneeWhen the bone is abnormal, the proximal broken bone has a rotation deformity, when L isAnkle joint’≠LAnkle jointWhen the bone is broken, the distal broken bone has rotational deformity;
the intraoperative reduction further comprises:
(4.5) if the fractured bone has the rotational deformity, carrying out the reduction operation of the internal rotation or the external rotation deformity;
the re-evaluation further comprises:
and repeating the preoperative assessment (4), re-assessing whether the reduced operation section has rotational deformity, and repeating the operation of intraoperative reduction (4.5) until the internal rotation or external rotation displacement is corrected.
4. The lower extremity fracture reduction system of claim 3, wherein said method of assessing a rotation deformity of a fractured bone further comprises or is replaced with:
obtaining a distance value L between the inner side end point of the fracture line at the proximal end of the fractured bone and the inner side end point of the fracture line at the distal end of the fractured bone on the C-arm machine perspective operation segment correction sheetInner partObtaining the distance value L between the outer side end point of the fracture line at the proximal end of the fractured bone and the outer side end point of the fracture line at the distal end of the fractured boneOuter coverAnd generating a result when LInner part≠LOuter coverIf so, evaluating that the fractured bone has rotational deformity, otherwise, evaluating that the fractured bone does not exist.
5. The lower extremity fracture reduction system of claim 1,
central axis L1、L2、L1' and L2' is obtained by the following process:
on the healthy side, two marking lines for connecting the edges of the two sides of each end bone are transversely made in the positive direction of each end bone, and the middle points of the two marking lines are connected to obtain the central axis of the end bone; and on the operation side, the healthy side is mirrored to the operative side, and the healthy side healthy sheet is rotated for the first time to make the healthy side near end coincide with the operative side near end, at this time L1Is at the position of L1' then, the healthy side righting piece is rotated for the second time to make the healthy side far awayEnd coincides with the distal end of the operative side, at which time L2Is at the position of L2’。
6. The lower extremity fracture reduction system of claim 1,
among the results generated, when K1' -K1 > 2 °, the presence of lateral angulation deformity of the fractured bone was assessed; when K2' -K2 > 2mm, the presence of lateral displacement of the fractured bone is assessed.
7. The lower extremity fracture reduction system of claim 2,
central axis L3、L4、L3' and L4' is obtained by the following process:
on the healthy side, two marking lines for connecting the edges of the two sides of each end bone are transversely made in the lateral direction of each end bone, and the middle points of the two marking lines are connected to obtain the central axis of the end bone; and is
In the art side, will be good for the side position piece mirror image that the side mark axis is to the side position piece of art side to carry out the rotation for the first time to good for side position piece, make good for the side near-end and art side near-end coincidence, L this moment3Is at the position of L3' then, the side healthy slice is rotated for the second time to make the distal healthy end coincide with the distal operative end, at this time, L4Is at the position of L4’。
8. The lower extremity fracture reduction system of claim 2,
among the results generated, when K3' -K3 > 2 °, the presence of angulation deformities before and after the fractured bone is evaluated; when K4' -K4 > 2mm, the presence of bone fragments was assessed for anteroposterior displacement.
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| CN202110873585.8A CN113576642B (en) | 2020-03-10 | 2020-03-10 | Reduction system for lower limb fracture, broken bone and rotation deformity |
| CN202010159773.XA CN111329571B (en) | 2020-03-10 | 2020-03-10 | A lower extremity fracture reduction system |
| CN202110873590.9A CN113576643B (en) | 2020-03-10 | 2020-03-10 | Reduction system for lateral deformity of fractured bones of lower limbs |
| CN202110871329.5A CN113576641B (en) | 2020-03-10 | 2020-03-10 | Reduction system for deformity before and after fracture and fracture of lower limb |
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| CN202110873590.9A Division CN113576643B (en) | 2020-03-10 | 2020-03-10 | Reduction system for lateral deformity of fractured bones of lower limbs |
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