CN111728689A - Minimally Invasive Stabilization System Guide for Posterior Ring of Pelvic Fractures - Google Patents

Abstract

The invention discloses a guide plate for a minimally invasive stabilization system for a posterior ring of a pelvic fracture, comprising: a rear guide plate and a side guide plate; the rear guide plate is connected with the side guide plate; both the rear guide plate and the side guide plate are provided with There are fixing holes; the fixing holes are used for implanting K-wires; the rear guide plate and the side guide plates are fixed by the K-wires; the rear guide plate contains the LC2 channel screw guide tube, and the side guide plate contains the sacral guide 1 channel screw guide tube and sacral 2 channel screw guide tube. The invention provides a minimally invasive stabilization system guide plate for the posterior ring of pelvic fracture, which adopts a combined design and is divided into two parts. Less invasive than existing guide solutions.

Description

Minimally Invasive Stabilization System Guide for Posterior Ring of Pelvic Fractures

technical field

The invention relates to the technical field of medical equipment, in particular, to a 3D printed pelvic fracture posterior ring minimally invasive stabilization system guide plate.

Background technique

Posterior pelvic ring fractures (sacral fractures, iliac fractures, etc.) can be internally fixed in a variety of ways. Studies have shown that screw fixation has biomechanical advantages and less trauma. Therefore, for patients with posterior pelvic ring fractures who have surgical indications, At present, channel screws are mostly used for internal fixation.

The traditional surgical operation needs to be monitored by the C-arm X-ray machine, and by constantly changing the special projection position of the C-arm, according to the adjacent relationship between the bone, the joint and the Kirschner wire displayed by the C-arm, the needle insertion point and the needle insertion direction can be adjusted to avoid Important blood vessels and nerves are damaged during the needle insertion process, resulting in neurological dysfunction and even death of patients. The main shortcomings of the traditional surgical operation method: 1. The needle insertion point and the needle insertion direction planned before operation cannot be located during the operation. During the operation, the needle insertion point and the needle insertion direction need to be adjusted repeatedly, as well as the C-arm and the projection position. Medical staff and patients suffer more radiation exposure. 2. It is difficult for the screw to reach the path and position planned before operation. 3. The long surgical exposure time and repeated changes of the C-arm position increase the risk of postoperative incision infection.

SUMMARY OF THE INVENTION

In order to solve the problems in the prior art, the embodiment of the present invention provides a guide plate for a minimally invasive stabilization system for the posterior ring of a pelvic fracture. The technical solution is as follows:

In one aspect, a minimally invasive stabilization system guide for the posterior ring of a pelvic fracture is provided, including: a posterior guide and a lateral guide; the posterior guide is connected to the lateral guide; both the posterior guide and the lateral guide are A fixing hole is provided; the fixing hole is used for implanting a K-wire; the rear guide plate and the lateral guide plate are fixed by the K-wire.

Further, three fixing holes are provided on the rear guide plate.

Further, a fixing hole is provided on the side guide plate.

Further, the rear guide plate fits with the corresponding anatomical position of the ilium, and is fixed by implanting a Kirschner wire through the fixing hole; the lateral guide plate and the fixed rear guide plate are combined in the body and fixed through the fixing hole.

Further, the guide plate of the minimally invasive stabilization system for the posterior ring of the pelvic fracture is made by 3D printing.

The beneficial effects brought by the technical solutions provided in the embodiments of the present invention are:

The invention provides a minimally invasive stabilization system guide plate for the posterior ring of pelvic fracture, which adopts a combined design and is divided into two parts. Less invasive than existing guide solutions.

Description of drawings

In order to illustrate the technical solutions in the embodiments of the present invention more clearly, the following briefly introduces the accompanying drawings used in the description of the embodiments. Obviously, the accompanying drawings in the following description are only some embodiments of the present invention. For those of ordinary skill in the art, other drawings can also be obtained from these drawings without creative effort.

1 is a schematic diagram of a guide plate for a minimally invasive stabilization system for a posterior ring of a pelvic fracture according to an embodiment of the present invention;

2 is a schematic diagram of a rear guide plate according to an embodiment of the present invention;

3 is a schematic diagram of a side guide plate according to an embodiment of the present invention;

Fig. 4 is a side view of a guide plate of a minimally invasive stabilization system for the posterior ring of a pelvic fracture according to an embodiment of the present invention.

Detailed ways

In order to make the objectives, technical solutions and advantages of the present invention clearer, the embodiments of the present invention will be further described in detail below with reference to the accompanying drawings.

The present invention provides a guide plate for a minimally invasive stabilization system for the posterior ring of pelvic fractures, see Figures 1-4, including: a rear guide plate 1 and a side guide plate 2; the rear guide plate 1 is connected with the side guide plate 2; the rear guide plate 1 Both the guide plate 1 and the side guide plate 2 are provided with fixing holes 3; the fixing holes 3 are used to implant K-wires; the rear guide plate 1 and the side guide plates 2 are fixed by the K-wires; The rear guide plate 1 includes the LC2 channel screw guide tube 4 , and the lateral guide plate 2 includes the sacral 1 channel screw guide tube 5 and the sacral 2 channel screw guide tube 6 .

In this embodiment, referring to FIG. 4 , the rear guide plate is arc-shaped, the rear guide plate includes a planned channel screw guide tube, namely the LC2 channel screw, and the side guide plate includes two planned channel screw guide tubes, namely Sacral 1 and Sacral 2 channel screws.

Further, three fixing holes are provided on the rear guide plate.

Further, a fixing hole is provided on the side guide plate.

Further, the rear guide plate fits with the corresponding anatomical position of the ilium, and is fixed by implanting a Kirschner wire through the fixing hole; the lateral guide plate and the fixed rear guide plate are combined in the body and fixed through the fixing hole.

Further, the guide plate of the minimally invasive stabilization system for the posterior ring of the pelvic fracture is made by 3D printing.

Referring to FIG. 4 , the surface of the rear guide plate 1 is provided with a triangular structure 7, which can cover part of the side guide plate 2, and a fixing hole 3 is formed on the triangular structure. Combine the two guides into one

In specific use, the rear guide plate and the side guide plate are implanted respectively, and the rear guide plate and the side guide plate are "integrated into one". The channel screw is implanted through the channel screw guide tube.

In this embodiment, the design and manufacture of the guide plate are provided, as follows:

1.1 Import the CT plain scan data of the patient's pelvis into Mimics 19.0 software in Dicom format, segment the bone and soft tissue through threshold segmentation (Thresholding), generate a pelvic mask, and use the Calculate 3D function to build a 3D model of the pelvis.

1.2 Use the built-in CAD module (Analysis Objects) of the software to build a cylinder (simulated screw), move the cylinder to the ideal screw position through the rotation and translation functions, and observe whether the position of the cylinder meets the requirements on a two-dimensional scan, such as If the position is not satisfied, adjust until satisfied. The diameter of the cannulated screw (provided by Johnson & Johnson Syndice) is usually 7.3mm, so the diameter of the cylinder is set to 7.3mm. However, before inserting the screw, a guide needle needs to be placed, and the guide needle is a 2.0mm diameter Kirschner wire. Therefore, the cylinder needs to be set to be hollow. Copy the already set diameter 7.3mm cylinder, the copied cylinder is completely coincident with the previous cylinder space position, change the copied cylinder parameters to 2.0mm in diameter, and subtract the two cylinders by Boolean operation, The generated new hollow cylinder is 7.3mm in diameter of outer circle and 2.0mm in diameter of hollow circle. The sacral 1, sacral 2 and LC2 screw guides were established in the same way.

1.3 Use the Dilate function in the Morphology Operations module to inflate the pelvic mask by 2 pixels (Pixels) to generate a new mask. Subtract the pelvic mask from the new mask by Boolean operation to obtain another mask, and then use the Calculate 3D function to build a 3D model of the mask obtained after the Boolean operation. The 3D model is equivalent to establishing a fully fitted shell on the patient's pelvis surface .

1.4 Use the surgery simulation (Simulate) module to perform the osteotomy operation on the "shell", and retain the part of the "shell" that you want to stay, that is, the bone guide plate. On the one hand, this part is expected to be small, but it can be reduced in practice. The peeling of soft tissue from the bone surface; on the other hand, it is hoped that the guide plate can be placed as accurately as the preoperative planning, which requires finding good anatomical landmarks as much as possible when designing the guide plate.

1.5 Through surgical simulation, a bone guide plate was finally determined. Through Boolean operation, the guide plate was Boolean addition with the hollow cylinders of sacral 1, sacral 2, and LC2 established before. In this way, the rear guide plate was combined with the LC2 channel screw guide tube, and The lateral guide plate is combined with the sacral 1 and sacral 2 screw guide tubes.

1.6 In actual operation, it is hoped that the guide plate will be implanted into the bone surface with little trauma. Therefore, the present invention divides the guide plate into two parts: the rear guide plate and the lateral guide plate. , reduce trauma. After overlapping with the respective anatomical landmarks and fitting with the bone surface, the guide plates are reassembled in the body, and three fixing holes are designed on the guide plate. The diameter of the fixing holes is also 2.0mm. Pins fix the guide plate on the bone surface to avoid displacement.

1.7 After designing the guide plate, export the three-dimensional data of the guide plate in Stl format, and make the real object through 3D printing technology.

At the same time, in this embodiment, the actual operation process is provided, and the details are as follows:

2.1 Make an incision in the posterior iliac skin, separate the soft tissue and reach the posterior iliac bone surface, peel off the muscles attached to the bone surface of the corresponding size according to the size of the posterior guide plate, fit the posterior guide plate to the corresponding anatomical position of the iliac bone, and implant it through the fixed hole The Kirschner wire secures the rear guide.

2.2 Make an incision on the outside of the ilium, separate the soft tissue to reach the bony surface of the ilium, peel off the muscles of the bony surface, combine the lateral guide plate and the fixed rear guide plate in the body, and fix them together through the fixing holes.

2.3 According to the patient's fracture type and actual needs, the 2.0mm Kirschner wire guide wire was implanted through the corresponding sacral 1, sacral 2, and LC2 screw guides, and the position of the guide wire was fluoroscopyed in the C-arm.

2.4 After the guide wire is implanted, take out the Kirschner wire with three fixed holes and take out the lateral guide plate and the rear guide plate respectively.

2.5 Measure the length of the screw to be implanted through the guide needle, screw in a 7.3mm cannulated screw, withdraw the guide needle, suture the incision, and complete the operation.

Scheme implementation and verification:

It was verified on the specimen in the early stage, the soft tissue on the bone surface was stripped, and after the position of the guide plate was satisfactory, 3 temporary Kirschner wires were implanted in sequence to fix the guide plate, and then S1, S2 and LC2 screws were placed, and the guide plate and the bone fit well. The position of the Kirschner wire conformed to the expected plan, and the repeat CT showed that the position of the Kirschner wire conformed to the expected target, and the effect was satisfactory.

The present invention includes S1, S2 and LC2 screw guide plates, includes all types of channel screws in the posterior pelvic ring, and can be selectively placed according to actual needs.

The guide plate adopts a combined bone sticking design, with accurate anatomical positioning, good fit, and good screw placement. The combined type can reduce soft tissue damage and is easy to operate.

The verification shows that the position of the screw inserted by the present invention conforms to the preoperative planning and design, the position is satisfactory, and the safety is high.

For patients, the preoperative plan is more precise and personalized.

The invention includes preoperative planning and design, CAD-aided design, 3D printing and other technologies. After learning, the whole process can be realized quickly, and the cost is low, and the patient's economic pressure is small.

The beneficial effects brought by the technical solutions provided in the embodiments of the present invention are:

More accurate preoperative planning: Through mimics software, a three-dimensional model is established by using the patient's CT scan data. On the model, the screw insertion point, needle insertion direction, and needle insertion depth can be accurately designed to achieve personalized and precise medical care.

More accurate and scientific plan implementation: The traditional operation is repeatedly adjusted under intraoperative fluoroscopy to confirm the optimal position and complete the nail placement, which cannot be effectively implemented according to the preoperative plan. The invention uses the 3D printing rapid prototyping technology to make the preoperative planning and design into a screw guide plate, which completely fits the patient's skeletal anatomical landmarks and can be implemented in full accordance with the preoperative planning scheme, and the screw position is consistent with the preoperative planning. .

Higher work efficiency: The successful placement of each screw in the traditional operation requires repeated projection of accurate C-arms, which is time-consuming and inefficient. The invention combines the sacral 1, sacral 2, and LC2 screw guide plates, which can be selectively placed or all placed according to needs, without repeatedly adjusting the position of the C arm, and greatly improving the work efficiency.

Safer working environment: Fewer C-arm exposures means less radiation exposure to medical staff and patients.

Lower risk of postoperative incision infection: The traditional operation steps are cumbersome and the incision exposure time is long, which theoretically increases the risk of incision infection.

Less surgical trauma: Our guide plate adopts a combined design and is divided into two parts. The guide plate is inserted through two minimally invasive incisions, and a channel is established under the muscle for combination. Less invasive than existing guide solutions.

The above are only preferred embodiments of the present invention and are not intended to limit the present invention. Any modification, equivalent replacement, improvement, etc. made within the spirit and principle of the present invention shall be included in the protection scope of the present invention. Inside.

Claims (5)

1. A minimally invasive stabilization system guide plate for posterior ring of pelvic fracture, characterized in that it comprises: a rear guide plate and a side guide plate; the rear guide plate is connected with the side guide plate; the rear guide plate and the side guide plate are connected Both are provided with fixing holes; the fixing holes are used for implanting K-wires; the rear guide plate and the side guide plates are fixed by the K-wires; the rear guide plate contains LC2 channel screw guide tubes, and the side guide plates are Contains the sacral 1 channel screw guide tube and the sacral 2 channel screw guide tube. 2 . The minimally invasive stabilization system guide plate for the posterior ring of pelvic fracture according to claim 1 , wherein three fixing holes are provided on the rear guide plate. 3 . 3 . The minimally invasive stabilization system guide plate for the posterior ring of pelvic fracture according to claim 2 , wherein a fixing hole is provided on the lateral guide plate. 4 . 4. The minimally invasive stabilization system guide plate for the posterior ring of pelvic fractures according to claim 3, characterized in that, the rear guide plate is fitted with the corresponding anatomical position of the ilium, and a Kirschner wire is implanted through the fixing hole for fixation; the lateral guide plate It is combined with the already fixed rear guide plate in the body and fixed through the fixing hole. 5 . The minimally invasive stabilization system guide plate for the posterior ring of the pelvic fracture according to claim 4 , wherein the minimally invasive stabilization system guide plate for the posterior ring of the pelvic fracture is made by 3D printing. 6 .

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