CN111772771B - First accurate formula thighbone neck surgery axis wicresoft mechanical navigation - Google Patents
First accurate formula thighbone neck surgery axis wicresoft mechanical navigation Download PDFInfo
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- CN111772771B CN111772771B CN202010809393.6A CN202010809393A CN111772771B CN 111772771 B CN111772771 B CN 111772771B CN 202010809393 A CN202010809393 A CN 202010809393A CN 111772771 B CN111772771 B CN 111772771B
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- 238000001356 surgical procedure Methods 0.000 title claims abstract description 21
- 210000001694 thigh bone Anatomy 0.000 title claims description 5
- 210000002436 femur neck Anatomy 0.000 claims abstract description 82
- 238000005259 measurement Methods 0.000 claims description 10
- 230000000694 effects Effects 0.000 claims description 8
- 239000000523 sample Substances 0.000 claims description 7
- 230000000712 assembly Effects 0.000 claims description 6
- 238000000429 assembly Methods 0.000 claims description 6
- 230000000399 orthopedic effect Effects 0.000 abstract description 3
- 238000004659 sterilization and disinfection Methods 0.000 abstract description 2
- 210000000689 upper leg Anatomy 0.000 description 8
- 238000000034 method Methods 0.000 description 7
- 230000000087 stabilizing effect Effects 0.000 description 7
- 239000000725 suspension Substances 0.000 description 6
- 238000012546 transfer Methods 0.000 description 6
- 210000000988 bone and bone Anatomy 0.000 description 4
- 230000001054 cortical effect Effects 0.000 description 4
- 238000013461 design Methods 0.000 description 4
- 238000005516 engineering process Methods 0.000 description 3
- 208000020089 femoral neck fracture Diseases 0.000 description 3
- 230000009286 beneficial effect Effects 0.000 description 2
- 238000012986 modification Methods 0.000 description 2
- 230000004048 modification Effects 0.000 description 2
- 238000011160 research Methods 0.000 description 2
- 230000006641 stabilisation Effects 0.000 description 2
- 238000011105 stabilization Methods 0.000 description 2
- 206010007710 Cartilage injury Diseases 0.000 description 1
- 206010017076 Fracture Diseases 0.000 description 1
- 229910000831 Steel Inorganic materials 0.000 description 1
- 208000027418 Wounds and injury Diseases 0.000 description 1
- 230000033228 biological regulation Effects 0.000 description 1
- 230000006378 damage Effects 0.000 description 1
- 230000007547 defect Effects 0.000 description 1
- 238000010586 diagram Methods 0.000 description 1
- 238000005553 drilling Methods 0.000 description 1
- 230000000642 iatrogenic effect Effects 0.000 description 1
- 208000014674 injury Diseases 0.000 description 1
- 230000001788 irregular Effects 0.000 description 1
- 238000002324 minimally invasive surgery Methods 0.000 description 1
- 238000012544 monitoring process Methods 0.000 description 1
- 230000000149 penetrating effect Effects 0.000 description 1
- 230000005855 radiation Effects 0.000 description 1
- 230000001105 regulatory effect Effects 0.000 description 1
- 239000010959 steel Substances 0.000 description 1
- 210000005065 subchondral bone plate Anatomy 0.000 description 1
- 238000011179 visual inspection Methods 0.000 description 1
Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- 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
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- 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
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/74—Devices for the head or neck or trochanter of the femur
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- 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
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/84—Fasteners therefor or fasteners being internal fixation devices
- A61B17/846—Nails or pins, i.e. anchors without movable parts, holding by friction only, with or without structured surface
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- 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
- A61B17/8897—Guide wires or guide pins
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- 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
- A61B17/90—Guides therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
- A61B2090/3904—Markers, e.g. radio-opaque or breast lesions markers specially adapted for marking specified tissue
- A61B2090/3916—Bone tissue
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
- A61B2090/3937—Visible markers
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- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Surgery (AREA)
- Medical Informatics (AREA)
- General Health & Medical Sciences (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
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- Animal Behavior & Ethology (AREA)
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- Oral & Maxillofacial Surgery (AREA)
- Pathology (AREA)
- Surgical Instruments (AREA)
Abstract
The invention belongs to the technical field of orthopedic operation equipment, and relates to a first-alignment type femoral neck surgery central axis minimally invasive mechanical navigation system which comprises a femoral neck positioning hook connecting component, an adapter, a porous positioning guide plate, a positioning guide, a slide bar right-angle adapter and a central axis positioning guide component. The invention can objectively and accurately and completely match the neck shaft angle, the front inclination angle and the front torsion angle, and ensure the accuracy of the central axis of the femoral neck surgery through the center of the femoral neck, realizes the initial accurate nail placement, has high accuracy, adopts a disassembly structure, is convenient for disinfection and reuse after operation, and has simple structure and multiple functions.
Description
Technical Field
The invention belongs to the technical field of orthopedic operation equipment, relates to auxiliary equipment for treating femoral neck fracture, and particularly relates to a minimally invasive mechanical navigation system for a central axis of head-to-head femoral neck surgery.
Background
In the hip-protecting treatment of femoral neck fracture, the hollow nail fixing operation is still the preferred scheme, and the placement of the hollow nail guide needle is the core technology and operation difficulty, whether the hollow nail fixing operation or the steel plate internal fixing operation is performed under the direct vision of incision and reduction or the minimally invasive percutaneous hollow nail fixing operation is performed, the space configuration is reasonable, the radiation is avoided or reduced, and the hollow nail guide needle is successfully placed at one time, so that the method is always the research hot spot and continuous pursuit of orthopedics doctors.
Currently, the main clinical technology is still to drill 1 guide pin into the proximal end of femur according to visual inspection and estimation, then repeatedly see-through the positive side position of femur neck by a C-arm X-ray machine, the position of the guide pin in the femur neck is used as a reference, the pin feeding point, direction and length of the guide pin are estimated to drill into 3-5 guide pins, after repeatedly see-through, the position, direction and length of each guide pin are adjusted until the 3 guide pins reach the proper positions under the perspective, 1 hollow pin is respectively screwed into the 3 guide pins, and the whole operation process is performed by hands of a doctor and bare hands under the repeated see-through monitoring of a C-arm X-ray machine, so that not only is the precision of the pin feeding point, direction and position of each hollow pin poor, but also the spatial distribution of the 3 hollow pins cannot be accurately controlled, the length and holding force of the screw have no objective standard, and the proximal bone cortex and acetabular cartilage injuries, the iatrogenic fractures and other minor injuries are extremely easy to be caused. In the operation, once the guide needle cannot be successfully placed once (first time, accurate for short, first time) and is easy to enter the original needle track during adjustment, the adjustment difficulty is greatly increased; repeated adjustment can greatly reduce the holding force of the hollow nails, and complications such as loosening, withdrawing, breaking and the like of the screws are caused. In the face of a large number of cases of failed nail placement, the first accurate nail placement needs to be solved urgently.
The current mainstream academic view holds that the ideal fixation is a plurality of hollow nails parallel to the direction of the central axis of the femoral neck. Therefore, the central axis of the femoral neck surgery can be accurately found in the operation, which is an ideal fixing premise; however, because the proximal femur anatomy is complex, the shape is extremely irregular, and there are individual differences in the neck shaft angle, the anteversion angle, and the anteversion angle, finding this central axis during surgery-a straight line parallel to the three angles and centered in the neck of the femur remains a significant challenge.
Various guiding and positioning devices designed by the current domestic and foreign scholars attempt to accurately put the hollow nails by means of matching specific anatomical marks, neck shaft angles, forward inclination angles and the like of the proximal femur, but due to individual anatomical differences, the understanding of the forward torsion angles is insufficient, the accuracy limitation of angle reference positioning and the like is caused, the placement error of the hollow nail guide needle is larger, and the surgical requirements cannot be met, so that the hollow nail guide needle cannot be popularized. The infrared navigation technology of the C-arm X-ray machine is combined, and although the accuracy of nail placement is improved, the popularization and the use of the C-arm X-ray machine in China are limited due to errors of a navigation system, high price, excessive dependence on rays, long operation time and the like. In addition, in clinical surgery, navigation techniques cannot accurately measure the distance from the center of the guide pin or the screw thread of the hollow pin to the cortical bone, nor can it be determined whether the guide pin reaches the subchondral bone. Navigation is also limited in its use in anatomical studies.
In a word, the research on the first-alignment femoral neck surgery central axis is not slow and critical at present, but lacks thinking and technical equipment.
Disclosure of Invention
The invention aims to overcome the defects of the prior art, and provides a head-alignment type mechanical navigation system for femoral neck surgery central axis, which is used for successfully determining the femoral neck surgery central axis once by using a fixed-point vertical offset method by taking the midpoint (front) P of the upper and lower diameters of the femoral neck isthmus as a mark point and taking half of the front and rear diameters of the femoral neck isthmus as an offset after searching a nail feeding point N through a nail feeding point positioning guide and completely matching the neck shaft angle, the front inclination angle and the front torsion angle of a femoral neck.
The invention adopts the technical scheme that:
a minimally invasive mechanical navigation system for a first-alignment femoral neck surgery central axis comprises a femoral neck positioning hook connecting component, an adapter, a porous positioning guide plate, a positioning guide, a slide bar right-angle adapter and a central axis positioning guide component;
the femur neck positioning hook connecting component comprises a positioning block, wherein a horizontal transverse positioning groove and a vertical connecting hole which penetrate through the positioning block and are staggered with each other are formed in the positioning block, a positioning hook is movably arranged in the positioning groove, a locking component for locking the positioning hook is arranged on the positioning groove, when the positioning hook moves left and right in place in the positioning groove, the positioning hook can be locked and fixed by the locking component, the positioning hook consists of a connecting section and a functional section, the connecting section is movably arranged in the positioning groove, a right-angle hook is arranged at the front end of the functional section, a plurality of vertical guide pin holes are arranged at the position close to the front end of the functional section, and a plurality of vertical calibration holes are arranged at the position close to the connecting section; the vertical connecting hole is internally and movably provided with a vertical connecting rod, the vertical connecting hole is provided with a locking assembly for locking the vertical connecting rod, and when the vertical connecting rod moves up and down in place in the vertical connecting hole, the vertical connecting rod can be locked and fixed by the locking assembly; the positioning block is provided with a positioning measurement hole in the same direction as the positioning groove, the positioning measurement hole is positioned below the positioning groove, the positioning measurement hole is movably provided with a probe, and the positioning hook and the probe can be used for multi-point measurement, so that whether the hooking position of the positioning hook is accurate or not can be finally determined, the upper and lower diameters of the femoral neck isthmus can be measured, and the midpoint of the upper and lower diameters in front of the femoral neck isthmus cortical bone can be found;
the adapter is provided with a horizontal transverse mounting hole and a vertical connecting hole which penetrate through the adapter and are staggered with each other, a vertical connecting rod on the femoral neck positioning hook connecting component penetrates through the vertical connecting hole on the adapter, so that the adapter is positioned above the femoral neck positioning hook connecting component, the transverse mounting hole on the adapter and a positioning groove on a positioning block of the femoral neck positioning hook connecting component are in the same direction and are positioned above the positioning groove, a porous positioning guide plate is movably arranged in the transverse mounting hole, and locking assemblies are respectively arranged on the transverse mounting hole and the vertical mounting hole and are respectively used for locking the porous positioning guide plate and the vertical connecting rod;
the multi-hole positioning guide plate consists of a connecting section and a functional section, the connecting section is movably arranged in a transverse mounting hole of the adapter, the front end of the functional section is provided with a connecting port perpendicular to the functional section, a plurality of vertical guide pinholes are arranged at a position close to the front end, a plurality of vertical calibration holes are arranged at a position close to the connecting section, the vertical guide pinholes on the multi-hole positioning guide plate and the vertical guide pinholes and the calibration holes are in one-to-one correspondence with the vertical guide pinholes on the positioning hooks of the femoral neck positioning hook connecting component, the distance between any vertical guide pinhole on the multi-hole positioning guide plate and any vertical calibration hole is equal to the distance between the corresponding vertical guide pinholes on the positioning hooks and the corresponding vertical calibration holes, a calibration needle is movably arranged on the vertical calibration holes, the position of the connecting section in the transverse mounting hole of the adapter is adjusted, and the calibration needle on the vertical calibration holes are vertically downwards inserted into the corresponding vertical calibration holes on the positioning hooks of the femoral neck positioning hook connecting component, so that the vertical guide pinholes on the multi-hole positioning guide plate are positioned right above the corresponding vertical guide pinholes on the positioning hooks of the femoral neck positioning hook connecting component (the number of the calibration holes is more, the positioning guide plate and the corresponding vertical guide pinholes are more than the corresponding to the vertical guide pinholes on the positioning hook connecting component, and the positioning guide assembly is more accurate than the positioning guide holes on the positioning guide hook and higher than the positioning guide holes;
the positioning guide comprises a positioning head, a plurality of horizontal guide pinholes are formed in the positioning head, the directions of the horizontal guide pinholes are vertical to the directions of positioning hooks on the femur neck positioning hook connecting component (the extension lines of horizontal projection of the horizontal guide pinholes are vertical to each other), a position-adjustable vertical rod is arranged on the positioning head, the position adjusting direction is the same as the direction of the positioning hooks (namely, the direction perpendicular to the horizontal guide pinholes), in general, various modes for adjusting the position in the mechanical industry are adopted, such as a chute is formed in the positioning head, a clamping block matched with the chute is arranged at the lower part of the vertical rod, and the vertical rod is locked and fixed by a locking assembly after moving in place; the vertical rod is provided with a slide rod right-angle adapter;
the sliding rod right-angle adapter consists of a vertical connector and a fixed rod perpendicular to the connector, a moving port is arranged on the connector, a locking assembly is arranged on the connector, the moving port of the connector is sleeved on the vertical rod of the positioning guide, the fixed rod extends outwards (the extending direction is consistent with the direction of a horizontal guide pinhole on the positioning guide) and is sleeved in a connecting port at the front end of a functional section of the porous positioning guide plate, the connector locks and fixes the sliding rod right-angle adapter by the locking assembly after moving vertically on the vertical rod of the positioning guide in place, and meanwhile, the fixed rod is locked and fixed by the locking assembly on the connecting port;
the utility model provides a three-dimensional positioning guide member, including being the slide bar of falling "L", the slide bar comprises vertical end and horizontal end, wherein vertical end sets up on the location director, the activity is provided with porous alignment slider and the supplementary measurement slider of anteversion on the horizontal end, the supplementary measurement slider of anteversion is located one side that is close to vertical end, the direction of horizontal end is the same with the dead lever direction of slide bar right angle adapter, all set up a plurality of vertical guide pin holes on porous alignment slider and the supplementary measurement slider of anteversion, the vertical guide pin hole that sets up on the porous alignment slider is unanimous with the vertical guide pin hole's that sets up on the porous location deflector distribution mode, when the porous alignment slider was adjusted to porous location deflector directly over, each vertical guide pin hole on the porous alignment slider all is located the vertical guide pin hole that corresponds on the porous location deflector. After the forward inclination angle auxiliary measuring slide block is moved to be in place, the guide pin can be used for ensuring that the device is matched with the forward inclination angle and the forward torsion angle objectively and accurately.
Further technical scheme is, the locating hook design is combined structure, including right angle hook and the porous locating plate that is "L" shape, right angle hook and porous locating plate constitute by linkage segment and functional segment, wherein vertical guide pin hole, vertical alignment hole all set up on the functional segment of porous locating plate, all set up the screw hole that the position corresponds (the setting position of screw hole is general all on the linkage segment) on right angle hook and the porous locating plate, be provided with fixing bolt on the screw hole, screw hole on precession right angle hook and the porous locating plate with fixing bolt can make right angle hook and porous locating plate fix side by side and make up the locating hook together.
The further technical scheme is that the positioning hooks, the porous positioning guide plates and the vertical guide pin holes on the porous direction-adjusting slide block are arranged linearly, and the rows are arranged in a staggered manner from left to right or from right to left. Because the vertical guide pin holes have a certain aperture, the vertical guide pin holes cannot be accurately corresponding to a certain specific size, and only the vertical guide pin holes are linearly arranged, and the vertical guide pin holes are arranged in a staggered manner from left to right or from right to left, so that a certain vertical guide pin hole can be corresponding to a certain size as far as possible within the error allowable range.
The further technical scheme is that the locking assembly is a bolt fixing assembly, such as the locking assembly arranged on the adapter, and comprises a locking bolt and a bolt hole which is arranged on any direction of the adapter, is communicated with the transverse mounting hole or the vertical connecting hole and is vertical to the transverse mounting hole or the vertical connecting hole, the locking bolt penetrates through the bolt hole to penetrate into the transverse mounting hole or the vertical connecting hole to resist against the porous positioning guide plate or the vertical connecting rod which is tightly placed in the transverse mounting hole or the vertical connecting hole, so that the porous positioning guide plate or the vertical connecting rod is prevented from shifting, and the locking and fixing effects are achieved.
The further technical scheme is that the two sides of the multi-hole direction-adjusting slide block are provided with fastening clamping blocks, the fastening clamping blocks are movably arranged at the horizontal end of the slide bar and can slide along the horizontal end, locking components are arranged on the fastening clamping blocks, when the multi-hole direction-adjusting slide block moves in place on the horizontal end of the slide bar, the fastening clamping blocks are moved and clamped on the two sides of the multi-hole direction-adjusting slide block and are locked and fixed by the locking components, and the effect of fixing the multi-hole direction-adjusting slide block is achieved.
The invention also comprises an adjusting and stabilizing support for adjusting and stabilizing the height and the azimuth of the first-alignment type thighbone neck surgery central axis minimally invasive mechanical navigation system, the adjusting and stabilizing support comprises an adjusting base, detachable hanging rods are arranged on the adjusting base at intervals side by side (the interval distance of the hanging rods is set by the minimum interval distance between a thighbone neck positioning hook connecting component and a positioning guide in the system), the left hanging rod is connected with a steering connector and a switching connecting rod, the left hanging rod can be connected with a vertical connecting rod by utilizing the steering connector and the switching connecting rod, and similarly, the right hanging rod is connected with the steering connector and the switching connecting rod, and the right hanging rod can be connected with a fixing rod of a right angle adapter of a sliding rod and/or the vertical rod on the positioning guide by utilizing the steering connector and the switching connecting rod, so that the effects of multi-connection point and multi-azimuth hanging support and fixation are achieved. The steering connector is provided with vertical holes and horizontal transverse holes which are vertical to each other and are staggered with each other, locking assemblies are arranged on the vertical holes and the horizontal transverse holes, and different switching connecting rods are sleeved into the vertical holes and the horizontal transverse holes and are used for locking assemblies, so that the hanging height of the vertical adjusting system and the azimuth of the transverse (horizontal) adjusting system can be adjusted.
In the invention, in order to ensure the precision of the device and the smoothness of the connection between the parts, the shapes of various connecting rods are matched with the shapes of corresponding grooves and holes, and the sizes of the connecting rods are slightly smaller than the sizes of the corresponding grooves and holes.
The invention has the beneficial effects that:
1. according to the invention, the guide pin on the porous positioning guide plate below the porous positioning guide plate and the guide pin hole on the positioning hook at the lowest position are correspondingly adjusted through the guide pin of the porous direction adjusting slide block, so that the guide pin and the positioning hook are completely matched with the neck shaft angle, the front inclination angle and the front torsion angle of the femoral neck, then the upper and lower diameters of the isthmus of the femur are measured through the positioning hook in the femoral neck positioning hook connecting component and the guide pin on the positioning measuring hole inserted into the positioning block, then the midpoint P of the upper and lower diameters of the front surface of the cortical of the isthmus of the femur is searched for serving as a mark point, so that the accurate offset direction is determined, the midpoint M of the front and rear diameters of the femoral neck is determined by using a fixed-point vertical offset method, then the nail inlet point N is searched by using the positioning guide, the central axis of the femoral neck is determined by connecting the M point with the N point, finally, a hollow nail is drilled from the proper position of the proximal end of the femoral neck along the parallel femoral neck surgery MN, the perspective adjustment is utilized in the drilling process, and a screw device is combined, so that the disposable successful nail placement is used, the fact that the accident is easily caused in the operation, the situation is reduced, and the medical source is effectively increased.
2. Through the regulation steady rest of design, adjust the position and the height of whole device, have support and stabilization, be convenient for use in the operation, a plurality of parts of design are connected convenient to detach simultaneously, the disinfection used repeatedly after the operation of being convenient for, simple structure, the function is various.
3. The use of the forward tilt angle auxiliary measuring slide block can ensure that the mechanical navigation system can objectively and accurately match the forward tilt angle and the forward torsion angle.
4. The positioning guide device can ensure the accuracy of the nail feeding point at the upper and lower positions and the front and rear positions of the proximal femur. The connecting line of the nail feeding point and the middle point of the upper and lower diameters of the neck portion of the femur ensures the accuracy of the neck stem angle.
5. The offset virtual point is the midpoint of the upper and lower diameters and the midpoint of the front and rear diameters of the neck portion of the femur, and the connecting line of the point and the nail feeding point not only completely matches the neck shaft angle, the front inclination angle and the front torsion angle, but also passes through the center of the neck of the femur, thereby ensuring the accuracy of the surgical central axis of the neck of the femur.
Drawings
FIG. 1 is a schematic front perspective view of the present invention;
FIG. 2 is a schematic side perspective view of the present invention;
FIG. 3 is an exploded schematic view of the femoral neck locating hook attachment member of the present invention;
FIG. 4 is an exploded view of the locating hook of the present invention;
FIG. 5 is a schematic view of the structure of the adapter of the present invention;
FIG. 6 is a schematic view of the structure of the porous positioning guide plate of the present invention;
FIG. 7 is a schematic view of the positioning guide of the present invention;
FIG. 8 is a schematic view of the structure of the slide bar right angle adapter of the present invention;
FIG. 9 is a schematic view of the structure of the center axis positioning guide member of the present invention;
FIG. 10 is a schematic illustration of an arrangement of vertical guide pin holes of the present invention;
FIG. 11 is a schematic structural view of a regulatory stabilization stent of the present invention;
fig. 12 is a use state effect diagram of the present invention.
In the figure: 1. a femoral neck locating hook connecting member; 2. a vertical connecting rod; 3. an adapter; 4. calibrating the needle; 5. a porous positioning guide plate; 6. a central axis positioning guide member; 7. the slide bar right angle adapter; 8. positioning a guide; 9. a probe; 10. a positioning hook; 11. calibrating the hole; 12. a vertical guide pin hole; 13. a fixing bolt; 14. a positioning block; 15. a vertical connecting hole; 16. a positioning groove; 17. positioning a measuring hole; 18. a locking bolt; 19. a right angle hook; 20. a porous positioning plate; 21. screw holes; 22. a transverse mounting hole; 23. a connection port; 24. a positioning head; 25. a horizontal guide pinhole; 26. a vertical rod; 27. a vertical connector; 28. a moving port; 29. a fixed rod; 30. a horizontal end; 31. a multi-hole direction-adjusting slide block; 32. fastening a clamping block; 33. the front dip angle assists in measuring the slide block; 34. a vertical through groove; 35. a vertical end; 36. adjusting the stabilizing seat; 37. a connecting seat; 38. a hanging rod; 39. steering connector; 40. a transfer connecting rod; 41. a vertical guide pin; 42. a horizontal guide pin.
Detailed Description
The invention will now be further illustrated by way of example, and not by way of limitation, with reference to the accompanying drawings.
In the structures shown in fig. 1 and 2, the first-alignment type mechanical navigation system for the central axis of the femoral neck surgery designed by the invention comprises a femoral neck positioning hook connecting component 1, an adapter 3, a porous positioning guide plate 5, a positioning guide 8, a slide bar right-angle adapter 7 and a central axis positioning guide component 9; the femur neck positioning hook connecting component 1 is connected with the adapter 3 through the vertical connecting rod 2, the porous positioning guide plate 5 is arranged on the adapter 3, the slide bar right angle adapter 7 is respectively connected with the porous positioning guide plate 5 and the positioning guide 8, and the central axis positioning guide component 9 is arranged on the positioning guide 8.
The femur neck positioning hook connecting component 1 designed by the invention, as shown in figures 3 and 4, comprises a positioning block 14, wherein the positioning block 14 is designed to be of a cuboid or cube structure and is convenient to detach and install, and a horizontal transverse positioning groove 16 and a vertical connecting hole 15 which penetrate through the positioning block and are staggered with each other are arranged on the positioning block, and the sections of the positioning block are of rectangular structures; the positioning hook 10 is movably arranged in the positioning groove 16, the positioning hook 10 is composed of a connecting section and a functional section, the connecting section is movably arranged in the positioning groove 16, a bolt hole which is communicated with the positioning groove and is vertical to the positioning groove is formed in the upper portion of the positioning block, a locking bolt 18 is arranged on the bolt hole, and when the connecting section of the positioning hook 10 moves in place in the positioning groove 16, the positioning hook 10 can be locked and fixed by screwing the locking bolt 18. The positioning hook 7 is designed into a combined structure, and comprises a right-angle hook 19 and a porous positioning plate 20 which are in an inverted L shape, wherein the right-angle hook 19 and the porous positioning plate 20 are respectively composed of a connecting section (all designed into a rectangular structure) and a functional section, a plurality of guide pin holes 12 are formed in the position, close to the front end, of the functional section of the porous positioning plate 20, a plurality of calibration holes 11 are formed in the position, close to the connecting section, of the right-angle hook 19 and the porous positioning plate 20, screw holes 21 corresponding to the positions are formed in the connecting section of the right-angle hook 19 and the porous positioning plate 20, fixing bolts 13 capable of fixing the right-angle hook and the porous positioning plate together side by side are arranged on the screw holes, and the shapes of the connecting sections of the right-angle hook 19 and the porous positioning plate 20 are slightly smaller than the corresponding sizes of the positioning grooves 13 after the connecting sections of the right-angle hook 19 and the porous positioning plate 20 are fixed together side by side. The vertical connecting rod 2 is movably arranged in the vertical connecting hole 15, the vertical connecting rod 2 is designed into a rectangular structure, the appearance is matched with the shape of the vertical connecting hole 15, the corresponding size is slightly smaller than that of the vertical connecting hole 15, a bolt hole which is communicated with the vertical connecting hole 15 and is perpendicular to the vertical connecting hole 15 is formed in the side face of the positioning block 14, a locking bolt 18 is arranged on the bolt hole, and when the vertical connecting rod 2 moves in place in the vertical connecting hole 15, the vertical connecting rod 2 can be locked and fixed by screwing the locking bolt 18. The positioning block 14 is provided with a positioning measuring hole 17 which is in the same direction as the positioning groove, the positioning measuring hole 17 is positioned below the positioning groove 16, and the positioning measuring hole is movably provided with a probe 9. The positioning hook and the probe can be used for measuring in multiple points, so that whether the hooking position of the final positioning hook is accurate or not can be measured, and the upper and lower diameters of the femoral neck isthmus can be measured, so that the midpoint of the upper and lower diameters in front of the femoral neck isthmus cortical bone can be found.
As shown in FIG. 5, the adapter 3 designed by the invention is designed into a square right-angle structure, one right-angle edge is provided with a horizontal transverse mounting hole 22 penetrating through the adapter, the other right-angle edge is provided with a vertical connecting hole corresponding to the vertical connecting hole 12 on the positioning block 11 of the femoral neck positioning hook connecting component 1, and the transverse mounting hole 22 and the vertical connecting hole on the adapter 3 are mutually staggered and have rectangular sections; the vertical connecting rod 2 on the femur neck positioning hook connecting component penetrates through the vertical connecting hole on the adapter, so that the adapter is positioned above the femur neck positioning hook connecting component, the transverse mounting hole 22 on the adapter and the positioning groove 16 on the positioning block of the femur neck positioning hook connecting component are in the same direction and are positioned above the same, the transverse mounting hole 22 is internally and movably provided with a porous positioning guide plate, the transverse mounting hole and the vertical mounting hole are respectively provided with a locking component (bolt fixing components) which is the same as the locking component on the femur neck positioning hook connecting component 1, and the locking components are tightly screwed and pressed by the locking bolts 18, so that the locking and fixing effects are achieved, and when the vertical connecting rod 2 and the porous positioning guide plate are moved in place, the locking components can lock the two components.
The multi-hole positioning guide plate 5 designed by the invention consists of a connecting section and a functional section, as shown in fig. 6, the connecting section is of a rectangular structure and is movably arranged in a transverse mounting hole 22 of an adapter (the connecting section adopts a rectangular structure which is not only matched with the transverse mounting hole 22 but also beneficial to locking and fixing), the front end of the functional section is provided with a rectangular connecting port 23 vertical to the functional section, a plurality of vertical guide pinholes 12 are arranged at the position close to the front end, a plurality of vertical alignment holes 11 are arranged at the position close to the connecting section, the vertical guide pinholes and the vertical alignment holes on the multi-hole positioning guide plate 5 are in one-to-one correspondence with the vertical guide pinholes and the alignment holes on the positioning hook 10 of the femoral neck positioning hook connecting component 1, the distance between any vertical guide pinhole on the multi-hole positioning guide plate and the corresponding vertical guide pinholes on the positioning hook are equal to the distance between the corresponding vertical guide pinholes on the positioning hook, the alignment needle 4 is movably arranged on the vertical alignment holes, the position of the connecting section in the transverse mounting hole 22 of the adapter is adjusted, the alignment needle on the vertical alignment hole is vertically downward and is inserted into the corresponding alignment holes on the positioning hook of the neck positioning guide component, so that the number of the vertical guide pinholes on the positioning guide plate is more than the corresponding vertical guide holes on the positioning guide hook 23;
the positioning guide 8 designed by the invention comprises a positioning head 24, as shown in fig. 7, a plurality of horizontal guide pinholes 25 are horizontally arranged on the positioning head, the directions of the horizontal guide pinholes are vertical to the directions of positioning hooks on a femoral neck positioning hook connecting component (the extension lines of horizontal projection of the horizontal guide pinholes are mutually vertical), a position-adjustable vertical rod 26 is arranged on the positioning head, the position adjusting direction is the same as the direction of the positioning hooks (namely, the direction vertical to the horizontal guide pinholes), and the section of the vertical rod 26 is in a rectangular structure; the vertical rod 26 is provided with a slide bar right angle adapter.
The slide bar right-angle adapter 7 designed by the invention is composed of a vertical connector 27 and a fixed rod 29 (the section is rectangular) perpendicular to the connector, as shown in fig. 8, a rectangular moving port 28 is arranged on the connector 27, a locking component is arranged on the connector, the moving port 28 of the connector is sleeved on the vertical rod 26 of the positioning guide, the fixed rod 29 extends outwards, the extending direction is consistent with the direction of a horizontal guide pinhole on the positioning guide, the fixed rod 29 is sleeved in a connecting port 23 at the front end of a functional section of the porous positioning guide plate, after the fixed rod 29 moves horizontally in place in the connecting port 23, the connector 27 moves vertically in place on the vertical rod 27 of the positioning guide, and then the slide bar right-angle adapter is locked and fixed by the locking component, and meanwhile, the fixed rod is locked and fixed by the locking component on the connecting port.
The central axis positioning guide member 6 designed by the invention comprises an inverted L-shaped sliding rod, as shown in fig. 9, wherein the sliding rod consists of a vertical end 35 and a horizontal end 30, the vertical end 35 is arranged on a positioning guide 8, a porous direction-adjusting slide block 31 and a forward inclination angle auxiliary measuring slide block 33 are movably arranged on the horizontal end, fastening clamping blocks 32 are arranged on two sides of the porous direction-adjusting slide block 31, a bolt fixing assembly is arranged on the fastening clamping blocks 32, and the forward inclination angle auxiliary measuring slide block is positioned on one side close to the vertical end; the horizontal end 30 is designed into a square rod-shaped structure, a vertical through groove 34 is arranged in the middle part, and the direction of the horizontal end is the same as the direction of a fixed rod of the slide rod right-angle adapter; the porous direction-adjusting slide block 31, the forward inclination angle auxiliary measuring slide block 33 and the fastening fixture block 32 are all provided with a back-shaped through hole, so that the porous direction-adjusting slide block, the forward inclination angle auxiliary measuring slide block and the fastening fixture block 32 can be sleeved on the horizontal end 30 and slide back and forth, after the porous direction-adjusting slide block 31 moves in place on the horizontal end 30, the fastening fixture block 32 moves from two sides of the porous direction-adjusting slide block and clamps the porous direction-adjusting slide block and is locked and fixed by a locking assembly, so that the porous direction-adjusting slide block is fixed, a plurality of vertical guide pinholes are arranged at the middle part of the forward inclination angle auxiliary measuring slide block, a plurality of vertical guide pinholes are arranged at the left part, the middle part and the right part of the porous direction-adjusting slide block, and the distribution mode of the vertical guide pinholes arranged on the porous direction-adjusting slide block is consistent, namely, when the porous direction-adjusting slide block is adjusted to be right above the porous positioning guide plate, each vertical guide pinhole on the porous positioning slide block is positioned right above the corresponding vertical guide pinhole on the porous positioning guide plate. After the forward tilt angle auxiliary measuring slide block 33 is moved to be in place, the guide pin can be used for ensuring that the device is matched with the forward tilt angle and the forward torsion angle objectively and accurately.
In the implementation of the present invention, since the vertical guide pin hole 12 has a certain aperture, it cannot be accurately corresponding to a specific size, in order to make a certain guide pin hole correspond to a certain size as far as possible within the allowable error range, the present invention arranges the vertical guide pin holes on the positioning hooks, the porous positioning guide plates and the porous direction-adjusting slide blocks in a linear manner, and the rows are arranged in a staggered manner from left to right or from right to left, as shown in fig. 10.
When the invention is applied, all parts in the whole device are required to be gradually installed and suspended for fixation, and the support is adopted to support and fix from multiple connection points and multiple directions, so that the stability of the whole system is ensured. Generally, either a conventional stent or a dedicated stent is used. The invention also designs a height and azimuth adjusting and stabilizing bracket special for adjusting and stabilizing the first-standard type mechanical navigation system for the central axis minimally invasive surgery of the femoral neck, as shown in fig. 11. The adjusting and stabilizing support comprises an adjusting base 36, the structural form of the adjusting base 36 can be various, as long as the stability of the adjusting base can be ensured, the stability of a suspended system is ensured, the adjusting base is provided with connecting seats 37 at intervals side by side (the interval distance is set by the minimum interval distance between a femoral neck positioning hook connecting component and a positioning guide in the system), the connecting seats 37 are provided with through holes and locking components, a detachable suspension rod 38 is sleeved in the through holes of the connecting seats 37 and fixed by the locking components, a steering connector 39 and a transfer connecting rod 40 are connected to the left suspension rod 38, the steering connector 30 and the transfer connecting rod 40 are utilized to enable the left suspension rod 38 to be connected with the vertical connecting rod 2, the right suspension rod is connected with the steering connector 39 and the transfer connecting rod 40, the steering connector 30 and the transfer connecting rod 40 are utilized to enable the right suspension rod 38 to be connected with a fixing rod of a right angle adapter and/or a vertical rod on the positioning guide, and the like can also be connected by utilizing universal clips and transfer connecting rods, so that the effects of multi-connection point, multi-azimuth suspension support and fixation are achieved. The steering connector 39 designed by the invention is basically the same as the adapter 3, and is provided with vertical holes and horizontal transverse holes which are mutually vertical and staggered, locking components are arranged on the vertical holes and the horizontal transverse holes, the shapes of the vertical holes and the horizontal transverse holes are set according to the cross section shape of the steering connecting rod 40, if the steering connecting rod 40 adopts a round rod, the shapes of the vertical holes and the horizontal transverse holes are round holes, different steering connecting rods are sleeved in the vertical holes and the horizontal transverse holes and locked and fixed by the locking components, so that the direction of the system can be adjusted from the hanging height and the transverse direction (horizontal direction) of the vertical adjusting system, and the aim of supporting and fixing the whole system is achieved.
The working principle of the invention is as follows:
in the operation of inserting the hollow pin guide pin for femoral neck fracture, the whole device is installed first, as shown in fig. 12.
The front end of the positioning hook 10 is hooked on the inner lower part of a femoral neck, a functional section is tightly attached to the front cortex of the femoral neck, firstly, a vertical guide pin 41 inserted on a porous direction adjusting slide block 31 is adjusted, a plurality of vertical guide pins 40 are correspondingly matched with the neck shaft angle, the front inclination angle and the front torsion angle of the femoral neck, then the upper and lower diameters of the femoral neck isthmus are measured by using a probe 9 on a positioning measuring hole 17 of the positioning hook 10 and a positioning block 14 in the femoral neck positioning hook connecting component 1, then the midpoint P of the upper and lower diameters in front of the femoral cortex of the femoral neck isthmus is found to be a mark point, the midpoint M of the front and rear diameters of the femoral neck is determined to be a coordinate origin by using a fixed point vertical offset method, then, a positioning guide 8 is used for finding a nail feeding point N (also can be determined by using the traditional femoral neck nail feeding point positioner) by using a horizontal guide pin hole 25, the M point and N point connecting line are determined, finally, a hollow nail is drilled from the proper position of the proximal end of the femoral neck by using the direction of the femoral neck surgical axis MN, the upper and lower diameter midpoint P in front of the femoral neck is found to be a mark point, the exact offset direction, the pilot screw is found, the pilot screw is used, the pilot screw is successfully has a limited success rate is reached, and the success rate is reduced, and the success rate is caused due to the practical accident is caused due to the practical situations, and the operation is limited.
The foregoing is merely a preferred embodiment of the present invention, and it should be noted that it will be apparent to those skilled in the art that several modifications and variations can be made without departing from the technical principle of the present invention, and these modifications and variations should also be regarded as the scope of the invention.
Claims (6)
1. A first accurate formula thighbone neck surgery axis wicresoft mechanical navigation system, its characterized in that: comprises a femur neck positioning hook connecting component, an adapter, a porous positioning guide plate, a positioning guide, a slide bar right-angle adapter and a central axis positioning guide component;
the femur neck positioning hook connecting component comprises a positioning block, wherein a horizontal transverse positioning groove and a vertical connecting hole which penetrate through the positioning block and are staggered with each other are formed in the positioning block, a positioning hook is movably arranged in the positioning groove, and a locking assembly for locking the positioning hook is arranged on the positioning groove; the positioning hook consists of a connecting section and a functional section, the connecting section is movably arranged in the positioning groove, the front end of the functional section is provided with a right-angle hook, the part close to the front end is provided with a plurality of vertical guide pin holes, and the part close to the connecting section is provided with a plurality of vertical calibration holes; a vertical connecting rod is movably arranged in the vertical connecting hole, and a locking assembly for locking the vertical connecting rod is arranged on the vertical connecting hole; the positioning block is provided with a positioning measuring hole which is in the same direction as the positioning groove, the positioning measuring hole is positioned below the positioning groove, and the positioning measuring hole is movably provided with a probe;
the adapter is provided with a horizontal transverse mounting hole and a vertical connecting hole which penetrate through the adapter and are staggered with each other, a vertical connecting rod on the femoral neck positioning hook connecting component penetrates through the vertical connecting hole on the adapter, the transverse mounting hole on the adapter and a positioning groove on a positioning block of the femoral neck positioning hook connecting component are in the same direction and are positioned above the positioning groove, a porous positioning guide plate is movably arranged in the transverse mounting hole, and locking assemblies are arranged on the transverse mounting hole and the vertical mounting hole;
the multi-hole positioning guide plate consists of a connecting section and a functional section, the connecting section is movably arranged in a transverse mounting hole of the adapter, the front end of the functional section is provided with a connecting port perpendicular to the functional section, a plurality of vertical guide pinholes are arranged at the position close to the front end, a plurality of vertical calibration holes are arranged at the position close to the connecting section, the vertical guide pinholes and the vertical calibration holes on the multi-hole positioning guide plate are in one-to-one correspondence with the vertical guide pinholes and the calibration holes on the positioning hooks of the femoral neck positioning hook connecting member, the distance between any vertical guide pinhole and any vertical calibration hole on the multi-hole positioning guide plate is equal to the distance between the corresponding vertical guide pinhole and the corresponding vertical calibration hole on the positioning hook, the calibration needle is movably arranged on the vertical calibration hole, and the locking assembly is arranged on the connecting port;
the positioning guide comprises a positioning head, a plurality of horizontal guide pinholes are formed in the positioning head, the directions of the horizontal guide pinholes are vertical to the directions of positioning hooks on the femur neck positioning hook connecting component, a position-adjustable vertical rod is arranged on the positioning head, and the position adjusting direction is the same as the direction of the positioning hooks; the vertical rod is provided with a slide rod right-angle adapter;
the sliding rod right-angle adapter consists of a vertical connector and a fixed rod perpendicular to the connector, a moving port is arranged on the connector, a locking assembly is arranged on the connector, the moving port of the connector is sleeved on the vertical rod of the positioning guide, and the fixed rod extends outwards and is sleeved in a connecting port at the front end of the functional section of the porous positioning guide plate;
the utility model provides a three-dimensional positioning guide member, including being the slide bar of falling "L", the slide bar comprises vertical end and horizontal end, and wherein vertical end sets up on the location director, the activity is provided with porous steering slider and the supplementary measurement slider of anteversion angle on the horizontal end, and the supplementary measurement slider of anteversion angle is located one side that is close to vertical end, and the direction of horizontal end is the same with the dead lever direction of slide bar right angle adapter, all sets up a plurality of vertical guide pin holes on porous steering slider and the supplementary measurement slider of anteversion angle, and the vertical guide pin hole that sets up on the porous steering slider is unanimous with the distribution mode of the vertical guide pin hole that sets up on the porous location deflector.
2. The first-standard femoral neck surgical central axis minimally invasive mechanical navigation system of claim 1, wherein: the utility model discloses a positioning hook, including the right angle hook and the porous locating plate that are "L" shape, right angle hook and porous locating plate constitute by linkage segment and functional section, and wherein vertical guide pinhole, vertical alignment hole all set up on the functional section of porous locating plate, all set up the screw hole that the position corresponds on right angle hook and the porous locating plate, are provided with fixing bolt on the screw hole.
3. The first-standard femoral neck surgical central axis minimally invasive mechanical navigation system of claim 1, wherein: the positioning hooks, the porous positioning guide plates and the vertical guide pin holes on the porous direction-adjusting slide block are arranged linearly, and the rows are arranged in a staggered manner from left to right or from right to left.
4. The first-standard femoral neck surgical central axis minimally invasive mechanical navigation system of claim 1, wherein: the locking assembly is a bolt-on assembly.
5. The first-standard femoral neck surgical central axis minimally invasive mechanical navigation system of claim 1, wherein: the two sides of the porous direction-adjusting sliding block are provided with fastening clamping blocks, the fastening clamping blocks are movably arranged at the horizontal ends of the sliding rods, and locking assemblies are arranged on the fastening clamping blocks.
6. The first-standard femoral neck surgical central axis minimally invasive mechanical navigation system of claim 1, wherein: the device comprises a main shaft, a first-standard femoral neck surgery central axis minimally invasive mechanical navigation system, a second-standard femoral neck surgery central axis minimally invasive mechanical navigation system, a first-standard femoral neck surgery central axis minimally invasive mechanical navigation system, a second-standard femoral neck surgery central axis, a first-standard femoral neck surgery central axis, a second-standard femoral neck, a third-standard and a right is arranged on the first-standard and a second-standard femoral neck surgery is arranged on the first; the steering connector is provided with a vertical hole and a horizontal transverse hole which are perpendicular to each other and are staggered with each other, and locking assemblies are arranged on the vertical hole and the horizontal transverse hole.
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CN113693702B (en) * | 2021-09-03 | 2022-08-16 | 邓迎生 | Head-on femoral neck hollow nail placing system based on individualized safety boundary |
CN113693701B (en) * | 2021-09-03 | 2023-02-17 | 邓迎生 | Femoral neck surgery central axis mechanical navigation system based on individualized safety boundary |
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