CN112315571A - Sternum suture anti-cutting hemostatic spacer - Google Patents

Sternum suture anti-cutting hemostatic spacer Download PDF

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CN112315571A
CN112315571A CN202011329060.XA CN202011329060A CN112315571A CN 112315571 A CN112315571 A CN 112315571A CN 202011329060 A CN202011329060 A CN 202011329060A CN 112315571 A CN112315571 A CN 112315571A
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hemostatic
steel wire
cutting
layer
gasket
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CN112315571B (en
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倪一鸣
郏蓁
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical 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
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/82Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin for bone cerclage
    • A61B17/823Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin for bone cerclage for the sternum
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical 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
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84Fasteners therefor or fasteners being internal fixation devices
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00743Type of operation; Specification of treatment sites
    • A61B2017/00796Breast surgery

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
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  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

The invention provides a sternum suture anti-cutting hemostatic spacer, and belongs to the technical field of medicine. It has solved the problem that current hemostasis sleeve pipe can't solve the steel wire and cut the production to the sternum. The sternum suture cutting-prevention hemostatic gasket is provided with a steel wire hole for a steel wire to penetrate through, and comprises a gasket base layer, a hemostatic layer and an elastic layer positioned between the gasket base layer and the hemostatic layer, wherein the hemostatic layer and the elastic layer can deform when the sternum suture cutting-prevention hemostatic gasket is pressed; the gasket base layer is provided with a notch which enables the steel wire to be embedded into the steel wire hole from the outer side, and the hemostatic layer and the elastic layer are provided with a cutting seam which enables the steel wire to be embedded into the steel wire hole from the outer side. When the sternum is closed and the steel wire is screwed on the skin side of the sternum, the hemostatic gasket moves and approaches along with the steel wire, the steel wire is pressed on the gasket base layer, the hemostatic layer and the elastic layer deform, and the hemostatic layer is tightly attached to the steel wire hole; thereby achieving the compression hemostasis effect and reducing the possibility of movement of the hemostatic spacer, and further reducing the possibility of sternal cutting by the steel wire.

Description

Sternum suture anti-cutting hemostatic spacer
Technical Field
The invention belongs to the technical field of medicine, and relates to a cutting-prevention hemostasis device, in particular to a sternum suture cutting-prevention hemostasis gasket.
Background
The median sternal incision is a standard extracorporeal circulation direct-view cardiac operation incision, namely, the sternum is completely cut into left and right halves from the xiphoid process to the manubrium of the chest, and after the operation is completed, the left and right halves of the sternum are sutured. The sternum suture method usually adopts a steel wire fixing method, and single-needle intermittent fixing and 8-shaped fixing are common fixing methods.
The steel wire fixing method has the advantages of convenient operation, exact fixation, economy, practicability and the like; but also has some disadvantages, and the poststernal steel wire eye bleeding is a common complication of the steel wire fixation method. The steel wire passes through the intercostal cartilage space and is easy to injure the internal thoracic artery; the steel wire is easy to cause the bleeding of marrow cavity when passing through the sternum stem and the corpus sternum. The chronic hemorrhage after operation drains only tens of milliliters of blood per hour after operation, but the chronic hemorrhage lasts for tens of hours after operation; moreover, such bleeding is more insidious and deep, and may be difficult to detect when closing the chest or difficult to detect when hemostasis is achieved. During tightening and after fixation of the steel wire, the steel wire can cut the sternum due to activities such as breathing and cough, so that the bleeding probability of the sternum of a patient is increased, even the sternum of part of patients is open, and the treatment of complications is extremely troublesome. The research of multiple centers finds that the ratio of thoracotomy hemostasis again caused by steel wire eye bleeding behind the sternum can reach 2-3% of the total number of hands; however, the sternal opening not only seriously affects the respiration and circulation of patients, but also easily causes infection, and the death rate of sternal infected patients is nearly 20%.
To this end, a sternal suture assembly (application No. 201820924074.8) having hemostatic function has been proposed, which comprises a steel wire, a hemostatic device, and a needle connected to one end of the steel wire; the hemostatic device comprises a degradable hemostatic sleeve and two gaskets respectively positioned at two ends of the hemostatic sleeve; the steel wire can freely pass through the hemostatic sleeve and the gasket. The length of the hemostatic sleeve is fixed, but the distance between two needle holes can not be matched with the length of the hemostatic sleeve in the operation, which adversely affects the operation duration and the sternum suture firmness; in addition, the hemostatic sleeve still cannot solve the problem of sternal cutting by steel wires.
Disclosure of Invention
The invention provides a sternum suture cutting-prevention hemostatic spacer, and aims to solve the technical problem of how to provide another device capable of stopping bleeding during sternum suture and reducing steel wire cutting for the sternum, and preferably improve the convenience of sternum suture operation.
The technical problem to be solved by the invention can be realized by the following technical scheme: a sternum suture anti-cutting hemostatic gasket is characterized in that a steel wire hole for a steel wire to penetrate through is formed in the sternum suture anti-cutting hemostatic gasket, the sternum suture anti-cutting hemostatic gasket comprises a gasket base layer, a hemostatic layer and an elastic layer positioned between the gasket base layer and the hemostatic layer, and the hemostatic layer and the elastic layer can deform when the sternum suture anti-cutting hemostatic gasket is pressed; the gasket base layer is provided with a notch which enables the steel wire to be embedded into the steel wire hole from the outer side, and the hemostatic layer and the elastic layer are provided with a cutting seam which enables the steel wire to be embedded into the steel wire hole from the outer side.
During the sternal suture operation, the steel wire firstly passes through the sternum stem or the sternum body; when compression hemostasis is needed at the sternum steel wire hole, the sternum suture anti-cutting hemostasis gasket is clamped on the steel wire close to the steel wire hole, and the hemostasis layer faces towards the sternum, namely, the steel wire is embedded into the steel wire hole through the notch and the cutting seam.
When the breastbone is closed and the steel wire is screwed on the skin side of the breastbone, the two ends of the steel wire move towards the skin side, the hemostatic gasket moves and approaches along with the steel wire, the steel wire is pressed on the gasket base layer, the hemostatic layer and the elastic layer deform, and the hemostatic layer is tightly attached to the steel wire hole; thereby achieving the compression hemostasis effect and reducing the possibility of movement of the hemostatic spacer, and further reducing the possibility of sternal cutting by the steel wire.
According to the actual situation, one or two steel wire holes can be arranged on the hemostatic pad. The first scheme is as follows: the hemostatic pad is provided with a steel wire hole, and the steel wire hole is generally positioned at the center of the hemostatic pad. Scheme II: the hemostatic spacer is provided with two steel wire holes, the hemostatic spacer is usually strip-shaped, and the two steel wire holes are respectively positioned at two ends of the hemostatic spacer. When the hemostatic spacer with two steel wire holes is used, the two steel wire holes correspond to the two steel wire holes on the sternum one by one, and the steel wires penetrating out of the steel wire holes are all embedded into the steel wire holes, so that the hemostatic spacer can keep the distance between the steel wires when the steel wires are screwed, and the possibility of cutting the sternum by the steel wires is reduced; this scheme also can improve the hemostasis gasket and to the more effective and definite oppression of steel wire eye, improve hemostatic effect.
In the above sternal suture anti-cutting hemostatic spacer, thread holes are formed on both sides of the spacer base layer. When necessary, if the compression force of the hemostatic pad is insufficient, the hemostatic pad can be selected to be tightly fixed to the steel wire eye through the suture passing hole. Specifically, a thin, needled suture (e.g., 4-0 prolene) is selected that is less likely to cause tissue bleeding; the skin side of the steel wire passes through the intercostal space before being drawn to reach the visceral side of the sternum, then passes through two wire holes of the hemostatic spacer, returns to the skin side from the sternum incised edge to be converged with the other end of the wire, and is tensioned and knotted to realize the compression of the hemostatic spacer on the steel wire eye.
Compared with the prior art, the sternum suture anti-cutting hemostatic gasket buckles the steel wire and tightly adheres to the steel wire hole, so that the movement of the steel wire is effectively limited, the cutting of the steel wire on the penetrated human tissue is reduced, the bleeding possibility is reduced, and the bleeding amount is reduced.
The sternum suture cutting-proof hemostatic gasket is further pressed after the steel wires are tightened, and the elastic layer deforms, so that the fitting degree of the hemostatic layer and the sternum stem or the sternum body is improved, the expansion of a cutting seam on the hemostatic layer is avoided, the acting force uniformity of the hemostatic layer pressed on the sternum stem or the sternum body is improved, and the hemostatic effect is improved.
The sternum suture cutting-proof hemostatic gasket can be installed only when a steel wire eye bleeds or has suspected bleeding symptoms behind the sternum, but the hemostatic gasket is arranged at each steel wire eye, so that the total amount of foreign matters in a patient is reduced.
The sternum suture cutting-prevention hemostatic spacer is not influenced by the length of the hemostatic sleeve and the thickness of the hemostatic spacer, the distance between steel wire holes does not need to be accurately controlled, and the difficulty of sternum suture operation is reduced. In the process of sternal suture operation, the operation method of tensioning the steel wire by installing the sternal suture cutting-prevention hemostatic spacer is basically the same as that by not installing the sternal suture cutting-prevention hemostatic spacer, so that the operation difficulty is reduced, and the popularization of the sternal suture cutting-prevention hemostatic spacer is facilitated.
In the sternal suture anti-cutting hemostatic spacer, the spacer base layer is made of a hard material; the hemostasis layer is made of PDS; the elastic layer is made of PVA. All gasket materials can be trimmed by surgical scissors; when two adjacent hemostatic gaskets are overlapped and intersected, the overlapped parts can be cut off to enable the two adjacent hemostatic gaskets to be abutted on the same plane, and the cutting force of the steel wire on the sternum can be shared by the gaskets when the steel wire is tightened. The hemostatic spacer with two wire holes can also be cut to form two hemostatic spacers with only one wire hole.
In the above-mentioned sternal suture anti-cutting hemostatic spacer, the elastic layer and the spacer base layer are connected through the elastic layer.
In the sternal suture anti-cutting hemostatic gasket, a sleeve is arranged at the steel wire hole in a penetrating way, and an avoiding opening is arranged on the side wall of the sleeve; the positions of the avoidance openings correspond to the positions of the openings and the cutting seams; the diameter of the sleeve is consistent with that of the steel wire, and the steel wire is completely filled in the sleeve after being placed in the sleeve, so that a bleeding drainage channel is prevented from being formed.
In the above-mentioned sternal suture anti-cutting hemostatic spacer, one end of the sleeve is connected with the spacer base layer as a whole.
In the above-mentioned sternal suture anti-cutting hemostatic spacer, the inner edge of the hemostatic layer is fixedly connected with the sleeve.
In foretell sternum sutures prevents cutting hemostatic spacer, the buckle is installed to the opening department of gasket basic unit, can prevent the steel wire roll-off that is located the steel wire hole when the buckle is in the lock joint.
Drawings
Fig. 1 and 2 are schematic perspective views of different viewing angles of a sternum suture anti-cutting hemostatic spacer according to an embodiment.
Fig. 3 is a schematic sectional view of the sternal suture cut-preventing hemostatic spacer in an applied state.
FIG. 4 is a perspective view of the suture cut-proof hemostatic spacer of the second embodiment.
FIG. 5 is a schematic front view of the sternum suture anti-cutting hemostatic spacer of the third embodiment.
FIG. 6 is a schematic top view of a third embodiment of a sternal suture cut-resistant hemostatic spacer.
In the figure, 1, a gasket base layer; 1a, opening; 1b, a wire hole; 1c, buckling; 2. a haemostatic layer; 3. an elastic layer; 4. a steel wire hole; 5. cutting a seam; 6. a sleeve; 6a, avoiding ports; 6b, a deformation groove; 7. a sternum; 7a, steel wire holes; 8. a steel wire; 9. and (4) protruding.
Detailed Description
The following are specific embodiments of the present invention and are further described with reference to the drawings, but the present invention is not limited to these embodiments.
The first embodiment is as follows: as shown in figures 1 to 3, the sternum suture cutting-proof hemostatic spacer has a multilayer structure, the end surface of the sternum suture cutting-proof hemostatic spacer is circular, and the diameter of the sternum suture cutting-proof hemostatic spacer is 10mm-20 mm.
The sternum suture cutting-proof hemostatic spacer comprises a spacer base layer 1, a hemostatic layer 2 and an elastic layer 3 positioned between the spacer base layer 1 and the hemostatic layer 2. The gasket base layer 1 is made of hard material, such as medical PU.
The hemostatic layer 2 is made of PDS, and the chemical name of PDS is poly-p-dioxanone. The elastic layer 3 has elasticity, and the elastic layer 3 is made of PVA; the elastic layer 3 is connected with the gasket base layer 1 through the elastic layer 3; therefore, the hemostatic layer 2 and the elastic layer 3 can deform when the sternum suture anti-cutting hemostatic gasket is pressed.
The center of the sternum suture anti-cutting hemostatic gasket is provided with a steel wire hole 4 for a steel wire 8 to penetrate, namely, holes are formed in the gasket base layer 1, the hemostatic layer 2 and the elastic layer 3; the gap 1a that makes the steel wire 8 can follow the steel wire hole 4 of embedding in the outside on the gasket basic unit 1, because hemostasis layer 2 and elastic layer 3 can be out of shape, all set up the kerf 5 on hemostasis layer 2 and elastic layer 3 and just make the steel wire 8 can follow the outside and imbed in the steel wire hole 4 and prevent that the steel wire 8 breaks away from the sternum and sews up and prevent cutting hemostasis gasket.
The sleeve 6 penetrates through the steel wire hole 4, an avoiding opening 6a and a deformation groove 6b are formed in the side wall of the sleeve 6, the position of the avoiding opening 6a corresponds to the positions of the opening 1a and the cutting seam 5, and therefore the steel wire 8 can be embedded into the sleeve 6. One end of the sleeve 6 is connected with the gasket base layer 1 into a whole, so that the sleeve has the advantages of simple structure and convenience in manufacturing, namely the hemostatic layer 2 and the elastic layer 3 are connected through the sleeve 6, the deformation directions of the hemostatic layer 2 and the elastic layer 3 are effectively limited, and the mounting stability and the mounting consistency of the sternum suture cut-preventing hemostatic gasket are improved.
As shown in fig. 3, after the steel wire 8 is tightened and fixed, the steel wire 8 is positioned in the sleeve 6, so that the sleeve 6 can effectively protect the hemostatic layer 2 and the elastic layer 3; the steel wire 8 is pressed on the gasket base layer 1, the elastic layer 3 and the hemostatic layer 2 are pressed and deformed, the hemostatic layer 2 is attached on the sternum 7, and obviously, the hemostatic layer 2 covers the steel wire eye 7 a.
The diameter of the sternum suture needle is usually larger than that of the steel wire 8, namely, the diameter of the steel wire eye 7a on the sternum 7 is larger than that of the steel wire 8, a gap is formed between the steel wire 8 and the side wall of the steel wire eye 7a, and as the inner edge of the hemostatic layer 2 is fixedly connected with the sleeve 6, the inner edge area of the hemostatic layer 2 is embedded into the steel wire eye 7a along with the end part of the sleeve 6, so that the inner edge opening of the steel wire eye 7a is effectively protected, and the hemostatic effect is effectively improved. Meanwhile, the avoiding opening 6a and the deformation groove 6b are arranged on the sleeve 6, so that the other end part of the sleeve 6 can be deformed, namely, the other end part of the sleeve 6 is contracted to eliminate the gap between the sleeve 6 and the steel wire 8, and the possibility of blood flowing out through the gap is reduced.
The gasket base layer 1 is provided with a plurality of thread holes 1b, the suture can pass through the thread holes 1b, the gasket base layer 1 is tied on the sternum 7 through the suture, the hemostasis layer 2 is attached to the sternum 7, and the elastic layer 3 is ensured to deform.
Example two: as shown in fig. 4, the structure and principle of the present embodiment are substantially the same as those of the first embodiment, and the substantially same points are not described redundantly, but only different points are described, where: buckle 1c is installed to gasket basic unit 1's opening 1a department, can not only improve gasket basic unit 1's intensity when buckle 1c is in the lock joint, can also prevent 8 roll-offs of steel wire, improves the sternum and sews up and prevent cutting hemostatic gasket installation fastness.
Example three: as shown in fig. 5, the structure and principle of the present embodiment are substantially the same as those of the first embodiment, and the substantially same points are not described redundantly, but only different points are described, where: the top surface of the sternum suture cutting-proof hemostatic gasket is provided with the bulge 9, the bulge 9 improves the friction force between the sternum suture cutting-proof hemostatic gasket and the sternum, so that the sternum suture cutting-proof hemostatic gasket is tightly attached to the sternum, the moving amplitude of the steel wire is reduced when the steel wire is stressed, and the cutting effect of the steel wire on the sternum is reduced. The protrusion 9 is located on the hemostatic layer 2, or the top surface of the gasket base layer 1 has an upper convex part, and the flexible hemostatic layer 2 and the elastic layer 3 are attached on the gasket base layer 1 to form the protrusion 9.
Example four: as shown in fig. 6, the structure and principle of the present embodiment are substantially the same as those of the first embodiment, and the substantially same points are not described redundantly, but only different points are described, where: the sternum suture anti-cutting hemostatic spacer is strip-shaped, and both ends of the sternum suture anti-cutting hemostatic spacer are provided with a steel wire hole 4 through which a steel wire 8 passes.

Claims (10)

1. The anti-cutting sternal suture hemostatic gasket is characterized in that a steel wire hole (4) for a steel wire (8) to penetrate through is formed in the anti-cutting sternal suture hemostatic gasket, the anti-cutting sternal suture hemostatic gasket comprises a gasket base layer (1), a hemostatic layer (2) and an elastic layer (3) positioned between the gasket base layer (1) and the hemostatic layer (2), and the hemostatic layer (2) and the elastic layer (3) can deform when the anti-cutting sternal suture hemostatic gasket is pressed; the gasket base layer (1) is provided with a notch (1 a) which enables the steel wire (8) to be embedded into the steel wire hole (4) from the outer side, and the hemostatic layer (2) and the elastic layer (3) are respectively provided with a cutting seam (5) which enables the steel wire (8) to be embedded into the steel wire hole (4) from the outer side.
2. The sternal suture anti-cutting hemostatic spacer according to claim 1, characterized in that it has a protrusion (9) on its top surface.
3. The sternal suture anti-cutting hemostatic spacer according to claim 2, characterized in that the protrusion (9) is located on the hemostatic layer (2); or the top surface of the gasket base layer (1) is provided with an upper convex part, and the flexible hemostatic layer (2) and the elastic layer (3) are attached to the gasket base layer (1) to form a bulge (9).
4. The sternal suture anti-cutting hemostatic spacer according to claim 1, wherein the number of the steel wire holes (4) is one, the steel wire hole (4) is located at the center of the sternal suture anti-cutting hemostatic spacer; or the number of the steel wire holes (4) is two, the sternum suture anti-cutting hemostatic gasket is strip-shaped, and the two steel wire holes (4) are respectively positioned at two ends of the sternum suture anti-cutting hemostatic gasket.
5. The sternal suture anti-cutting hemostatic spacer according to claim 1, wherein the spacer substrate (1) is made of hard material.
6. The sternal suture anti-cutting hemostatic spacer according to claim 1, characterized in that the elastic layer (3) is connected with the spacer substrate (1) through the elastic layer (3).
7. The sternal suture anti-cutting hemostatic spacer according to any one of claims 1 to 6, wherein a sleeve (6) is arranged at the steel wire hole (4) in a penetrating manner, and an avoiding opening (6 a) is arranged on the side wall of the sleeve (6); the positions of the avoidance opening (6 a) correspond to the positions of the notch (1 a) and the cutting seam (5); one end of the sleeve (6) is connected with the gasket base layer (1) into a whole.
8. The sternal suture anti-cutting hemostatic spacer according to claim 7, characterized in that the inner edge of the hemostatic layer (2) is fixedly connected with the sleeve (6).
9. The sternal suture anti-cutting hemostatic spacer according to any one of claims 1 to 6, wherein the spacer base layer (1) is provided with a plurality of thread holes (1 b).
10. The sternal suture anti-cutting hemostatic spacer according to any one of claims 1 to 6, wherein a buckle (1 c) is installed at the gap (1 a) of the spacer substrate (1), and the steel wire (8) in the steel wire hole (4) can be prevented from sliding out when the buckle (1 c) is fastened.
CN202011329060.XA 2020-11-24 2020-11-24 Sternum suture cutting-prevention hemostatic pad Active CN112315571B (en)

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Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN110664457A (en) * 2019-09-30 2020-01-10 上海九生医学仪器有限公司 Abdominal compression hemostatic pad
CN110680449A (en) * 2019-10-30 2020-01-14 李锦恒 Disconnect-type blood vessel hemostasis pincers based on barb is connected
US20200022814A1 (en) * 2018-07-19 2020-01-23 CryoHeart Laboratories, Inc. System and method to fuse bone
CN213850990U (en) * 2020-11-24 2021-08-03 倪一鸣 Sternum suture anti-cutting hemostatic spacer

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20200022814A1 (en) * 2018-07-19 2020-01-23 CryoHeart Laboratories, Inc. System and method to fuse bone
CN110664457A (en) * 2019-09-30 2020-01-10 上海九生医学仪器有限公司 Abdominal compression hemostatic pad
CN110680449A (en) * 2019-10-30 2020-01-14 李锦恒 Disconnect-type blood vessel hemostasis pincers based on barb is connected
CN213850990U (en) * 2020-11-24 2021-08-03 倪一鸣 Sternum suture anti-cutting hemostatic spacer

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