CN112426217B - Spinous process reconstruction opening door plate - Google Patents
Spinous process reconstruction opening door plate Download PDFInfo
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- CN112426217B CN112426217B CN202011190485.7A CN202011190485A CN112426217B CN 112426217 B CN112426217 B CN 112426217B CN 202011190485 A CN202011190485 A CN 202011190485A CN 112426217 B CN112426217 B CN 112426217B
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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
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7062—Devices acting on, attached to, or simulating the effect of, vertebral processes, vertebral facets or ribs ; Tools for such devices
- A61B17/7064—Devices acting on, attached to, or simulating the effect of, vertebral facets; Tools therefor
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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
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7062—Devices acting on, attached to, or simulating the effect of, vertebral processes, vertebral facets or ribs ; Tools for such devices
- A61B17/7067—Devices bearing against one or more spinous processes and also attached to another part of the spine; Tools therefor
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- Orthopedic Medicine & Surgery (AREA)
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Abstract
The invention discloses a spinous process reconstruction door opening plate, which belongs to the technical field of orthopedic implants and comprises an upper fixing plate, a spinous process fixing plate, a middle fixing plate, a vertebral lamina door opening supporting plate and a lower fixing plate which are sequentially connected, wherein the upper fixing plate is transversely provided with a pair of first through holes side by side, and spinous process reset screws for fixing the cut spinous process and the vertebral lamina are arranged in the first through holes from the top of the spinous process to the inside; the middle fixing plate is transversely provided with a pair of second through holes in parallel, and first vertebral plate screws for fixing an upper vertebral plate at the opening of the vertebral plate are arranged in the second through holes; the lower fixing plate is transversely provided with a pair of third through holes side by side, and second vertebral plate screws used for fixing the lower vertebral plate at the opening of the vertebral plate are arranged in the third through holes. The invention can reset the cut spinous process, the reset spinous process is not easy to shift, and the fixation is reliable; the spinous process reduction screw is driven inwards from the top of the spinous process, so that the operation and observation of a doctor in the operation process are greatly facilitated.
Description
Technical Field
The invention relates to the technical field of orthopedic implants, in particular to a spinous process reconstruction door opening plate.
Background
At present, in the posterior cervical spine canal expanding and forming operation, in order to open a groove at the side of a vertebral lamina portal axis, ligaments and muscles on spinous processes need to be peeled off and the spinous processes are cut off, a posterior vertebral ligament complex body consists of the spinous processes, interspinous ligaments and supraspinal ligaments, and the spinous processes, the interspinous ligaments and the muscles attached to the interspinous ligaments are key factors for maintaining the static stability of cervical vertebrae, so that after the spinous processes are cut off, the phenomena of chronic pain, stiffness and heaviness of neck, shoulder and back and limited movement of the cervical vertebrae, namely the axial symptoms of the cervical vertebrae, can occur in a part of patients, and the occurrence probability is 45% -80%.
In order to solve the problems, the spinous process is fixed in a manner of winding a titanium plate and a steel wire rope in the prior art, the spinous process fixing manner is unstable and related to fixing methods of different doctors, and uncertainty is high; in the prior art, a vertebral plate forming and supporting device is adopted, screws penetrate through the lateral surface of the spinous process to fix the spinous process, the visual field and operation of a doctor are difficult in the spinous process fixing mode, and the single screw fixation has rotation and influences the stability.
Disclosure of Invention
The invention aims to solve the technical problem of providing the spinous process reconstruction door opening plate which is reliable in fixation, does not influence the visual field and is convenient to operate.
In order to solve the technical problems, the invention provides the following technical scheme:
the utility model provides a door plant is opened in spinous process rebuild, includes upper fixed plate, spinous process fixed plate, well fixed plate, vertebral lamina opening door backup pad and the lower fixed plate that connects gradually, wherein:
the upper fixing plate is transversely provided with a pair of first through holes side by side, and spinous process reduction screws for fixing the truncated spinous process and the vertebral plate are arranged in the first through holes and are driven inwards from the top of the spinous process;
the middle fixing plate is transversely provided with a pair of second through holes side by side, and first vertebral plate screws for fixing an upper vertebral plate at the opening of the vertebral plate are arranged in the second through holes;
the lower fixing plate is transversely provided with a pair of third through holes side by side, and second vertebral plate screws used for fixing a lower vertebral plate at the opening of the vertebral plate are arranged in the third through holes.
Furthermore, the end part of the upper fixing plate is provided with a bending clamping angle.
Furthermore, the spinous process fixing plate is convex arc-shaped or straight.
Furthermore, a fourth through hole is formed in the spinous process fixing plate, a spinous process fixing screw for fixing the truncated spinous process from the side surface is arranged in the fourth through hole, and an included angle between the axis of the fourth through hole and the vertical surface is 30-60 degrees.
Furthermore, a screw guide boss is arranged at the first through hole and/or the fourth through hole.
Further, the vertebral plate backup pad that opens the door is the L shape, including the riser portion and with the horizontal plate portion that the riser portion links to each other, riser portion and horizontal plate portion junction inboard are equipped with the first spike of horizontal extension, horizontal plate portion and bottom plate junction inboard are equipped with the second spike of vertical extension.
Further, temporary pressurizing holes are formed in the vertical plate portions; and/or the transverse plate part is designed to be gentle in radian, and the connecting end of the transverse plate part and the vertical plate part is higher than the connecting end of the vertical plate part and the lower fixing plate.
Furthermore, the included angle between the second supporting leg and the lower fixing plate is 90-120 degrees.
Furthermore, the lower end faces of the nail heads of the spinous process reduction screw, the first vertebral plate screw and the second vertebral plate screw are all of spherical structures, and the first through hole, the second through hole and the third through hole are all of spherical groove structures matched with the spherical structures.
Furthermore, the upper fixing plate, the spinous process fixing plate, the middle fixing plate, the vertebral lamina door opening supporting plate and the lower fixing plate are all titanium plates.
Furthermore, the thickness of the titanium plate is 0.4-1 mm.
The invention has the following beneficial effects:
the spinous process reconstruction door opening plate is integrally in the shape of the Chinese character 'wang', can restore the cut spinous process, and is not easy to shift and reliable in fixation along with long-term use; the spinous process reduction screw is arranged on the upper fixing plate, and is driven inwards from the top of the spinous process, so that the operation and observation of a doctor in the operation process are greatly facilitated, the spinous process reduction screw is perpendicular to the section of the spinous process, and the fixing effect is better.
Drawings
FIG. 1 is a schematic structural view of a first embodiment of a spinous process reconstruction door opener panel of the present invention;
FIG. 2 is a schematic structural view of a second embodiment of a spinous process reconstruction door opener panel of the present invention;
fig. 3 is a schematic view of the spinous process reconstruction opening plate of fig. 1 and 2 in use;
FIG. 4 is a schematic view of an improved spinous process reconstruction door opener of FIG. 1;
FIG. 5 is a schematic view of an improved spinous process reconstruction door opener of FIG. 2;
fig. 6 is a schematic view of the spinous process reconstruction opening plate shown in fig. 4 and 5 in use.
Detailed Description
In order to make the technical problems, technical solutions and advantages of the present invention more apparent, the following detailed description is given with reference to the accompanying drawings and specific embodiments.
The invention provides a spinous process reconstruction door opening plate, which comprises an upper fixing plate 1, a spinous process fixing plate 2, a middle fixing plate 3, a vertebral lamina door opening supporting plate 4 and a lower fixing plate 5 which are sequentially connected as shown in figures 1-3, wherein:
the upper fixing plate 1 is transversely provided with a pair of first through holes side by side, and spinous process reduction screws 6 for fixing the truncated spinous process 9 and the vertebral plate are arranged in the first through holes and are driven inwards from the top of the spinous process;
the middle fixing plate 3 is transversely provided with a pair of second through holes in parallel, and a first vertebral plate screw 7 for fixing an upper vertebral plate 10 at the opening of the vertebral plate is arranged in each second through hole;
the lower fixing plate 5 is transversely provided with a pair of third through holes side by side, and second vertebral plate screws 8 for fixing a lower vertebral plate 11 at the opening of the vertebral plate are arranged in the third through holes;
the upper fixing plate 1, the middle fixing plate 3 and the lower fixing plate 5 are approximately arranged in parallel.
During the cervical vertebra single door opening operation, as shown in fig. 3, firstly, a vertebral lamina at one side of the cervical vertebra (the lower side of the embodiment shown in fig. 3) of a diseased part is cut, an upper vertebral lamina 10 at the upper side of the cut is slotted at the door shaft side (the upper side of the embodiment shown in fig. 3) to cut off the spinous process 9, so that the cut-off upper vertebral lamina 10 can rotate slightly around the slotted at the door shaft side, then the spinous process reconstruction door opening plate of the invention is implanted, wherein the spinous process fixing plate 2 is used for being arranged in a way of being attached to the cut-off spinous process 9, and the cut-off spinous process 9 is fixed at the proper position of the upper vertebral lamina 10 by means of the upper fixing plate 1, the middle fixing plate 3 and screws on the middle fixing plate, so that the ligament is prevented from being stretched due to deviation of the spinous process in the prior art, and a patient feels uncomfortable; the vertebral plate door-opening supporting plate 4 can adopt various conventional structural forms in the field, is used for supporting in the vertebral plate incision, provides powerful support for the upper vertebral plate 10 and the lower vertebral plate 11 on two sides of the incision by means of the middle fixing plate 3, the lower fixing plate 5 and screws on the middle fixing plate and the lower fixing plate, avoids the door-opening vertebral plate from being closed again, keeps the expansion effect of the vertebral canal, and realizes effective decompression inside the vertebral canal.
In the prior art, a screw is usually driven into the side surface of the spinous process, namely a screw hole is arranged on the side surface of the spinous process, and the screw is usually fixed by a single screw, so that the visual field and the operation of a doctor are both difficult, and meanwhile, the single screw is fixed to have rotatability and influence on the stability; on the other hand, if the screw is driven into the spinous process from the lateral surface of the spinous process, the included angle between the screwing direction of the screw and the direction of the section (in the horizontal direction) of the spinous process is too small, that is, the screw is obliquely driven into the section of the spinous process, the driving difficulty is high, the fixation is not stable enough, and the spinous process is easy to shift to the door spindle side along with long-term use.
In the invention, the spinous process fixing plate 2 is attached to the truncated spinous process 9, the spinous process reduction screw 6 is arranged on the upper fixing plate 1, and the spinous process reduction screw 6 is driven inwards from the top of the spinous process 9:
1. the screw hole corresponding to the spinous process reduction screw 6 is arranged at the top of the spinous process, and the plane where the screw hole is arranged is vertical to the sight of a doctor, so that the doctor can operate and observe the spinous process reduction screw greatly in the operation process;
2. the screw is driven into the top of the spinous process, so that the screwing-in direction of the screw is vertical or nearly vertical to the section direction of the spinous process, the fixing effect of the screw is better, and the driving difficulty of the screw is greatly reduced;
3. the shape of the spinous process fixing plate 2 is combined with the spinous process reduction screw 6, so that the spinous process can be more stably fixed;
4. the spinous process reduction screws 6 are arranged side by side, and the length of the screws is long (specifically, the length can be 16-20mm), so that the fixation effect is better.
In conclusion, the spinous process reconstruction door opening plate is integrally in the shape of the Chinese character 'wang', can restore the cut spinous process, is not easy to shift along with long-term use, and is reliable in fixation; the spinous process reduction screw is arranged on the upper fixing plate, and is driven inwards from the top of the spinous process, so that the operation and observation of a doctor in the operation process are greatly facilitated, the spinous process reduction screw is perpendicular to the section of the spinous process, and the fixing effect is better.
The invention belongs to a spinous process reconstruction scheme for stripping one side of muscle and reserving ligament and muscle on the other side of the muscle. The invention mainly peels off the unilateral muscle ligament of the cervical posterior in the operation process, and reconstructs the position of the spinous process, aiming at leading the spinal cord to drift backwards, indirectly reducing pressure and better avoiding cervical vertebra axial symptoms (axial pain and the like) after the operation. The invention relates to a spinous process reconstruction plate capable of reserving supraspinal ligaments and muscles, which is suitable for treating cervical spinal stenosis symptoms and multi-segment spinal cord type cervical spondylosis.
In the invention, the spinous process fixing plate 2 can be a convex arc in the embodiment shown in fig. 1 or a straight shape in the embodiment shown in fig. 2, for the convex arc-shaped spinous process fixing plate, the radian of the plate can be designed according to the anatomical structure characteristics of cervical vertebrae of different segments, the arc-shaped plate is particularly suitable for cervical vertebrae C3-C5 segments, the radian of the plate can be completely attached to the spinous process structure, and then the truncated spinous process and the vertebral plate are fixed by using the spinous process reset screw; for the straight spinous process fixing plate, the straight spinous process fixing plate is more attached to the cervical vertebra C6-C7 segment, the straight plate can be bent by a small amplitude in the operation according to the structure of the cervical vertebra segment to attach the spinous process structure, and the cut spinous process and the vertebral plate are fixed by using the spinous process reduction screw.
As an improved embodiment, as shown in fig. 4, the end of the upper fixing plate 1 may be provided with a curved clip angle 13 for temporarily holding the spinous process, so as to improve the stability of the spinous process during the fixation, when the whole door-opening plate is fixed during the operation, four screws including the first vertebral plate screw 7 and the second vertebral plate screw 8 on the right side may be driven first to realize the initial fixation, then the cut spinous process 9 is clipped at the curved clip angle 13 for the temporary fixation, and finally two screws including the spinous process reduction screw 6 on the left side are driven.
As shown in fig. 4 to 6, in order to improve the fixation firmness of the spinous processes, a fourth through hole may be formed in the spinous process fixation plate 2, a spinous process fixation screw 12 for laterally fixing the truncated spinous process is disposed in the fourth through hole, and an included angle between an axis of the fourth through hole and a vertical plane is 30 to 60 degrees, which facilitates the fixation of the screw. The length of the spinous process fixing screw 12 can be flexibly adjusted according to the size of the spinous process, so as to avoid interference with a vertical screw (i.e., the spinous process reduction screw 6), and the length can be 4mm, 6mm, or 8mm, for example. And, the first through hole and/or fourth through hole department can be equipped with screw guide boss 15, 25, and this screw guide boss makes through-hole here high, and the screw direction of being convenient for avoids the skew.
Preferably, the fourth through holes may be one or a pair, and the embodiment of the invention is not limited thereto.
1-3, to better accommodate the shape of the laminotomy, the laminboard door opening support plate 4 may be L-shaped, including a vertical plate 41 and a horizontal plate 42 connected to the vertical plate 41, wherein a first support leg 43 extending laterally is provided at the inner side of the junction between the vertical plate 41 and the horizontal plate 42 to support the incised end of the upper laminboard 10; a second vertically extending brace 44 is provided inwardly of the junction of the cross plate portion 42 and the lower fixation plate 5 to support the cut end of the lower lamina 11 thereat. The term "medial" in this section refers to the side of the plate body facing the vertebral body.
Further, a temporary pressurizing hole 411 may be formed on the vertical plate 41 to cooperate with the three-jaw reduction forceps to temporarily fix the truncated spinous process and the spinous process for reconstructing the door plate. The horizontal plate part 42 is preferably designed with a gentle arc and protrudes slightly upwards, i.e. the connection end with the vertical plate part 41 is higher than the connection end with the lower fixing plate 5, so as to increase the opening area of the spinal canal on the premise of ensuring the strength of the whole spinous process reconstruction door opening plate. The included angle between the second supporting foot 44 and the lower fixing plate 5 can be 90-120 degrees, so as to better match with the cut-off section of the door-opening side vertebral plate, and the support is firmer.
Preferably, the lower end faces of the nail heads of the spinous process reduction screw 6, the first vertebral plate screw 7 and the second vertebral plate screw 8 are all of a spherical structure, and the first through hole in the upper fixing plate 1, the second through hole in the middle fixing plate 3, the third through hole in the lower fixing plate 5 and the fourth through hole are all of a spherical groove structure matched with the spherical structure, so that the plates can be firmly fixed to bones, and the plates are more stably fixed to vertebral plates. The upper fixing plate 1, the spinous process fixing plate 2, the middle fixing plate 3, the vertebral plate door opening supporting plate 4 and the lower fixing plate 5 are preferably titanium plates made of pure titanium materials and can be integrally formed, and the thickness can be 0.4-1mm, so that the plate body has better plasticity.
While the foregoing is directed to the preferred embodiment of the present invention, it will be understood by those skilled in the art that various changes and modifications may be made without departing from the spirit and scope of the invention as defined in the appended claims.
Claims (9)
1. The utility model provides a door opening plate is rebuild to spinous process which characterized in that, including the upper fixed plate, spinous process fixed plate, well fixed plate, the vertebral lamina that connect gradually backup pad and bottom plate that open the door, wherein:
the upper fixing plate is transversely provided with a pair of first through holes side by side, and spinous process reduction screws for fixing the truncated spinous process and the vertebral plate are arranged in the first through holes and are driven inwards from the top of the spinous process;
the middle fixing plate is transversely provided with a pair of second through holes side by side, and first vertebral plate screws for fixing an upper vertebral plate at the opening of the vertebral plate are arranged in the second through holes;
the lower fixing plate is transversely provided with a pair of third through holes side by side, and second vertebral plate screws for fixing a lower vertebral plate at the opening of the vertebral plate are arranged in the third through holes;
the spinous process fixing plate is in a convex arc shape or a straight shape which is attached to the side surface of the truncated spinous process.
2. The spinous process reconstruction door opening plate of claim 1, wherein an end of the upper fixation plate is provided with a curved snap angle.
3. The spinous process reconstruction door plate according to claim 1, wherein a fourth through hole is provided on the spinous process fixation plate, a spinous process fixation screw for fixing the truncated spinous process from the side is provided in the fourth through hole, and an included angle between an axis of the fourth through hole and a vertical plane is 30 to 60 degrees.
4. The spinous process reconstruction door plate of claim 3, wherein the first through hole and/or the fourth through hole is provided with a screw guide boss.
5. The spinous process reconstruction door opening plate according to claim 1, wherein the vertebral plate opening support plate is L-shaped and comprises a vertical plate portion and a lateral plate portion connected to the vertical plate portion, a first supporting leg extending in the lateral direction is provided inside a joint of the vertical plate portion and the lateral plate portion, and a second supporting leg extending in the vertical direction is provided inside a joint of the lateral plate portion and the lower fixing plate.
6. The spinous process reconstruction door opening plate of claim 5, wherein the vertical plate portion is provided with a temporary pressurizing hole; and/or the transverse plate part is designed to be gentle in radian, and the connecting end of the transverse plate part and the vertical plate part is higher than the connecting end of the vertical plate part and the lower fixing plate.
7. The spinous process reconstruction door opening plate of claim 5, wherein an included angle between the second supporting leg and the lower fixing plate is 90-120 degrees.
8. The spinous process reconstruction door opening plate of claim 1, wherein the lower end surfaces of the nail heads of the spinous process reduction screw, the first vertebral plate screw and the second vertebral plate screw are all spherical structures, and the first through hole, the second through hole and the third through hole are all spherical groove structures matched with the spherical structures.
9. The spinous process reconstruction opening plate of any one of claims 1 to 8, wherein the upper fixation plate, the spinous process fixation plate, the middle fixation plate, the lamina opening support plate and the lower fixation plate are titanium plates, and the thickness of the titanium plates is 0.4 to 1 mm.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN202011190485.7A CN112426217B (en) | 2020-10-30 | 2020-10-30 | Spinous process reconstruction opening door plate |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN202011190485.7A CN112426217B (en) | 2020-10-30 | 2020-10-30 | Spinous process reconstruction opening door plate |
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| CN112426217A CN112426217A (en) | 2021-03-02 |
| CN112426217B true CN112426217B (en) | 2022-03-04 |
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| Application Number | Title | Priority Date | Filing Date |
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| CN202011190485.7A Active CN112426217B (en) | 2020-10-30 | 2020-10-30 | Spinous process reconstruction opening door plate |
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| Publication number | Publication date |
|---|---|
| CN112426217A (en) | 2021-03-02 |
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