Background
Mandibular condyle fractures are relatively common fractures, accounting for 29% to 52% of all mandibular fractures (ref [1 ]). At present, most students at home and abroad agree that open reduction (open reduction) of condyle fracture can lead patients to obtain better prognosis, and the function recovery of temporomandibular joint is better with fewer complications (refer to [2 ]). Open reduction refers to surgical open reduction and fixation. There is currently no unified standard for open fracture reduction surgical indications and there is no controversy. But basically recognizes that the condylar fracture with limited opening, obvious displacement and dislocation, serious angulation (more than or equal to 90 degrees) and the like should be treated by timely operation.
The operation access way for the operation treatment of the condylar fracture mainly comprises an ototomy, a retrojaw incision, a submandibular incision and an endoscope-assisted intraoral incision. The operation method mainly comprises the steps of titanium plate fixation after reduction, titanium nail or steel wire fixation sagittal fracture, small fracture block removal, reduction of joint disc and the like. Although scholars have made many researches and efforts to improve the therapeutic effect of the condylar fracture operation, the condylar fracture still belongs to the operation with complex operation and high operation risk in the maxillofacial fracture operation at present. The main difficulties are that the fracture operation area is difficult to reveal, the fracture block is difficult to dissect and reset, and the fracture block is difficult to reliably fix.
At present, no effective auxiliary instrument and method exist for exposing an operation area in a condyle fracture operation, the traditional method and some existing auxiliary surgical instruments are difficult to realize stable and reliable fixation, and secondary damage to the condyle tuberosity, the joint disc and surrounding soft tissues is avoided (refer to [3-6 ]).
Reference to [1].Marwan,H.and Y.Sawatari,What Is the Most Stable Fixation Technique for Mandibular Condyle FractureJournal of oral and maxillofacial surgery:official journal of the American Association of Oral and Maxillofacial Surgeons,2019.77(12):p.2522.e1-2522.e12.
Reference to [2].Madadian MA,Simon S,Messiha A.Changing trends in the management of condylar fractures.Br J Oral Maxillofac Surg.2020Aug 3:S0266-4356(20)30378-8.
Reference to [3].Sabesan,T.and W.J.Peters,Modified plastic spatula:a condylar retractor.The British journal of oral&maxillofacial surgery,2006.44(5):p.412-3.
Reference to [4].Kheradpir,A.R.,A.T.Chien and R.S.R.Julian,Transoral osteosynthesis of subcondylar fractures of the mandible using a fenestrated Levassier-Merrill retractor.Journal of oral and maxillofacial surgery:official journal of the American Association of Oral and Maxillofacial Surgeons,2011.69(7):p.2006-11.
Reference to [5].Han,C.,et al.,New surgical instrument for the treatment of condylar fractures:the digitised condylar retractor.The British journal of oral&maxillofacial surgery,2020.58(4):p.432-436.
Reference to [6].Huang,X.,et al.,Postoperative outcomes of adult patients with sagittal fractures of mandibular condyle:Quantitative evaluation and retrospective factor analysis.Journal of cranio-maxillo-facial surgery:official publication of the European Association for Cranio-Maxillo-Facial Surgery,2020.48(4):p.421-426.
Disclosure of Invention
The invention aims to design a novel open reduction joint spreader for mandibular condyle fracture, solve the problem that the operation area in the condyle fracture is difficult to reveal, improve the subsequent anatomic reduction and fixed vision and space of fracture blocks, and reduce the operation difficulty.
The invention discloses a novel open reduction joint spreader for mandibular condyle fracture, which comprises a left handle and a right handle, wherein the left handle and the right handle both comprise a working section and a holding section, the joint of the working section and the holding section of the left handle is hinged with the joint of the working section and the holding section of the right handle, a spring plate is arranged on the opposite side of the holding section of the left handle or the right handle, a vertical section perpendicular to the working section is arranged at the far joint end of the working section of the left handle and the right handle, the vertical section is perpendicular to a plane formed by the two oppositely arranged working sections, a groove is arranged on the far working section side of any vertical section, the notch of the groove is positioned on the unfolding side of the working section in a space position, and the size of the notch is matched with an auxiliary screw.
As an optimal setting scheme, the spreader consists of a left handle and a right handle, wherein the left handle and the right handle are both provided with a working section and a holding section, the working section is also called a front end, the holding section is also called a rear end, a joint part exists between the front end and the rear end, the two joint parts are provided with concave-convex matching structures, the two joint parts are hinged together through the concave-convex matching structures, and then the left handle and the right handle are stabilized by using other auxiliary parts, so that the left handle and the right handle can be unfolded and closed by taking the hinge point as a fulcrum; the left side handle and the right side handle are opened or closed more conveniently and smoothly, spring plates are arranged on the opposite sides of the holding sections of the left side handle or the right side handle, a vertical section perpendicular to the working sections is arranged at the far joint part end of the working sections of the left side handle and the right side handle and perpendicular to a plane formed by the two oppositely arranged working sections, the thickness and the operation depth of soft tissues in the temporomandibular joint area are fully considered, the length of the vertical section is 20-25 mm under the condition of not interfering the operation vision, the operation area clearance is reliably opened for facilitating the fixing of the auxiliary screw, a groove is arranged on the far working section side of any vertical section, the groove is slightly larger than the auxiliary screw, the notch of the groove is positioned on the unfolding side of the working section in a space position, the size of the groove is matched with the auxiliary screw, and the auxiliary screw can be placed into the groove when the auxiliary screw is applied, so that the auxiliary screw can be firmly spread in the groove and is not easy to be dislocated, the combined holding structure can stably open the operation area, and the operation space is fully exposed.
The invention is further better realized by adopting the arrangement structure that the left side handle and the right side handle are also provided with limiting plates for connecting the two holding sections, one end of each limiting plate is fixedly connected with one holding section, and the other end of each limiting plate is movably connected with the other holding section through a screw.
As the preferable setting scheme, the spreader is also provided with a limiting plate, the limiting plate can be connected with the holding sections of the left side handle and the right side handle, when the setting is carried out, one end of the limiting plate is fixed on one holding section, and the other end can be used for movably connecting the width of the spreader to the other holding section through a screw according to the requirement.
Further, in order to better realize the invention, the arrangement structure is particularly adopted, wherein a chute with a plurality of limiting holes is arranged on the limiting plate.
The holding section is provided with a hole for interference fit with the columnar bulge, the limiting plate is provided with a chute with a plurality of limiting holes, the other holding section is also provided with a hole, and the hole is preferably a threaded hole, so that the screw can be screwed into the screw, when the spreader is spread to a proper width, the screw fixed on the holding section can be clamped into any limiting hole in the chute, thereby enabling the spreader to be in a required constant width, so that a user can not have inconstant spreading width during use, and the operation effect is affected.
Further, in order to better realize the invention, the arrangement structure is adopted, in particular, the joint parts of the left side handle and the right side handle are hinged together through pins.
As a preferable arrangement scheme, after the joint parts of the left handle and the right handle are hinged together, the left handle and the right handle can be further fixed by the pin, so that the left handle and the right handle can be freely opened and closed by taking the pin as a rotating shaft.
In order to achieve the invention even better, the spring plate is fastened to the grip section of the left-hand handle by means of a fastening screw.
As a preferred arrangement, the spring plate is fixed to the grip section of the left-hand handle by means of a set screw, the movable surface of the spring plate being supported on the right-hand handle,
Further to better practice the invention, it is particularly advantageous to provide the left and right handles with grooves on opposite sides of the gripping sections for engaging the spring plates.
As a preferred arrangement, grooves are provided on the opposite sides of the gripping sections of the left hand grip or/and the right hand grip, the fixed surface of the spring plate being fixed in the groove of one gripping section, preferably the left hand grip, and the movable surface of the spring plate being slidable in the groove of the other gripping section, preferably the right hand grip, according to the spreader spreading size.
The invention is further better realized by adopting the arrangement structure that the working sections of the left handle and the right handle are arc-shaped, so that the surgical field of view can be better displayed, and the operation is convenient.
Compared with the prior art, the invention has the following advantages:
the invention effectively solves the problem of difficult exposure of the operation area in the condyle fracture, and improves the visual field and space of the subsequent fracture block dissection reduction.
The working end of the invention is arranged to be of an arc structure protruding outwards, so that the surgical field can be better displayed, and the operation is convenient. The front end of the working section is provided with a vertical section structure, the length of the vertical section structure fully considers the thickness of soft tissues of the temporomandibular joint area and the operation depth, and the vertical section structure extends into the operation gap under the condition of not obstructing the operation visual field.
The limiting holes arranged on the limiting plate can fully consider the requirements in operation, judge the width of the operation area according to experience, and design proper intervals so as to meet the requirements of different patients and different widths of the operation area, and can be adjusted randomly and fixed by itself, so that the stability of the opening width can be ensured, and hands of an assistant can be liberated, and the limiting plate is more labor-saving, quicker and time-saving.
Detailed Description
The present invention will be described in further detail with reference to examples, but embodiments of the present invention are not limited thereto.
For the purpose of making the objects, technical solutions and advantages of the embodiments of the present invention more apparent, the technical solutions of the embodiments of the present invention will be clearly and completely described below with reference to the accompanying drawings in the embodiments of the present invention, and it is apparent that the described embodiments are some embodiments of the present invention, but not all embodiments. All other embodiments, based on the embodiments of the invention, which are apparent to those of ordinary skill in the art without inventive faculty, are intended to be within the scope of the invention. Thus, the following detailed description of the embodiments of the invention, as presented in the figures, is not intended to limit the scope of the invention, as claimed, but is merely representative of selected embodiments of the invention.
In the description of the present invention, it should be understood that the orientation or positional relationship indicated by the terms and the like is based on the orientation or positional relationship shown in the drawings, and is merely for convenience in describing the present invention and simplifying the description, and does not indicate or imply that the apparatus or element to be referred to must have a specific orientation, be constructed and operated in a specific orientation, and thus should not be construed as limiting the present invention.
Furthermore, the terms "first," "second," and the like, are used for descriptive purposes only and are not to be construed as indicating or implying a relative importance or implicitly indicating the number of technical features indicated. Thus, a feature defining "a first" or "a second" may explicitly or implicitly include one or more such feature. In the description of the present invention, the meaning of "a plurality" is two or more, unless explicitly defined otherwise.
In the present invention, unless explicitly specified and limited otherwise, the terms "mounted," "connected," "disposed," "deployed," "secured," and the like are to be construed broadly, and may be, for example, fixedly connected, detachably connected, or integrally formed, particularly by means other than by screwing, interference fit, riveting, screw-assisted connection, and the like, in any of a variety of conventional mechanical connection means. The specific meaning of the above terms in the present invention can be understood by those of ordinary skill in the art according to the specific circumstances.
In the present invention, unless expressly stated or limited otherwise, a first feature "above" or "below" a second feature may include both the first and second features being in direct contact, as well as the first and second features not being in direct contact but being in contact with each other through additional features therebetween. Moreover, a first feature being "above," "over" and "on" a second feature includes the first feature being directly above and obliquely above the second feature, or simply indicating that the first feature is higher in level than the second feature. The first feature being "under", "below" and "beneath" the second feature includes the first feature being directly under and obliquely below the second feature, or simply means that the first feature is less level than the second feature.
It is noted that, in the present application, some technical means that are known or conventional in the art may not be specifically described herein, but the technical means cannot be specifically disclosed herein, and the present application is not considered to be in accordance with the twenty-sixth third aspect of the patent law.
Example 1:
As shown in fig. 1-5, the novel joint spreader for open reduction of mandibular condyle fracture comprises a left handle 1 and a right handle 2, wherein the left handle 1 and the right handle 2 comprise a working section and a holding section, the joint of the working section and the holding section of the left handle 1 is hinged with the joint of the working section and the holding section of the right handle 2, a spring plate 3 is arranged on the opposite side of the holding section of the left handle 1 or the right handle 2, a vertical section 12 perpendicular to the working section is arranged at the far joint end of the working section of the left handle 1 and the right handle 2, the vertical section 12 is perpendicular to a plane (working surface 11) formed by the two arranged working sections, a groove 8 is arranged on the far working section side of any one vertical section 12, the notch of the groove 8 is positioned on the unfolding side of the working section in a space position, and the notch size is matched with an auxiliary screw 13.
As a preferable arrangement scheme, the spreader consists of two main parts of a left handle 1 and a right handle 2, wherein the left handle 1 and the right handle 2 are both provided with a working section and a holding section, the working section is also called a front end, the holding section is also called a rear end, a joint part exists between the front end and the rear end, the two joint parts are provided with concave-convex matching structures, the two joint parts are hinged together through the concave-convex matching structures, and then the joint parts are stabilized by utilizing other auxiliary parts, so that the left handle 1 and the right handle 2 can perform unfolding and closing actions by taking the hinge point as a fulcrum; in order to make the opening or closing of the left and right handles 1 and 2 more convenient and smooth, a spring plate 3 is arranged on the opposite side of the holding section of the left or right handles 1 and 2, a vertical section 12 perpendicular to the working section is arranged at the far joint end of the working section of the left and right handles 1 and 2 for facilitating the extending operation, the vertical section 12 is perpendicular to the plane (working surface 11) formed by the two working sections, the length of the vertical section 12 is 20-25 mm in order to facilitate the reliable opening of the operating area gap and the fixing of the auxiliary screw 13, a groove 8 is arranged on the far working section side of any one of the vertical sections 12, the groove 8 is slightly larger than the auxiliary screw 13, the notch of the groove 8 is positioned on the expanding side of the working section in space position, the size of the notch is matched with the auxiliary screw 13, the auxiliary screw 13 can be easily placed into the groove 8 under the condition of not interfering the operating field, the stable holding gap can be stably placed in the groove 8 when the combined holding gap is applied, fully exposing the operation area and expanding the operation space.
Example 2:
The embodiment is further optimized on the basis of the embodiment, the same parts as the technical scheme are not repeated here, and as shown in fig. 1-5, the arrangement structure is particularly adopted, wherein a limiting plate 4 for connecting two holding sections is further arranged on the left side handle 1 and the right side handle 2, one end of the limiting plate 4 is fixedly connected with one holding section, and the other end of the limiting plate 4 is movably connected with the other holding section through a screw 7.
As the preferable setting scheme, the spreader is also provided with a limiting plate 4, the limiting plate 4 can be connected with the holding sections of the left side handle 1 and the right side handle 2, when the setting is carried out, one end of the limiting plate 4 is fixed on one holding section, and the other end can movably connect the spreading width of the spreader on the other holding section through a screw 7 according to the requirement.
Further, in order to better realize the invention, a special arrangement is adopted in which a chute with a plurality of limiting holes 10 is arranged on the limiting plate 4.
As a preferable arrangement scheme, the limiting plate 4 is provided with a cylindrical bulge 9 for being fixed on a holding section, a hole for interference fit of the cylindrical bulge 9 is correspondingly arranged on the holding section, the limiting plate 4 is provided with a chute with a plurality of limiting holes 10, and the other holding section is also provided with a hole, preferably a threaded hole, so that the hole can be screwed into the screw 7, and when the spreader is spread to a proper width, the screw 7 fixed on the holding section can be clamped into any limiting hole in the chute, so that the spreader is in a required constant width, and a user can not have non-constant spreading width when using the spreader, thereby affecting the operation effect.
Example 3:
the embodiment is further optimized on the basis of any one of the embodiments, and the same parts as the technical scheme are not repeated here, as shown in fig. 1-5, and in order to better realize the invention, the arrangement structure is particularly adopted, wherein the joint parts of the left handle 1 and the right handle 2 are hinged together through pins 6.
As a preferable arrangement scheme, after the joint parts of the left handle 1 and the right handle 2 are hinged together, the two handles can be further fixed by the pin 6, so that the two handles can be freely opened and closed by taking the pin 6 as a rotation shaft.
Example 4:
The embodiment is further optimized on the basis of any one of the above embodiments, and the same parts as the above technical solutions will not be described again here, as shown in fig. 1 to 5, and in order to better implement the present invention, the following arrangement structure is particularly adopted, in which the spring plate 3 is fixed on the holding section of the left side handle 1 through the fixing screw 5.
As a preferred arrangement, the spring plate 3 is fastened to the grip section of the left-hand handle 1 by means of a fastening screw 5, the active surface of the spring plate 3 being supported on the right-hand handle 2,
Further to better implement the invention, an arrangement is particularly adopted in which grooves for engaging the spring plate 3 are provided on opposite sides of the gripping sections of the left and right hand handles 1, 2.
As a preferred arrangement, grooves are provided on the opposite side of the gripping sections of the left hand grip 1 and/or the right hand grip 2, the fixed surface of the spring plate 3 being fixed in the groove of one gripping section (preferably the left hand grip 1), the movable surface of the spring plate 3 being slidable in the groove of the other gripping section (preferably the right hand grip 2) according to the spreader spreading size.
Example 5:
The embodiment is further optimized on the basis of any one of the embodiments, and the same parts as the technical scheme are not repeated here, as shown in fig. 1-5, and in order to better realize the invention, the arrangement structure is particularly adopted, wherein the working sections of the left handle 1 and the right handle 2 are arc-shaped structures, so that the surgical field can be better displayed, and the operation is convenient.
Example 6:
as shown in fig. 1 to 5, the embodiment provides a specific structure of a novel open reduction joint spreader for mandibular condyle fracture, which comprises a left handle 1, a right handle 2, a spring plate 3, a limiting plate 4, a fixing screw 5, a pin 6, a screw 7, a groove 8, a columnar bulge 9 and a vertical section 12;
The front end of the left handle 1 is a working section, and the rear end is a holding section. The working end is arc-shaped protruding outwards, so that the surgical field can be better exposed, and the operation is not hindered. The front end also comprises a vertical section 12 which is vertically oriented and longitudinal and can extend into the surgical incision, and is L-shaped, and the length of the vertical section 12 is consistent with the depth of soft tissues of the surgical incision. The top of the working section is provided with a groove 8 structure facing outwards, and auxiliary screws 13 at two ends of a joint cavity gap are clamped into the groove 8 and used for fixing the auxiliary screws 13 to serve as stress points to prop up the joint gap;
the inner side surface of the holding section of the left handle 1 is provided with screw holes, and a fixing screw 5 is used for fixing the spring plate 3;
the upper surface of the holding section of the left handle 1 is provided with concave holes (holes), the lower surface of the limiting plate 4 is provided with columnar bulges 5, and the columnar bulges and the limiting plate are embedded structures (as shown in figure 5).
The structure of the working section of the right handle 2 is symmetrical to that of the left handle 1, the upper surface of the holding section is provided with a screw hole, a built-in screw 7 is used for limiting the limiting plate 4, and the inner side of the right handle 2 is provided with an elongated groove (slot) for placing the spring piece 3;
the structure of the intersection (joint) of the left handle 1 and the right handle 2 is a concave-convex matching structure, and is fixed and connected into a whole by a pin 6, so that the connection is stable and the movement is free.
The main structure of the limiting plate 4 is a chute type (comprising a plurality of limiting holes 10), the bottom of the left side is provided with a columnar bulge (figure 5) which is connected with a concave hole of the holding section of the left side handle 1, a screw 7 can be arranged in the chute of the limiting plate 4 and used for controlling the opening width, the structure is stable after the screw 7 is clamped in the chute of the limiting plate 4, and the limiting plate can move freely and flexibly;
The fixed surface of the spring plate 3 is connected with the left handle 1 by means of the fixing screw 5, the right side (movable surface) of the spring plate 3 is abutted against the inner side surface of the right handle 2, and can be placed into the inner side surface of the right handle 2 to be connected by a long groove (groove), and slide in the long groove, so that the connection is stable, the slipping is not easy, and the safety is high.
When in use:
1. An auxiliary screw 13 is respectively implanted at two ends of the condyle joint area, namely, the zygomatic arch and the condyle neck;
2. the working sections of the left handle 1 and the right handle 2 extend into the operation area, and auxiliary screws 13 are respectively arranged in grooves 8 at the front ends of the left handle 1 and the right handle 2;
3. According to the size of the fracture displacement, the required visual field and space for reduction and fixation are controlled by an operator to hold the end limiting plate 4, and the screw 7 is clamped into the target chute (the limiting hole 10) to be fixed, so that the joint expansion is completed.
The foregoing description is only a preferred embodiment of the present invention, and is not intended to limit the present invention in any way, and any simple modification, equivalent variation, etc. of the above embodiment according to the technical matter of the present invention are within the scope of the present invention.