CN113440240B - Acetabulum posterior column screw guide device and use method thereof - Google Patents
Acetabulum posterior column screw guide device and use method thereof Download PDFInfo
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- CN113440240B CN113440240B CN202110457479.1A CN202110457479A CN113440240B CN 113440240 B CN113440240 B CN 113440240B CN 202110457479 A CN202110457479 A CN 202110457479A CN 113440240 B CN113440240 B CN 113440240B
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- 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
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- 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
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- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
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- A61B17/808—Instruments for holding or positioning bone plates, or for adjusting screw-to-plate locking mechanisms
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- A—HUMAN NECESSITIES
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
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- 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
- A61B17/86—Pins or screws or threaded wires; nuts therefor
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- 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
- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
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Abstract
The invention discloses an acetabulum posterior column screw guide device. It comprises a grab handle, a positioner, a drill guide cylinder, a fixing bolt and a screwdriver; the positioner is detachably connected with the arched edge steel plate; one end of the fixing bolt is detachably connected with the arched edge steel plate, and the other end of the fixing bolt is embedded on the positioner; the grab handle is detachably connected with the positioner; the drill guide cylinder is of a cylindrical hollow structure; the drill guide cylinder is detachably connected with the positioner. The invention overcomes the defects that the traditional technology that the risk of entering the joint and damaging important nerve vessels is high and the X-ray fluoroscopy is needed repeatedly in the operation when the acetabulum posterior column screw is placed; the problems of high use cost, complex operation in operation and the like of a 3D printing guide plate, navigation and the like are solved; has the advantages of accurate and safe nail placement, convenient and flexible operation, and the like. The invention also discloses a use method of the acetabulum posterior column screw guide device.
Description
Technical Field
The invention relates to the field of medical instruments for orthopedics, in particular to an acetabulum posterior column screw guide device. More particularly, it is a channel screw guide for acetabular posterior column fractures. The invention also relates to a use method of the acetabulum posterior column screw guide device.
Background
With the progress of aging of population, the acetabular fracture gradually develops towards senile osteoporotic fracture, and meanwhile, in order to adapt to the characteristic that elderly patients cannot tolerate large wounds, the internal fixation instrument and method for acetabular fracture also turn to a more minimally invasive screw fixation approach. The channel screw technology is similar to the technology of a long-bone intramedullary nail, has good biomechanical stability, and is relatively convenient and minimally invasive to place, particularly the acetabulum posterior column screw is the screw technology most commonly used for acetabulum fracture. However, the acetabulum has a complex surrounding structure, a plurality of nerve vessels and broken lines in a deeper position of the pelvic cavity, and dangerous situations such as damage to the surrounding nerve vessels, driving of screws into joints and the like easily occur in the nail placing process. Meanwhile, the position of the guide pin needs to be determined through repeated fluoroscopy in the process of putting the traditional rear column screw, the time of the operation is prolonged through the repeated fluoroscopy, and radiation risks are brought to a patient and a doctor.
In recent years, a 3D printing guide plate technology is used for placing a rear column screw, so that the accuracy and the safety of nail placing can be guaranteed, but the cost of preoperative planning and 3D printing increases the medical burden, and the 3D printing guide plate technology is difficult to combine with conventional internal implants such as steel plates, and the mutual interference situation is easy to occur. The 3D printing guider is generally customized and not universal, and cannot be matched with a steel plate; navigation and robot technology based on two-dimensional and three-dimensional images achieve good application effect in the aspect of rear column screw placement, but the new technology and equipment are frequently purchased in tens of millions, so that the navigation and robot technology is difficult to widely use nationwide.
Based on the facts, the group develops a universal acetabulum posterior column screw guide device which can be used in combination with a steel plate based on an acetabulum model of population big data on the basis of an acetabulum integrated anatomic locking pressurizing steel plate which is developed by self and provides a using method of the universal acetabulum posterior column screw guide device.
Disclosure of Invention
The invention aims to provide an acetabulum posterior column screw guide device which is a universal device, is matched with an arched edge steel plate for use, and has convenient operation and high accuracy; the problems that the damage risk of the acetabulum posterior column channel screw to nerve vessels is high, the radioactive damage is large, the use cost of a 3D printing guide plate, navigation and the like is high, and the combination with an arched edge steel plate is difficult and the like in the traditional technology are solved.
The second purpose of the invention is to provide a using method of the acetabulum posterior column screw guiding device, the screw is placed quickly, safely and accurately, and the operation risk is greatly reduced.
In order to achieve the first object of the present invention, the technical solution of the present invention is: post screw guider behind acetabular bone, its characterized in that: comprises a grab handle, a positioner, a drill guide cylinder, a fixing bolt and a screwdriver;
the positioner is detachably connected with the arched edge steel plate; one end of the fixing bolt is detachably connected with the arched edge steel plate, and the other end of the fixing bolt is embedded on the positioner;
the grab handle is detachably connected with the positioner;
the drill guide cylinder is of a cylindrical hollow structure; the drill guide cylinder is detachably connected with the positioner.
In the above technical solution, the positioner is a square structure; the locator is provided with a handle groove, a fixing hole and a guide drilling hole;
the grab handle is detachably connected with the grab handle groove;
the fixing bolt is positioned in the fixing hole;
the drill guide barrel is detachably connected with the drill guide hole; the pilot hole is of an inclined cylindrical structure.
In the technical scheme, the grab handle groove is positioned on the upper surface of the positioner;
the fixing hole and the pilot drill hole are both of through hole structures and penetrate through the upper surface and the lower surface of the positioner.
In the technical scheme, the handle groove is a threaded hole;
the grab handle is a straight long rod-shaped structure, and the head end is provided with a thread; the head end of the grab handle is connected with the grab handle groove through threads.
In the technical scheme, the fixing hole is a threaded hole; the fixing holes comprise a first fixing hole and a second fixing hole; the first fixing hole is positioned on the upper surface of the positioner, the second fixing hole is positioned on the lower surface of the positioner, and the first fixing hole is communicated with the second fixing hole; the fixing bolt comprises a full-thread screw and a tail cap; the tail cap is positioned at the tail part of the full-thread screw; the diameter of the full thread screw is smaller than that of the tail cap;
the tail cap is arranged in the first fixing hole in a matched mode, and the full-thread screw is positioned on the second fixing hole and the arched edge steel plate;
when the locator is matched with the arched edge steel plate, the fixing hole is coaxial and collinear with the fixing screw hole on the arched edge steel plate.
In the technical scheme, the screwdriver is a quincunx-shaped cylinder with an expanded tail end;
the screwdriver is matched and connected with the tail cap;
the fixed teeth are arranged on the lower end surface of the positioner;
the fixed teeth are in a double-tooth structure; the fixed teeth are clamped with the arched edge steel plate.
In the technical scheme, the back inclination angle of the guide drilling hole is 50-70 degrees, and the camber angle is 100-130 degrees.
In the technical scheme, the back-tilting angle of the pilot hole is 60-80 degrees, and the camber angle is 100-130 degrees.
In order to achieve the second object of the present invention, the technical solution of the present invention is: the use method of the acetabulum posterior column screw guide device is characterized in that: comprises the following steps of (a) preparing a solution,
the method comprises the following steps: when the arched edge steel plate is placed at the correct position above the arched edge, the positioner is placed on the arched edge steel plate through the grab handle, and the position of the positioner is adjusted through the grab handle, so that the positioner is matched with the arched edge steel plate;
step two: the fixed teeth are clamped on the arched edge steel plate through the grab handle;
the fixing bolt is arranged in the fixing hole of the positioner and the fixing hole on the arched edge steel plate through a screwdriver, and the positioner and the arched edge steel plate are fixedly connected;
step three: the guide pin is placed into the target position and the target depth through a guide drill cylinder connected in the guide drill hole;
step four: taking down the drill guide cylinder; screwing an acetabulum posterior column screw along the guide pin;
step five: the oblique position of the ilium and the oblique position of the obturator foramen of the pelvis are observed through a C-shaped arm X-ray machine, and the position and the depth of the acetabulum posterior column screw are confirmed;
step six: the fixing bolt and the positioner are taken out in sequence.
The invention has the following advantages:
(1) Flexible use and wide adaptation diseases;
the pilot drilling hole provided by the invention comprises two types: a guide drill hole is inclined towards the ischial spine and is used for guiding a rear column screw to be placed into the ischial spine; the other type of guide drill hole inclines towards the ischial tuberosities and is used for guiding a rear column screw to be placed into the ischial tuberosities; posterior column fracture, transverse fracture, anterior column fracture with posterior half transverse fracture, T-shaped fracture and double-column fracture in the acetabular fracture are combined with posterior column fracture, so that the incidence rate of the posterior column fracture is very high, the running of fracture lines is changeable, the fracture lines can be generally divided into high-position posterior column fracture lines and low-position posterior column fracture lines according to the positions of the posterior column fracture lines, the high-position posterior column fracture lines are positioned at the upper 1/2 between ischial spines and ischial major incisures, and therefore posterior column screws facing the ischial spines can be fixed; the low-position fracture line is positioned at the lower 1/2 part between the ischial spine and the greater incisure of the ischial bones and can be fixed only by a rear column screw facing to the ischial tuberosity; the two types of the device are just correspondingly guided to the two rear column screws (namely, the rear column screw which is correspondingly guided to the ischial spine and the rear column screw which is correspondingly guided to the ischial tuberosity), so the device can guide the rear column screws according to different use conditions, thereby fixing most rear column fractures; particularly, under the conditions that the low-position posterior column broken line and the posterior column screw are lengthened and the placing difficulty is increased sharply, the guide device has absolute indications and can ensure that the lengthened posterior column screw is positioned and guided;
(2) The rear column screw is quickly, safely and accurately placed, and the operation risk is greatly reduced;
the rear column screw guided by the device is safely and reliably placed, the possibility of surgical injury is greatly reduced, the operation is convenient and quick, the reduction of the surgical time is facilitated, and the surgical safety is improved; the defect that the traditional method has poor accuracy in placing the rear column screw is overcome, the position of the guide pin is often determined by repeating the perspective of the C-arm machine in the operation, the radiation injury of a patient and medical staff is increased, and the operation time is prolonged; due to the objective limitation of two-dimensional perspective, the defects that a rear column screw enters a joint or serious consequences such as iatrogenic neurovascular injury are caused due to the possibility of wrong judgment are likely to occur;
(3) The rear column bolt is combined with the arched edge steel plate, so that the interference between the rear column bolt and the steel plate is avoided;
the device is based on the anatomical arch-shaped edge steel plate, the position and the direction of the positioner can be determined after the arch-shaped edge steel plate is successfully placed, the device is convenient and easy to operate, is in seamless connection, is more beneficial to the surgical process, and avoids the embarrassing situation that a screw and the arch-shaped edge steel plate are mutually interfered; the defect that the existing technologies such as 3D printing guide plates, navigation and robots are not matched with conventional arched edge steel plates (the arched edge steel plates are the steel plate types most frequently used for fixing acetabular fractures and are also an indispensable part) and the problem that the arched edge steel plates are blocked to be placed due to the fact that the technologies such as the 3D printing guide plates, the navigation and the robots are used for leading in the rear column screws is solved, and the rear column screws and the arched edge steel plates are difficult to coordinate with each other is overcome.
The invention is a universal device, can be repeatedly used and has lower cost; the invention can be directly used in the operation, does not need any preoperative preparation, is simpler to use, has smaller wound and saves the operation time; the invention can be used together with the arched edge steel plate, so that the mutual interference with the arched edge steel plate can be avoided, the operation process is facilitated, and the operation success rate is increased; the process of placing the rear column screw into the device can be carried out under the direct vision of eyes, so that the device is safer, more accurate in nail placement, more convenient and flexible to use and the like; the defects that the traditional technology that the risk of entering joints and damaging important nerve vessels is high and repeated X-ray fluoroscopy is needed in the operation when the acetabulum posterior column screw is placed is overcome; the problems of high use cost, complex operation in operation and the like of a 3D printing guide plate, navigation and the like are solved.
In conclusion, the acetabulum posterior column screw guiding device and method are suitable for various acetabulum fractures involving the posterior column, are suitable for the posterior column screw guiding of high-position and low-position posterior column bone broken lines, and have the advantages of flexible use, wide adaptation diseases, safe and reliable screw implantation and low surgical risk; meanwhile, the fixing device is matched with the arched edge steel plate, so that the fixing strength of the acetabulum is enhanced, and the mutual interference of the lag screw and the steel plate is avoided.
Drawings
Fig. 1 is a schematic view of the structure of an anatomical locking compression plate above an integrated arcuate rim.
Fig. 2 is a schematic perspective view of the positioner of the present invention.
Fig. 3 is a schematic bottom view of the positioner of the present invention.
Fig. 4 is a schematic structural view of the grip of the present invention.
Fig. 5 is a schematic structural view of the fixing bolt of the present invention.
Fig. 6 is a schematic structural view of the drill guiding barrel according to the present invention.
FIG. 7 is a cross-sectional view of the retainer for a low back post screw of the present invention.
Fig. 8 is a cross-sectional view of the present invention retainer for a high rear stud screw.
Fig. 9 is a cross-sectional view of a peg of the present invention.
Fig. 10 is a front view schematically illustrating the fixing bolt of the present invention.
Fig. 11 is a left side view of fig. 10.
FIG. 12 is a schematic view of the fixing pin of the present invention installed in the fixing hole of the positioner and protruding from the second fixing hole of the positioner to be fixed in the positioning hole of the steel plate with an arched edge.
Fig. 13 is a schematic view of the working structure of the embodiment 1 of the present invention for guiding the low rear pillar screw.
Fig. 14 is a schematic view of the working structure of the embodiment 2 of the invention for guiding the high rear stud screws.
Fig. 15 is a schematic view of the structure of the acetabulum of the pelvis.
In fig. 13 and 14, a denotes a fractured acetabulum.
In the figure, 1-a grab handle, 2-a locator, 2.1-a grab handle groove, 2.2-a fixing hole, 2.21-a first fixing hole, 2.22-a second fixing hole, 2.23-a third fixing hole, 2.3-a guide drilling hole, 2.4-a fixing tooth, 3-a guide drilling barrel, 4-a fixing bolt, 4.1-a full-thread screw, 4.2-a tail cap, 4.3-a screwdriver fixing hole, 5-a screwdriver, 6-an arched edge steel plate and 7-a guide needle.
Detailed Description
The embodiments of the present invention will be described in detail with reference to the drawings, but the present invention is not limited to these embodiments. While the advantages of the invention will be clear and readily understood by the description.
With reference to the accompanying drawings: the acetabulum posterior column screw guide device comprises a grab handle 1, a positioner 2, a drill guide cylinder 3, a fixing bolt 4 and a screwdriver 5;
the positioner 2 is detachably connected with the arched edge steel plate 6; one end of the fixing bolt 4 is detachably connected with the arched edge steel plate 6, and the other end of the fixing bolt is embedded on the positioner 2 and movably connected with the fixing hole (as shown in fig. 12);
the grab handle 1 is detachably connected with the positioner 2;
the drill guide cylinder 3 is of a cylindrical hollow structure; the drill guide cylinder 3 is detachably connected with the positioner 2.
Further, the positioner 2 is a square structure; the locator 2 is provided with a handle groove 2.1, a fixed hole 2.2 and a pilot drill hole 2.3;
the grab handle 1 is detachably connected with the grab handle groove 2.1;
the fixing bolt 4 is positioned in the fixing hole 2.2 (as shown in figure 12); the fixing hole 2.2 is an I-shaped hole with large upper and lower end apertures and small middle aperture, the fixing bolt 4 is embedded in the fixing hole 2.2 and is movably connected with the fixing hole 2.2, namely, the fixing bolt 4 can move downwards to the full thread screw 4.1 to be screwed in and separated from the fixing hole on the arched edge steel plate 6, the fixing and connecting positioner 2 and the arched edge steel plate 6, and can also move upwards to the full thread screw 4.1 to be screwed out of the fixing hole on the arched edge steel plate 6.
The drill guiding barrel 3 is detachably connected with the drill guiding hole 2.3; the retainer 2 may be coupled to the handle, the drill guide barrel, the securing stud, and the arcuate rim plate, respectively, to secure the retainer 2, orient the rear stud screw channel, and guide the placement of the rear stud screw.
Further, the grab handle groove 2.1 is positioned on the upper surface of the locator 2;
the fixing hole 2.2 and the pilot drill hole 2.3 are both of a through hole structure and penetrate through the upper surface and the lower surface of the positioner.
Further, the grab handle groove 2.1 is a threaded hole;
the grab handle 1 is a straight long rod-shaped structure, and the head end is provided with threads; the head end of the grab handle 1 is connected with the grab handle groove 2.1 through threads; the tip of the grab handle 1 is provided with a thread which can be coupled with a grab handle groove on the positioner, and the tail end of the grab handle 1 is thickened so as to be convenient for holding; the grip 1 is used to hold the positioner 2 to adjust and maintain the orientation and position of the positioner 2.
Furthermore, the fixing hole 2.2 is a threaded hole and is matched with the external thread of the fixing bolt 4; the fixing holes 2.2 comprise a first fixing hole 2.21, a second fixing hole 2.22 and a third fixing hole 2.23; the first fixing hole 2.21 is positioned on the upper surface of the positioner 2, the second fixing hole 2.22 is positioned on the lower surface of the positioner 2, and the third fixing hole 2.23 is positioned between the first fixing hole 2.21 and the second fixing hole 2.22; the first fixing hole 2.21, the second fixing hole 2.22 and the third fixing hole 2.23 are communicated; the inner diameter of the third fixing hole 2.23 is smaller than the inner diameter of the first fixing hole 2.21 and smaller than the inner diameter of the second fixing hole 2.22;
the fixing bolt 4 comprises a full thread screw 4.1, a tail cap 4.2 and a screwdriver fixing hole 4.3; the tail cap 4.2 is positioned at the tail part of the full thread screw 4.1; the diameter of the full thread screw 4.1 is smaller than that of the tail cap 4.2;
the screwdriver fixing hole 4.3 is positioned on the tail cap 4.2;
the outer diameter of the tail cap 4.2 is smaller than the inner diameter of the first fixing hole 2.21 and larger than the inner diameter of the third fixing hole 2.23; the outer diameter of one end of the full-thread screw 4.1, which is far away from the tail cap 4.2, is smaller than the inner diameter of the second fixing hole 2.22 and larger than the inner diameter of the third fixing hole 2.23; the outer diameter of one end of the full thread screw 4.1 adjacent to the tail cap 4.2 is smaller than or equal to the inner diameter of the third fixing hole 2.23;
the tail cap 4.2 is arranged in the first fixing hole 2.21 in a matching mode, and the full-thread screw 4.1 is positioned on the second fixing hole 2.22 and the arched edge steel plate 6 (as shown in figures 5, 9 and 13);
when the retainer is mated with the arching steel plate, the fixing holes 2.2 are co-axial and co-linear with the fixing screw holes on the arching steel plate 6 (as shown in fig. 12, 13 and 14).
Further, the pilot hole 2.3 is in an inclined circular structure (as shown in fig. 2, 3, 7, 8, 13 and 14);
the upper part of the pilot hole 2.3 is provided with a thread;
the tip end of the drill guide cylinder 3 is provided with threads, and the tail end of the drill guide cylinder is provided with straight knurls;
the tip of the drill guiding barrel 3 is connected with the upper part of the drill guiding hole 2.3 through threads.
Further, the positioner is about 30mm long, about 25mm wide and about 20mm thick.
Further, the length of the grab handle 1 is 150-250mm; the tail end of the grab handle 1 is provided with straight knurls (as shown in figures 4, 13 and 14), and the diameter of the tail end is about 10mm; the diameter of the thread at the head end of the grab handle 1 is about 5mm;
the handle groove 2.1 is of a cylindrical structure; the diameter of the handle groove 2.1 is about 5mm, and the depth is about 10mm; the grip groove 2.1 is internally threaded to mate with the external thread of the tip of the grip 1 (as shown in fig. 2, 3, 13, 14).
Further, the diameter of the full thread screw 4.1 is about 2.5mm; the tail cap 4.2 is in a plum blossom-shaped structure, and the diameter of the tail cap 4.2 is about 3.5mm; the fixing bolt 4 can be matched and connected with a fixing hole 2.2 on the positioner 2, when the positioner 2 is correctly matched with the arched edge steel plate 6, the fixing bolt 4 can pass through the fixing hole 2.2 and be screwed into the fixing hole on the arched edge steel plate 6, and the positioner 2 and the arched edge steel plate 6 are fixed and used for locking the positioner 2, preventing the positioner 2 from shifting and ensuring that a rear column screw is accurately led in;
the first fixing hole 2.21 has a diameter of about 3.6mm and a depth of about 5mm; the second fixing hole 2.22 has a diameter of about 2.6mm and a depth of about 15mm.
Further, the outer diameter of the drill guiding barrel 3 is about 10mm, and the inner diameter is about 2.6mm; the straight knurling at the tail end of the drill guiding barrel 3 is about 10mm in length and about 15mm in diameter (as shown in figures 6, 13 and 14); the drill guide cylinder 3 is provided with thickened straight knurling for convenient hand holding; the drill guiding barrel is mainly used for placing the guide pin 7 and guiding the rear column screw, so that the rear column screw is accurately guided, soft tissues such as skin, peritoneum, muscles and the like are protected, and the soft tissues are prevented from being damaged in the process of placing the guide pin 7;
the diameter of the pilot hole 2.3 is about 10mm; the upper part of the pilot hole 2.3 is provided with a thread with the depth of about 5mm, which is matched with the external thread at the tip of the pilot drill cylinder 3; the lower part of the pilot hole 2.3 is of a smooth surface structure.
Further, the fixed teeth 2.4 are arranged on the lower end surface of the positioner 2;
the fixed teeth 2.4 are in a double-tooth structure, and the teeth of the fixed teeth 2.4 can be clamped on the arched edge steel plate to assist in fixing the positioner; the fixed teeth 2.4 are clamped with the arched edge steel plate 6 (as shown in fig. 2, 3, 7, 8, 13 and 14).
Further, the screwdriver 5 is a quincunx cylinder with an enlarged tail end;
the screwdriver 5 is matched and connected with a screwdriver fixing hole 4.3 on the tail cap 4.2; the screwdriver 5 is matched and connected with a screwdriver fixing hole 4.3 on the tail cap 4.2 of the fixing bolt 4, the fixing bolt 4 is screwed into the fixing hole 2.2 on the locator 2 and the fixing hole on the arched edge steel plate 6, and the locator 2 and the arched edge steel plate 6 are fixed (as shown in fig. 13).
Further, the drill guide hole 2.3 has a backward inclination angle of 60 to 80 degrees and an outward inclination angle of 100 to 130 degrees, and guides the rear pillar screw so that the rear pillar screw is inserted in the direction of the ischial spine (see fig. 8 and 14).
Further, the drill guide hole 2.3 has a backward inclination angle of 50 to 70 degrees and an outward inclination angle of 100 to 130 degrees, and the rear pillar screw is guided so as to be inserted in the ischial tuberosity direction (as shown in fig. 7 and 13).
The invention is respectively used for the implantation of the posterior column screws of the ischiadic spines and the ischiadic tuberosities, and can deal with the acetabular posterior column fractures with different characteristics; from the structural aspect, the positioner comprises a plurality of guide drilling angles, and different guide drilling angles are respectively used for guiding the placement of the posterior column screws of the ischial spines and guiding the placement of the posterior column screws of the ischial tuberosities; from the functional aspect, the invention is mainly used for posterior column fractures of different types, when the backward inclination angle of the guide drilling hole 2.3 is 60-80 degrees and the camber angle is 100-130 degrees, the invention is used for fixing the high-position posterior column fracture line, and the position of the fracture line is 1/2 from the greater incisure of the ischium to the ischium spine; when the backward inclination angle of the pilot hole 2.3 is 50-70 degrees and the camber angle is 100-130 degrees, the invention has the function of fixing the low-position posterior column fracture line, and the fracture line is positioned from the greater incisure of the ischia to 1/2 of the lower part of the ischial spine; therefore, the invention can be suitable for various types of rear column fractures and fully play the role of pressurizing and fixing the rear column by the front approach.
With reference to the accompanying drawings: the use method of the acetabulum posterior column screw guide device comprises the following steps,
the method comprises the following steps: the guide device is combined with an anatomical steel plate above an arched edge, when the arched edge steel plate 6 is placed at a correct position above the arched edge, (the guide device needs to be used through an approach in front of acetabular fracture, such as an approach beside rectus abdominis, an approach of iliofencomental groin, an approach of high-position iliofencomental groin, and the like), the positioner 2 is placed on the arched edge steel plate 6 (namely, the anatomical locking compression steel plate above the integrated arched edge is shown in figure 1) through the grab handle 1, and the position of the positioner 2 is adjusted through the grab handle 1, so that the positioner 2 is matched with the arched edge steel plate 6 (a fixing hole 2.2 is coaxial and collinear with a fixing screw hole on the arched edge steel plate 6);
step two: the fixed teeth 2.4 are clamped on the arched edge steel plate 6 through the grab handle 1;
the fixing bolt 4 is placed in the fixing hole 2.2 of the positioner 2 and the fixing hole on the arched edge steel plate 6 through the screwdriver 5, and the positioner 2 and the arched edge steel plate 6 are fixedly connected; because the arched edge steel plate 6 is designed in an anatomical mode, the structural variation of the arched edge is small, and the position is relatively fixed during the operation; the rear column screw channel (the hollow part of the drill guide barrel 3) is relatively large, and has a large fault-tolerant rate, so that the safety and the accuracy of the rear column screw are guaranteed;
step three: a guide pin 7 is arranged in a target position through a drill guide barrel 3 connected in the drill guide hole 2.3;
step four: taking down the drill guiding barrel 3; screwing the acetabulum posterior column screw with a proper length along the guide pin 7;
step five: the oblique position of the ilium and the oblique position of the obturator foramen of the pelvis are observed by a C-shaped arm X-ray machine, and the position and the depth of the acetabulum posterior column screw are confirmed;
step six: the fixing pin 4 and the retainer 2 are sequentially removed (as shown in fig. 13 and 14).
In order to more clearly illustrate the advantages of the acetabular posterior column screw guide device and the use method thereof in comparison with the prior art, the two technical schemes are compared by workers, and the comparison results are as follows:
as can be seen from the above table, compared with the prior art, the acetabulum posterior column screw guide device and the use method thereof have the advantages that the posterior column screw is quickly, safely and accurately placed, the operation risk is low, and the mutual interference between the screw and the arched edge steel plate is avoided.
Examples
As shown in fig. 15: the acetabulum is composed of three irregular bones, namely pubis, ischium and ilium; on the inner aspect, an arc-shaped protruding edge is arranged at the junction of the ischium and the ilium and extends to the pubis, namely an arch-shaped edge A, from the far end; the arcuated bone is thick and dense, is the boundary line of true and false pelvis and is the core area for fixing after the fracture of acetabulum; the ischia forms the back part of the acetabulum, the back edge of the ischia is a smooth arc-shaped ischia major incisure B, the lower part of the major incisure is stopped at an ischia spine C protruding towards the back inner side, and the lower part of the ischia is a rough ischia tuberosity D; the high-position posterior column fracture is fracture from the apex of the greater incisional point of the ischium to 1/2 of the ischium spine, and can be fixed by a high-position posterior column screw, namely the screw is stopped at the ischium spine; the low-position posterior column fracture is fracture from the apex of the greater incisional notch of the ischium to 1/2 of the ischium below the ischium spine, and can be fixed by a low-position posterior column screw, namely the screw is stopped at the ischium tuberosity.
Example 1: high-position rear column screw guiding device
As shown in fig. 8 and 14, for a patient with a certain fractured acetabulum (in the case of high posterior column fracture), the guidance of high posterior column screws is performed by using the acetabular posterior column screw guidance device according to the present embodiment. The acetabulum posterior column screw guide device comprises a grab handle 1, a positioner 2, a drill guide barrel 3, a fixing bolt 4 and a screwdriver 5; wherein, the back inclination angle of the pilot hole 2.3 on the positioner 2 is 60 degrees, and the camber angle is 100 degrees. The grab handle 1 and the drill guide cylinder 3 are both arranged on the positioner 2;
the grab handle, the positioner, the drill guide cylinder, the screwdriver and the fixing bolt in the embodiment are all made of stainless steel.
The use method of the acetabulum posterior column screw guide device comprises the following steps:
after the anatomical steel plate above the arch-shaped edge is correctly placed, the positioner 2 is fixed on the arch-shaped edge steel plate 6 through the fixed teeth 2.4 and the fixed bolts 4, and a guide pin with the diameter of 2.5mm is placed into the rear column screw through the drill guide cylinder 3 to reach the level (target position) of the ischial spine; taking down the drill guiding barrel 3, and screwing a hollow lag screw (namely a rear column screw) with the length of 6.5mm or 7.3mm or other proper lengths along the guide pin 7; confirming the position and the depth of the rear column screw by the perspective of a C-shaped arm X-ray machine on the oblique position of the ilium and the closed hole of the pelvis; the securing peg 4 and the retainer 2 are then removed in sequence.
The acetabulum posterior column screw is a hollow lag screw with the diameter of 6.5mm or 7.3mm, the diameter of the drill guide hole is about 10mm, and the conventionally used hollow lag screw with the diameter of 6.5mm or 7.3mm can be allowed to pass through; the acetabulum posterior column screw with other diameters can be selected according to actual conditions; after the guide pin is placed in, the locator does not need to be taken down, and the guide pin, the locator and the like are taken out after the screw is directly screwed in.
And (4) conclusion: this embodiment uses with the cooperation of arcuation reason steel sheet, convenient operation, and the accuracy is high, and quick, safety, accuracy, greatly reduced operation risk are put into to this embodiment screw.
Example 2: high-position rear column screw guide device
For a patient with certain acetabulum fracture (in the case of high posterior column fracture), the acetabulum posterior column screw guide device described in the embodiment is used for guiding high posterior column screws. The acetabulum posterior column screw guide device and the use method thereof in the embodiment are the same as embodiment 1, and the difference is that: the pilot hole 2.3 in the positioner 2 has a rearward inclination of 67 degrees and an outward inclination of 118 degrees.
And (4) conclusion: this embodiment uses with the cooperation of arcuation reason steel sheet, convenient operation, and the accuracy is high, and quick, safety, accuracy, greatly reduced operation risk are put into to this embodiment screw.
Example 3: high-position rear column screw guide device
For a patient with certain acetabulum fracture (in the case of high posterior column fracture), the acetabulum posterior column screw guide device described in the embodiment is used for guiding high posterior column screws. The acetabulum posterior column screw guide device and the use method thereof in the embodiment are the same as embodiment 1, and the difference is that: the pilot hole 2.3 in the fixture 2 has a back rake angle of 80 degrees and a camber angle of 130 degrees.
And (4) conclusion: this embodiment uses with the cooperation of arcuation reason steel sheet, convenient operation, and the accuracy is high, and quick, safety, accuracy, greatly reduced operation risk are put into to this embodiment screw.
Example 4: low-position rear column screw guide device
For a patient with certain acetabulum fracture (in the case of low posterior column fracture), the acetabulum posterior column screw guide device described in the embodiment is used for guiding low posterior column screws. As shown in fig. 7 and 13, the acetabular posterior column screw guide device and the using method thereof in the embodiment are the same as those in embodiment 1, except that: the pilot hole on the fixture has a back rake angle of 50 degrees and a camber angle of 100 degrees.
And (4) conclusion: this embodiment uses with the cooperation of arcuation reason steel sheet, convenient operation, and the accuracy is high, and quick, safety, accuracy, greatly reduced operation risk are put into to this embodiment screw.
Example 5: low-position rear column screw guide device
For a patient with certain acetabulum fracture (in the case of low posterior column fracture), the acetabulum posterior column screw guide device described in the embodiment is used for guiding low posterior column screws. The acetabulum posterior column screw guide device and the use method thereof in the embodiment are the same as embodiment 4, and the difference is that: the pilot hole on the fixture has a backrake angle of 58 degrees and a camber angle of 113 degrees.
And (4) conclusion: this embodiment uses with the cooperation of arcuation reason steel sheet, convenient operation, and the accuracy is high, and quick, safety, accuracy, greatly reduced operation risk are put into to this embodiment screw.
Example 6
For a patient with certain acetabulum fracture (in the case of low posterior column fracture), the acetabulum posterior column screw guide device described in the embodiment is used for guiding low posterior column screws. The acetabulum posterior column screw guide device and the use method thereof in the embodiment are the same as embodiment 4, and the difference is that: the pilot bore on the fixture has a back rake angle of 70 degrees and a camber angle of 130 degrees.
And (4) conclusion: this embodiment uses with the cooperation of arcuation reason steel sheet, convenient operation, and the accuracy is high, and this embodiment screw is put into fast, safety, accuracy, greatly reduced operation risk.
Other parts not described belong to the prior art.
Claims (7)
1. Post screw guider behind acetabular bone, its characterized in that: comprises a grab handle (1), a locator (2), a drill guide cylinder (3), a fixing bolt (4) and a screwdriver (5);
the positioner (2) is detachably connected with the arched edge steel plate (6); one end of the fixed bolt (4) is detachably connected with the arched edge steel plate (6), and the other end of the fixed bolt is embedded in the positioner (2);
the grab handle (1) is detachably connected with the positioner (2);
the drill guide cylinder (3) is of a cylindrical hollow structure; the drill guide cylinder (3) is detachably connected with the positioner (2);
the positioner (2) is of a square structure; the locator (2) is provided with a handle groove (2.1), a fixed hole (2.2) and a drill guide hole (2.3); the grab handle (1) is detachably connected with the grab handle groove (2.1);
the fixing bolt (4) is matched and connected with a fixing hole (2.2) on the positioner (2), when the positioner (2) is correctly matched with the arched edge steel plate (6), the fixing bolt (4) penetrates through the fixing hole (2.2) and is screwed into the fixing hole on the arched edge steel plate (6), the positioner (2) and the arched edge steel plate (6) are fixed and used for locking the positioner (2), the positioner (2) is prevented from shifting, and the rear column screw is ensured to be accurately led in;
the fixing hole (2.2) is an I-shaped hole with large upper end aperture and lower end aperture and small middle aperture, the fixing bolt (4) is embedded in the fixing hole (2.2) and is movably connected with the fixing hole (2.2), the fixing bolt (4) moves downwards until the full-thread screw (4.1) is screwed into the fixing hole on the arched edge steel plate (6), and the fixing bolt (4) is fixedly connected with the positioner (2) and the arched edge steel plate (6) or moves upwards until the full-thread screw (4.1) is screwed out of the fixing hole on the arched edge steel plate (6);
the drill guide cylinder (3) is detachably connected with the drill guide hole (2.3); the locator (2) is respectively coupled with the grab handle, the drill guide cylinder, the fixing bolt and the arched edge steel plate to fix the locator (2), determine the direction of the rear column screw channel and guide the placement of the rear column screw.
2. The acetabular posterior stud screw guide of claim 1, wherein: the handle groove (2.1) is positioned on the upper surface of the positioner (2);
the fixing hole (2.2) and the drill guide hole (2.3) are both of a through hole structure and penetrate through the upper surface and the lower surface of the positioner.
3. The acetabular posterior column screw guide of claim 2, wherein: the handle groove (2.1) is a threaded hole;
the grab handle (1) is of a straight long rod-shaped structure, and the head end of the grab handle is provided with threads; the head end of the grab handle (1) is connected with the grab handle groove (2.1) through screw threads.
4. The acetabular posterior column screw guide of claim 3, wherein: the fixing hole (2.2) is a threaded hole; the fixing holes (2.2) comprise a first fixing hole (2.21) and a second fixing hole (2.22); the first fixing hole (2.21) is positioned on the upper surface of the positioner (2), the second fixing hole (2.22) is positioned on the lower surface of the positioner (2), and the first fixing hole (2.21) is communicated with the second fixing hole (2.22);
the fixing bolt (4) comprises a full thread screw (4.1) and a tail cap (4.2); the tail cap (4.2) is positioned at the tail part of the full thread screw (4.1); the diameter of the full thread screw (4.1) is smaller than that of the tail cap (4.2);
the tail cap (4.2) is installed in the first fixing hole (2.21) in a matched mode, and the full-thread screw (4.1) is located on the second fixing hole (2.22) and the arched edge steel plate (6);
when the locator is matched with the arched edge steel plate, the fixing holes (2.2) are coaxial and collinear with the fixing screw holes on the arched edge steel plate (6).
5. The acetabular posterior column screw guide of claim 4, wherein: the screwdriver (5) is a quincunx cylinder with an enlarged tip and an enlarged tail end;
the screwdriver (5) is matched and connected with the tail cap (4.2);
the fixed teeth (2.4) are arranged on the lower end surface of the positioner (2);
the fixed teeth (2.4) are in a double-tooth structure; the fixed teeth (2.4) are clamped with the arched edge steel plate (6).
6. The acetabular posterior column screw guide of claim 5, wherein: the back inclination angle of the pilot hole (2.3) is 50-70 degrees, and the camber angle is 100-130 degrees.
7. The acetabular posterior column screw guide of claim 5, wherein: the back inclination angle of the guide drilling hole (2.3) is 60-80 degrees, and the camber angle is 100-130 degrees.
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| CN202110457479.1A CN113440240B (en) | 2021-04-27 | 2021-04-27 | Acetabulum posterior column screw guide device and use method thereof |
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| Application Number | Priority Date | Filing Date | Title |
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| CN202110457479.1A CN113440240B (en) | 2021-04-27 | 2021-04-27 | Acetabulum posterior column screw guide device and use method thereof |
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| CN113440240B true CN113440240B (en) | 2023-02-28 |
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Citations (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN104188716A (en) * | 2014-07-10 | 2014-12-10 | 王钢 | Acetabulum parastyle and posterior column united steel plate |
| CN105769319A (en) * | 2016-03-19 | 2016-07-20 | 王钢 | Posterior fixing steel plate for fracture of acetabular anterior and posterior columns |
| CN111821011A (en) * | 2020-08-28 | 2020-10-27 | 西安市红会医院 | Adjustable atlas screw positioning and guiding device |
-
2021
- 2021-04-27 CN CN202110457479.1A patent/CN113440240B/en active Active
Patent Citations (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN104188716A (en) * | 2014-07-10 | 2014-12-10 | 王钢 | Acetabulum parastyle and posterior column united steel plate |
| CN105769319A (en) * | 2016-03-19 | 2016-07-20 | 王钢 | Posterior fixing steel plate for fracture of acetabular anterior and posterior columns |
| CN111821011A (en) * | 2020-08-28 | 2020-10-27 | 西安市红会医院 | Adjustable atlas screw positioning and guiding device |
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| CN113440240A (en) | 2021-09-28 |
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