CN113940747A - Positioning and navigation device for orthopedic implant nail hole intraosseous passage - Google Patents
Positioning and navigation device for orthopedic implant nail hole intraosseous passage Download PDFInfo
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- CN113940747A CN113940747A CN202010683066.0A CN202010683066A CN113940747A CN 113940747 A CN113940747 A CN 113940747A CN 202010683066 A CN202010683066 A CN 202010683066A CN 113940747 A CN113940747 A CN 113940747A
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- 239000007943 implant Substances 0.000 title claims abstract description 31
- 230000000399 orthopedic effect Effects 0.000 title claims abstract description 29
- 238000000034 method Methods 0.000 abstract description 28
- 238000002474 experimental method Methods 0.000 abstract description 6
- 238000002594 fluoroscopy Methods 0.000 description 7
- 210000000988 bone and bone Anatomy 0.000 description 6
- 238000003780 insertion Methods 0.000 description 6
- 230000037431 insertion Effects 0.000 description 6
- 230000001054 cortical effect Effects 0.000 description 4
- 230000005855 radiation Effects 0.000 description 3
- 238000001356 surgical procedure Methods 0.000 description 3
- 208000010392 Bone Fractures Diseases 0.000 description 2
- 238000011161 development Methods 0.000 description 2
- 230000000694 effects Effects 0.000 description 2
- 238000002513 implantation Methods 0.000 description 2
- 230000000149 penetrating effect Effects 0.000 description 2
- 210000000689 upper leg Anatomy 0.000 description 2
- 206010017076 Fracture Diseases 0.000 description 1
- 230000006978 adaptation Effects 0.000 description 1
- 230000003321 amplification Effects 0.000 description 1
- 238000010586 diagram Methods 0.000 description 1
- 239000003623 enhancer Substances 0.000 description 1
- 210000003414 extremity Anatomy 0.000 description 1
- 238000003384 imaging method Methods 0.000 description 1
- 238000013383 initial experiment Methods 0.000 description 1
- 230000007774 longterm Effects 0.000 description 1
- 238000003199 nucleic acid amplification method Methods 0.000 description 1
- 238000011160 research Methods 0.000 description 1
- 108010048734 sclerotin Proteins 0.000 description 1
- 238000004088 simulation Methods 0.000 description 1
- 230000000087 stabilizing effect Effects 0.000 description 1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
- A61B2034/2046—Tracking techniques
- A61B2034/2051—Electromagnetic tracking systems
Abstract
The utility model discloses a positioning navigation device of an orthopedic implant nail hole intraosseous channel, which comprises two laser emitting pieces and a binding belt, wherein the binding belt is bound on an image intensifier of a C-shaped arm X-ray machine or a G-shaped arm X-ray machine; the two laser emitting pieces are arranged on the binding belt and can move along the binding belt; the problem that laser positioning can only position the point of inserting the kirschner wire into the needle and cannot navigate a needle inserting path in the prior art is improved. A plurality of experiments prove that the navigation process of positioning the nail hole intraosseous channel of the orthopedic implant by utilizing the Kirschner wire can be realized only by one-time perspective when the orthopedic implant is used, so that the accurate positioning can be carried out on the needle inserting point, and meanwhile, the accurate navigation can be carried out on the needle inserting direction. The method is high in accuracy rate, simple and practical, and has good clinical application prospect.
Description
Technical Field
The utility model relates to a positioning navigation device of an orthopedic implant nail hole intraosseous channel, belonging to the field of medical instruments.
Background
At present, in the process of an operation, orthopedic implants such as intramedullary nails, bone fracture plates, channel screws (hollow nails) and the like need to be positioned by utilizing a guide to an intraosseous channel of the implant under the guidance of a fluoroscopy machine, and after the orthopedic implants are positioned to an ideal position, the screws are implanted along a guide pin positioning path to complete the fixation of the implant. The existing operation process is that the operator directly carries out the positioning of the intra-osseous nail hole channel by hand under the fluoroscopy by means of a C-shaped arm X-ray machine or a G-shaped arm X-ray machine, and the specific positioning method comprises the following steps: firstly, positioning the position of a nail hole by utilizing an X-ray machine in a perspective manner, then inserting a kirschner wire into the body surface of a human body under the condition of perspective, stopping the kirschner wire when the needle point reaches the outer surface of a bone, determining the position of the needle point of the kirschner wire in the middle of the nail hole in a perspective manner, lightly knocking the kirschner wire into near-side cortical bone, wherein the needle point enters the cortical bone by about 2mm, adjusting the direction of the kirschner wire after the needle point is positioned in the middle of the nail hole in a perspective manner, so that the kirschner wire forms a round point in the perspective manner, keeping the position in the center of a perspective shadow of the nail hole (particularly, when the experience of an operator is insufficient, the position is difficult to keep, a long learning curve is needed), then knocking the kirschner wire into the near-side cortical bone by using an electric drill, penetrating the nail hole, penetrating the opposite-side cortical bone, and then performing perspective again, and seeing that the kirschner wire passes through the center of the nail hole, thereby completing the satisfactory positioning. If the imaging shows that the kirschner wire passes through the nail hole, the operation needs to be repeated again. Multiple positioning operations can damage local sclerotin more, and the occurrence probability of local secondary fracture and screw withdrawal is greatly increased. Moreover, the operation process needs a plurality of X-ray fluoroscopy, and the fluoroscopy times are more frequent for inexperienced doctors. X-rays have radiation damage to human bodies, the operation time of orthopedic surgery is long, and doctors and patients need to receive excessive radiation under the condition of frequent fluoroscopy.
In order to solve the above problems, the skilled in the art has proposed a method of using laser to assist positioning, which uses two in-line laser lines to project onto the skin surface of a human body to form a cross-shaped cross line, where the cross point is the needle insertion point of the kirschner wire. The method can position the needle insertion point, and one-time perspective positioning is reduced. However, since the laser is projected on the body surface of the human body, the laser only has the function of positioning the needle insertion point, and cannot perform the navigation function in the needle insertion process on the intra-osseous passage of the nail hole in the human body. Therefore, laser-assisted positioning has great limitations in orthopedic surgical positioning. Technicians also use a mechanical positioning device for positioning, for example, an intramedullary nail is connected with a positioning device, but the mechanical positioning device can not accurately position the intraosseous channel of the nail hole because the intramedullary nail is twisted in the implantation process and the axis of the screw hole is changed.
How to solve the problems of the prior art described above is still a hot spot of long-term research by those skilled in the art.
Disclosure of Invention
The technical problem that this disclosure will solve is to provide a positioning navigation device for realizing accurate aiming of intraosseous implant nail hole intraosseous passage by using laser.
In order to achieve the purpose, the following technical scheme is adopted in the disclosure:
a positioning navigation device of an orthopedic implant nail hole intraosseous passage is used for a C-shaped arm X-ray machine or a G-shaped arm X-ray machine; the positioning navigation device comprises two laser emitting pieces and a binding belt, wherein the binding belt is bound on an image intensifier of the C-shaped arm X-ray machine or the G-shaped arm X-ray machine; the two laser emitting pieces are arranged on the binding belt and can move along the binding belt;
the two laser emitting parts are respectively a first laser emitting part and a second laser emitting part; the first laser emitting piece and the second laser emitting piece are identical in structure and respectively comprise a fixed seat, a laser pen fixing device and a laser pen capable of emitting linear light, the fixed seat is connected with the binding belt, the laser pen fixing device is connected with the fixed seat, the laser pen fixing device is provided with a laser pen fixing channel, the laser pen fixing channel and the laser pen fixing device are coaxially arranged, the laser pen can freely rotate around an axis in the laser pen fixing channel, the laser pen is inserted from the top of the laser pen fixing channel, and the linear laser light emitted by the laser pen is emitted from the bottom of the laser pen fixing channel;
the first laser emitting piece is arranged on the extension line of the positioning line B, and the linear laser emitted by the first laser emitting piece is superposed with the positioning line C; the positioning line B is arranged on the end face of an image intensifier of the C-shaped arm X-ray machine or the G-shaped arm X-ray machine, and the positioning line B is superposed with the positioning line A in the exposure area of the display screen during perspective; the positioning line C and the positioning line B are arranged in parallel and keep a certain distance, and are overlapped with the positioning line B and the positioning line A in a display screen exposure area during perspective; the positioning line A is a horizontal axis of an exposure area of a display screen of a C-shaped arm X-ray machine or a G-shaped arm X-ray machine, and the positioning line A passes through the center point of the exposure area of the display screen;
the second laser emitting piece is arranged on the extension line of the positioning line E, and the linear laser emitted by the second laser emitting piece is superposed with the positioning line F; the positioning line E is arranged on the end face of an image intensifier of the C-shaped arm X-ray machine or the G-shaped arm X-ray machine, and the positioning line E is superposed with the positioning line D in an exposure area of the display screen during perspective; the positioning line F and the positioning line E are arranged in parallel and keep a certain distance, and are overlapped with the positioning line E and the positioning line D in a display screen exposure area during perspective; the positioning line D is a vertical axis of a display screen exposure area of a C-shaped arm X-ray machine or a G-shaped arm X-ray machine, and passes through the center point of the display screen exposure area;
the positioning line A and the positioning line D are perpendicular to each other in the display screen exposure area.
Preferably, the positioning navigation device further comprises a positioning plate in a display screen exposure area, the positioning plate is matched with the display screen in shape and can cover the surface of the display screen, and the positioning line A scale and the positioning line D scale are marked on the positioning plate.
Preferably, the surface of the X-ray box aligner of the C-arm X-ray machine or the G-arm X-ray machine is further provided with a positioning line G, and the linear laser line emitted by the first laser emitting piece is superposed with the positioning line G.
Preferably, the surface of the X-ray box aligner of the C-arm X-ray machine or the G-arm X-ray machine is further provided with a positioning line H, and the linear laser line emitted by the second laser emitting piece is superposed with the positioning line H.
Preferably, the positioning navigation device further comprises a fixing support, the fixing support comprises a fixing panel, and the positioning line C and the positioning line F are arranged on the fixing panel.
Preferably, the fixing seat is provided with a through hole, and the binding band passes through the through hole.
Preferably, the positioning navigation device further comprises an angle fixing seat, and the angle fixing seat is arranged between the fixing seat and the laser pen fixer.
Preferably, the angle fixing seat can make the laser pen holder and the fixing seat form an included angle of 40-60 degrees.
Preferably, the width of the linear laser line emitted by the laser pen projected on the surface of the human skin is not more than 2 mm.
Preferably, the distance between the laser pen and the projection position of the human body target is 60-70 cm.
Preferably, the fixing base and the binding surface of the image intensifier of the C-arm X-ray machine or the G-arm X-ray machine are provided with a structure for increasing friction.
Preferably, the binding band is provided with a fixing slot on the binding face of the fixing seat.
Wherein, preferably, the binding belt is provided with an elastic adjusting piece.
The positioning and navigation device for the orthopedic implant nail hole intraosseous passage provided by the disclosure improves the problem that in the prior art, laser positioning can only position the needle inserting point of the Kirschner wire and cannot navigate the needle inserting path. A plurality of experiments prove that the navigation process of positioning the nail hole intraosseous channel of the orthopedic implant by utilizing the Kirschner wire can be realized only by one-time perspective when the orthopedic implant is used, so that the accurate positioning can be carried out on the needle inserting point, and meanwhile, the accurate navigation can be carried out on the needle inserting direction. The method is high in accuracy rate, simple and practical, radiation damage is reduced to the greatest extent, and the method has a good clinical application prospect.
Drawings
In order to more clearly illustrate the embodiments of the present disclosure or the technical solutions in the prior art, the drawings used in the embodiments will be briefly described below. It is to be understood that the drawings in the following description are merely exemplary of the disclosure, and that other drawings may be derived from those drawings by one of ordinary skill in the art without undue inventive faculty.
Fig. 1 is a schematic overall structure diagram of a positioning navigation device provided in the present disclosure;
FIG. 2 is a schematic view of a laser emitting member according to the present disclosure;
FIG. 3 is a schematic view of a positioning plate according to the present disclosure;
FIG. 4 is a schematic view illustrating a positioning plate in use according to the present disclosure;
FIG. 5 is a schematic illustration of the positioning of a first laser emitter according to the present disclosure;
FIG. 6 is a schematic view of the positioning of the second laser emitting member according to the present disclosure
FIG. 7 is a schematic view of a use state of the present disclosure;
FIG. 8 is a first schematic view of the present disclosure utilizing laser line navigation during surgery;
FIG. 9 is a second schematic view of the present disclosure utilizing laser line navigation during surgery;
FIG. 10 is a schematic view of a femoral model used in the experiments of the present disclosure;
FIG. 11 is a perspective view illustrating a distal nail hole of an intramedullary nail according to the present disclosure;
FIG. 12 is a schematic view of a Kirschner wire being driven in using the projection laser line positioning navigation of the present disclosure;
FIG. 13 is a schematic view of a kirschner wire being driven into two nail holes at the distal end of a femoral intramedullary nail respectively by using the present disclosure;
FIG. 14 is a perspective view of a K-wire after insertion.
Description of reference numerals:
the laser emitting device comprises a laser emitting component 1, a first laser emitting component 11, a fixed seat 111, a laser pen fixing device 112, a laser pen 113, a through hole 114, a laser pen fixing channel 115, an angle fixed seat 116, a rib 117 and a first laser line 118;
a second laser emitter 12, a second laser line 121;
the binding belt 2, the fixing clamping groove 21 and the tightness adjusting piece 22;
a G-arm X-ray machine 3, an image intensifier 31;
the device comprises a circular exposure area 4, a positioning plate 5, a positioning line A scale 51, a positioning line D scale 52, a display screen 6 and an X-ray box aligner 7;
a fixed bracket 8, a fixed panel 81;
a Kirschner wire 9;
positioning line A, positioning line B, positioning line C, positioning line D, positioning line E, positioning line F, positioning line G and positioning line H.
Detailed Description
The technical solutions in the embodiments of the present disclosure will be clearly and completely described below with reference to the drawings in the embodiments of the present disclosure, and it is obvious that the described embodiments are only a part of the embodiments of the present disclosure, and not all of the embodiments. All other embodiments, which can be derived by one of ordinary skill in the art from the embodiments disclosed herein without making any creative effort, fall within the scope of the present disclosure.
It should be noted that, if directional indications (such as up, down, left, right, front, and back … …) are involved in the disclosed embodiment, the directional indications are only used to explain the relative position relationship between the components, the motion situation, and the like in a specific posture (as shown in the drawing), and if the specific posture is changed, the directional indications are changed accordingly.
In addition, in the description of the present disclosure, the terms used are for illustrative purposes only and are not intended to limit the scope of the present disclosure. The terms "comprises" and/or "comprising" are used to specify the presence of stated elements, steps, operations, and/or components, but do not preclude the presence or addition of one or more other elements, steps, operations, and/or components.
The terms "first," "second," and the like may be used to describe various elements, not necessarily order, and not necessarily limit the elements.
In addition, in the description of the present disclosure, "a plurality" means two or more unless otherwise specified. These terms are only used to distinguish one element from another.
The present disclosure is used in conjunction with prior art G-arm or C-arm X-ray machines. This open image intensifier 31 that relates to, X-ray case aligner 7 and display screen are the indispensable parts of prior art G shape arm or C shape arm X-ray machine, image intensifier 31 and rather than supporting the use of the X-ray case aligner 7 just setting up, X-ray case aligner 7 is the X ray source, image intensifier 31 is the X ray receiver, the circular exposure area of display screen shows for the image area that image intensifier received, consequently circular exposure area rigidity on the display screen, for consequently this open adaptation prior art arbitrary G shape arm or C shape arm X-ray machine.
As shown in fig. 1 and 2, the positioning navigation device for the orthopedic implant nail hole intraosseous passage provided by the embodiment of the present disclosure can be used in combination with a C-arm X-ray machine or a G-arm X-ray machine 3. C shape arm X-ray machine and G shape arm X-ray machine 3 are prior art, and two kinds of X-ray machines all have image intensifier 31 moreover, and C shape arm X-ray machine has an image intensifier 31, and G shape arm X-ray machine 3 has two image intensifiers 31, and this positioning navigation device mainly bindes and uses on image intensifier 31. Since the patient lies on the operating table, the C-arm X-ray machine needs to rotate the image intensifier 31 to the horizontal position in the orthopedic operation, with the end of the image intensifier 31 facing the patient. The G-arm X-ray machine 3 performs fluoroscopy by using the horizontal image intensifier 31.
In this embodiment, a specific structure and a using method of the positioning and navigation device are described by taking the G-arm X-ray machine 3 as an example. The positioning navigation device can be bound on a C-shaped arm X-ray machine for use in the same way, and the technical effect is consistent with that of the G-shaped arm X-ray machine 3.
The positioning navigation device comprises two laser emitting pieces 1 and a binding belt 2. The binding band 2 is bound to the image intensifier 31 of the G-arm X-ray machine 3. The two laser transmitters 1 are provided on the binding band 2 and are movable along the binding band 2. The specific structure of the laser emitting member 1 is described below:
as shown in fig. 2, the two laser emitting devices 1 are a first laser emitting device 11 and a second laser emitting device 12, respectively. In the present embodiment, the first laser emitting device 11 is taken as an example for specific structural description, and the second laser emitting device 12 has the same structure.
The first laser transmitter 11 includes a holder 111, a laser pointer holder 112, and a laser pointer 113 that emits a linear light. The fixing base 111 is connected with the binding belt 2 in a way that the fixing base 111 is provided with a through hole 114, the shape of the through hole 114 is matched with that of the binding belt 2 so as to facilitate the binding belt 2 to pass through the through hole 114, and the fixing base 111 can reciprocate by taking the binding belt 2 as a track. The laser pointer holder 112 is connected to the holder 111, in this embodiment fixedly, preferably integrally. The laser pen holder 112 is a cylinder structure in this embodiment, two ends of the laser pen holder are open, a laser pen fixing channel 115 is arranged in the laser pen holder, the laser pen fixing channel 115 and the laser pen holder 112 are coaxially arranged, the laser pen 113 can freely rotate around the axis of the laser pen 113 in the laser pen fixing channel 115, the emitting end of the laser pen 113 is inserted into the channel from the top of the laser pen fixing channel 115, and the linear laser line emitted by the laser pen 113 is emitted from the bottom of the laser pen fixing channel 115; the top and bottom portions described herein are explained in that, when the laser pointer 113 is inserted into the laser pointer fixing passage 115, the end of the pen tail is the top portion, and the end opposite to the top portion, i.e., the end of the pen tip, is the bottom portion, and the laser light of the laser pointer 113 is emitted from the pen tip. When the axis of the laser pen 113 is parallel to the axis of the image intensifier 31, the irradiation range is limited, and in order to make the irradiation range of the laser line larger, the embodiment further includes an angle fixing base 116, and the angle fixing base 116 is disposed between the fixing base 111 and the laser pen fixing base 112. In this embodiment, the angle fixing seat 116 can make an included angle of 40-60 degrees between the laser pointer holder 112 and the fixing seat 111, and the laser line irradiation area is feasible within the included angle range, which is 45 degrees in this embodiment.
The present embodiment focuses on the positions of the first laser transmitter 11 and the second laser transmitter 12.
As shown in fig. 4 to 6, the position of the first laser emitting member 11 is set on the extension line of the positioning line B, and the linear laser emitted by the first laser emitting member coincides with the positioning line C; the positioning line B is arranged on the end face of the image intensifier 31 of the G-shaped arm X-ray machine 3, and the positioning line B is superposed with the positioning line A in the circular exposure area 4 of the display screen 6 during perspective; the positioning line C and the positioning line B are arranged in parallel and keep a certain distance, and are overlapped with the positioning line B and the positioning line A in a circular exposure area 4 of a display screen 6 in perspective; the positioning line A is a horizontal axis of a circular exposure area 4 of a display screen 6 of the G-shaped arm X-ray machine 3, and the positioning line A passes through the center point of the circular exposure area 4 of the display screen 6.
The method for determining the position comprises the following steps:
(1) determining a positioning line A: as shown in fig. 4, the display screen 6 of the G-arm X-ray machine 3 has a circular exposure area 4. As shown in fig. 5(c), the circular exposure area 4 is a perspective development area of the image intensifier 31, and the position of the area is fixed in the display screen 6. Firstly, finding a horizontal axis of the circular exposure area 4, wherein the horizontal axis passes through the center point of the circular exposure area 4 and is a positioning line A;
(2) determining a positioning line B: as shown in fig. 5(B), a positioning line B is provided on the end face of the image intensifier 31 of the G-arm X-ray machine 3, and the position of the positioning line B appearing in the circular exposure area 4 of the display screen 6 in perspective coincides with the positioning line a;
(3) determining a positioning line C: as shown in fig. 5(C), the positioning line C and the positioning line B are arranged in parallel, and keep a certain distance therebetween, and the positioning line C coincides with the positioning line B and the positioning line a in the circular exposure area 4 of the display screen 6 during perspective. The positioning line C is preferably arranged at a position intermediate the image intensifier 31 and the X-ray box aligner 7, i.e. the distance between the positioning line C and the positioning line B is equal to the distance between the positioning line C and the positioning line G, so that the positioning line C can be deviated to the positioning line B, but the positioning line C is not too close to the positioning line G, thereby avoiding amplification and affecting positioning.
The method can realize three-line superposition, namely the positioning line A, the positioning line B and the positioning line C are superposed in the circular exposure area 4 of the display screen 6. At this time, the first laser emitting component 11 is disposed on the extension line of the positioning line B, the positioning line B is located on the end surface of the image intensifier 31, the intersection point of the extension line and the edge of the image intensifier 31 is the position of the first laser emitting component 11, and the axis of the laser pen 113 and the positioning line B are located on the same plane.
The linear laser line irradiated by the laser pointer 113 is overlapped with the positioning line C.
The position of the second laser emitting part 12 is arranged on the extension line of the positioning line E, and the linear laser emitted by the second laser emitting part 12 is superposed with the positioning line F; the positioning line E is arranged on the end face of the image intensifier 31 of the G-shaped arm X-ray machine 3, and the positioning line E is superposed with the positioning line D in the circular exposure area 4 of the display screen 6 during perspective; the positioning line F and the positioning line E are arranged in parallel and keep a certain distance, and are overlapped with the positioning line E and the positioning line D in a circular exposure area of the display screen 6 in perspective view; the positioning line D is a vertical axis of a circular exposure area 4 of a display screen 6 of the G-shaped arm X-ray machine, and the positioning line D passes through a circular point of the circular exposure area 4 of the display screen 6.
The method for determining the position of the second laser emitting device 12 is the same as the method for determining the position of the first laser emitting device 11, and specifically includes the following steps:
(1) determining a positioning line D: as shown in fig. 6(c), the display screen 6 of the G-arm X-ray machine 3 has a circular exposure area 4, and the circular exposure area 4 is a perspective development area of the image intensifier 31 and is fixed in position in the display screen 6. Firstly, finding a vertical axis of the circular exposure area 4, wherein the vertical axis passes through the center point of the circular exposure area 4, and the horizontal axis is a positioning line D;
(2) determining a positioning line E: as shown in fig. 6(b), a positioning line E is provided on the end face of the image intensifier 31 of the G-arm X-ray machine 3, and the position of the positioning line E appearing in the circular exposure area 4 of the display screen 6 in perspective coincides with the positioning line D;
(3) determining a positioning line F: as shown in fig. 6(c), the positioning line F and the positioning line E are arranged in parallel and keep a certain distance therebetween, and the positioning line F, the positioning line E and the positioning line D coincide with each other in the circular exposure area 4 of the display screen 6 during fluoroscopy. Preferably, the location line F is suggested to be located at a position intermediate the image intensifier 31 and the X-ray box aligner 7, i.e. the distance between the location line F and the location line E is equal to the distance between the location line F and the location line H, which may be offset to the location line B, but is not preferably offset from the location line G
The method can realize three-line superposition, namely the positioning line D, the positioning line E and the positioning line F are superposed in the circular exposure area 4 of the display screen 6.
The positioning line A and the positioning line D are mutually perpendicular in the circular exposure area of the display screen 6, and the intersection point of the positioning line A and the positioning line D is a circular point of the circular exposure area 4.
As shown in fig. 3 and 4, in order to determine the horizontal axis and the vertical axis of the circular exposure area 4, the present embodiment further includes a positioning plate 5 (fig. 4(a)) of the display screen exposure area (i.e., the circular exposure area) of the display screen 6, the positioning plate 5 is matched with the display screen 6 in shape and can be covered on the surface of the display screen 6 (see fig. 4(b) and 4(c)), and the positioning plate 5 is marked with a positioning line a scale 51 and a positioning line D scale 52. When the positioning device is used, the positioning line A and the positioning line D of the circular exposure area 4 can be found only by covering the positioning plate 5 on the display screen 6.
As shown in fig. 7, a positioning line G is further disposed on the surface of the X-ray box aligner 7 of the G-arm X-ray machine 3, and a laser line generated by the first laser emitter 11 when the linear laser line emitted by the sub-emitter is projected on the surface of the X-ray box aligner 7 is the positioning line G. The surface of the X-ray box aligner 7 of the G-shaped arm X-ray machine 3 is also provided with a positioning line H, and a laser line generated when a linear laser line emitted by the second laser emitting part 12 is projected on the surface of the X-ray box aligner 7 is the positioning line H.
The positioning line G and the positioning line H are used for secondarily positioning the position of the laser line in the operation.
In order to facilitate finding the positions of the positioning line C and the positioning line F, the embodiment further includes a fixing bracket 8, the fixing bracket 8 includes a fixing panel 81, and the positioning line C and the positioning line F are both disposed on the fixing panel 81.
Because the diameter of the nail hole of the orthopedic implant is about 3-5 mm, in order to facilitate positioning, the width of the linear laser line emitted by the laser pen 113 projected on the surface of the skin of the human body does not exceed 2mm, and preferably 2mm is selected in the embodiment. The width of the laser line is directly related to the distance between the laser pen 113 and the projection object, and the distance can be adjusted according to the actual operation condition, so long as the width of the laser line projected on the skin surface of the human body is not more than 2 mm. In the embodiment, the distance between the laser pointer 113 and the human body is 60-70 cm, preferably 60 cm. The projection distance of the laser pen is within 1 meter, and the width of the line is not more than 2 millimeters. Therefore, the optimal 2 mm-diameter Kirschner wire is selected for the positioning guide pin.
In order to increase the stability of the laser pointer 113 when emitting light, the joint surface between the fixing base 111 and the image intensifier 31 of the G-arm X-ray machine 3 is provided with a structure for increasing friction, in this embodiment, a rib 117.
The binding belt 2 is provided with a fixing slot 21 on the surface of the fixing base 111, and the fixing slot 21 is mainly used for stabilizing the position of the fixing base 111 on the binding belt 2.
In order to facilitate the binding of the binding band 2 to the influence enhancer 31, the binding band 2 is provided with a tension adjuster 22. The adjustment member may be of the prior art. In this embodiment, the elastic member 22 is a binding band, and the end portion thereof is provided with a fastening structure.
In the initial experiment of the inventor, only the positioning line C and the positioning line A are overlapped, the positioning line F and the positioning line D are overlapped to position the laser pen, the positioning line B and the positioning line E are not arranged, the laser pen positioned by the positioning method integrating the two lines into one has poor precision in the model experiment, the success rate is low, and the laser pen needs to be debugged repeatedly, so that the later adjustment is a method integrating the three lines into one, and the precision is greatly improved. On the other hand, the laser pen fixing channel of the laser pen fixer is matched with the external dimension of the laser pen. Can be fixed in the laser pen fixer with the laser pen stability after the laser pen inserts, the laser pen fixer still is equipped with backstop portion at the laser pen transmitting end, prevents that the laser pen from falling out, in order to increase the stability of laser pen, still can add in practical application and establish elasticity rubber band secondary fixed.
The method for using the intramedullary nail distal locking nail hole is described below by taking the intramedullary nail distal locking nail hole as an example, and the method for realizing positioning navigation by using other implant nail holes is the same.
(1) Before an operation, the positions of the first laser emitting piece 11 and the second laser emitting piece 12 and the positions of emitted linear laser lines are determined by the method, then the fixing support 8 is removed, the laser pen 113 of the first laser emitting piece 11 and the laser pen of the second emitting piece are started, the laser lines emitted by the first laser emitting piece 11 are projected on the surface of the X-ray box aligner 7 to form a positioning line G, the laser lines emitted by the second laser emitting piece 12 are projected on the surface of the X-ray box aligner 7 to form a positioning line H, and the positioning line G and the positioning line H are marked by the marking pen;
(2) in the operation, the position of the affected limb of the patient is adjusted by one-time perspective, so that the nail hole at the distal end of the intramedullary nail presents a perfect circle on the display screen 6, and the center of the perfect circle coincides with the center of the circle (the intersection point of the positioning line A and the positioning line D) of the circular exposure area 4 of the display screen 6;
(3) opening the laser pen 113 of the first laser emitting piece 11 and the laser pen of the second laser emitting piece 12, coinciding the first laser line 118 of the first laser emitting piece 11 with the positioning line G marked in the step (1), and coinciding the second laser line 121 of the second laser emitting piece 12 with the positioning line H marked in the step (1), at this time, the two laser lines form a cross laser line on the body surface of the patient, the kirschner wire 9 is driven into the human body through the intersection point of the two laser lines, and the needle tail of the kirschner wire 9 always keeps the plane where the first laser line 118 is located and the plane where the second laser line 121 is located in the driving process, that is, the laser line is irradiated on the needle body when the kirschner wire 9 keeps on the plane where the first laser line 118 is located, and if the kirschner wire 9 deviates from the plane where the first laser line 118 is located, the laser line is far away from the needle body 9. In the same way, the second laser line 121 must always irradiate on the needle body of the kirschner wire 9. Therefore, the laser line is utilized to realize the navigation of the intraosseous channel in the driving process of the Kirschner wire 9;
(4) confirming the position of the driven Kirschner wire 9 by means of perspective, enlarging an intraosseous channel along the Kirschner wire 9 by using a drill with a specific specification, and placing a screw with a proper length to complete locking of a distal nail hole of the intramedullary nail.
The inventor proves that the positioning and navigation device can accurately position the needle insertion point and can accurately realize the whole-course navigation effect in the Kirschner wire implantation process through a plurality of times of femoral model experiments. As shown in fig. 10, the femur model is placed in the simulation box to be invisible, and an intramedullary nail is placed in the femur model to simulate the real condition of a human body. As shown in fig. 11, through one-time perspective, the distal nail hole of the intramedullary nail presents a perfect circle image on the display screen, and the circle dot coincides with the intersection point of the positioning line A and the positioning line D or only the circle dot is ensured to be located near the intersection point, and the display screen displays the situation of the circle exposure area. As shown in fig. 12, two laser emitting parts are used for emitting two intersecting laser lines, the intersection point and the plane of the two laser lines are used for positioning the point where the Kirschner wire is inserted, and the plane of the Kirschner wire is positioned in the process of inserting the Kirschner wire so as to navigate the intraosseous channel of the Kirschner wire. As shown in FIG. 12, two Kirschner wires are driven into two nail holes at the distal end of the intramedullary nail by using the positioning and navigating device. As shown in fig. 13, after the kirschner wire is driven in by the positioning and navigation device under the condition of no perspective, the position of the kirschner wire is confirmed by perspective, and the positioning and navigation device can accurately navigate the driving of the kirschner wire into the bone tunnel by a laser line under the condition of no perspective. The inventor confirms that the results are consistent through a plurality of experiments, the success rate is high, and the operation is simple, convenient and accurate.
Claims (13)
1. A positioning navigation device of an orthopedic implant nail hole intraosseous passage is connected with a C-shaped arm X-ray machine or a G-shaped arm X-ray machine (3), and is characterized by comprising two laser emitting pieces (1) and a binding belt (2), wherein the binding belt (2) is bound on an image intensifier (31) of the C-shaped arm X-ray machine or the G-shaped arm X-ray machine (3); the two laser emitting pieces (1) are arranged on the binding belt (2) and can move along the binding belt (2);
the two laser emitting parts (1) are respectively a first laser emitting part (11) and a second laser emitting part (12); the first laser emitting piece (11) and the second laser emitting piece (12) are identical in structure and respectively comprise a fixing seat (111), a laser pen fixing device (112) and a laser pen (113) capable of emitting linear light, the fixing seat (111) is connected with the binding band (2), the laser pen fixing device (112) is connected with the fixing seat (111), the laser pen fixing device (112) is provided with a laser pen fixing channel (115), the laser pen fixing channel (115) and the laser pen fixing device (112) are coaxially arranged, the laser pen (113) can freely rotate around an axis in the laser pen fixing channel (115), the laser pen (113) is inserted from the top of the laser pen fixing channel (115), and the linear laser line emitted by the laser pen (113) is emitted from the bottom of the laser pen fixing channel (115);
the first laser emitting piece (11) is arranged on the extension line of the positioning line B, and the linear laser emitted by the first laser emitting piece (11) is superposed with the positioning line C; the positioning line B is arranged on the end face of an image intensifier (31) of the C-shaped arm X-ray machine or the G-shaped arm X-ray machine (3), and the positioning line B is superposed with the positioning line A in a circular exposure area (4) of the display screen (6) during perspective; the positioning line C and the positioning line B are arranged in parallel and keep a certain distance, and are overlapped with the positioning line B and the positioning line A in a circular exposure area (4) of a display screen (6) during perspective; the positioning line A is a horizontal axis of a circular exposure area (4) of a display screen (6) of a C-shaped arm X-ray machine or a G-shaped arm X-ray machine (3), and passes through a circular point of the circular exposure area (4) of the display screen (6);
the second laser emitting piece (12) is arranged on the extension line of the positioning line E, and the linear laser emitted by the second laser emitting piece (12) is superposed with the positioning line F; the positioning line E is arranged on the end face of an image intensifier (31) of the C-shaped arm X-ray machine or the G-shaped arm X-ray machine (3), and the positioning line E is overlapped with the positioning line D in a circular exposure area (4) of the display screen (6) during perspective; the positioning line F and the positioning line E are arranged in parallel and keep a certain distance, and are overlapped with the positioning line E and the positioning line D in a circular exposure area (4) of a display screen (6) during perspective; the positioning line D is a vertical axis of a circular exposure area (4) of a display screen (6) of a C-shaped arm X-ray machine or a G-shaped arm X-ray machine (3), and passes through a circular point of the circular exposure area (4) of the display screen;
the positioning line A and the positioning line D are perpendicular to each other in the circular exposure area (4) of the display screen.
2. The device for positioning and navigating the passage in the nail hole of the orthopedic implant according to claim 1, further comprising a positioning plate (5) for a display screen (6), wherein the positioning plate (5) is matched with the display screen (6) in shape and can be covered on the surface of the display screen (6), and the positioning line A scale (51) and the positioning line D scale (52) are marked on the positioning plate (5) and are used for marking the positioning line A and the positioning line D of the circular exposure area (4).
3. The orthopedic implant nail hole intraosseous passage positioning navigation device of claim 1, characterized in that:
the surface of an X-ray box aligner (7) of the C-shaped arm X-ray machine or the G-shaped arm X-ray machine (3) is further provided with a positioning line G, and a linear laser line emitted by the first laser emitting piece (11) is coincided with the positioning line G.
4. An orthopedic implant nail hole intraosseous passage positioning navigation device as in claim 3, characterized in that:
the surface of an X-ray box aligner (7) of the C-shaped arm X-ray machine or the G-shaped arm X-ray machine (3) is also provided with a positioning line H, and a linear laser line emitted by the second laser emitting piece (12) is superposed with the positioning line H.
5. The device for the positional guidance of intraosseous passages of orthopedic implant staples as claimed in claim 1, characterized in that it further comprises a fixation support (8), said fixation support (8) comprising a fixation panel (81), said positioning line C and said positioning line F being provided on said fixation panel (81).
6. The orthopedic implant nail hole intraosseous passage positioning navigation device of claim 1, characterized in that:
the fixing seat (111) is provided with a through hole (114), and the binding belt (2) penetrates through the through hole (114).
7. The device for positioning and navigating a passage in an osseous implant nail hole as claimed in claim 1, further comprising an angular fixing seat (116), said angular fixing seat (116) being arranged between said fixing seat (111) and said laser pen holder (112).
8. The orthopedic implant nail hole intraosseous passage positioning navigation device of claim 7, characterized in that:
the angle fixing seat (116) can enable an included angle of 40-60 degrees to be formed between the laser pen fixing device (112) and the fixing seat (111).
9. The orthopedic implant nail hole intraosseous passage positioning navigation device of claim 1, characterized in that:
the width of the linear laser line emitted by the laser pen (113) projected on the surface of the skin of the human body is not more than 2 mm.
10. The orthopedic implant nail hole intraosseous passage positioning navigation device of claim 1, characterized in that:
the distance between the laser pen (113) and the projection position of the human body target is 60-70 cm.
11. The orthopedic implant nail hole intraosseous passage positioning navigation device of claim 1, characterized in that:
and a structure for increasing friction force is arranged on the binding surface of the fixed seat (111) and the image intensifier (31) of the C-shaped arm X-ray machine or the G-shaped arm X-ray machine (3).
12. The orthopedic implant nail hole intraosseous passage positioning navigation device of claim 1, characterized in that:
the binding belt (2) and the binding surface of the fixed seat (111) are provided with fixed clamping grooves (21).
13. The orthopedic implant nail hole intraosseous passage positioning navigation device of claim 1, characterized in that:
the binding belt (2) is provided with an elastic adjusting piece (22).
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| CN202010683066.0A CN113940747B (en) | 2020-07-15 | 2020-07-15 | Positioning navigation device for bone channel of nail hole of orthopedic implant |
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| CN113940747B (en) | 2024-04-16 |
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