CN116747001B - Positioning, drilling and threading integrated guide for coracoid process and use method - Google Patents

Positioning, drilling and threading integrated guide for coracoid process and use method Download PDF

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Publication number
CN116747001B
CN116747001B CN202310667799.9A CN202310667799A CN116747001B CN 116747001 B CN116747001 B CN 116747001B CN 202310667799 A CN202310667799 A CN 202310667799A CN 116747001 B CN116747001 B CN 116747001B
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China
Prior art keywords
frame
guide
coracoid
hole
line
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CN202310667799.9A
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CN116747001A (en
Inventor
费文勇
王永祥
卢耀甲
戴纪杭
文旦
杨宇夏
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Northern Jiangsu Peoples Hospital
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Northern Jiangsu Peoples Hospital
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/90Guides therefor
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/1778Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the shoulder
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8061Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates specially adapted for particular bones
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/808Instruments for holding or positioning bone plates, or for adjusting screw-to-plate locking mechanisms
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84Fasteners therefor or fasteners being internal fixation devices
    • A61B17/842Flexible wires, bands or straps
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8861Apparatus for manipulating flexible wires or straps
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8897Guide wires or guide pins
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/92Impactors or extractors, e.g. for removing intramedullary devices

Abstract

The invention discloses a coracoid process positioning, drilling and threading integrated guide device and a use method thereof, and belongs to the technical field of guide devices. Compared with the prior art needing to search for half an hour to one hour, the design and operation greatly improve the operation efficiency, save the operation time and avoid damaging the vascular nerves and soft tissues near the coracoid substrate.

Description

Positioning, drilling and threading integrated guide for coracoid process and use method
Technical Field
The invention relates to a guide, in particular to a coracoid positioning, drilling and threading integrated guide, and also relates to a use method of the guide, in particular to a coracoid positioning, drilling and threading integrated guide, and belongs to the technical field of guides.
Background
Acromioclavicular dislocation is more common in clinic, accounting for about 4% of total joint dislocation and 12% of dislocation of shoulder injury.
The anatomy of acromioclavicular joint is the joint with the inner edge of acromion connected with the outer end of collarbone, and the tendinous attachment part of the joint capsule, acromioclavicular ligament, coracoid ligament, deltoid muscle and trapezius is the main part for maintaining the stability of acromioclavicular joint.
In the prior art, when the collarbone upwarp resetting and fixing is carried out, a steel plate structure is not ideal, nerve vessels densely distributed below the coracoid substrate are easily touched when punching and threading are carried out on the coracoid substrate, and particularly when a steel wire line below the coracoid substrate is positioned, more soft tissues around the coracoid substrate need to be stripped, and medical accidents often occur due to higher risk of manual searching, so that the integrated guide for positioning, drilling and threading for the coracoid substrate and the use method are designed.
Disclosure of Invention
The invention mainly aims to provide the coracoid process positioning, drilling and threading integrated guide device and the method, which realize the functions of positioning accurately, protecting vascular nerves and guiding out steel wires conveniently and rapidly.
The aim of the invention can be achieved by adopting the following technical scheme:
the utility model provides a coracoid is with location, drilling, line integration director that crosses, includes integrated into one piece's C type frame subassembly and cavity external screw thread pipe, C type frame subassembly includes the side bearer, goes up frame and lower frame, the side of side bearer is equipped with operating handle, go up and seted up three at least group guiding hole on the frame, down set up the collude the line hole that corresponds with the guiding hole on the frame the inner wall of guiding hole is equipped with the internal thread, guiding hole and external screw thread pipe threaded connection.
Preferably, the diameter of the thread hooking hole gradually decreases from top to bottom from a position close to the upper frame.
Preferably, the inner diameter of the upper end of the thread hooking hole is 2-2.3mm, and the inner diameter of the lower end of the thread hooking hole is 1.5-2.0mm.
Preferably, the inner diameter of the upper end of the thread hooking hole is smaller than the inner diameter of the guide hole.
Preferably, the external thread pipe has an external diameter of 3mm, an internal diameter of 2.2-2.6mm, and an internal diameter of 3mm.
Preferably, the side edges of the lower frame are arc-shaped, and the lower frame is abutted against the basal part of the coracoid process of the patient in use.
Preferably, the distance between the bottom end of the upper frame and the top end of the lower frame is 1.6-2.0cm.
Preferably, the line connecting the middle points of the two guide holes farthest from the upper frame and the middle points of the two hooking holes farthest from the lower frame is named as line A, the included angle between the circle center connecting line of the guide hole farthest from the side frame and the hooking hole farthest from the side frame and the line A is 25-30 degrees, and the included angle between the circle center connecting line of the guide hole closest to the side frame and the hooking hole closest to the side frame and the line A is 8-12 degrees.
The method for using the coracoid process positioning, drilling and threading integrated guide comprises the following steps:
step one: clamping the guide on the coracoid process;
step two: placing a Kirschner wire into the external threaded pipe, and driving the Kirschner wire and the external threaded pipe into the coracoid process by using an electric drill;
step three: when the external threaded pipe cannot be screwed in continuously, taking out the Kirschner wire and the electric drill;
step four: the wire is fed into the externally threaded tube, and when the wire penetrates the lower frame, the wire is continuously fed while horizontally moving or rotating the guide along the coracoid process to have a reversible angle, and then the guide is turned over, thereby removing the wire from the hooking line Kong Gouchu.
Preferably, when the steel wire penetrates through the lower frame in the fourth step, the method specifically comprises the following steps: and marking a position which is more than 2.6cm away from the lower end point of the steel wire on the steel wire, and turning over when the steel wire enters the position beyond the position.
The beneficial technical effects of the invention are as follows:
according to the coracoid positioning, drilling and threading integrated guide device and method provided by the invention, the hooking hole with the inner diameter smaller than that of the positioning hole is arranged on the lower frame, so that the positioning is accurate, and the steel wire can be conveniently led out through arranging the hooking hole into a structure with the upper part thick and the lower part thin.
Drawings
Fig. 1 is a schematic perspective view of a positioning, drilling and threading integrated guide for coracoid process according to the present invention.
Fig. 2 is a view showing an initial use state of the coracoid positioning, drilling and threading integrated guide according to the present invention.
Fig. 3 is a rotational use state diagram of the coracoid positioning, drilling and threading integrated guide according to the present invention.
Fig. 4 is a cross-sectional view of the lower rack of fig. 1.
In the figure: 1-operating handle, 2-C type frame subassembly, 3-cavity external screw thread pipe, 4-guiding hole, 5-collude line hole, 6-steel wire, 7-A line, 8-coracoid process, 21-side bearer, 22-upper frame, 23-lower frame.
Detailed Description
In order to make the technical solution of the present invention more clear and obvious to those skilled in the art, the present invention will be described in further detail with reference to examples and drawings, but the embodiments of the present invention are not limited thereto.
As shown in fig. 1-4, the positioning, drilling and threading integrated guide for coracoid process provided in this embodiment includes an integrally formed C-shaped frame assembly 2 and a hollow external threaded tube 3, the C-shaped frame assembly 2 includes a side frame 21, an upper frame 22 and a lower frame 23, an operation handle 1 is disposed at a side end of the side frame 21, at least three sets of guide holes 4 are formed in the upper frame 22, a thread hooking hole 5 corresponding to the guide hole 4 is formed in the lower frame 23, internal threads are disposed on an inner wall of the guide hole 4, and the guide hole 4 is in threaded connection with the external threaded tube 3. The upper frame 22 is 1.4-2.0cm and the lower frame 23 is 1-1.5cm in length.
As shown in fig. 4, the diameter of the hooking hole 5 gradually decreases from top to bottom at a position close to the upper frame 22.
Further, the inner diameter of the upper end of the thread hooking hole 5 is 2-2.3mm, and the inner diameter of the lower end of the thread hooking hole 5 is 1.5-2.0mm.
Further, the inner diameter of the upper end of the hooking hole 5 is smaller than the inner diameter of the guide hole 4.
Further, the external thread tube 3 has an external diameter of 3mm, an internal diameter of 2.2-2.6mm, and an internal diameter of 3mm of the pilot hole 4.
The design can avoid damage to vascular nerves and soft tissues near the coracoid process substrate caused by continuous drilling of the Kirschner wire and the electric drill, the outer diameter of the externally threaded tube 3 is equal to the inner diameter of the guide hole 4, and the inner diameter of the upper end of the thread hooking hole 5 is smaller than the outer diameter of the externally threaded tube 3, so that when the externally threaded tube 3 is abutted to the lower frame 23, the externally threaded tube 3 cannot continuously advance anymore no matter how, and the drilling is finished at the moment. Because the external thread tube 3 is matched with the guide hole 4, the punching position of the coracoid needle and the electric drill to the coracoid process can be fixed, the guide hole 4 corresponds to the thread hooking holes 5 one by one, and soft tissues and vascular nerves near the coracoid process substrate are prevented from being damaged.
Further, the side edge of the lower frame 23 is arc-shaped, and the lower frame 23 abuts against the basal portion of the coracoid process of the patient in use.
Further, the distance between the bottom end of the upper frame 22 and the top end of the lower frame 23 is 1.6-2.0cm. The coracoid process has the thickness of about 1.5cm, and the distance of 1.6-2.0cm is designed so that the guide device can avoid the phenomenon that the coracoid process cannot be blocked due to too small distance (or the coracoid process cannot be blocked due to injury to the coracoid process) and can avoid shaking due to the fact that the coracoid process cannot be blocked due to too large distance.
Further, the line between the midpoint of the two guide holes of the upper frame 22 farthest from each other and the midpoint of the two hooking holes of the lower frame 23 farthest from each other is designated as line a 7, the included angle between the line connecting the center of the guide hole of the side frame 21 farthest from each other and the hooking hole of the side frame 21 farthest from each other and the line a 7 is 25-30 °, and the included angle between the line connecting the center of the guide hole of the side frame 21 closest to each other and the hooking hole of the side frame 21 closest to each other and the line a is 8-12 °.
Because the individual differences of patients, the coracoid structures are slightly different, and through the design of the structure, the included angles between the guide holes and the line hooking holes and the line A are adjustable, so that the problem that most of patients are different in coracoid structure due to the individual differences can be solved, and the positioning accuracy is ensured.
The method for using the coracoid process positioning, drilling and threading integrated guide comprises the following steps: the skin is first incised along the outer side of the patient's collarbone to the coracoid site, muscle tissue is separated, and soft tissue surrounding the coracoid site is cleaned, and then,
step one: the doctor clamps the guide on the coracoid process 8 through the operation handle 1; the upper frame 22 is above the coracoid process 8, the lower frame 23 is abutted under the base of the coracoid process 8, the position of the guide is adjusted so that the position to be drilled is located at the center of the coracoid process 8,
step two: placing a Kirschner wire into the externally threaded tube 3, and driving the Kirschner wire and the externally threaded tube 3 into coracoid process by using an electric drill;
step three: when the external threaded pipe cannot be screwed in continuously, taking out the Kirschner wire and the electric drill;
as shown in fig. 2-3, step four: the wire 6 is fed into the externally threaded tube, and when the wire 6 penetrates the lower frame 23, the feeding of the wire 6 is continued while horizontally moving or rotating the guide along the coracoid process 8 so as to have a reversible angle, and then the guide is turned over, thereby removing the wire 6 from the hooking line Kong Gouchu. Due to the effect of the external thread pipe 3, the guide holes 4 and the thread hooking holes 5 are guaranteed to be matched one by one during drilling, so that the effect of accurate positioning is realized, and the safety is high.
Further, in the fourth step, when the steel wire 6 penetrates the lower frame 23, specifically: a position of more than 2.6cm from the lower end of the wire 6 is marked on the wire 6, and when the wire 6 goes beyond this position, the guide is horizontally moved or rotated along the coracoid process 8 to have a reversible angle, and then turned. Since the thickness of both the upper frame 22 and the lower frame 23 is 2-3mm, the distance between the bottom end of the upper frame 22 and the top end of the lower frame 23 is 1.6-2.0cm, so that the wire guide 5 is necessarily penetrated when the length of the wire entering the guide is not less than 2.6cm, the guide is horizontally moved or rotated along the coracoid process 8 to have a reversible angle, because the shape of the upper frame 22 and the lower frame 23 is curved to conform to the shape of the coracoid process 8 for the purpose of enhancing the stability, the guide must be horizontally rotated or moved along the coracoid process 8 before the guide is turned, so that the guide is angled to be turned along the coracoid process 8, and damage to the coracoid process 8 is avoided, and for a doctor who can do the operation, the guide designed in the present invention is operated as a conventional technical means to cause no damage to the coracoid process 8 when the guide is turned, the wire is guided out along with the wire guide hole 5 of the lower frame 23, as shown in detail in fig. 3. The method is simple to operate, greatly improves the operation efficiency, saves the operation time, and avoids the situation that the vascular nerves and soft tissues near the coracoid substrate are secondarily injured due to manual thread hooking by doctors. Finally, the guide is detached from the wire 6, the specific operation being known in the art, for example: the doctor uses forceps to pinch the steel wire between the coracoid substrate and the lower frame 23, separates the bottom end of the steel wire 6 from the lower frame 23, pulls down the steel wire 6, separates the top end of the steel wire 6 from the upper frame 22, completely separates the guider from the incision, and forces the steel wire 6 upwards until the top end of the steel wire 6 penetrates out of the guide hole 4.
And then or before drilling holes on the collarbone, wherein the preferable number of the holes drilled on the collarbone is 2,2 holes are respectively positioned at two sides of the holes on the coracoid process, the wires are fed in from the holes on the collarbone and hooked on the steel wires fed into the coracoid process after being fed out, the doctor continuously acts on the steel wires led out from the hooked wire holes, so that the wires are brought into the holes penetrating the coracoid process, and finally, the wires at the three holes are knotted and fixed through the titanium plate, so that the operation is completed.
The above is merely a further embodiment of the present invention, but the protection scope of the present invention is not limited thereto, and any person skilled in the art will be able to apply equivalents and modifications according to the technical solution and the concept of the present invention within the scope of the present invention disclosed in the present invention.

Claims (1)

1. The utility model provides a coracoid is with location, drilling, line integration director that crosses which characterized in that: the novel plastic handle comprises a handle assembly and comprises a C-shaped frame assembly (2) and a hollow external thread pipe (3) which are integrally formed, wherein the C-shaped frame assembly (2) comprises a side frame (21), an upper frame (22) and a lower frame (23), an operation handle (1) is arranged at the side end of the side frame (21), at least three groups of guide holes (4) are formed in the upper frame (22), a thread hooking hole (5) corresponding to the guide holes (4) is formed in the lower frame (23), internal threads are formed in the inner wall of the guide holes (4), and the guide holes (4) are in threaded connection with the external thread pipe (3);
the diameter of the thread hooking hole (5) gradually decreases from top to bottom from the position close to the upper frame (22);
the inner diameter of the upper end of the thread hooking hole (5) is 2-2.3mm, and the inner diameter of the lower end of the thread hooking hole (5) is 1.5-2.0mm;
the inner diameter of the upper end of the thread hooking hole (5) is smaller than the inner diameter of the guide hole (4);
the external thread pipe (3) has an external diameter of 3mm, an internal diameter of 2.2-2.6mm, and an internal diameter of the guide hole (4) of 3mm;
the side edge of the lower frame (23) is arc-shaped, and the lower frame (23) is abutted against the basal part of the coracoid process of a patient in use;
the distance between the bottom end of the upper frame (22) and the top end of the lower frame (23) is 1.6-2.0cm;
the midpoint connection line of the two guide holes farthest from the upper frame (22) and the midpoint connection line of the two hooking holes farthest from the lower frame (23) is named as A line (7), the included angle between the circle center connection line of the guide holes farthest from the side frame (21) and the hooking holes farthest from the side frame (21) and the A line (7) is 25-30 degrees, and the included angle between the circle center connection line of the guide holes closest to the side frame (21) and the hooking holes closest to the side frame (21) and the A line is 8-12 degrees.
CN202310667799.9A 2023-06-07 2023-06-07 Positioning, drilling and threading integrated guide for coracoid process and use method Active CN116747001B (en)

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US5409490A (en) * 1993-08-16 1995-04-25 Depuy Inc. Shoulder separation reconstruction
EP1996096A2 (en) * 2006-03-22 2008-12-03 Depuy Products, Inc. Nail plate and jig therefor
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CN208756143U (en) * 2018-05-30 2019-04-19 兰州大学 Posterior cruciate ligament rebuilds guider
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CN219089609U (en) * 2022-07-28 2023-05-30 中国人民解放军海军军医大学第一附属医院 Integrated guide for coracoid process boneless fixing technology for acromioclavicular dislocation

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