CN117860325A - Ankle joint outside collateral ligament repair and reconstruction operation fixing system - Google Patents

Abstract

The invention relates to the technical field of medical appliances, and discloses an ankle outside collateral ligament repair and reconstruction operation fixing system, which comprises a fibula side portal nail for ligament repair or reconstruction operation, a talus side wedge nail for ligament reconstruction operation and matched appliances; portal nails are used to secure ligaments or transplanted tendons to fibula, wedge nails are used for tendon fixation: a plurality of barbs are arranged on both sides of the inner wall of the door-shaped nail; according to the invention, the portal nail is arranged on the fibula side, the space between the portal nail and the fibula is used for fixing the ligament or transplanting the tendon, the tendon is protected when the wedge-shaped nail is arranged on the talus side, the structure of the pressurized inner buckle is provided, the pull-out resistance is good, the contact area between the ligament and the fibula is increased, and the healing of the ligament or transplanting the tendon and the bone is facilitated. And for the reconstruction surgery, the wedge-shaped nail provided by the fixing system can avoid annular extrusion of the tendon by the extrusion screw which is clinically used at present, and simultaneously increase the contact area of the tendon and the bone canal to accelerate the healing of the tendon.

Description

Ankle joint outside collateral ligament repair and reconstruction operation fixing system

Technical Field

The invention relates to the technical field of medical instruments, in particular to an ankle lateral collateral ligament repair and reconstruction operation fixing system.

Background

Ankle lateral collateral ligament injury is one of the most frequent motor injuries. The lateral collateral ligaments consist of the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL) and the posterior talofibular ligament, the most commonly damaged of which are the anterior talofibular ligament and the calcaneofibular ligament.

Referring to fig. 11 of the specification, the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) are both flat structures, the ATFL has a double-bundle structure, and the dead point of the fibula and the talus is a region, not a point

About 20-40% of patients who have injuries to the lateral collateral ligaments of the ankle are not effective in conservative treatment, and gradually develop chronic lateral ankle instability, manifested as lateral pain, laxity and repeated sprains of the ankle, requiring surgical treatment. For patients with better quality of residual ligaments, ankle lateral ligament repair is a common surgical procedure (fig. 12), requiring tightening of the ligaments by a threaded anchor to suture the ligaments to bony dead centers; for patients with ligament loss, systemic joint laxity, high BMI and high exercise demands, bone tracts are drilled at osseous dead centers of the ligaments, and transplanted autologous tendons are fixed on the corresponding bone tracts by pressing screws, so that an anatomic reconstruction operation is performed (fig. 13).

See fig. 12 of the specification, process of ligament repair surgery: (A) Cutting the separated ligament, (B) drilling holes at osseous dead points of the ligament to implant a string anchor; (C-F) suturing the ligament and the support belt to complete the repair operation,

see fig. 13 of the specification, an operation schematic diagram of anatomical reconstruction and a fixation mode of tendons. (A) Drilling a bone canal at a osseous dead point, pulling a transplanted tendon into the bone canal, wherein the tendon can only be a single tendon but can not achieve double-bundle reconstruction of anatomy, and (B, C) fixing the tendon by extruding a screw, so that the transplanted tendon is damaged to a certain extent

The current procedure for the anatomic repair of the lateral malleolus ligament is: and (3) placing an anchor at the dead point of the distal fibula from the anterior fibula ligament and the calcaneofibular ligament, suturing the residual ligament tissue by using the tail line of the anchor, and then tightening the suture for knotting and fixing. Drawbacks of this operation include: 1. the number of the anchors is large (1-3), the positions of the anchors need to be accurately positioned, the experience requirement on operators is high, if the experience of the operators is insufficient, the anchors are easy to be positioned in a non-anatomic way, and the curative effect of the operation is affected. 2. Because the anchor is placed in the position only in a hole of 2mm, the contact area between the stitched ligament and the osseous dead point is limited, so that the healing of the ligament and the tendinous bone is slower, the local stress of the anchor can be caused, the ligament is cut, and the risks of anchor falling off, operation failure and the like can be caused. 3. The tension of the ligament is closely related to the suture needle-in position, and since the ligament suture is performed after the anchor is implanted and finally knotted, the tension of the ligament is already determined and cannot be adjusted, so that the ligament suture is too loose or too tight, and the operation effect is affected.

The current technology for reconstructing the external ankle ligament by using the tendon needs to fix and transplant the tendon by using extrusion screws on the fibula, the talus and the calcaneus respectively, and the operation has the defects that: 1. the extrusion screw causes great damage and extrusion injury to the tendon graft, which affects the healing of the transplanted tendon; 2. the anterior talofibular ligament is of a flat ribbon-like structure, the dead points on the fibula and the talus are long strips, and the ligament fixed by using a circular extrusion nail with the diameter of 5-6mm does not reconstruct the anatomical form of the dead points of the ligament, which is not beneficial to the recovery of the ligament function. 3. The bone on the fibula side is thin and fragile, the technical requirement on the operation is very high when a 5-6mm bone tunnel is manufactured according to an anatomical site, the bone tunnel is easily split when the extrusion screw is drilled and put in, even the ligament is not firmly fixed, and even the fracture occurs.

Disclosure of Invention

The present invention aims to provide an ankle lateral collateral ligament repair and reconstruction surgery fixing system, which solves the problems in the background art.

In order to achieve the above purpose, the present invention provides the following technical solutions:

the ankle outside collateral ligament repair and reconstruction operation fixing system comprises a double-needle suture line for repairing ligaments, a fibula side portal nail for ligament repair or reconstruction operation, a talus side wedge nail for ligament reconstruction operation and a matched instrument for fixing the portal nail;

the portal nail is used for fixing a ligament or a transplanted tendon on a fibula and is inserted on the fibula side, the wedge nail is used for protecting the tendon and is fixedly arranged on the talus side, the matched instrument is used for drilling at a osseous dead point and fixing the portal nail and the wedge nail on the osseous dead point:

the inner wall both sides of door-shaped nail all are provided with a plurality of barb, have the function of pressurization inner buckle, trapezoidal structure is personally submitted to wedge nail one end, and a plurality of cell body has been seted up to the lateral wall edge of wedge nail.

Optionally, the door-shaped nail comprises two inserting parts and an action part, the two inserting parts are fixedly connected to two sides of one end of the action part, and one end of each inserting part is provided with a tip inclined inwards.

Optionally, a plurality of the barbs are fixedly mounted on the inner sides of the two insertion parts, and the tip ends of the barbs are directed toward the acting part.

Optionally, the action part is arc structure, and the one end fixedly connected with of action part has a plurality of toper piece.

Optionally, the top fixedly connected with a plurality of erection column of action part, just the toper piece corresponds fixed connection respectively in the one end of erection column.

Optionally, a notch is formed in one end face of the wedge-shaped nail.

Optionally, two sides of the inserted end of the wedge-shaped nail are provided with penetrating plugs, and the penetrating plugs are positioned at the narrowest end of the wedge-shaped nail.

Optionally, a first chamfer is provided at a corner of an end face of the wedge-shaped nail, and a second chamfer is provided at an edge of a side wall of the wedge-shaped nail.

The positioning sleeve is used for fixing the drilling position, the embedding device is used for fixing the portal nail on a ligament on the fibula side of a patient, and the nail holder is used for holding the portal nail.

The invention has at least the following beneficial effects:

aiming at repair operation, (1) the goal of anatomical positioning can be achieved by installing the portal nail in the fibula side osseous dead point area, (2) the contact area of the ligament and the fibula is increased, the ligament is prevented from being cut, the ligament healing is facilitated, the number of consumable materials can be reduced, the operation flow is simplified, and the cost is reduced; (3) after the ankle joint is fixed in a standard position, the ligament is tightened and knotted, so that the tension of the ligament can be regulated, and complications such as limited joint movement are avoided; (4) and the space between the portal nail and the fibula is used for fixing the ligament, so that the ligament or the transplanted tendon can be directly fixed on the fibula, the damage to fibula bone caused by sidetrack bone taking of the fibula is avoided, and the pull-out resistance is good. And simultaneously, for the reconstruction operation, (1) the wedge-shaped nail provided by the fixing system can realize reconstruction of the anterior ligament of the double-bundle talofibular, and (2) the transplanted tendon can realize flat-band-shaped contact with the bone canal so as to avoid annular extrusion of the nail to the tendon, and simultaneously, the contact area of the tendon and the bone canal is increased so as to accelerate healing of the tendon and the bone canal.

Drawings

In order to more clearly illustrate the technical solutions of the embodiments of the present invention, the drawings that are needed for the description of the embodiments will be briefly described below, it will be apparent that the drawings in the following description are only some embodiments of the present invention, and other drawings can be obtained according to these drawings without inventive effort for a person skilled in the art

FIG. 1 is a schematic view of the structure of the portal nail of the present invention;

FIG. 2 is a top view of the portal staple of the present invention;

FIG. 3 is a schematic view of the wedge nail structure of the present invention;

FIG. 4 is a front view of the wedge nail of the present invention;

FIG. 5 is a side view of the wedge nail of the present invention;

FIG. 6 is a schematic illustration of the operation of the present invention, with gray black nails being talus side wedge nails and gray nails being fibula side door nails;

FIG. 7 is a front view of the portal staple positioning sleeve of the present invention;

FIG. 8 is a side view of the portal staple positioning sleeve of FIG. 7 in accordance with the present invention;

FIG. 9 is a schematic view of the staple holder of the portal staple of the present invention;

FIG. 10 is a schematic view of the structure of the embedment device of the portal nail of the present invention;

FIG. 11 is a schematic structural view of the anterior talofibular ligament superior and inferior bundles (ATFL-SB) and the calcaneofibular ligament;

FIG. 12 is a schematic view of an ankle lateral ligament prosthesis;

FIG. 13 is a schematic view of an anatomic reconstruction procedure;

FIG. 14 is a view of a fibula side door nail fixation procedure;

fig. 15 is a view of the talar side wedge fixation procedure.

In the drawings, the list of components represented by the various numbers is as follows:

1. a door-shaped nail; 11. a mounting column; 12. a tip; 2. a cone; 3. a barb; 4. wedge-shaped nails; 41. a tank body; 42. a notch; 43. threading a plug; 44. a first chamfer; 45. and (5) a second chamfer.

Detailed Description

The following description of the embodiments of the present invention will be made clearly and completely with reference to the accompanying drawings, in which it is apparent that the embodiments described are only some embodiments of the present invention, but not all embodiments. All other embodiments, which can be made by those skilled in the art based on the embodiments of the invention without making any inventive effort, are intended to be within the scope of the invention.

Referring to fig. 1 to 15, the present invention provides a fixation system for a collateral ligament repair and reconstruction operation of an ankle joint, comprising a fibula side portal screw 1 for a ligament repair operation and a talus side wedge screw 4 for a ligament reconstruction operation;

the door-shaped nail 1 is used for fixing a ligament to a fibula and is inserted at the fibula side, and the wedge-shaped nail 4 is used for protecting tendons and is installed and fixed at the talus side; when in use, the portal screw 1 is arranged on the fibula side, and the space between the portal screw 1 and the fibula is used for fixing the ligament, the tendon is protected when the wedge-shaped screw 4 is arranged on the talus side, and the contact area between the ligament and the fibula is increased:

the two sides of the inner wall of the door-shaped nail 1 are provided with a plurality of barbs 3, one end of the wedge-shaped nail 4 is in a trapezoid structure, the edge of the side wall of the wedge-shaped nail 4 is provided with a plurality of groove bodies 41, the barbs 3 arranged on the inner side of the door-shaped nail 1 can be firmly fixed on the fibula, the number of the barbs 3 is preferably 3, and the groove bodies 41 are used for increasing the contact area of the wedge-shaped nail 4 and the installation limiting effect; the positioning sleeve is used for fixing the drilling position, the embedding device is used for fixing the portal nail 1 on a ligament on the fibula side of a patient, and the nail holder is used for holding the portal nail.

The matched instrument comprises: the positioning sleeve is used for positioning osseous dead points of fibula or talus and drilling holes, then the nail holder is used for holding the door-shaped nail or wedge-shaped nail to be aligned with the drilling hole position, and the embedding device is used for embedding the door-shaped nail or wedge-shaped nail into the drilling hole position.

In some embodiments, referring to fig. 1, the portal nail 1 includes two insertion parts and an action part, wherein the two insertion parts are fixedly connected to two sides of one end of the action part, and one end of the insertion part is provided with an inward inclined tip 12; the portal screw 1 can be more smoothly mounted on the fibula side by using the tip 12, and the portal screw 1 can be firmly mounted and fixed by adopting two inserting parts.

In some embodiments, referring to fig. 1, a plurality of the barbs 3 are fixedly installed at the inner sides of two insertion parts, and the tip direction of the barbs 3 is directed toward the acting part; the arranged barbs 3 are used for conveniently realizing limit on the door-shaped nails 1, and the door-shaped nails 1 are prevented from being separated or loosened at the installation position.

In some embodiments, referring to the figures, the acting part is in an arc structure, and one end of the acting part is fixedly connected with a plurality of conical parts 2; the top of the acting component is fixedly connected with a plurality of mounting columns 11, and the conical parts 2 are respectively and correspondingly and fixedly connected to one ends of the mounting columns 11; the supporting strength of the door bolt 1 can be increased by the action part of the arc structure, and further stable installation and fixation can be realized by the installed cone 2 also being installed at the target position.

In some embodiments, referring to fig. 3, a notch 42 is formed on one end surface of the wedge-shaped nail 4; the material consumption of the wedge-shaped nail 4 can be reduced and the whole weight can be reduced by reasonably arranging the notch 42.

Further, referring to fig. 4 again, two sides of the insertion end of the wedge-shaped nail 4 are provided with insertion pins 43, and the insertion heads 43 are located at the narrowest end of the wedge-shaped nail 4, so that the wedge-shaped nail 4 can be conveniently installed by using the installed insertion heads 43.

In some embodiments, referring to fig. 3, a first chamfer 44 is formed at a corner of an end face of the wedge-shaped nail 4, and a second chamfer 45 is formed at an edge of a side wall of the wedge-shaped nail 4; by providing the first chamfer 44 and the second chamfer 45 it is ensured that damage to the organ is minimized when installing the wedge 4.

The working flow and principle of the invention are as follows: firstly, preparing materials such as instruments, sutures, bandages and the like required by the operation.

The surgical site is then sterilized prior to surgery and the surgical cap is worn. For fibula side fixing operators, the anterior talofibular ligament and the calcaneofibular ligament are firstly separated or tendon is ready to be transplanted, the ligament or tendon is woven for standby through a suture (figure 14A), then the drilling position is fixed through a positioning sleeve in a matched instrument, and then an electric drill is used for drilling (figure 14B); the portal screw is then held by a screw holder in the kit, and the portal screw 1 and ligament are secured to the fibula side by an inserter (fig. 10), and the portal screw 1 is inserted into the fibula side by a continuous depression (fig. 14C). The portal screw 1 is gradually advanced, and the barbs 3 are also installed at the target location during the gradual advancement. The talus side is fixed in a similar manner, the tendon graft is woven for later use (fig. 15A), and then the tendon graft is positioned by the cone 2 (fig. 15B), the woven tendon graft is pulled into the talus side for fixation, the ankle joint is fixed in a standard posture, and the wedge-shaped nail is inserted by the insertion device (fig. 15C).

Fig. 14 fibula side door nail fixation procedure. (A) braiding ligaments or transplanting tendons for later use; (B) a locator locates the borehole; (C) Fix the position, tighten the braiding ligament and embed the embedding device.

Fig. 15 talar side wedge fixation procedure. (A) weaving and transplanting tendons for standby; (B) a locator locates the borehole; (C) Fixing the position, tightening the tendon, embedding the embedding device, and (D) fixing the talus side by wedge-shaped nails and the fibula side by door-shaped nails.

It is noted that relational terms such as first and second, and the like are used solely to distinguish one entity or action from another entity or action without necessarily requiring or implying any actual such relationship or order between such entities or actions. Moreover, the terms "comprises," "comprising," or any other variation thereof, are intended to cover a non-exclusive inclusion, such that a process, method, article, or apparatus that comprises a list of elements does not include only those elements but may include other elements not expressly listed or inherent to such process, method, article, or apparatus.

Although embodiments of the present invention have been shown and described, it will be understood by those skilled in the art that various changes, modifications, substitutions and alterations can be made therein without departing from the principles and spirit of the invention, the scope of which is defined in the appended claims and their equivalents.

Claims (9)

1. The ankle lateral collateral ligament repair and reconstruction surgery fixing system is characterized by comprising a fibula lateral portal nail (1) for ligament repair or reconstruction surgery, a talus lateral wedge nail (4) for ligament reconstruction surgery and matched instruments (a positioning sleeve, an embedding device and a nail holder) for fixing the portal nail;

the portal nail (1) is used for fixing a ligament or transplanted tendon on a fibula and is inserted on the fibula side, the wedge nail (4) is used for protecting the tendon and is fixedly arranged on the talus side, the matched instrument is used for drilling holes at osseous dead points, and the portal nail and the wedge nail are embedded and fixed on the osseous dead points:

the novel door-shaped nail is characterized in that a plurality of barbs (3) are arranged on two sides of the inner wall of the door-shaped nail (1), the novel door-shaped nail has the function of pressurizing and buckling, one end of the wedge-shaped nail (4) is of a trapezoid structure, and a plurality of groove bodies (41) are formed in edges of the side wall of the wedge-shaped nail (4).

2. The ankle lateral collateral ligament repair and reconstruction surgical fixation system of claim 1, wherein: the door-shaped nail (1) comprises two inserting parts and an acting part, the two inserting parts are fixedly connected to two sides of one end of the acting part, and a tip (12) inclining inwards is arranged at one end of the inserting part.

3. The ankle lateral collateral ligament repair and reconstruction surgical fixation system of claim 2, wherein: a plurality of the barbs (3) are fixedly arranged on the inner sides of the two inserting parts, and the tip ends of the barbs (3) point to the acting parts.

4. The ankle lateral collateral ligament repair and reconstruction surgical fixation system of claim 2, wherein: the action part is of an arc-shaped structure, and one end of the action part is fixedly connected with a plurality of conical parts (2).

5. The ankle lateral collateral ligament repair and reconstruction surgical fixation system of claim 4, wherein: the top of the acting component is fixedly connected with a plurality of mounting columns (11), and the conical parts (2) are respectively and correspondingly fixedly connected with one ends of the mounting columns (11).

6. The ankle lateral collateral ligament repair and reconstruction surgical fixation system of claim 1, wherein: a notch (42) is formed in one end face of the wedge-shaped nail (4).

7. The ankle lateral collateral ligament repair and reconstruction surgical fixation system of claim 1, wherein: the two sides of the inserting end of the wedge-shaped nail (4) are provided with penetrating plugs (43), and the penetrating plugs (43) are positioned at the narrowest end of the wedge-shaped nail (4).

8. The ankle lateral collateral ligament repair and reconstruction surgical fixation system of claim 1, wherein: a first chamfer (44) is formed in a corner of one end face of the wedge-shaped nail (4), and a second chamfer (45) is formed in an edge of the side wall of the wedge-shaped nail (4).

9. The ankle lateral collateral ligament repair and reconstruction surgical fixation system of claim 1, wherein: the positioning sleeve is used for fixing the drilling position, the embedding device is used for fixing the portal nail (1) on a ligament on the fibula side of a patient, and the nail holder is used for holding the portal nail.