CN211094531U - Puncture positioning system and accurate stereotaxic apparatus for intracranial hematoma minimally invasive puncture - Google Patents
Puncture positioning system and accurate stereotaxic apparatus for intracranial hematoma minimally invasive puncture Download PDFInfo
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- CN211094531U CN211094531U CN201921139149.2U CN201921139149U CN211094531U CN 211094531 U CN211094531 U CN 211094531U CN 201921139149 U CN201921139149 U CN 201921139149U CN 211094531 U CN211094531 U CN 211094531U
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- A61B17/34—Trocars; Puncturing needles
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Abstract
The utility model provides a precise three-dimensional positioner, which is used for intracranial hematoma minimally invasive puncture, and comprises a positioning device and a positioning belt, wherein the positioning device comprises a support frame, a sliding part and a reference rod, the support frame comprises a top plate, a bottom plate and a connecting plate, the top plate is arranged oppositely, the connecting plate is connected with the bottom plate and the top plate, and the top plate is provided with a sliding hole and an angle positioning scale mark; three first reference rod positioning holes are formed in the bottom plate along the sliding hole; three first drainage tube positioning holes are formed in the bottom plate corresponding to the three first reference rod positioning holes; the sliding part is arranged on the top plate through a bolt, and second reference rod positioning holes and second drainage tube positioning holes are formed in the sliding part at intervals; one end of the reference rod is inserted in the first reference rod positioning hole, and the reference rod penetrates through the sliding hole and the second reference rod positioning hole; the positioning belt is arranged on the supporting frame. The accurate three-dimensional positioner can improve the accuracy of puncture in intracranial hematoma minimally invasive puncture. The utility model also provides a puncture positioning system for intracranial hematoma minimally invasive puncture.
Description
Technical Field
The utility model relates to a positioner, concretely relates to puncture positioning system and accurate stereotaxic apparatus for intracranial hematoma puncture wicresoft puncture art.
Background
The cerebral apoplexy is the first cause of death of human beings at present, and is characterized by high morbidity, high mortality and high disability rate, wherein the morbidity of cerebral hemorrhage is 60-80 people/10 ten thousand per year, the cerebral hemorrhage accounts for about 20-30% of all cerebral apoplexy in China, the mortality rate in the acute stage is as high as 30-40%, and more than 30% of survivors leave functional disorders; the cerebral hemorrhage of adults in Europe and America accounts for 10% -20% of all cerebral apoplexy, and the fatality rate is 23% -52%.
Based on the limitations of large trauma and high risk of cerebral hemorrhage patients and the rapid reduction of local pressure to induce rebleeding or aggravation of edema in the craniotomy, the minimally invasive hematoma drainage method increasingly pays more attention to and is applied to the clinic. The minimally invasive hematoma drainage method generally adopts a line drawing method, an aiming method and the like to perform puncture according to the principle nearby, the puncture direction is inaccurate, the depth of a drainage tube cannot be changed, the puncture drainage is mainly performed in a local small range, hematoma is not thoroughly cleared, and furthermore, the puncture of a brainstem, a third ventricle and a fourth ventricle is dared to be performed and the puncture of a longer drainage tube is not required. Based on this, the improved soft channel stereotaxic technique is widely applied to the minimally invasive hematoma drainage method, and the technique needs the soft channel drainage tube to enter the intracranial for a long distance (about 12cm is needed for the hemorrhage in the basal ganglia region), needs accurate positioning, particularly needs accurate positioning for the drainage of the third ventricle, the fourth ventricle and the brainstem, and does not allow multiple times of puncture, otherwise, the injury is large, the effect is poor, particularly, the brainstem puncture does not allow failure. However, many years of clinical experience shows that the puncture accuracy is not high, and beginners are lower. In the operation process, the puncture tube placement position is still inaccurate, multiple times of puncture and repeated CT inspection are needed, and because no specific reference object exists, each time the tube placement is a new tube replacement process, multiple times of puncture enable operators, assistants and CT technicians to be tired, and further increase the risk of patient hemorrhage, and family members are distrusted.
SUMMERY OF THE UTILITY MODEL
Aiming at the problems of incomplete hematoma removal and difficult positioning in the improved soft channel technology in the puncture of the conventional method based on the principle of proximity, an accurate three-dimensional positioner capable of improving the puncture accuracy of the intracranial hematoma minimally invasive puncture is provided.
In order to achieve the above purpose, the utility model adopts the technical proposal that:
an accurate three-dimensional positioner is used for intracranial hematoma minimally invasive puncture, and comprises a positioning device and a positioning belt, wherein the positioning device comprises a support frame, a sliding part and a reference rod, the support frame comprises a top plate, a bottom plate and a connecting plate, the top plate and the bottom plate are arranged oppositely, and the connecting plate is connected with the bottom plate and the top plate; the top plate is provided with a sliding hole in a through mode, and angle positioning scale marks extending along the length direction of the sliding hole are further arranged on the top plate; three first reference rod positioning holes are formed in the bottom plate at intervals along the length direction of the sliding hole, and the distance between every two adjacent first reference rod positioning holes is 15 mm; three first drainage tube positioning holes are formed in the bottom plate in a penetrating mode corresponding to the three first reference rod positioning holes, and the connecting line of each first drainage tube positioning hole and the corresponding first reference rod positioning hole is perpendicular to the length direction of the sliding hole; the sliding part is arranged on the top plate through a bolt, the sliding part can be forced to move along the sliding hole when the bolt is in a loosened state, second reference rod positioning holes and second drainage tube positioning holes are formed in the sliding part at intervals, the connecting line of the second reference rod positioning holes and the second drainage tube positioning holes is perpendicular to the length direction of the sliding hole, the second reference rod positioning holes and the three first reference rod positioning holes are located in the same vertical plane and are communicated with the sliding hole, and the second drainage tube positioning holes and the three first drainage tube positioning holes are located in the same vertical plane and are used for a drainage tube to pass through; one end of the reference rod is alternatively inserted into the first reference rod positioning hole, and the reference rod penetrates through the sliding hole and the second reference rod positioning hole; the positioning strap is connected to at least one element of the top plate, the bottom plate, and the connecting plate to position the positioning device on the head of the patient.
Further, the sliding part comprises a sliding plate and a flexible gasket, the sliding plate is slidably supported on the top plate, the flexible gasket is located on the side face, opposite to the top plate, of the sliding plate, the second reference rod positioning hole penetrates through the sliding plate and the flexible gasket, the bolt comprises a screw and a nut matched with the screw, the screw penetrates through the flexible gasket, the sliding plate and the sliding hole in sequence, and the nut is screwed with the screw.
Furthermore, the top plate, the bottom plate, the connecting plate and the sliding plate are all made of transparent materials.
Furthermore, a drainage tube avoiding hole is formed in one side of the top plate in a penetrating mode and is located below the second drainage tube positioning hole and communicated with the second drainage tube positioning hole.
Furthermore, the number of the connecting plates is two, the two connecting plates are arranged oppositely, and two opposite sides of each connecting plate are respectively connected with the top plate and the bottom plate; the sliding hole and the first reference rod positioning hole are both positioned between the two connecting plates; each connecting plate is provided with a mounting hole in a through way; the positioning belt penetrates through the mounting holes in the two connecting plates and is supported on the bottom plate; and reference rod avoiding holes are also formed in the positioning belt at intervals along the direction of the sliding hole.
Further, the reference rod is made of bone material.
Furthermore, the outer wall of the reference rod is provided with a positioning line parallel to the length direction of the reference rod.
Further, positioner still includes the protractor, the protractor reaches first drainage tube locating hole is located respectively the relative both sides of support frame, the protractor with roof reaches bottom plate fixed connection, be equipped with three angular surveying scales of group on the protractor, the center of three angular surveying scales of group corresponds three first reference pole locating hole respectively to measure the inclination of reference pole respectively in three first reference pole locating hole department.
The utility model also provides another kind of accurate stereotaxic apparatus for intracranial hematoma minimal access puncture, including positioner and location area, positioner includes support frame, slider, reference pole and protractor, the support frame includes roof, bottom plate and connecting plate, the roof sets up with the bottom plate relatively, the connecting plate is connected the bottom plate and the roof; a sliding hole is formed in the top plate in a penetrating manner; three first reference rod positioning holes are formed in the bottom plate at intervals along the length direction of the sliding hole, and the distance between every two adjacent first reference rod positioning holes is 15 mm; three first drainage tube positioning holes are formed in the bottom plate in a penetrating mode corresponding to the three first reference rod positioning holes, and the connecting line of each first drainage tube positioning hole and the corresponding first reference rod positioning hole is perpendicular to the length direction of the sliding hole; the sliding part is arranged on the top plate through a bolt, the sliding part can be forced to move along the sliding hole when the bolt is in a loosened state, second reference rod positioning holes and second drainage tube positioning holes are formed in the sliding part at intervals, the connecting line of the second reference rod positioning holes and the second drainage tube positioning holes is perpendicular to the length direction of the sliding hole, the second reference rod positioning holes and the three first reference rod positioning holes are located in the same vertical plane and are communicated with the sliding hole, and the second drainage tube positioning holes and the three first drainage tube positioning holes are located in the same vertical plane and are used for a drainage tube to pass through; one end of the reference rod is alternatively inserted into the first reference rod positioning hole, and the reference rod penetrates through the sliding hole and the second reference rod positioning hole; the protractor is fixedly connected with at least one element of the top plate, the bottom plate and the connecting plate, three groups of angle measurement scales are arranged on the protractor, and the centers of the three groups of angle measurement scales respectively correspond to the three first reference rod positioning holes so as to measure the inclination angles of the reference rods at the three first reference rod positioning holes respectively; the positioning strap is connected to at least one element of the top plate, the bottom plate, and the connecting plate to position the positioning device on the head of the patient.
The utility model also provides a puncture positioning system for intracranial hematoma minimally invasive puncture, which comprises any two of the above precise three-dimensional positioners, wherein the positioning belt of one precise three-dimensional positioner is of a non-metal ring belt structure, and the positioning device of the precise three-dimensional positioner is made of non-metal materials; the positioning belt of the other accurate three-dimensional positioner is a flexible metal belt, and the length of the positioning belt is smaller than that of the non-metal endless belt.
Due to the adoption of the technical scheme, the utility model discloses following beneficial effect has:
1. according to the accurate three-dimensional positioner, the three first reference rod positioning holes are formed in the bottom plate, when the accurate three-dimensional positioner is used, the first reference rod positioning hole in the middle position is coincided with the forehead middle mark point, and at the moment, the position of the first reference rod positioning hole corresponding to the intracranial hematoma position is the actual puncture point. One end of the reference rod is inserted into a first reference rod positioning hole corresponding to the intracranial hematoma position, the reference rod is made to rotate by taking the puncture point as a center, so that the included angle between the reference rod and the plumb line is consistent with the included angle determined on the CT plane, and at the moment, the length direction of the reference rod is the puncture direction. And because the first drainage tube positioning hole corresponds to the first reference rod positioning hole, and the second drainage tube positioning hole corresponds to the second reference rod positioning hole, the connecting line of the first drainage tube positioning hole and the second drainage tube positioning hole is parallel to the reference rod, in the operation, the positioning device is translated, so that the first drainage tube positioning hole is aligned to the actual puncture point, and the drainage tube sequentially passes through the first drainage tube positioning hole and the second drainage tube positioning hole to enter the brain, thereby ensuring that the drainage tube is consistent with the puncture direction, achieving the purpose of improving the puncture accuracy rate of intracranial hematoma minimally invasive puncture, greatly reducing injury, reducing the risk of rebleeding, reducing the times of re-examination CT, and improving the efficiency and the treatment effect. The included angle between the reference rod and the plumb line can be rapidly calculated according to the angle positioning scale mark and/or the protractor, and the use is more convenient.
2. Above-mentioned intracranial hematoma wicresoft puncture art is with puncture positioning system, including two accurate stereotaxis, one of them accurate stereotaxis adopts non-metallic clitellum, for use before the art, utilizes non-metallic clitellum can be fixed in patient's head with positioner better, avoids the patient to remove and leads to positioner to shift and reduce positioning accuracy. Another accurate stereotaxic apparatus adopts shorter flexible strap, and its area occupied is little, does benefit to the disinfection in the art, avoids the area body of overlength to lead to the patient to infect, reduces the possibility of infecting in the art, and flexible strap is difficult for the lateral bending deformation, can improve the accuracy of location.
3. Above-mentioned intracranial hematoma is accurate stereotaxic ware that puncture positioning system for minimal access puncture art used before the art, its reference pole adopt the bone material to make, and the material of positioner, clitellum all does not have the metal simultaneously, has avoided the influence of metal artifact under the CT, has further improved the accuracy of location.
Drawings
Fig. 1 is a schematic structural view of a puncture positioning system for intracranial hematoma puncture minimally invasive puncture in a preferred embodiment of the present invention.
Fig. 2 is a schematic structural diagram of the precise three-dimensional positioner of fig. 1, with a protractor removed.
Fig. 3 is a schematic structural diagram of the precise three-dimensional positioner shown in fig. 2, with a positioning belt removed.
Fig. 4 is a front view of the positioning device of fig. 1.
Fig. 5 is a top view of the top plate of fig. 3.
Fig. 6 is a schematic view of the structure of the sliding plate of fig. 3.
Fig. 7 is a schematic structural view of the flexible gasket of fig. 3.
Fig. 8 is a reference diagram of a using state of the precise three-dimensional positioner according to the embodiment of the present invention.
Description of the main elements
100-puncture positioning system for intracranial hematoma minimally invasive puncture, 2, 4-accurate three-dimensional positioner, 5-positioning device, 52-support frame, 521-top plate, 523-bottom plate, 525-connecting plate, 54-sliding part, 542-sliding plate, 544-flexible gasket, 56-reference rod, 562-observation hole, 58-bolt, 582-screw, 584-nut, 6-positioning belt, 62-positioning mark, 64-limiting part, 7-sliding hole, 8-angle positioning scale line, 10-first reference rod positioning hole, 11-first drainage tube positioning hole, 12-second reference rod positioning hole, 13-second drainage tube positioning hole, 14-mounting hole, 15-reference rod avoiding hole, 16-first connecting piece, 17-a second connecting piece, 18-a drainage tube avoiding hole, 19-a positioning line, 20-a through hole, 21-a through hole, 23-an angle gauge, 232-an angle measuring scale, 234-a angle measuring plate and 200-a drainage tube.
Detailed Description
The technical solutions in the embodiments of the present invention will be described clearly and completely with reference to the accompanying drawings in the embodiments of the present invention, and it is obvious that the described embodiments are only some embodiments of the present invention, not all embodiments. Based on the embodiments in the present invention, all other embodiments obtained by a person skilled in the art without creative work belong to the protection scope of the present invention.
It will be understood that when an element is referred to as being "secured to" another element, it can be directly on the other element or intervening elements may also be present. When a component is referred to as being "connected" to another component, it can be directly connected to the other component or intervening components may also be present. When a component is referred to as being "disposed on" another component, it can be directly on the other component or intervening components may also be present. The terms "vertical," "horizontal," "left," "right," and the like as used herein are for illustrative purposes only.
Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. The terminology used in the description of the invention herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the invention. As used herein, the term "and/or" includes any and all combinations of one or more of the associated listed items.
Referring to fig. 1, a preferred embodiment of the present invention provides a puncture positioning system 100 for intracranial hematoma minimally invasive puncture, comprising two precise three-dimensional positioners 2 and 4. Of the two accurate stereotaxic devices 2 and 4, one accurate stereotaxic device 2 is used before an operation and used for adjusting the puncture angle before the operation, and the other accurate stereotaxic device 4 is used in the operation and used for providing a guide direction for puncture in the operation. The precision stereotaxic apparatus 2 does not need to be sterilized, and the precision stereotaxic apparatus 4 needs to be sterilized before use.
Referring to fig. 2 and fig. 3, the two precise three-dimensional positioners 2 and 4 each include a positioning device 5 and a positioning belt 6 connected to the positioning device 5. The positioning device 5 comprises a support frame 52, a slide 54 and a reference bar 56. The supporting frame 52 includes a top plate 521, a bottom plate 523 and a connecting plate 525, the top plate 521 is disposed opposite to the bottom plate 523, and the connecting plate 525 connects the bottom plate 523 and the top plate 521. In this embodiment, the number of the connecting plates 525 is two, two connecting plates 525 are disposed opposite to each other, and the top plate 521 and the bottom plate 523 are connected to opposite sides of each connecting plate 525. The top plate 521 is provided with a sliding hole 7 in a penetrating manner, the top plate 521 is further provided with angle positioning scale marks 8 extending along the length direction of the sliding hole 7, and the angle positioning scale marks 8 can be arranged on the top plate 5 by printing and the like. Three first reference lever positioning holes 10 are formed in the bottom plate 523 at intervals along the length direction of the sliding hole 7, and the distance between two adjacent first reference lever positioning holes 10 is 15mm, so that the positions of the first reference lever positioning holes 10 correspond to the puncture points. The first reference bar positioning hole 10 is used for positioning the reference bar 56, wherein the first reference bar positioning hole 10 in the middle position is also used for aligning with the forehead centre mark point to position the positioning device 5. While the first reference-lever positioning hole 10 is formed in a through hole shape in the present embodiment, it is understood that the first reference-lever positioning hole 10 may be formed in a blind hole shape or the like in other embodiments. Three first drainage tube positioning holes 11 are further formed in the bottom plate 523 corresponding to the three first reference rod positioning holes 10 in a penetrating manner, and a connecting line of the center of each drainage tube positioning hole 11 and the center of the corresponding first reference rod positioning hole 10 is perpendicular to the length direction of the sliding hole 7. In this embodiment, each first draft tube positioning hole 11 penetrates the top surface, the bottom surface and one of the side edges of the bottom plate 523. The sliding hole 7, the three first reference rod positioning holes 10 and the three first drainage tube positioning holes 11 are all located between the two connecting plates 525.
The slider 54 is attached to the top plate 521 by bolts 58 and can be forced to move along the slide hole 7 when the bolts 58 are in a loosened state. The sliding member 54 is provided with second reference rod positioning holes 12 and second drainage tube positioning holes 13 at intervals, a connecting line of the center of the second reference rod positioning hole 12 and the center of the second drainage tube positioning hole 13 is perpendicular to the length direction of the sliding hole 7, the second reference rod positioning hole 12 and the three first reference rod positioning holes 10 are located in the same vertical plane and are communicated with the sliding hole 7, and the second drainage tube positioning hole 13 and the three first drainage tube positioning holes 11 are located in the same vertical plane and are used for a drainage tube 200 to pass through. In the present embodiment, the slider 54 includes a sliding plate 542 and a flexible pad 544, the sliding plate 542 is slidably supported on the top plate 521, the flexible pad 544 is located on a side surface of the sliding plate 542 facing away from the top plate 521, and the second reference lever positioning hole 12 penetrates the sliding plate 542 and the flexible pad 544. Referring to fig. 4, fig. 6 and fig. 7, the bolt 58 includes a screw 582 and a nut 584 cooperating with the screw 582, the screw 582 sequentially penetrates the flexible gasket 544, the sliding plate 542 and the sliding hole 7, specifically: the flexible gasket 544 is provided with a through hole 20 in a penetrating way, and the sliding plate 542 is provided with a through hole 21 in a penetrating way; the screw 582 is inserted through the through hole 20, the through hole 21, and the slide hole 7 in this order. A nut 584 is threadably engaged with the screw 582 and is positioned on a side of the top plate 521 opposite the flexible pad 544. The flexible pad 544 is preferably made of a rubber material.
One end of the reference lever 56 is selectively inserted into the three first reference lever positioning holes 10, and the reference lever 56 passes through the slide hole 7 and the second reference lever positioning hole 12. In the present embodiment, the positioning strap 6 is mounted on the connecting plate 525 to position the positioning device 5 on the head of the patient, specifically: each connecting plate 525 is provided with a mounting hole 14 in a penetrating way; the positioning belt 6 penetrates through the mounting holes 14 on the two connecting plates 525 and is supported on the bottom plate 523; the positioning belt 6 is further provided with three reference rod avoiding holes 15 at intervals along the direction of the sliding hole 7, the reference rod avoiding holes 15 are used for allowing the reference rods 56 to pass through, and the distance between every two adjacent reference rod avoiding holes 15 is equal to the distance between every two adjacent first reference rod positioning holes 10. Referring to fig. 1 again, in the precise stereotaxic apparatus 2 used before the operation, the positioning belt 6 is a flexible belt made of a non-metal material, such as rubber. One end of the flexible belt is provided with a first connecting piece 16, the other end of the flexible belt is provided with a second connecting piece 17, and the first connecting piece 16 and the second connecting piece 17 can be detachably connected together, so that the flexible belt forms an endless belt structure surrounding the head of the patient. The first connecting member 16 and the second connecting member 17 can be a hook surface and a hair surface of a hook and loop fastener, or a male buckle and a female buckle of a hidden buckle, respectively. The positioning belt 6 of the precise stereotaxic apparatus 4 used in the operation is a flexible metal belt made of flexible metal material, and the length of the positioning belt 6 is smaller than that of the positioning belt 6 in the precise stereotaxic apparatus 2 used before the operation. The flexible metal strip is provided with positioning marks 62 for alignment with the median line at the level of the maximum haematoma. In the embodiment, the positioning belt 6 of the precise stereotaxic apparatus 4 used in the operation is preferably made of aluminum sheets, has good elastic deformation capacity, and can flexibly deform according to the radian of the brain of the patient so as to be better attached to the head of the patient; meanwhile, the aluminum sheet is not as easily bent and deformed as the rubber belt, so that the positioning mark 62 is deviated from or is not easily aligned with the median line on the hematoma maximum level. In the present embodiment, both free ends of the flexible metal strip are bent to form the stopper portions 64 to prevent the flexible metal strip from coming off the mounting hole 14.
Referring to fig. 3, in the present embodiment, a drainage tube avoiding hole 18 is further formed through one side of the top plate 521, and the drainage tube avoiding hole 18 is located below the second drainage tube positioning hole 13 and is communicated with the second drainage tube positioning hole 13. The drain clearance hole 18 is for the drainage tube 200 to pass through.
Referring to fig. 4, in the present embodiment, a positioning line 19 parallel to the length direction of the reference bar 56 is provided on the outer wall of the reference bar 56, so that the medical staff can position the reference bar 56.
In the present embodiment, the top plate 521, the bottom plate 523, the connecting plate 525, and the sliding plate 542 are made of transparent materials.
In this embodiment, the reference shaft 56 is made of a bone material, and preferably has the same diameter as the diameter of the drainage tube 200. Preferably, the reference rod 56 is made of bovine bone, so that the reference rod has high strength, is not easy to break in the machining process, is not easy to bend and deform in the using process, and can further improve the positioning accuracy. The top plate 521, the bottom plate 523, the connecting plate 525, the sliding plate 542, the bolt 58, and the like of the positioning device 5 in the precise stereotaxic apparatus 2 used before surgery are preferably made of non-metallic materials, such as plastics.
In the present embodiment, the positioning device 5 further includes a protractor 23, and the protractor 23 is fixedly connected to the top plate 521 and the bottom plate 523 by bonding or the like. Three groups of angle measurement scales 232 are arranged on the protractor 23, and the centers of the three groups of angle measurement scales 232 correspond to the three first reference rod positioning holes 10 respectively and are used for measuring the inclination angles of the reference rods 56 at the three first reference rod positioning holes 10 respectively. In this embodiment, the angle gauge 23 is formed by splicing three angle gauge plates 234, each angle gauge plate 234 is fixedly connected with the top plate 521 and the bottom plate 523 by means of bonding or the like, the plane of each angle gauge plate 234 is perpendicular to the line connecting the center of each drainage tube positioning hole 11 and the center of the corresponding first reference rod positioning hole 10, the centers of each set of angle measurement scales 232 and the center of the corresponding first reference rod positioning hole 10 and the center of the drainage tube positioning hole 11 corresponding to the first reference rod positioning hole 10 are located on the same straight line, and the zero scale line of each set of angle measurement scales 232 is perpendicular to the line connecting the first drainage tube positioning hole 11 and the corresponding first reference rod positioning hole 10. Three sets of angle measuring scales 232 are provided on the sides of the three measuring angle plates 234 facing the reference lever 56, respectively. It will be appreciated that in other embodiments, three sets of angle measurement scales 232 may be provided on the same plate.
The angle of inclination of the reference rod 56 can be measured twice by the protractor 23, and the angle of inclination can be matched with the angle positioning scale marks 8, so that the test precision of the precise three-dimensional positioners 2 and 4 can be further improved. It is understood that the protractor 23 may also be fixedly connected to other parts of the support frame 52, for example, two opposite sides of the protractor 23 may be fixedly connected to the two connecting plates 525, or the top plate 521, the bottom plate 523 and the connecting plates 525, etc., as long as the protractor 23 can be fixed to the support frame 52. In the present embodiment, the protractor 23 and the first drainage tube positioning hole 11 are respectively located at two opposite sides of the support frame 52, so that the inclination angle of the reference rod 56 can be observed, and the protractor 23 does not affect the puncturing operation of the drainage tube 200. Preferably, the protractor 23 is made of a non-metallic material, such as a transparent plastic plate.
In this embodiment, the reference rod 56 is further provided with an observation hole 562 through the reference rod, so that the medical staff can conveniently check the position of the positioning line 19 on the reference rod 56 on the angle measurement scale 232 through the observation hole 562, and the precision of angle positioning is improved.
The following briefly describes the method of use of the puncture positioning system 100 for intracranial hematoma puncture:
step S1: determination of standard plane: taking the canthus line (namely OM line) passing through the crystalline lens and the external auditory portal at two sides as a standard plane at the same time, and performing skull CT scanning at the interlayer spacing of 5mm to obtain a CT plain film;
step S2: determination of the maximum level of hematoma: marking a maximum hematoma layer on the CT plain film, calculating the distance from a standard plane (namely a skull base layer) to the maximum hematoma layer, drawing a front central line along the center of a nasal tip, a nasal root and a skull top, measuring a corresponding arc distance from the nasal root (a crystalline body position) to the maximum hematoma layer of the frontal part along the front central line, and making a frontal part mark; in the same way, the corresponding mark points of the maximum hematoma level are marked above the external auditory canals on both sides, and the three mark points (the center point of the forehead and the upper points of the external auditory canals on both sides) are connected into a plane, namely a puncture plane, which is identical with the maximum hematoma level on the CT plane. Respectively sticking 3 electrode plates on the three mark points for the purpose of rechecking CT to determine the puncture direction and the like;
step S3: and (3) determining the direction of the drainage tube in the puncture plane: marking a median line on the maximum hematoma layer of the CT plain film, marking a position 15mm beside the median of the frontal part of the hematoma side by using a ruler (the actual puncture point position is relatively fixed, the frontal puncture point position is relatively fixed, the position is flat, a drainage tube is easy to fix, the frontal sinus is avoided, and the sagittal sinus is raised), marking the position (5-10 mm away from the edge of the hematoma) of the far end of the longest axis of the maximum hematoma layer to be reached, intersecting the connecting line of the two points with the median line to obtain an included angle, and measuring the degree of the included angle by using a protractor. Steps S1-S3 are prior art and will not be described in detail herein for brevity.
Step S4: the puncture direction is determined by adjusting the accurate stereotaxic apparatus 2 used before the operation: the accurate stereotaxic apparatus 2 used before the operation is fixed on the head of a patient through the positioning belt 6, and the first reference rod positioning hole 10 located in the middle position in the accurate stereotaxic apparatus 2 used before the operation is coincided with the forehead middle mark point, at the moment, the position of the first reference rod positioning hole 10 corresponding to the position of the intracranial hematoma is the actual puncture point. Inserting one end of a reference rod 56 into one of the first reference rod positioning holes 10 according to the intracranial hematoma position (15 mm away from the anterior median hole, corresponding to 15mm lateral to the anterior median line of the forehead on the CT plain), for example, if the intracranial hematoma position is located on the left side of the midline of the brain, passing one end of the reference rod 56 through the sliding hole 7, the corresponding reference rod avoiding hole 15 on the positioning belt 6 and then inserting into the first reference rod positioning hole 10 on the left side of the midline of the forehead, and if the intracranial hematoma position is located on the right side of the midline of the brain, passing one end of the reference rod 56 through the sliding hole 7, the corresponding reference rod avoiding hole 15 on the positioning belt 6 and then inserting into the first reference rod positioning hole 10 on the right side of the midline of the forehead; if the intracranial hematoma position is deviated to the midline of the brain, one end of the reference rod 56 passes through the sliding hole 7 and the corresponding reference rod avoiding hole 15 on the positioning belt 6 in sequence and then is inserted into the first reference rod positioning hole 10 aligned with the mark point in the middle of the forehead, namely in the middle position. The other end of the reference lever 56 can be moved to adjust the inclination angle of the reference lever 56 so that the angle between the reference lever 56 and the plumb line coincides with the angle determined in step S3, which is the catheter insertion direction. The method specifically comprises the following steps: in this embodiment, the surfaces of the top plates 521 in the two puncturing positioners are provided with angle positioning scale lines 8, the arrangement of the angle positioning scale lines 8 is shown in fig. 5, three original points are arranged at intervals of the angle positioning scale lines 8, the three original points correspond to the three first reference rod positioning holes 10 respectively, and the distance between two adjacent scales in the angle positioning scale lines 8 is 1 mm. One end of the reference rod 56 is inserted into the first reference rod positioning hole 10, the free end of the reference rod 56 is moved along the sliding hole 7, and the reference rod 56 drives the sliding member 54 to move along the sliding hole 7. For every 1mm movement of the reference rod 56, i.e. one graduation, which corresponds to an angle of 2.5 ° of the reference rod 56, the reference rod 56 is moved along the sliding hole 7 by a predetermined graduation position after the included angle is measured in the CT plane, and during this process, the inclination angle of the reference rod 56 can also be determined by the protractor 23. After the reference rod 56 moves to the predetermined calibration position, the nut 584 is tightened to fix the sliding member 54 to the support frame 52, thereby preventing the positioning accuracy from being reduced due to the accidental movement of the sliding member 54 and the reference rod 56. It is to be understood that the arrangement of the angular positioning graduation marks 8 is not limited to the present embodiment, as long as it can assist the medical staff in positioning the reference lever 56 to a desired angle.
Step S5: and (3) performing standard plane CT (computed tomography) review to determine whether the mark point is correct and whether the extension line in the direction of the reference rod 56 in the accurate stereotaxic apparatus 2 used before the operation is consistent with the route and the arriving position of the drainage tube to be actually operated, if not, adjusting to be consistent to ensure that the drainage tube can be actually operated, and most of the drainage tubes can be successfully operated at one time in practice through multiple operations. After the review, the inclination angle of the reference rod 56 in the precise stereotaxic apparatus 2 used before the operation is finally determined. The tilt angle of the reference rod 56 in the precision stereotaxic apparatus 4 used during the operation is adjusted to be consistent with the tilt angle of the reference rod 56 finally determined by the precision stereotaxic apparatus 2 used before the operation.
Step S6: the accurate three-dimensional positioner 2 used before the operation is taken down from the head of a patient, the patient is disinfected and anesthetized, the accurate three-dimensional positioner 4 used in the operation is placed on the head of the patient, the first reference rod positioning hole 10 located in the middle position in the accurate three-dimensional positioner 4 used in the operation is enabled to coincide with the center mark point of the forehead, the positioning mark 62 of the positioning belt 6 is aligned with the center line on the maximum hematoma layer, the positioning device 5 is translated, the first drainage tube positioning hole 11 corresponding to the reference rod 56 is located at the actual puncture point, an assistant presses the positioning belt 6 of the accurate three-dimensional positioner used in the operation to prevent the positioning belt from moving, then the drainage tube 200 sequentially penetrates through the second drainage tube positioning hole 13 and the first drainage tube positioning hole 11 to enter the brain, and the puncture direction of the drainage tube 200 can be ensured to be consistent with the inclination angle of the reference rod 56 (fig.. Preferably, adopt the utility model discloses intracranial hematoma minimal access surgery of embodiment fixes a position with puncture positioning system 100, can also be in the aseptic piece of cloth of other parts of patient's head during the operation, as long as spill that will puncture can (traditional drawing line method, aiming method and improvement soft passageway stereotaxic method all need expose patient's whole head, lead to the patient intraoperative infection chance to increase) for it is more sanitary, reduces bacterial infection.
Frontal access is so positioned, actually the thalamic hemorrhage, cerebellar hemorrhage puncture point, fourth ventricle and brainstem are relatively fixed, the cerebral lobe hemorrhage puncture point is changeable (the hematoma position and the morphological change are changed), for example: for cerebellum, brainstem hemorrhage, fourth ventricular puncture site: a quadrilateral two-diagonal continuous midpoint is formed on the horizontal line of the occipital tuberosity, the hairline, the lateral margin of the mastoid and the posterior midline and is relatively fixed; the thalamic puncture point is 10-20mm above the tip of the ear, depending on hematoma; the positions of other cerebral hemorrhage puncture points are changed greatly, but important blood vessels and important functional areas need to be avoided, and only by fixing the puncture point position, the drainage tube direction can be determined according to the frontal approach included angle method.
In the above accurate stereotaxic apparatus 2,4, the bottom plate 523 is provided with three first reference rod positioning holes 10, when in use, the first reference rod positioning hole 10 located at the middle position is overlapped with the forehead middle mark point, and at this time, the position of the first reference rod positioning hole 10 corresponding to the intracranial hematoma position is the actual puncture point. One end of the reference rod 56 is inserted into the first reference rod positioning hole 10 corresponding to the intracranial hematoma position, and then the reference rod 56 is rotated around the puncture point, so that the included angle between the reference rod 56 and the plumb line is consistent with the included angle determined on the CT plane, and at this time, the length direction of the reference rod 56 is the puncture direction. And because the first drainage tube positioning hole 11 corresponds to the first reference rod positioning hole 10, and the second drainage tube positioning hole 13 corresponds to the second reference rod positioning hole 12, the connecting line of the first drainage tube positioning hole 11 and the second drainage tube positioning hole 13 is parallel to the reference rod 56, and the drainage tube 200 sequentially passes through the first drainage tube positioning hole 11 and the second drainage tube positioning hole 13 to enter the brain, so that the consistency of the drainage tube 200 and the puncture direction can be ensured, the aim of improving the puncture accuracy of the intracranial hematoma minimally invasive puncture is fulfilled, the injury is greatly reduced, the risk of rebleeding is reduced, the frequency of re-examining CT is reduced, and the efficiency and the treatment effect are improved. The included angle between the reference rod 56 and the plumb line can be quickly calculated according to the angle positioning scale mark 8 on the top plate 521, so that the use is more convenient.
The accurate three-dimensional positioners 2 and 4 have simple structure and small volume, and are convenient to apply to intracranial hematoma puncture.
Above-mentioned accurate stereotaxic apparatus 2,4, it includes three first reference pole locating hole 10 for this positioner 5 can carry out the puncture location to the intracranial hematoma position of different positions, reaches multi-purpose, and it is more convenient to use.
The puncture positioning system 100 for the intracranial hematoma minimally invasive puncture adopts two accurate three-dimensional positioners 2 and 4 aiming at the condition that preoperative equipment does not need to be disinfected and intraoperative equipment needs to be disinfected, wherein one accurate three-dimensional positioner 2 adopts an annular belt structure made of non-metallic materials, and for preoperative use, the positioning belt 6 adopting the non-metallic annular belt structure can better fix the positioning device 5 on the head of a patient, so that the positioning device 5 is prevented from shifting due to the movement of the patient and the positioning precision is reduced; and the ring belt structure made of non-metal materials can avoid the influence of metal artifacts under CT, thereby being convenient for CT reexamination. The other accurate three-dimensional positioner 4 is made of a short flexible metal belt, the occupied area is small, the sterilization in the operation is facilitated, the positioning belt 6 is made of a flexible metal material, and the deformation of the positioning belt in the sterilization process cannot occur easily like a rubber material.
Above-mentioned intracranial hematoma wicresoft puncture is with puncture positioning system 100, reference pole 56 in accurate stereotaxic locator 2,4 adopts the bone material to make, adopts positioner 5, the material of location area 6 in the accurate stereotaxic locator 2 all to have no metal before the art simultaneously, has avoided the influence of metal artifact under the CT, and the CT of being convenient for is reexamined, has further improved the accuracy of location.
In the puncture positioning system 100 for intracranial hematoma minimally invasive puncture, the reference rod 56 is provided with the positioning line 19 parallel to the length direction of the reference rod 56, and the medical staff can conveniently judge the moving distance of the reference rod 56 along the sliding hole 7 by using the positioning line 19. The accurate stereotaxic apparatus 4 used in the operation is provided with a positioning mark 62 on a positioning belt 6, and is used for aligning with a median line on the maximum hematoma layer in the operation so as to further improve the positioning accuracy of the positioning device 5.
In the puncture positioning system 100 for intracranial hematoma minimally invasive puncture, the sliding member 54 further includes a flexible pad 544, and the friction between the flexible pad 544 and the reference rod 56 can be increased, so as to better fix the reference rod 56. In the puncture positioning system 100 for intracranial hematoma minimally invasive puncture, the reference rod 56 can change the angle to adapt to different puncture parts, so that the most satisfactory effect is achieved; the support frame 52 and the sliding plate 542 are made of transparent materials, so that the position and direction of the puncture point and the condition of the reference rod 56 can be seen, and timely adjustment is facilitated.
Compared with the positioning mode that repeated puncture and poor tube placing position are needed to cause repeated damage, bleeding risks are increased, and the hematoma removing effect is affected, the accurate three-dimensional positioning devices 2 and 4 improve the puncture success rate, improve the working efficiency, more importantly, reduce the risk of re-bleeding, ensure the key step of removing and draining hematoma, provide possibility for saving life better, save time and energy of operators, save the cost of repeated CT check and the like.
Because the bleeding of the basal ganglia is the most common, the bleeding accounts for 50% -60% of the cerebral hemorrhage, the bleeding of the thalamus accounts for 10% -15%, the bleeding of the thalamus accounts for about 70% of the cerebral hemorrhage, the accurate three-dimensional positioners 2 and 4 are the most adept to position the two positions, and other positions have no problem, so that the puncture problem of most cerebral hemorrhage patients is solved.
It will be appreciated that the positioning strap 6 may be connected to other portions of the support frame 52, such as the connecting plate 525 and/or the bottom plate 523 and/or the top plate 521, as long as the positioning strap 6 can be connected to the support frame 52 and the positioning device 5 can be positioned on the head of the patient by using the positioning strap 6.
It is to be understood that the number of the connecting plates 525 is not limited to two in the present embodiment, and may be one or two or more, as long as the top plate 521 and the bottom plate 523 can be connected.
It will be appreciated that in other embodiments, the angular positioning scale 8 may be omitted and the angle of inclination of the reference bar 56 may be measured using the protractor 23 only.
The above description is for the detailed description of the preferred possible embodiments of the present invention, but the embodiments are not intended to limit the scope of the present invention, and all equivalent changes or modifications accomplished under the technical spirit suggested by the present invention should fall within the scope of the present invention.
Claims (10)
1. The utility model provides an accurate stereotaxic apparatus for intracranial hematoma wicresoft puncture art which characterized in that: the positioning device comprises a supporting frame, a sliding part and a reference rod, wherein the supporting frame comprises a top plate, a bottom plate and a connecting plate, the top plate and the bottom plate are arranged oppositely, and the connecting plate is connected with the bottom plate and the top plate; the top plate is provided with a sliding hole in a through mode, and angle positioning scale marks extending along the length direction of the sliding hole are further arranged on the top plate; three first reference rod positioning holes are formed in the bottom plate at intervals along the length direction of the sliding hole, and the distance between every two adjacent first reference rod positioning holes is 15 mm; three first drainage tube positioning holes are formed in the bottom plate in a penetrating mode corresponding to the three first reference rod positioning holes, and the connecting line of each first drainage tube positioning hole and the corresponding first reference rod positioning hole is perpendicular to the length direction of the sliding hole; the sliding part is arranged on the top plate through a bolt, the sliding part can be forced to move along the sliding hole when the bolt is in a loosened state, second reference rod positioning holes and second drainage tube positioning holes are formed in the sliding part at intervals, the connecting line of the second reference rod positioning holes and the second drainage tube positioning holes is perpendicular to the length direction of the sliding hole, the second reference rod positioning holes and the three first reference rod positioning holes are located in the same vertical plane and are communicated with the sliding hole, and the second drainage tube positioning holes and the three first drainage tube positioning holes are located in the same vertical plane and are used for a drainage tube to pass through; one end of the reference rod is alternatively inserted into the first reference rod positioning hole, and the reference rod penetrates through the sliding hole and the second reference rod positioning hole; the positioning strap is connected to at least one element of the top plate, the bottom plate, and the connecting plate to position the positioning device on the head of the patient.
2. The precision stereotaxic apparatus according to claim 1, wherein: the sliding part comprises a sliding plate and a flexible gasket, the sliding plate is slidably supported on the top plate, the flexible gasket is located on the side face, opposite to the top plate, of the sliding plate, the second reference rod positioning hole penetrates through the sliding plate and the flexible gasket, the bolt comprises a screw and a nut matched with the screw, the screw penetrates through the flexible gasket, the sliding plate and the sliding hole in sequence, and the nut is screwed with the screw.
3. The accurate stereotaxic apparatus according to claim 2, wherein: the top plate, the bottom plate, the connecting plate and the sliding plate are all made of transparent materials.
4. The precision stereotaxic apparatus according to claim 1, wherein: and a drainage tube avoiding hole is further formed in one side of the top plate in a penetrating mode, is positioned below the second drainage tube positioning hole and is communicated with the second drainage tube positioning hole.
5. The precision stereotaxic apparatus according to claim 1, wherein: the number of the connecting plates is two, the two connecting plates are arranged oppositely, and two opposite sides of each connecting plate are respectively connected with the top plate and the bottom plate; the sliding hole and the first reference rod positioning hole are both positioned between the two connecting plates; each connecting plate is provided with a mounting hole in a through way; the positioning belt penetrates through the mounting holes in the two connecting plates and is supported on the bottom plate; and reference rod avoiding holes are also formed in the positioning belt at intervals along the direction of the sliding hole.
6. The precision stereotaxic apparatus according to claim 1, wherein: the reference rod is made of bone material.
7. The precision stereotaxic apparatus according to claim 1, wherein: and the outer wall of the reference rod is provided with a positioning line parallel to the length direction of the reference rod.
8. The precision stereotaxic apparatus according to claim 1, wherein: the positioning device further comprises a protractor, the protractor and the first drainage tube positioning holes are respectively located on two opposite sides of the support frame, the protractor is fixedly connected with the top plate and the bottom plate, three groups of angle measurement scales are arranged on the protractor, and centers of the three groups of angle measurement scales respectively correspond to the three first reference rod positioning holes so as to measure inclination angles of the reference rods respectively at the three first reference rod positioning holes.
9. The utility model provides an accurate stereotaxic apparatus for intracranial hematoma wicresoft puncture art which characterized in that: the positioning device comprises a supporting frame, a sliding part, a reference rod and a protractor, wherein the supporting frame comprises a top plate, a bottom plate and a connecting plate; a sliding hole is formed in the top plate in a penetrating manner; three first reference rod positioning holes are formed in the bottom plate at intervals along the length direction of the sliding hole, and the distance between every two adjacent first reference rod positioning holes is 15 mm; three first drainage tube positioning holes are formed in the bottom plate in a penetrating mode corresponding to the three first reference rod positioning holes, and the connecting line of each first drainage tube positioning hole and the corresponding first reference rod positioning hole is perpendicular to the length direction of the sliding hole; the sliding part is arranged on the top plate through a bolt, the sliding part can be forced to move along the sliding hole when the bolt is in a loosened state, second reference rod positioning holes and second drainage tube positioning holes are formed in the sliding part at intervals, the connecting line of the second reference rod positioning holes and the second drainage tube positioning holes is perpendicular to the length direction of the sliding hole, the second reference rod positioning holes and the three first reference rod positioning holes are located in the same vertical plane and are communicated with the sliding hole, and the second drainage tube positioning holes and the three first drainage tube positioning holes are located in the same vertical plane and are used for a drainage tube to pass through; one end of the reference rod is alternatively inserted into the first reference rod positioning hole, and the reference rod penetrates through the sliding hole and the second reference rod positioning hole; the protractor is fixedly connected with at least one element of the top plate, the bottom plate and the connecting plate, three groups of angle measurement scales are arranged on the protractor, and the centers of the three groups of angle measurement scales respectively correspond to the three first reference rod positioning holes so as to measure the inclination angles of the reference rods at the three first reference rod positioning holes respectively; the positioning strap is connected to at least one element of the top plate, the bottom plate, and the connecting plate to position the positioning device on the head of the patient.
10. The utility model provides an intracranial hematoma puncture positioning system for wicresoft's puncture technique which characterized in that: the three-dimensional precision positioner comprises two precision three-dimensional positioners as claimed in any one of claims 1 to 9, wherein the positioning belt of one precision three-dimensional positioner is of a non-metal belt structure, and the positioning device of the precision three-dimensional positioner is made of a non-metal material; the positioning belt of the other accurate three-dimensional positioner is a flexible metal belt, and the length of the positioning belt is smaller than that of the non-metal endless belt.
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| CN201811145107X | 2018-09-29 | ||
| CN201811145107.XA CN109091214A (en) | 2018-09-29 | 2018-09-29 | Intracranial hematoma Minimally invasive puncture Needle localization system and accurate stereotaxic apparatus |
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| CN211094531U true CN211094531U (en) | 2020-07-28 |
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| CN201811145107.XA Withdrawn CN109091214A (en) | 2018-09-29 | 2018-09-29 | Intracranial hematoma Minimally invasive puncture Needle localization system and accurate stereotaxic apparatus |
| CN201910652968.5A Pending CN110192915A (en) | 2018-09-29 | 2019-07-19 | Intracranial hematoma Minimally invasive puncture Needle localization system and accurate stereotaxic apparatus |
| CN201921139149.2U Active CN211094531U (en) | 2018-09-29 | 2019-07-19 | Puncture positioning system and accurate stereotaxic apparatus for intracranial hematoma minimally invasive puncture |
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| CN201910652968.5A Pending CN110192915A (en) | 2018-09-29 | 2019-07-19 | Intracranial hematoma Minimally invasive puncture Needle localization system and accurate stereotaxic apparatus |
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| CN110192915A (en) * | 2018-09-29 | 2019-09-03 | 刘国军 | Intracranial hematoma Minimally invasive puncture Needle localization system and accurate stereotaxic apparatus |
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| Publication number | Priority date | Publication date | Assignee | Title |
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| US20220054219A1 (en) * | 2019-04-24 | 2022-02-24 | Fundacion Abood Shaio En Reestructuracion | Guide and support for performing craniofacial punctions |
| CN111166436B (en) * | 2020-02-12 | 2022-12-06 | 刘增辉 | Orienter for craniocerebral puncture |
| CN112006756B (en) * | 2020-08-12 | 2022-05-31 | 云南省中医医院(云南中医药大学第一附属医院) | Intervertebral foramen mirror channel guide module and using method thereof |
| CN112022501A (en) * | 2020-09-23 | 2020-12-04 | 中国人民解放军32298部队 | Mark appearance convenient to ophthalmic surgery uses |
| CN113729942B (en) * | 2021-10-08 | 2023-03-24 | 重庆市急救医疗中心 | Hematoma removing equipment intelligent positioning device and navigation system based on mixed reality technology |
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| Publication number | Priority date | Publication date | Assignee | Title |
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| KR101489440B1 (en) * | 2013-12-20 | 2015-02-03 | 경북대학교 산학협력단 | Guiding protractor system using leveler for accurate ventriculostomy |
| CN204410966U (en) * | 2014-07-21 | 2015-06-24 | 何承彪 | The three-dimensional guider of intracranial hematoma Wicresoft |
| CN204092126U (en) * | 2014-09-30 | 2015-01-14 | 舞阳县中心医院 | A kind of intracerebral hematoma soft passage microtrauma puncture position finder |
| KR101638055B1 (en) * | 2014-12-31 | 2016-07-08 | 주식회사 아모그린텍 | Guide apparatus for puncturing a injection needle |
| US10682156B2 (en) * | 2015-05-28 | 2020-06-16 | Akm A. Rahman | Angle-guidance device and method for CT guided drainage and biopsy procedures |
| CN105832427B (en) * | 2016-03-18 | 2019-01-18 | 南京鼓楼医院 | The external laser alignment guidance system of intracranial hematoma microscopic wound dissection and localization method |
| CN109091214A (en) * | 2018-09-29 | 2018-12-28 | 刘国军 | Intracranial hematoma Minimally invasive puncture Needle localization system and accurate stereotaxic apparatus |
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2018
- 2018-09-29 CN CN201811145107.XA patent/CN109091214A/en not_active Withdrawn
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- 2019-07-19 CN CN201910652968.5A patent/CN110192915A/en active Pending
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| CN110192915A (en) * | 2018-09-29 | 2019-09-03 | 刘国军 | Intracranial hematoma Minimally invasive puncture Needle localization system and accurate stereotaxic apparatus |
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| CN109091214A (en) | 2018-12-28 |
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