Navigation device for cortical bone screw in spinal minimally invasive surgery
Technical Field
The utility model relates to the technical field of medical equipment, concretely relates to a navigation head that is arranged in backbone minimal access surgery cortical bone screw.
Background
When the vertebral fracture of an osteoporosis patient needs to be reset and the stability and the fusion rate need to be improved after lumbar decompression fusion, an internal spinal fixing device is often required to be added, and a cortical bone screw passes through three layers of cortex to enhance the holding force of the screw and reduce the exposure of the soft tissues beside the vertebra. The minimally invasive cortical bone screw operation of spinal percutaneous puncture is to put several positioning needles into the small incision in the center of the spinous process, and put the screws into the vertebral body, without putting the percutaneous pedicle screws into the small incisions on the two sides of the spinous process, thus avoiding the skin incision and subcutaneous injury caused by the traditional percutaneous pedicle screw bilateral placement, and having the advantages of less incision, less bleeding, beautiful appearance, quick recovery and the like. However, the existing cortical bone screw positioner fully exposes soft tissues around the spinous process, not only has poor positioning precision, but also has tedious assembly, long time consumption and inconvenient use.
SUMMERY OF THE UTILITY MODEL
An object of the utility model is to provide a navigation head for cortical bone screw among backbone minimal access surgery for solve present cortical bone screw locator positioning accuracy nature poor and use inconvenient scheduling problem.
The utility model provides a navigation device for cortical bone screw in spinal minimally invasive surgery, which comprises a spinous process clamp, a positioning square tube, a kirschner wire, a navigation control device, a screw sleeve and an arc protractor, wherein the spinous process clamp comprises two spinous process clamping pieces which are pivoted with the positioning square tube; the Kirschner wire is arranged in the positioning square tube in a penetrating manner, and the bottom of the Kirschner wire is arranged in the spinous process clamp in a penetrating manner; the navigation control device is arranged on the positioning square tube in a sliding mode, a height scribing line is marked on the positioning square tube, and the navigation control device can adjust the height on the positioning square tube according to the height scribing line; the navigation control device comprises a screw sleeve clamp capable of being adjusted in a rotating mode, and the screw sleeve penetrates through the screw sleeve clamp; the arc protractor is arranged at the upper end of the screw sleeve, a zero-degree datum line is arranged on the side face of the height scribing line of the positioning square pipe, and the arc protractor is parallel to the side face where the zero-degree datum line of the positioning square pipe is located.
Preferably, the back end of the spinous process clamping piece is provided with a spinous process clamping lug, and the two spinous process clamping pieces are pivoted with the two sides of the bottom of the positioning square tube through the spinous process clamping lugs.
Preferably, an angle groove is arranged on the spinous process clamping ear of at least one of the two spinous process clamping pieces.
Preferably, the navigation control device further comprises a positioning pipe clamp, a positioning pipe clamp screw button and a connecting sleeve, wherein the positioning pipe clamp is sleeved on the positioning square pipe in a vertically sliding manner; the positioning pipe clamp is characterized in that threaded holes and connecting sleeve holes are respectively formed in two ends of the positioning pipe clamp, a screw rod is arranged at the inner end of a positioning pipe clamp screw button, and the screw rod of the positioning pipe clamp screw button rotates in the threaded hole of the positioning pipe clamp until the screw rod of the positioning pipe clamp screw button locks the positioning square pipe; the screw sleeve presss from both sides with pass through between the square pipe of location the adapter sleeve is connected, the adapter sleeve hole is the smooth circular port of inner wall, the outer wall of adapter sleeve is cylindrical, be equipped with the screw thread on the inner wall of adapter sleeve, the adapter sleeve can rotate install in the adapter sleeve of location pipe clamp is downthehole, the screw rod end of screw sleeve clamp with the adapter sleeve passes through threaded connection.
Preferably, the navigation control device further comprises a screw sleeve clamping screw button, a screw sleeve perforation is arranged in the screw sleeve clamp, the screw sleeve penetrates through the screw sleeve perforation of the screw sleeve clamp, a screw rod is arranged at the inner end of the screw sleeve clamping screw button, the screw rod of the screw sleeve clamping screw button can rotate in the threaded hole of the screw sleeve clamp until the screw rod of the screw sleeve clamping screw button is locked by the screw sleeve.
Preferably, the screw sleeve clamp is provided with a notch along the thread direction, and the width of the notch is 1.5 mm.
Preferably, the outer contour of the cross section of the positioning square pipe is rectangular, and the inner contour of the cross section of the positioning pipe clamp is rectangular.
Preferably, a rotation angle value is arranged on the arc protractor, and the rotation angle value range is-45 degrees to 45 degrees.
The utility model has the advantages that:
the utility model discloses a navigation head for cortical bone screw among backbone minimal access surgery, with the spinous process clamp as the base of stabilizing the ke shi needle, make the safe effectual puncture of ke shi needle advance in the spinous process sclerotin, location side pipe, the direction regulation of three dimension has been realized in navigation control device and the combination of screw sleeve, the accuracy of putting the nail and the repeatability of putting the nail have been improved, can prevent cortical bone screw because the lumbar vertebrae isthmus special anatomical position and the offset of location, the destruction of the musculature and the centrum isthmus around the spinous process has been avoided, muscle has been protected, the bone tissue structure, reduce the peeling off of vertebra paraspinal muscle, it is not good to have avoided the maloperation in the art and cause cortical bone screw position, the maneuverability that percutaneous cortical bone screw put into has been guaranteed. In addition, the assembly and the disassembly are very convenient, the operation time is shortened, the operability and the practicability are greatly improved, the reusability of the device can be improved, and the operation cost is saved.
Drawings
Fig. 1 is a front view of a navigation device provided in embodiment 1 of the present invention;
fig. 2 is a rear view of a navigation device provided in embodiment 1 of the present invention;
fig. 3 is an exploded view of a navigation device according to embodiment 1 of the present invention.
Detailed Description
The following examples are intended to illustrate the invention, but are not intended to limit the scope of the invention.
In the description of the embodiments of the present invention, it should be noted that the terms "left" and "right" are the orientation or position relationship described based on the drawings, and the purpose is for convenience of description of the present invention. The terms "first", "second", etc. are used for descriptive purposes and are not to be construed as indicating or implying relative importance or implicitly indicating the number of technical features indicated.
It should be noted that "anterior" in the embodiments refers to a direction toward the spine, and "posterior" refers to a direction away from the spine.
Example 1
Embodiment 1 provides a navigation device for a cortical bone screw in minimally invasive spine surgery, and the structure thereof is described in detail below.
Referring to fig. 1, the positioning device for cortical bone screws in minimally invasive spine surgery comprises a spinous process clamp 1, a positioning square tube 2, a kirschner wire 3, a navigation control device 4, a screw sleeve 5 and an arc protractor 6.
The spinous process clamp 1 comprises two spinous process clamping pieces, each spinous process clamping piece is an arc piece with a sharp head end and a wide tail end, the two spinous process clamping pieces are parallel to each other and fixedly connected through a transverse piece, a spinous process clamping lug 11 is arranged at the rear end of each spinous process clamping piece, a through hole is formed in each spinous process clamping lug 11, two through holes are symmetrically formed in two sides of the bottom of the positioning square tube 2, a pivot 21 is respectively inserted into the through holes in the two spinous process clamping lugs 11 and the through holes in two sides of the bottom of the positioning square tube 2, and the spinous process clamp 1 is pivotally connected with; an angle groove 12 is arranged on the spinous process clamping ear 11 of at least one of the spinous processes.
Firstly, preoperative imaging measurement is carried out, then the height is determined according to the result and the height groove 20 of the positioning square tube 2 is combined, the spinous process clamping ear 11 is used for positioning, and a positioning pin, namely the kirschner pin 3, of the cortical bone is placed into the upper end of the positioning square tube 2.
The kirschner wire 3 is arranged in the positioning square tube 2 in a penetrating way, and the bottom of the kirschner wire 3 passes through the pivot 21 and reaches the inside of the spinous process clamp 1.
The navigation control device 4 is slidably arranged on the positioning square tube 2 and can adjust the height of the positioning square tube 2.
Specifically, the navigation control device 4 includes a pilot tube clamp 41, a pilot tube clamp knob 42, a screw sleeve clamp 43, a screw sleeve clamp knob 44, and a connection sleeve 45.
In order to improve the stability of the sleeving, the outer contour of the cross section of the positioning square tube 2 is rectangular, the inner contour of the cross section of the positioning pipe clamp 41 is rectangular, and the positioning pipe clamp 41 is sleeved on the positioning square tube 2 in a vertically sliding manner.
Two ends of the positioning pipe clamp 41 are respectively provided with a threaded hole and a connecting sleeve hole, the inner end of the positioning pipe clamp screw button 42 is provided with a screw rod, and the screw rod of the positioning pipe clamp screw button 42 rotates in the threaded hole of the positioning pipe clamp 41 until the screw rod of the positioning pipe clamp screw button 42 locks the positioning square pipe 2; the connecting sleeve hole is a circular hole with a smooth inner wall, and the positioning square tube 2 is marked with a height scale line 20.
The two ends of the screw sleeve clamp 43 are respectively provided with a screw rod and a threaded hole,
the screw sleeve clamp 43 is connected with the positioning square tube 2 through a connecting sleeve 45, the outer wall of the connecting sleeve 45 is cylindrical, threads are arranged on the inner wall of the connecting sleeve 45, the connecting sleeve 45 can be rotatably arranged in a connecting sleeve hole of the positioning tube clamp 41, and the screw end of the screw sleeve clamp 43 is in threaded connection with the connecting sleeve 45.
The screw sleeve clamp 43 is internally provided with a screw sleeve through hole 430, the screw sleeve 5 is arranged on the screw sleeve through hole 430 of the screw sleeve clamp 43 in a penetrating manner, the inner end of the screw sleeve clamp screw button 44 is provided with a screw rod, and the screw rod of the screw sleeve clamp screw button 44 can rotate in the threaded hole of the screw sleeve clamp 43 until the screw rod of the screw sleeve clamp screw button 44 locks the screw sleeve 5.
In order to facilitate the kirschner wire 3 implanted in the pedicle to escape from the screw sleeve clamp 43, a gap 431 is preferably formed in the screw sleeve clamp 43 along the thread direction, and the width of the gap 431 is 1.5 mm.
A zero degree reference line 21 is provided on a side surface of the height scale line 20 of the positioning square tube 2, and preferably, two zero degree reference lines 21 are provided on two side surfaces of the height scale line 20 of the positioning square tube 2, respectively.
The arc protractor 6 is arranged at the upper end of the screw sleeve 5 and is parallel to the side face where the zero-degree reference line 21 of the positioning square tube 2 is located, and a rotation angle value is arranged on the arc protractor 6 and ranges from minus 45 degrees to 45 degrees.
The spinous process clamp 1 is used for clamping the spinous process on the spine and also used as a base for stabilizing the Kirschner wire 3;
the spinous process clamp 1 is pivotally connected with the positioning square tube 2, so that the positioning square tube 2 can rotate in the left-right direction conveniently;
the kirschner wire 3 is used for penetrating through the positioning square tube 2 and puncturing into spinous process sclerotin, and restricts the movement of the upper kirschner wire 3 along the axial direction of the spine;
the positioning pipe clamp 41 can be sleeved on the positioning square pipe 2 according to the height requirement, so that the vertical height direction control in the fixing process of the cortical bone screw is facilitated, wherein the height scale line 20 is used for reading the height value of the navigation control device 4;
because the connecting sleeve 45 can be rotatably arranged in the connecting sleeve hole of the positioning pipe clamp 41, the screw sleeve clamp 43 in threaded connection with the connecting sleeve 45 can also rotate back and forth along the axis of the navigation control device 4 along with the back and forth rotation process of the screw sleeve 5, and the rotation angle value is used for reading the rotation angle of the screw sleeve clamp 43;
the screw sleeve 5 is used for penetrating the cortical bone screw positioning pin.
Example 2
Embodiment 2 provides a method for using the navigation device for the cortical bone screw in the minimally invasive spine surgery, which adopts the navigation device for the cortical bone screw in the minimally invasive spine surgery provided in embodiment 1, and the method for using the navigation device comprises the following steps:
step S1: the spinous process clamp 1 clamps the spinous process on the spine;
step S2: the positioning square tube 2 is rotated left and right along the pivot 21 until a proper angle is selected, and the rotation angle is determined through the angle scribing line 12;
the determination method of the proper angle comprises the following steps: firstly, performing preoperative CT image analysis; secondly, carrying out intraoperative debugging according to an analysis result, specifically, selecting an angle according to an angle between a preoperative CT sagittal position planning Kirschner wire 3 positioning line and a vertebral body upper end plate line, and finely adjusting the positioning direction of the Kirschner wire 3 through an intraoperative lumbar vertebra lateral X-ray sheet.
Step S3: the kirschner wire 3 passes through the positioning square tube 2, passes through the spinous process clamp 1 and penetrates into the spinous process of the spine;
step S4: sliding the navigation control device 4 up and down along the positioning square tube 2 until reaching a proper height scale;
the determination method of the proper height comprises the following steps:
firstly, performing preoperative CT image analysis, wherein the height determination is to plan a trajectory line of the transpedicular cortical bone screw nail from inside to outside according to a preoperative CT axial position, the trajectory line is a certain angle range and is generally 15-30 degrees, a screw actual edge line with the width of a screw tail cap is reserved on the trajectory line, meanwhile, the edge line is prevented from contacting with a spinous process, and the distance from the trajectory line and the focus of a spinous process positioning rod to the spinous process bone surface is the height;
and secondly, carrying out intraoperative debugging according to the analysis result, specifically, determining the height to avoid contacting the shortest height of the spinous process in the nail placing process of the cortical bone screw planned according to the preoperative CT axis, and simultaneously, immediately adjusting the height through the exposed anatomical form of the spinous process in the operation, wherein the exposed anatomical form of the spinous process can adjust the height of the navigation control device according to the preoperative CT planned height under direct vision.
Step S5: inserting the kirschner wire 3 into the screw sleeve 5, and implanting the kirschner wire 3 into the first vertebral pedicle;
step S6: loosening the screw sleeve 5 by rotating the screw sleeve clamping button 44, and withdrawing the screw sleeve 5 to fix the bottom of the Kirschner wire 3 on the first pedicle of vertebral arch;
step S7: slightly poking the upper part of the kirschner wire 3 retained on the first pedicle of vertebral arch to make the kirschner wire 3 fall out from the gap 431 of the screw sleeve clamp 43;
step S8: rotating the screw sleeve clamp 43 until the screw sleeve through hole 430 of the screw sleeve clamp 43 is symmetrical with the screw sleeve through hole 430 of the screw sleeve clamp 43 where the first k-wire 3 is implanted into the first pedicle, inserting the screw sleeve 5 from the screw sleeve through hole 430, and fixing the screw sleeve 5 by rotating the screw sleeve clamp knob 44;
step S9: repeating the step S5, and implanting the Kirschner wire 3 into the second pedicle of vertebral arch;
step S10: repeating the step S6 to fix the bottom of the Kirschner wire 3 on the second pedicle;
step S11: the kirschner wire 3 and the spinous process clamp 1 in the positioning square tube 2 are sequentially pulled out.
Although the invention has been described in detail with respect to the general description and the specific embodiments, it will be apparent to those skilled in the art that modifications and improvements can be made based on the invention. Therefore, such modifications and improvements are intended to be within the scope of the invention as claimed.