CN212234641U - Percutaneous minimally invasive in-vitro reduction integrated device for vertebral fracture - Google Patents

Abstract

The utility model discloses a percutaneous minimally invasive in-vitro reduction integrated device for vertebral fracture, which comprises a track, a reduction arm, a hollow screw sleeve and an elongated hollow screw; the track is provided with length scales; the reset arm is connected with the track and the lengthened hollow screw sleeve, the lengthened hollow screw is sleeved in the hollow screw sleeve, and the far end of the lengthened hollow screw is designed into a spiral blade or a thread. The device combines the advantage that the internal fixation and reduction effect is good in the traditional thoracolumbar fracture incision reduction and the advantage that the PKP or PVP operation can relieve pain instantly and rebuild the stability of the injured vertebra rapidly, and achieves the effects of correcting the physiological curvature of the spine well, relieving pain and recovering the function of the spine on the premise of minimally invasive, simple, safe and effective operation.

Description

Percutaneous minimally invasive in-vitro reduction integrated device for vertebral fracture

Technical Field

The utility model relates to the technical field of medical equipment, concretely relates to centrum fracture percutaneous minimally invasive external reduction integrated device.

Background

With the aging population and lifestyle changes, osteoporosis has become a globally recognized public health problem, being the chronic disease ranked 6 worldwide. At present, the number of osteoporosis patients in China is over 2 hundred million, Osteoporotic Vertebral Compression Fractures (OVCFs) are the most common complications of osteoporosis, the incidence rate of the osteoporosis is increased year by year, and 5000 ten thousand cases are predicted in 2020. OVCF causes vertebral body collapse and spinal deformation, induces a series of spinal biomechanical changes and even causes nerve damage^[1-2]. OVCF has become an important problem threatening the survival status of elderly patients, presenting an unprecedented challenge to clinicians^[3]。

Percutaneous Vertebroplasty (PVP) and Percutaneous Kyphoplasty (PKP) are important means of treating OVCF. PVP is percutaneous puncture, a pedicle of vertebral arch channel is established, and bone cement is injected into a vertebral body through the channel; the PKP is that a saccule which can be expanded is arranged in a vertebral body through a pedicle channel, and the fracture is reduced by the distraction of the saccule. The compressed vertebral body is withdrawn from the saccule after satisfactory reduction, then bone cement is injected into the vertebral body, and finally the local stability of the vertebral body fracture is obtained^[4-5]. Professor Garfin president of North American spine association was written in 2001, and the OVCF minimally invasive surgery method can relieve the pain of the waist and the back of a patient by 95 percent and improve the life quality of the patient, which cannot be achieved by the traditional treatment means^[6]。

Previous studies show that the kyphosis is closely related to the survival of patients, excessive kyphosis is a potential risk factor for shortening the life expectancy of the old, and the relevance can be related to the kyphosisIs increased and enhanced^[7]. The principle of PVP and PKP product design is to reposition a compressed fractured vertebral body using postural repositioning or intraoperative dilation with a balloon placed into the vertebral body. In PVP and PKP operations, it is found that the vertebral body with more serious partial compression can not be effectively reduced, and the obvious kyphosis deformity of the spine still exists after the operation. The imbalance of the biological force lines of the spine can lead to a number of complications: for example, the height of the vertebral body is continuously lost after operation, the vertebral body is easy to fall down to induce secondary osteoporosis fracture, intractable chest, waist and back pain, lung hypofunction, digestive system abnormality, pain of hip and knee joint of lower limb and the like^[8]Part of the patient thus even needs to be operated again^[9]. Bone cement leakage is a common complication of PVP and PKP surgery. When bone cement is injected into vertebral body, it must have a certain fluidity, and when it is stressed, the bone cement can flow into fracture gap and nerve vein cluster region of bone defect region to produce leakage^[10]. Disruption of the posterior wall structure will directly affect the procedure, since the chance of leakage in the spinal canal is greatly increased when injecting bone cement for PVP or PKP procedures, which is classified in some literature as a contraindication for vertebroplasty^[11]。

The traditional spine fracture surgical treatment mode is incision reduction, reduction and fixation through internal fixation. The reduction of the vertebral pedicle by using the intact ligaments around the vertebral body ensures the good reduction effect of the fracture in clinic^[12]. However, such surgery is highly traumatic, long, bleeding, and slow to recover after surgery, whereas OVCF is often an elderly patient with complicated and serious medical conditions, and many patients cannot tolerate traditional open internal fixation surgery. After serious osteoporosis internal fixation, there may be adverse consequences such as internal fixation loosening, fracture, and displacement, so that some patients have to face the next operation^[13]. Therefore, there are fewer and fewer clinical reports of conventional open reduction internal fixation surgical treatment of OVCF.

In conclusion, the main direction for solving the above problems is to explore a treatment method for OVCF surgical treatment with minimal trauma, simple operation, good fracture reduction, safety, reliability and definite curative effect.

Reference documents:

1. chenhao, Yang Huilin, etc. the thinking of diagnosis and treatment of osteoporotic vertebral compression fracture [ J ] Chinese trauma journal of orthopedics, 2019,21(4): 366-.

2. Yang Huilin, Liu Qiang, etc. osteoporosis resistant vertebral body compression fracture patients commonly recognized by osteoporosis resistant standard therapist [ J ] China medical journal, 2018,98(11): 803-.

3.Wang G,Yang H,Chen K.Osteoporotic vertebral compression fractures with intravertebral cleft treated by percutaneous balloon kyphoplasty[J].J Bone Joint Surg Br,2010,92(11):1553-1557.

4.Lee JH,Lee DO,Lee JH,et al.Comparison of radiological and clinical results of balloon kyphoplasty according to anterior height loss in the osteoporotic vertebral fracture[J].Spine,2014,14(10):2281-2289.

5.Maestretti G,Sutter P,Monnard E,et al.A prospective study of percutaneous balloon kyphoplasty with calcium phosphatecement in traumatic vertebral fractures:10-year results[J].Eur Spine,2014,23(6):1354-1360.

6.Garfin SR,Yuan HA,Reìley MA.New technologìes in spine:kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fracture[J].Spine(Phila Pa l976),2001,26(14):1511-1515.

7.Kado DM,Duong T,Stone KL,et a1.Incident vertebral fractures and mortalityin older women:aprospective study.Osteoporos Int,2003,14(7):589-594.

8.Yu W,Liang，Yao Z,et a1.Risk factors for recollapse of the augmemed vertebrae after percutaneous vertebroplasty for osteoporotic vertebral fractures with intravertebral vacuum eleft[J].Medicine,2017,96(2):e5675.

9.Li X,Lu Y,Lin X.Refracture of osteoporotic vertebral body after treatment by balloon kphoplasty:three cases report[J].Medicine,2017,96(49):e8961.

10.Vogl TJ,Pflugmacher R,Hierholzer J,et al.Cement directed kyphoplasty reduces cement leakage as compared with vertebroplasty:results of a controlled,randomized trial[J].Spine,2013,38(20):1730-1736.

11. Blue billow, Chenyang, Yang Xin Jian, fracture progress after vertebroplasty [ J ]. J. spinal cord of China 2015,25(2):179-182.

12. Wang licensed, Liangqing, etc. combined with one-way and universal pedicle screws for treating thoracolumbar fractures [ J ] through percutaneous internal fixation of injured vertebrae, China journal of trauma, 2013,29(5):431-437, DOI:10.3760/cma.j.issn.1001-8050.2013.05.010.

13. Ma Ching Feng, Chen Bo Hua, Li Juan, etc. Transpedicular bone grafting vertebroplasty in combination with pedicle screw simultaneous fixation for treating thoracolumbar fracture [ J ]. Zhonghua trauma journal, 2013,29(6):513-515.DOI:10.3760/cma.i.issn.1001.8050.2013.06.009.

14.Ailon T,Shaffrey CI,Lenke LC,et al.Progressive spinal kyphosis in aging puplation[J].Neurosurgery,2015,77(Suppl 4):S164-172.

15.Sadiqi S,Verlaan J,Lehr AM,et al.Measurement of kyphosis and bertebral body height loss in traumatic spine fractures:an international study[J].Eur Spine J,2017,26(5):1483-1491.

SUMMERY OF THE UTILITY MODEL

In order to solve the above problems in the prior art, the utility model provides a centrum fracture percutaneous minimal invasion integrated device that resets in vitro has easy operation, and patient's wound is little, the fracture resets advantages such as good, safe and reliable.

The utility model provides a vertebral fracture percutaneous minimally invasive in vitro reduction integrated device, which comprises a track, a reduction arm, a hollow screw sleeve and an elongated hollow screw;

the track is provided with length scales;

the reset arm comprises a sliding seat and a rotating sleeve which are mutually nested and combined; the sliding seat is provided with a first through hole for the rail to pass through and a first locking piece for fixing the relative position of the rail and the sliding seat; one end of the rotating sleeve is provided with a rotating part which can rotate relative to the rotating sleeve, and the rotating part is provided with a second through hole for the hollow screw sleeve to pass through; the rotating part is also provided with a second locking part for fixing the relative position of the rotating sleeve and the rotating part; the rotating sleeve is provided with an angle ruler;

the hollow screw sleeve is of a hollow tubular structure;

the lengthened hollow screw is sleeved in the hollow screw sleeve and is of a hollow tubular structure, and the far end of the lengthened hollow screw is designed into a spiral blade or a thread.

Optionally or preferably, in the percutaneous minimally invasive in-vitro reduction integrated device for vertebral body fracture, the upper surface of the track is provided with rack-shaped length scales; the sliding seat is also provided with a containing sleeve, a rotating nut is arranged in the containing sleeve, and the outer surface of the rotating nut is in a sawtooth shape and is occluded with the rack-shaped length scale of the track.

Optionally or preferably, in the percutaneous minimally invasive in-vitro reduction integrated device for vertebral fracture, one end of the rotating sleeve, which is close to the rotating part, is cylindrical, the outer surface of the rotating sleeve is provided with sawteeth to form an angle ruler, and the second button can be meshed and clamped with the sawteeth after being buckled and pressed.

Optionally or preferably, in the percutaneous minimally invasive in-vitro reduction integrated device for vertebral body fracture, a wrench is further installed on the second locking member and used for locking the second locking member.

Optionally or preferably, in the percutaneous minimally invasive in-vitro reduction integrated device for vertebral body fracture, the sliding seat is provided with an inner ring with a cylindrical periphery, the sliding seat is rotatably sleeved with a hollow annular outer ring, the outer ring is provided with a through hole with internal threads, the inner ring is nested in the outer ring, and the inner ring and the outer ring are relatively fixed by screwing a screw into the through hole.

Optionally or preferably, in the percutaneous minimally invasive in-vitro reduction integrated device for vertebral body fracture, a groove is formed in the inner wall of the second through hole of the rotating part, a bump is arranged on the outer wall of the hollow screw sleeve, and the bump is clamped into the groove to fix the hollow screw sleeve in the second through hole.

Optionally or preferably, in the percutaneous minimally invasive in-vitro restoration integrated device for vertebral body fracture, a blind hole is formed in the rotating part and is connected with the rotating sleeve in an inserting mode, a through hole with internal threads is formed in the side wall of the blind hole, and after the rotating part is connected with the rotating sleeve in an inserting mode, the rotating part and the rotating sleeve are fixed relatively through a screw screwed in the through hole.

Optionally or preferably, in the percutaneous minimally invasive in-vitro reduction integrated device for vertebral body fracture, the outer surface of the outer wall of the upper end of the lengthened hollow screw is of a flat structure.

Optionally or preferably, in the percutaneous minimally invasive in-vitro restoration integrated device for vertebral body fracture, the first locking member and the second locking member are self-locking buckles with springs, and the first locking member is fixed on the sliding seat and is pressed on the track through the elasticity of the springs; the second locking member is fixed to the rotating portion and pressed against the rotating sleeve by an elastic force of the spring.

The utility model provides a centrum fracture percutaneous minimal invasion integrated device that resets in vitro has following beneficial effect.

(1) The device realizes the universal adjustable function through the sliding seat and the rotating sleeve of the reset arm, is more beneficial to flexibly embedding the lengthened hollow screw, shortens the operation time and reduces the operation difficulty; the front and rear columns of the vertebral body are segmented by the lengthened hollow screws connected by the two reset arms, so that the vertebral body can be reset step by step, and the operation steps are more flexible and reasonable.

(2) The lengthened hollow screw with the spiral blade or the thread can increase the axial contact area in the vertebral body, is spirally arranged, reduces the loss of the vertebral pedicle and the vertebral body bone mass, improves the reduction effect, and reduces the cutting to the vertebral body during reduction. The device percutaneous puncture combines the design of extension cannulated screw, has improved the security when puncture and putting the nail in the operation process, has reduced risks such as damage nerve, blood vessel.

(3) The length scale on the track and the angle ruler on the rotating sleeve of the reset arm are convenient for referring to preoperative imaging measurement data, provide more accurate reference for the operation reset process, quantify the operation effect, avoid excessive distraction and reduce the damage to adjacent vertebral bodies.

(4) Through setting up first retaining member and second retaining member, can make adjustment length or angle back at every turn, can lock the adjustment position, when the auto-lock buckle of taking the spring is preferably used, more can the automatic locking after the adjustment operation at every turn, further simplified operation shortens operation time.

(5) The device only needs consumables of puncture needle and lengthened hollow screw, and the rest is the equipment which can be repeatedly sterilized, thereby greatly reducing the operation cost, lightening the economic burden of the patient and saving the social resources.

Drawings

FIG. 1 is a schematic view of the overall structure of the percutaneous minimally invasive in-vitro reduction integrated device for vertebral fracture in example 1;

FIG. 2 is a schematic view of a track structure with a length scale on the surface;

FIG. 3 is a schematic view of a rail back structure;

FIG. 4 is a schematic view of a slider structure;

FIG. 5 is a schematic view of a rotating nut;

FIG. 6 is a schematic view of a first securing member;

FIG. 7 is a schematic view of a rotating sleeve structure;

FIG. 8 is a schematic view of a second locking arrangement;

FIG. 9 is a schematic view of the wrench;

FIG. 10 is a schematic view of the disassembled structure of the locking second locking member when the wrench is pressed down;

FIG. 11 is a schematic view of a rotating portion;

FIG. 12 is a schematic view of the construction of an elongated cannulated screw sleeve;

FIG. 13 is a schematic view of an elongated cannulated screw.

In the figure:

1: track, 11: length scale, 12: inner groove, 2: slide, 21, housing sleeve, 211: observation hole, 22: inner ring, 23: locking groove, 24: fixing seat, 25: first through hole, 3: rotating sleeve, 31: outer ring, 32: screw hole, 33: angle ruler, 34: plug-in part, 4: cannulated screw sleeve, 41: bump, 5: extended cannulated screw, 51: hollow hole, 52: thread or screw blade, 6: turning the nut, 7: first locking member, 71: first bayonet, 72: perforation, 73: first acupressure plate, 8: second locking member, 81: left button, 82: right button, 83: second pressure finger, 84: second bayonet, 85: return angle, 9: spanner, 10: rotating part, 101: second through hole, 102: groove, 103: and a screw hole.

Detailed Description

The technical solutions of the present invention will be explained and explained in detail with reference to the accompanying drawings and examples, so that those skilled in the art can better understand the present invention and implement the present invention.

Example 1

Referring to fig. 1, the percutaneous minimally invasive extracorporeal reduction integrated device for vertebral fracture is a model and comprises a track 1, a sliding seat 2, a rotating sleeve 3, a rotating part 10, a hollow screw sleeve 4 and a lengthened hollow screw.

The slide 2, the rotary sleeve 3 and the rotary part 10 together form a restoring arm structure. The reduction arm is used for reducing the rotation center and the mechanical fulcrum of the centrum front column by rotating the hollow screw sleeve 4.

Referring to fig. 2 and 3, the track 1 is a long plate-shaped structure with saw-tooth length scales 11 on the surface, and each saw tooth is equal in size. The back is provided with an inner groove 12, and the inner groove 12 has the function of reducing weight and is convenient to operate. The track 1 provides a track and a mechanical center for axial repositioning.

Referring to fig. 4 in conjunction with fig. 1, the slider 2 includes a receiving sleeve 21, a cylindrical inner ring 22, a locking groove 23, a fixing seat 24, and a first through hole 25. The first through hole 25 is used for the track 1 to pass through, and the locking groove 23 corresponds to the side of the track 1 with the length scale 11. Referring to fig. 5, the receiving sleeve 21 is used for receiving the rotating nut 6, and the outer surface of the rotating nut 6 is serrated and engaged with the rack-shaped length scale 11 of the track 1. The carriage 2 can be moved relative to the rail 1 by rotating the swivel nut 6. The accommodating sleeve 21 is also provided with an observation hole 211 for facilitating cleaning after operation. The cylindrical inner ring 22 is intended to be nestingly engaged with the outer ring of the rotating sleeve 3. Referring to fig. 6, the fixing seat 24 is used for combining with the first locking member 7, the first locking member 7 is mounted on the fixing seat 24 by a fixing shaft threaded with a spring and passing through a through hole 72 of the first locking member 7, two ends of the spring wire are extended to respectively abut against the first locking member 7 and the fixing seat 24, and the position of the first clamping knife 71 corresponds to the locking groove 23. Under the state of not applying force, the elastic action of the spring enables the first clamping knife 71 to be clamped on the length scales 11 of the track 1, and the automatic locking function is realized. When the first acupressure plate 73 is pressed, the first bayonet 71 is disengaged from the track 1.

Referring to fig. 7 and 11 in combination with fig. 1, the rotating sleeve 3 includes an outer ring 31, a protractor 33 and an inserting portion 34, in combination with fig. 4, the outer ring 31 is used to be inserted into the inner ring 22 of the sliding seat 2 to realize the rotating connection with the sliding seat 2, the outer ring 31 is further provided with a screw hole 32, and when the outer ring 31 is rotated to a proper position, a screw can be screwed into the screw hole 32 to abut against the inner ring 22 to be fixed, so that the relative fixing state of the rotating sleeve 3 and the sliding seat 2 is achieved. The rotating sleeve 3 is inserted into the rotating part 10 through the inserting part 34, and a cylindrical angle gauge 33 with saw teeth on the outer surface is formed between the inserting part 34 and the outer ring 31 at one end of the rotating sleeve close to the rotating part 10. The second locking member 8 can engage with the serrations of the bevel 33.

Referring to fig. 8, the second locking member 8 is formed by inserting a left button 81 and a right button 82 through a fixing shaft (not shown) through which a spring is inserted, and both ends of the spring wire are extended to respectively abut against the left button 81 and the right button 82. Referring to fig. 1, the right button 82 is fixed to the rotary unit 10, and the left button 82 has a second pressing plate 83 at an upper portion thereof and a second blade 84 at a lower portion thereof. In the state of no force application, the elastic action of the spring makes the second clamping knife 84 clamped in the saw teeth of the angle ruler 33, and the automatic locking function is realized.

Referring to fig. 9, a wrench 9 is mounted on the second locker 8 and functions to lock the second locker 8. Spanner 9 is a structure that can rotate at 90 jiaos for second retaining member 8, is similar to the sword portion of hand hay cutter, is equipped with the connecting hole on spanner 9, passes through the connecting hole with rivet or other structures and installs it on retaining member 8, and spanner 9 is equipped with two baffles with second retaining member 8's the position of being connected: outer and inner barriers, referring to fig. 8, when installed, the outer barrier is located outside the right button 82 and the inner barrier is located inside the right button 82 (between the right button 82 and the left button 81). There is a inflection angle 85 right button 82 side, and when spanner 9 lifted, second retaining member 8 was kept away from to the right angle structure that spanner 9 was close to two baffles, pinch the left and right button 81 and 82 this moment, and inflection angle 85 can cross the side of left button 81, makes the left and right button ability relative movement (second finger board 83 is close to or keeps away from right button 82), and at this moment second retaining member 8 can drive the rotating part 10 and the hollow screw sleeve 4 that connects and rotatory for the arm that resets, conveniently adjusts the anticipated position. When the desired position is adjusted, the wrench 9 is pressed down (the state in fig. 1, only one wrench 9 is shown in fig. 1, actually two wrenches are provided, and two second locking members 8 are respectively matched with one wrench 9), referring to fig. 10 in conjunction with fig. 1, after the wrench 9 is pressed down, the right-angle structure of the wrench 9 is clamped at the inflection angle 85 of the right button 82, so that the left button 81 and the right button 82 cannot move relatively, that is, the second pressing plate 83 is not pinched, and the rotating part 10 is fixed in place, thereby facilitating the later operation. When readjustment is needed, the wrench 9 can be lifted to restore the activity.

Referring to fig. 10, one end of the rotating portion 10 is provided with a blind hole (not shown) for the insertion of the insertion portion 34, the other end is provided with a second through hole 101 for the insertion of the hollow screw sleeve 4, and the second through hole 101 is further provided with a groove 102, in combination with fig. 12, the outer side wall of the hollow screw sleeve 4 is provided with a protrusion 41, and when the hollow screw sleeve 4 is inserted into the second through hole 101, the protrusion 41 is inserted into the groove 102 to fix the hollow screw sleeve 4 and the hollow screw sleeve to each other. In addition, the blind hole side wall of the rotating part 10 is further provided with a screw hole 103, and the inserting part 34 of the rotating sleeve 3 is cylindrical, so that the rotating part 10 can rotate relative to the rotating sleeve 3 after being inserted, and when the rotating part is adjusted to a proper rotating position, the rotating sleeve 3 and the rotating part 10 can be relatively fixed by screwing a screw into the screw hole 103 to abut against the inserting part 34.

Referring to fig. 12 and 13, the elongated cannulated screw 5 is inserted into the elongated cannulated screw sleeve 4, the elongated cannulated screw 5 is provided with a central bore 51 along the shaft and a threaded or helical blade 52 at the lower end. The hollow screw sleeve 4 plays a role in connecting the lengthened hollow screw 5 with the reduction arm, the strength of the lengthened hollow screw 5 is enhanced, the force on the reduction arm is transferred to the surface of the pedicle of vertebral arch, and the force arm in the reduction process is shortened. The lengthened hollow screw 5 is used for being placed into a normal vertebral body adjacent to the fractured vertebral body through a percutaneous minimally invasive way, and provides a mechanical fulcrum for the reduction of the fractured vertebral body.

The vertebral fracture percutaneous minimally invasive in-vitro reduction integrated device is used for being combined with PVP or PKP operation, and can effectively solve the following problems:

(1) with simple PVP or PKP operation on OVCF, the compressed fractured vertebral body cannot be satisfactorily reset and reshaped in partial patients. Through the percutaneous minimally invasive in-vitro reduction integrated device for vertebral fracture, the compressed vertebral body can be more effectively and accurately reduced, the lost height of the vertebral body is recovered, and the kyphosis is corrected.

(2) Cement leakage is a common and serious complication during PVP and PKP procedures, and particularly, fracture of the posterior wall of the vertebral body once becomes a contraindication to the procedures. The vertebral body height is recovered to the maximum extent and the volume in the vertebral body is enlarged by utilizing the tension belt effect when the percutaneous minimally invasive in-vitro reduction integrated device for vertebral body fracture is reduced and the dual force of the expansion of a balloon in the vertebral body when necessary. For patients with vertebral body posterior wall fracture, the risk of bone cement leakage in the next PVP \ PKP operation process is effectively reduced, the operation safety is improved, and the operation indications are enlarged.

(3) The traditional incisional reduction internal fixation operation for spinal fracture has the defects of large wound, much bleeding, long operation time, slow postoperative recovery, internal fixed objects left in a body, accelerated intervertebral disc degeneration or vertebral body fracture caused by stress concentration of adjacent segments of a fixed segment, high operation cost and the like. The vertebral fracture percutaneous minimally invasive in-vitro reduction integrated device is used for percutaneous temporary distraction reduction in vitro, is combined with PVP or PKP operation, can complete reduction under a tiny incision, shortens operation time and reduces intraoperative hemorrhage. Not only achieves the effect of incision reduction, but also avoids the related complications after the indwelling internal fixation operation and reduces the reoperation rate.

(4) In order to reduce the damage to the adjacent vertebral bodies in the processes of screw placement and reduction, the screw blade-shaped pedicle lengthening hollow screw is specially designed. Put the effect that the surrounding cancellous bone of nail head continuous extrusion reaches the bone of planting in the nail in-process, compare the design of helicitic texture and can obviously reduce the destruction to the adjacent vertebra centrum, make the screw of spiral blade formula pin head possess the bigger stronger contact surface in the vertebra simultaneously, strengthened hollow screw's holding power, reduce the cutting to normal centrum at the in-process screw that resets.

The operation steps are as follows:

the patient lies on the perspective operating bed after the patient is satisfied with general anesthesia and lies on the prone position, and the chest and the anterior superior iliac spines at the two sides are provided with soft pads to suspend the abdomen. And (5) spreading a towel for conventional disinfection, and pasting an aseptic operation sticking film.

Selecting one side with heavy compression of the vertebral body according to images before the operation, determining a nail feeding point of the vertebral pedicle at the same side of the upper vertebral body and the lower vertebral body adjacent to the injured vertebral body under the perspective positioning of a C-shaped arm X-ray perspective machine, cutting a 0.5cm incision on the body surface, taking a vertebral pedicle puncture needle to feed the needle along the vertebral pedicle, monitoring and determining the position of the puncture needle by the C-shaped arm X-ray perspective machine, placing a guide needle after the position of the puncture needle is satisfied, taking out the puncture needle, and placing two lengthened hollow screws 5 in the vertebral body in a bone hammer tapping mode along the. The C-arm X-ray machine determines that the position of the lengthened hollow screw 5 is satisfactory (the head of the screw is positioned right on the spinous process connecting line, and the lateral position is close to the front edge of the vertebral body). A hollow screw sleeve 4 is arranged on the lengthened hollow screw 5 to ensure that the hollow screw sleeve 4 reaches the joint surface of the joint bulge, the track 1 is close to the surface of the skin as much as possible, and the external resetting integrated device is connected to lock the resetting arm and the track 1. According to the data of the height loss and angulation of the vertebral body measured by the imaging before the operation, the injured vertebral body is gradually reset by using an in-vitro resetting device under the monitoring of a C-shaped arm X-ray fluoroscopy machine and by using a graduated scale on a track 1 as a mark.

(1) Reduction of posterior column height in vertebral body: firstly, locking the position of the hollow screw sleeve 4 relative to the rotating sleeve 3 through a second locking piece 8 on the reset arm; rotating the rotating nut 6 on the track 1, gradually opening the reset arm along the track 1 by referring to the length scale 11 on the track 1, and recovering the height of the posterior column in the vertebral body; after the axial resetting is completed, the track 1 is automatically locked with the relative position of the resetting arm through the first locking piece 7.

(2) Restoring the height of the anterior column of the vertebral body: firstly, with the axis of the reset arm as the center, referring to an angle ruler 33 of a rotating sleeve 3 on the reset arm, gradually rotating a lengthened hollow screw sleeve 4 at one side of the compression and collapse of the vertebral body end plate in the opposite direction of the vertebral body compression, and observing that a second locking piece 8 is automatically locked after the anterior column of the vertebral body is satisfactorily reset; and secondly, if the upper end plate and the lower end plate are compressed, the sleeve 4 of the lengthened hollow screw at the far end and the near end is rotated respectively to reset.

And C-shaped arm X-ray fluoroscopy machine is used for puncturing through the vertebral pedicle of the injured vertebra under fluoroscopy, the inner core of the puncture needle is taken out after the puncture needle enters the vertebral body, the bone drill is slowly drilled into the vertebral body along the working sleeve, and the bone drill is taken out after the drill bit is pointed to the position of about 0.5cm away from the front edge of the vertebral body. The expansion saccule connected with the pressurizer filled with the contrast agent is placed into the vertebral body along the working sleeve, so that the saccule is rightly positioned in the middle of the vertebral body, and the side position is about 0.5cm away from the front edge of the vertebral body. The balloon is gradually expanded by referring to the pressure reading of the pressurizer and the injection volume scale reading under the monitoring of the C-shaped arm X-ray fluoroscopy machine, so that the height of the vertebral body is further restored, and the collapsed end plate is reset. When the bone cement is prepared and stirred to reach the toothpaste stage, the bone cement is injected into the special bone cement push rod and slowly, slightly and repeatedly injected into the bone cement through the damaged vertebral pedicle working sleeve. The C-shaped arm X-ray fluoroscopy machine can observe the dispersion condition of the bone cement in the vertebral body under fluoroscopy, thereby avoiding leakage and overflow.

After the bone cement is heated and solidified, the vertebral fracture percutaneous minimally invasive in-vitro reduction integrated device and the vertebral forming instrument are removed. And (5) flushing with physiological saline and suturing the incision. And (5) wrapping the sterile dressing.

After the operation, the patient is observed that the vital signs are stable and no nervous system symptom exists after the anesthesia recovery, and the patient can return to the ward. And (4) rechecking X-ray examination on the first day after operation, and wearing the chest and waist support to go to the ground and discharge from a hospital.

The alternative mode is as follows: (1) the anesthesia mode can be flexibly selected according to the condition of a patient: general anesthesia, local anesthesia and intravenous compound anesthesia or local infiltration anesthesia. (2) Whether the percutaneous minimally invasive in-vitro reduction integrated device for vertebral fracture needs temporary reduction and whether balloon expansion is needed in the operation depend on the condition of actual reduction of the vertebral body during each operation step: if the vertebral body is reset satisfactorily when the patient is in the prone position, temporary resetting through the pedicle is not needed; after the vertebral body is temporarily reset through the vertebral pedicle, only PVP is needed without PKP; if the reduction is not satisfactory, the balloon is required to further assist in reduction.

The utility model discloses a design theory and advantage:

the idea is as follows: inside and outside dual reset, direct reset adds indirect reset, and the effect that resets is better. And (3) indirect resetting: a tension band principle of transpedicular reduction (the fractured vertebral body is dragged by using a fibrous ring, an anterior longitudinal ligament and a posterior longitudinal ligament which are connected with an adjacent vertebra so as to reduce the fractured block of the vertebral body); direct reset: balloon-expanded kyphoplasty (direct reduction from inside of a compressed vertebral body after expansion of a balloon placed inside a fractured vertebral body).

② the advantages are: the two operation modes make up for the deficiency, and the benefit of the patient is maximized. The percutaneous minimally invasive in-vitro reduction integrated device for vertebral fracture combines the advantages of good traditional incision reduction internal fixation reduction effect and the advantages of instant pain relieving and rapid vertebral wound stability reconstruction in PKP or PVP operation, avoids the defects of large trauma, much bleeding, slow postoperative recovery and the like in the traditional operation and the defects of poor vertebral compression fracture reduction, high bone cement leakage rate and the like in single PKP or PVP operation, and achieves good correction of spine physiological curvature and recovery of patients and spine functions on the premise of minimally invasive, simple, safe and effective operation.

The utility model discloses an economic effect and social:

the percutaneous minimally invasive in-vitro reduction integrated device for vertebral fracture aims to recover the normal force line lost due to vertebral compression fracture, avoid the continuous loss of vertebral height caused by postoperative vertebral column imbalance, easily fall down to induce secondary osteoporosis fracture, intractable chest, waist and back pain, pulmonary hypofunction, digestive system abnormality, pain of lower limb hip and knee joint and the like^[8]Improving multiple organ functions such as pulmonary function, improving postoperative life quality of patients, and reducing death rate caused by OVCF^[14]；

The whole minimally invasive surgery is small in surgical wound, safe and effective, more patients can easily accept and tolerate the surgery, beneficial people are enlarged, and serious complications and high treatment cost caused by conservative treatment of patients who do not have surgery or cannot tolerate the surgery are reduced; compared with the patient who does not correct the spine line of force, the good spine line of force can reduce the risk of fall injury and fracture again, reduce the cost of treatment such as hospitalization and related operations again, and better save social resources^[7，9，15]。

The inventive concept is explained in detail herein using specific examples, and the above description of the embodiments is only used to help understand the core idea of the present invention. It should be understood that any obvious modifications, equivalents and other improvements made by those skilled in the art without departing from the spirit of the present invention are intended to be included within the scope of the present invention.

Claims (9)

1. The percutaneous minimally invasive in-vitro reduction integrated device for vertebral fracture is characterized by comprising a track, a reduction arm, a hollow screw sleeve and a lengthened hollow screw;

the track is provided with length scales;

the reset arm comprises a sliding seat and a rotating sleeve which are mutually nested and combined; the sliding seat is provided with a first through hole for the rail to pass through and a first locking piece for fixing the relative position of the rail and the sliding seat; one end of the rotating sleeve is provided with a rotating part which can rotate relative to the rotating sleeve, and the rotating part is provided with a second through hole for the hollow screw sleeve to pass through; the rotating part is also provided with a second locking part for fixing the relative position of the rotating sleeve and the rotating part; the rotating sleeve is provided with an angle ruler;

the hollow screw sleeve is of a hollow tubular structure;

the lengthened hollow screw is sleeved in the hollow screw sleeve and is of a hollow tubular structure, and the far end of the lengthened hollow screw is designed into a spiral blade or a thread.

2. The integrated percutaneous minimally invasive in-vitro reduction device for vertebral fracture according to claim 1, wherein the upper surface of the track is provided with rack-shaped length scales; the sliding seat is also provided with a containing sleeve, a rotating nut is arranged in the containing sleeve, and the outer surface of the rotating nut is in a sawtooth shape and is occluded with the rack-shaped length scale of the track.

3. The integrated percutaneous minimally invasive external reduction device for vertebral fracture according to claim 1, wherein one end of the rotating sleeve close to the rotating part is cylindrical, the outer surface of the rotating sleeve is provided with sawteeth to form an angle ruler, and the second locking part can be engaged and clamped with the sawteeth.

4. The percutaneous minimally invasive in-vitro reduction integrated device for vertebral fracture according to claim 3, wherein a wrench is further installed on the second locking member and used for locking the second locking member.

5. The percutaneous minimally invasive in-vitro reduction integrated device for vertebral body fracture according to claim 1, wherein the sliding seat is provided with an inner ring with a cylindrical periphery, a hollow annular outer ring is sleeved on the rotating sleeve, a through hole with internal threads is formed in the outer ring, the inner ring is nested in the outer ring, and the inner ring and the outer ring are relatively fixed by screwing a screw into the through hole.

6. The percutaneous minimally invasive in-vitro reduction integrated device for vertebral fracture according to claim 1, wherein a groove is formed in the inner wall of the second through hole of the rotating part, a bump is arranged on the outer wall of the hollow screw sleeve, and the bump is clamped into the groove, so that the hollow screw sleeve is fixed in the second through hole.

7. The integrated percutaneous minimally invasive in-vitro reduction device for vertebral fracture according to claim 1, wherein a blind hole is formed in the rotating part and is inserted into the rotating sleeve, a through hole with internal threads is formed in the side wall of the blind hole, and after the rotating part is inserted into the rotating sleeve, a screw is screwed into the through hole to fix the rotating part and the rotating sleeve relatively.

8. The integrated percutaneous minimally invasive in-vitro reduction device for vertebral fracture according to claim 1, wherein the outer surface of the outer wall of the upper end of the elongated hollow screw is of a flat structure.

9. The integrated percutaneous minimally invasive in-vitro reduction device for the vertebral body fracture according to any one of claims 1 to 8, wherein the first locking piece and the second locking piece are self-locking buckles with springs, and the first locking piece is fixed on the sliding seat and is pressed on the track through the elasticity of the springs; the second locking member is fixed to the rotating portion and pressed against the rotating sleeve by an elastic force of the spring.

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