CN212679241U

CN212679241U - Positioning sighting device for percutaneous implantation of sacroiliac joint screw under orthophoto examination

Info

Publication number: CN212679241U
Application number: CN202020444006.9U
Authority: CN
Inventors: 殷渠东
Original assignee: Wuxi No 9 Peoples Hospital
Current assignee: Wuxi No 9 Peoples Hospital
Priority date: 2020-03-31
Filing date: 2020-03-31
Publication date: 2021-03-12
Anticipated expiration: 2030-03-31

Abstract

The utility model relates to a location sight that is used for percutaneous implantation sacroiliac joint screw under orthopedics perspective belongs to medical instrument technical field. The device comprises a positioning mechanism A and an aiming mechanism B; the positioning mechanism A is connected with the aiming mechanism B in a matching way; the positioning mechanism A specifically comprises a positioning cross rod, a positioning slide block, a positioning bolt and a positioning rod; the aiming mechanism B specifically comprises a C-shaped arm, a sliding groove and a sleeve. Adopt when the location sight carries out sacroiliac joint screw fixation, only need implant under the positive position perspective monitoring, have implant sacroiliac joint screw fixation method perspective few, implant screw method simple, implant screw safety, the high characteristics of the degree of accuracy.

Description

Positioning sighting device for percutaneous implantation of sacroiliac joint screw under orthophoto examination

Technical Field

The utility model relates to a location sight that is used for percutaneous implantation sacroiliac joint screw under orthopedics perspective belongs to medical instrument technical field.

Background

Sacroiliac joint fracture or separation belongs to unstable posterior pelvic ring, is common in clinic, most patients need surgical treatment, and the sacroiliac joint fracture or separation is fixed in front or back steel plate screws after incision in the past, but the surgical injury is large and bleeding is more. Recently, percutaneous sacroiliac joint screw fixation is gradually a new internal fixation method, which belongs to a minimally invasive surgery, important lumbosacral nerves and iliac vessels are arranged around a screw channel, once the screw implantation deviation is large, serious neurovascular injury complications can occur, and even the life is threatened, so that the existing percutaneous implantation sacroiliac joint screw fixation method needs to repeatedly perform fluoroscopy for multiple times at a pelvic inlet position, an outlet position and a sacral lateral image or an oblique image to determine whether a puncture needle position and an implantation screw are correct, therefore, an operator needs to be familiar with relevant anatomical imaging characteristics and experience to carry out the percutaneous implantation sacroiliac joint screw fixation method, the percutaneous implantation sacroiliac joint screw has a learning curve, the implantation screw quality is related to the experience of the operator, and the operation is carried out only in a part of larger hospitals at present.

Disclosure of Invention

The utility model aims at providing a method of implanting sacroiliac joint screw fixation under ordinary perspective need be in the shortcoming of multiple position perspective such as pelvis entry position, export position and sacrum side position image, provides a location sight that is used for implanting sacroiliac joint screw under positive perspective, and the perspective is few, implantation method is simple, safety, accurate when adopting this equipment to carry out sacroiliac joint screw implantation, grasps fast easily and promotes.

The technical proposal of the utility model is that a positioning sighting device for percutaneous implantation of sacroiliac joint screw under orthophoto view, which comprises a positioning mechanism A and a sighting mechanism B; the positioning mechanism A is connected with the aiming mechanism B in a matching way;

the positioning mechanism A specifically comprises a positioning cross rod, a positioning slide block, a positioning bolt and a positioning rod; two sides of the positioning cross rod are respectively provided with two positioning sliding blocks, the positioning sliding blocks are connected with the positioning cross rod in a sliding manner, and the upper part of each positioning sliding block is positioned through a positioning bolt; positioning rods are respectively arranged in the positioning sliding blocks;

the aiming mechanism B specifically comprises a C-shaped arm, a sliding groove and a sleeve; one end of the C-shaped arm is connected with the positioning rod in a sliding and rotating mode; the C-shaped arm is provided with a chute, and a sleeve is arranged in the chute; the sleeve is hollow inside, and can adjust the angle and fix on C type arm as required.

The positioning rod specifically comprises a positioning rod body, a positioner and a positioning needle; the locating pin is located the locating lever body lower extreme, and the locator can reciprocate at the body lower extreme.

The positioner is a nut with expanded threads, the position of the positioner on the positioning rod body is adjusted according to the distance between the central bone surface of the lateral mass at the rear of the sacrum of the patient and the central shaft of the sacroiliac joint screw measured by CT before the operation, so that the length of the positioning needle of the positioning rod is consistent with the distance (namely the distance d inserted into the sacrum), and the aim of accurately positioning the outlet of the sighting device B and the central shaft of the screw channel is fulfilled.

When in use, the locating needle point part on the locating mechanism A of the utility model is located at the sacroiliac joint screw channel at the center of the sacral vertebral lateral mass. According to literature studies and imaging measurements, in the coronal plane, the central axis of the screw channel of the first sacral vertebrae is located in the center of the line connecting the upper edge of the vertebral body of the first sacral vertebrae and the first sacral foramen, and the screw channel of the second sacral vertebrae corresponds to the center of the line connecting the second sacral foramen and the third sacral foramen. Therefore, the utility model discloses during the use, on positive perspective imaging, the locating needle point portion of first sacrum is located the nodical point of the perpendicular line of the upper reason of the centrum of first sacrum and first sacrum hole line central authorities with the horizontal line of lateral mass central authorities, and the locating needle point portion of second sacrum is located the nodical point of the perpendicular extension line of second, third sacrum hole line central authorities and lateral mass central authorities.

The length of the positioning transverse rod is 15-25 cm; the length of the positioning rod is 15-25 cm; the length of the sleeve is 5-8 cm;

the diameter of the positioning needle is 2 mm; the diameter of the positioner is larger than that of the positioning needle; the inner diameter of the sleeve is greater than 2 mm.

The device also comprises a through hole and a fixing screw; a through hole is formed in one side of the C-shaped arm, and the C-shaped arm can slide up and down along the positioning rod through the through hole and is fixed through a fixing screw.

The sliding groove specifically comprises a side groove and a C-shaped groove; the side groove penetrates through the side surface of the C-shaped arm, and the shape of the side groove is consistent with that of the side surface of the C-shaped arm; the C-shaped groove penetrates through the upper surface and the lower surface and is communicated with the side grooves; the cross section of the sliding groove is in a cross shape.

The sleeve specifically comprises a sleeve body, a positioning assembly, a fixing nut and a positioning short rod; the positioning assembly is arranged in the sleeve body, positioning short rods are arranged on two sides of the positioning assembly, and the positioning assembly is hollow; the inlet rod body is rotationally connected with the sleeve body through a positioning short rod; the positioning short rod penetrates through the sleeve body, and the sleeve is fixed in the sliding groove through the fixing nut which rotates on the positioning short rod.

And scales are arranged on the positioning rod and the C-shaped arm.

The sleeve can be adjusted in orientation and relative position to the C-arm as desired. When the telescopic locating rod is used, the intersection point of the extension line of the sleeve and the locating rod is ensured to be positioned at the tip end of the locating rod. Specifically, the angle (e) of the central axis of the sacroiliac joint screw passage in the horizontal plane (cross-section) is measured from a pre-operative CT horizontal plane image of the patient, and the angle (f) of the central axis of the sacroiliac joint screw passage in the coronal plane is measured from a coronal image. When the sacroiliac joint implanting device is used, one end of the C-shaped arm is rotatably connected with one positioning rod on the affected side, so that the axis of the longitudinal sliding chute of the C-shaped arm of the aiming mechanism is consistent with the angulation and the e angle of the positioning cross rod, the position of the sleeve on the sliding chute of the C-shaped arm of the aiming mechanism is adjusted to be consistent with the angulation and the f angle of the positioning rod, the sleeve in the direction is fixed through screws respectively, the sleeve in the direction is kept to be inserted into the guide pin to the tip of the sacroiliac joint positioning rod on the sacroiliac side through the skin, then a hollow screw with a proper length is selected to be screwed into the hollow screw along the guide pin to fix the sacroiliac.

A specific fixing method for percutaneous implantation of a sacroiliac joint screw under orthophoto-scopy comprises the steps of only embedding a positioning rod of a positioning mechanism A under the orthophoto-scopy monitoring, embedding a guide pin to a needle point of a positioning needle of the positioning rod in a sleeve of a sighting mechanism B, and then embedding a hollow screw along the guide pin, wherein the conventional method does not need lateral or oblique fluoroscopy imaging monitoring of the implanted screw.

The utility model has the advantages that: adopt when the location sight carries out sacroiliac joint screw fixation, only need implant the screw on the positive position formation of image, it is few to have implantation sacroiliac joint screw fixation method perspective, implant the screw method simple, implant the characteristics of screw safety, accuracy, avoided not having location sight percutaneous implantation sacroiliac joint screw to need in pelvis access & exit position, export position and sacrum side position or add multiple positions such as oblique position image see-through's defect many times repeatedly, also avoided the quality difference of implanting the screw great, relevant with art person's experience, have defects such as study curve, consequently implant sacroiliac joint screw fixation's method is mastered and is promoted more easily fast under the ordinary perspective.

Drawings

Fig. 1 is a front view of the structure of the present invention.

Fig. 2 is a schematic perspective view of the present invention.

Fig. 3 is a schematic view of the sleeve structure of the present invention.

Fig. 4 is a schematic view of a surgical site of a sacroiliac joint in a human body.

Fig. 5 is a schematic view of the position of the screws into which the device of the present invention is positioned.

Fig. 6 is a schematic view of another screw position into which the device of the present invention is positioned.

Fig. 7 is a schematic view of the distance between the central posterior facet of the lateral mass of the sacrum and the central axis of the sacroiliac screw of the present invention.

Fig. 8 is a schematic view of the angle e when the present invention is in use.

Fig. 9 is a schematic view of the angle f in use of the present invention.

Description of reference numerals: 1. positioning the cross bar; 2. positioning the sliding block; 3. positioning the bolt; 4. positioning a rod; 4-1, a positioning rod body; 4-2, a positioner; 4-3, a positioning needle; 5. a C-shaped arm; 6. a chute; 6-1, side grooves; 6-2, C-shaped groove; 7. a sleeve; 7-1, a sleeve body; 7-2, a positioning component; 7-3, fixing a nut; 7-4, positioning a short rod; 8. a through hole; 9. a set screw; 10. and (4) calibration.

Detailed Description

As shown in fig. 1-3, the positioning sighting device for percutaneous implantation of the sacroiliac joint screw under orthophoto perspective comprises a positioning mechanism A and a sighting mechanism B; the positioning mechanism A is connected with the aiming mechanism B in a matching way;

the positioning mechanism A specifically comprises a positioning cross rod 1, a positioning slide block 2, a positioning bolt 3 and a positioning rod 4; two positioning slide blocks 2 are respectively arranged on two sides of the positioning cross rod 1, the positioning slide blocks 2 are connected with the positioning cross rod 1 in a sliding mode, and the upper portion of each positioning slide block 2 is positioned through a positioning bolt 3; positioning rods 4 are respectively arranged in the positioning sliding blocks 2;

the aiming mechanism B specifically comprises a C-shaped arm 5, a sliding groove 6 and a sleeve 7; one end of the C-shaped arm 5 is connected with the positioning rod 4 in a sliding manner; the C-shaped arm 5 is provided with a chute 6, and a sleeve 7 is arranged in the chute 6; the sleeve 7 is hollow, can adjust the angle as required and is fixed on the C-shaped arm 5.

The positioning rod 4 specifically comprises a positioning rod body 4-1, a positioner 4-2 and a positioning needle 4-3; the locating pin 4-3 is arranged at the lower end of the locating rod body 4-1, and the locator 4-2 can move up and down at the lower end of the body 4-1.

The device also comprises a through hole 8 and a fixing screw 9; a through hole 8 is formed in one side of the C-shaped arm 5, and the C-shaped arm 5 can slide up and down along the positioning rod 4 through the through hole 8 and is fixed through a fixing screw 9.

The sliding groove 6 specifically comprises a side groove 6-1 and a C-shaped groove 6-2; the side groove 6-1 penetrates through the side surface of the C-shaped arm 5, and the shape of the side groove is consistent with that of the side surface of the C-shaped arm 5; the C-shaped groove 6-2 penetrates through the upper surface and the lower surface and is communicated with the side groove 6-1; the cross section of the sliding groove 6 is cross-shaped.

The sleeve 7 specifically comprises a sleeve body 7-1, a positioning component 7-2, a fixing nut 7-3 and a positioning short rod 7-4; the positioning component 7-2 is arranged in the sleeve body 7-1, positioning short rods 7-4 are arranged on two sides of the positioning component 7-2, and the positioning component 7-2 is hollow; the inlet rod body 7-1 is rotationally connected with the sleeve body 7-1 through a positioning short rod 7-4; the positioning short rod 7-4 penetrates through the sleeve body 7-1, and the sleeve 7 is fixed in the sliding groove 6 by rotating the fixing nut 7-3 on the positioning short rod 7-4.

The sleeve 7 can be adjusted in orientation and relative position to the C-arm 5 as desired.

The positioning cross rod 1, the positioning rod 4 and the C-shaped arm 5 are provided with scales.

When in use, the intersection point of the extension line of the sleeve 7 and the positioning rod 4 is ensured to be positioned at the tip end of the positioning rod 4.

The positioner 4-2 is an expanded nut and is engaged with the lower end thread of the positioning rod body 4-1 in the axial direction; the different lengths are selected according to the distance d between the central back bone surface of the lateral mass of different sacrums and the central axis of the sacroiliac screw of different patients, so that the length of the positioning needle is consistent with that of the positioning needle 4-3 to be inserted, and the depth of the needle insertion is controlled.

The length of the positioning cross rod 1 is 15-25 cm; the length of the positioning rod 4 is 15-25 cm; the length of the sleeve 7 is 5-8 cm;

the diameter of the positioning needle 4-3 is 2 mm; the diameter of the positioner 4-2 is larger than that of the positioning needle 4-3; the internal diameter of the sleeve 7 is greater than 2 mm.

A schematic view of the surgical site for implantation of the sacroiliac joint screws in a human is shown in fig. 4. The utility model discloses during the use, at first the three-dimensional CT imaging examination of going on before the patient's art, the horizontal plane angulation (e angle) and the coronal plane angulation (f angle) of the sacroiliac joint screw passageway center pin of survey patient first and second sacrum to and distance (d) of sacrum lateral mass central authorities rear bone surface apart from screw passageway center pin. After anesthesia is successful, the patient is in the prone position, the affected limb is firstly pulled to carry out traction reduction, and the sacroiliac joint is reduced to satisfy the condition and then is positioned in the right position for fluoroscopy, and the sighting device is percutaneously implanted into the sacroiliac joint screw for fixation. The screw implantation direction is principally from posterior to anterior (e angle), from outer down to inner up (f angle). The schematic view of implantation from back to front is shown in fig. 5, and the schematic view of implantation of the screw from outside to bottom to inside is shown in fig. 6. The distance (d) of the central posterior facet of the sacral lateral mass from the central axis of the screw channel is shown in fig. 7.

First, a positioning rod is inserted under orthoscopic monitoring. According to the distance (d) from the central axis of the screw channel measured by the CT examination before the operation, the position of the positioner 4-2 is adjusted to ensure that the length of the positioning needle 4-3 is equal to the distance (the depth of the positioning needle inserted into the middle of the sacral lateral mass). Under the orthoscopic monitoring, the left and right positioning rods 4 of the positioning mechanism A are symmetrically and vertically placed on the rear bone plane of the left and right sacral vertebrae lateral masses of a patient, and the positioning needles 4-3 are positioned: the tip of the positioning needle (4-3) of the first sacrum is positioned at the intersection point of the horizontal extension line of the upper edge of the vertebral body of the first sacrum and the connecting line of the first sacral foramen and the vertical extension line of the side mass center, and the tip of the positioning needle (4-3) of the second sacrum is positioned at the intersection point of the horizontal line of the connecting line of the second sacral foramen and the third sacral foramen and the vertical line of the side mass center. Then, two positioning rods are inserted into the sacral vertebrae parallel and perpendicular to the sacrum (insertion depth d). And then, fixing the two positioning rods 4 and the positioning cross rod 1 by using the positioning bolts 3 and the positioning slide blocks 2. Second, the position of the sight into the nail sleeve is determined. Firstly, the C-shaped arm 5 is adjusted to a specified position of the positioning rod, so that the angle between the axis of the longitudinal chute of the C-shaped arm and the positioning transverse rod is consistent with the angle e (figure 8); the sleeve 7 of the sight B is then positioned so that the angle of angulation with the rod coincides with the f angle (fig. 9), the sleeve in this orientation is held in contact with the skin, and finally the C-arm and nut are fixed to the sleeve 7 using the set screw 9 respectively. Third, the lead and implant screw are inserted through the sleeve 7. Firstly, inserting a guide needle through a sleeve, wherein the guide needle passes through the skin, the ilium and the sacroiliac joint to reach the tip of a positioning rod 4 (a needle tip of a positioning needle 4-3) of the sacrum; and finally selecting a hollow screw with a proper length according to the length of the sacroiliac joint screw channel measured by the preoperative CT examination, and screwing the hollow screw along the puncture guiding needle to fix the sacroiliac joint.

Claims

1. A location sight for implanting sacroiliac joint screw under orthophoto perspective percutaneous, characterized by: comprises a positioning mechanism A and an aiming mechanism B; the positioning mechanism A is connected with the aiming mechanism B in a matching way;

the positioning mechanism A specifically comprises a positioning cross rod (1), a positioning sliding block (2), a positioning bolt (3) and a positioning rod (4); two positioning sliding blocks (2) are respectively arranged on two sides of the positioning cross rod (1), the positioning sliding blocks (2) are connected with the positioning cross rod (1) in a sliding mode, and the upper portion of each positioning sliding block (2) is positioned through a positioning bolt (3); positioning rods (4) are respectively arranged in the positioning sliding blocks (2);

the aiming mechanism B specifically comprises a C-shaped arm (5), a sliding groove (6) and a sleeve (7); one end of the C-shaped arm (5) is connected with the positioning rod (4) in a sliding manner; a chute (6) is arranged on the C-shaped arm (5), and a sleeve (7) is arranged in the chute (6); the sleeve (7) is hollow, can adjust the angle as required and is fixed on the C-shaped arm (5).

2. The positioning sight for percutaneous implantation of a sacroiliac joint screw under orthoscopic visualization of claim 1, wherein: the positioning rod (4) specifically comprises a positioning rod body (4-1), a positioner (4-2) and a positioning needle (4-3); the locating pin (4-3) is positioned at the lower end of the locating rod body (4-1), and the locator (4-2) can move up and down at the lower end of the body (4-1).

3. The positioning sight for percutaneous implantation of a sacroiliac joint screw under orthoscopic visualization of claim 1, wherein: the device also comprises a through hole (8) and a fixing screw (9); c type arm (5) one side is opened has through-hole (8), and C type arm (5) can slide from top to bottom along locating lever (4) through-hole (8) to it is fixed through set screw (9).

4. The positioning sight for percutaneous implantation of a sacroiliac joint screw under orthoscopic visualization of claim 1, wherein: the sliding groove (6) specifically comprises a side groove (6-1) and a C-shaped groove (6-2); the side groove (6-1) penetrates through the side surface of the C-shaped arm (5), and the shape of the side groove is consistent with that of the side surface of the C-shaped arm (5); the C-shaped groove (6-2) penetrates through the upper surface and the lower surface and is communicated with the side groove (6-1); the cross section of the sliding groove (6) is in a cross shape.

5. The positioning sight for percutaneous implantation of a sacroiliac joint screw under orthoscopic visualization of claim 1, wherein: the sleeve (7) specifically comprises a sleeve body (7-1), a positioning assembly (7-2), a fixing nut (7-3) and a positioning short rod (7-4); the positioning component (7-2) is arranged in the sleeve body (7-1), positioning short rods (7-4) are arranged on two sides of the positioning component (7-2), and the positioning component (7-2) is hollow; the inlet rod body is rotationally connected with the sleeve body (7-1) through a positioning short rod (7-4); the positioning short rod (7-4) penetrates through the sleeve body (7-1), and the sleeve (7) is fixed in the sliding groove (6) through the fixing nut (7-3) which rotates on the positioning short rod (7-4).

6. The positioning sight for percutaneous implantation of a sacroiliac joint screw under orthoscopic visualization of claim 5, wherein: the sleeve (7) can be adjusted in direction and relative position to the C-shaped arm (5) according to requirements.

7. The positioning sight for percutaneous implantation of a sacroiliac joint screw under orthoscopic visualization of claim 5, wherein: scales (10) are arranged on the positioning rod (4) and the C-shaped arm (5).

8. The positioning sight for percutaneous implantation of a sacroiliac joint screw under orthoscopic visualization of claim 1, wherein: when the telescopic positioning rod is used, the intersection point of the extension line of the sleeve (7) and the positioning rod (4) is ensured to be positioned at the tip end of the positioning rod (4).

9. The positioning sight for percutaneous implantation of a sacroiliac joint screw under orthoscopic visualization of claim 2, wherein: the positioner (4-2) is an expanded nut and is in threaded connection with the lower end of the positioning rod body (4-1).

10. The positioning sight for percutaneous implantation of a sacroiliac joint screw under orthoscopic visualization of claim 2, wherein: the length of the positioning cross rod (1) is 15-25 cm; the length of the positioning rod (4) is 15-25 cm; the length of the sleeve (7) is 5-8 cm;

the diameter of the positioning needle (4-3) is 2 mm; the diameter of the positioner (4-2) is larger than that of the positioning needle (4-3); the inner diameter of the sleeve (7) is larger than 2 mm.