CN218922717U - Bone cutting guide plate around knee joint and bone cutting device - Google Patents

Abstract

The utility model discloses a knee joint surrounding osteotomy guide plate and osteotomy device, which comprises a clamping main plate, wherein a sliding rod is arranged on the clamping main plate, a clamping auxiliary plate is arranged opposite to the clamping main plate, one side surface of the sliding rod is provided with a plurality of first guide holes, the first guide holes longitudinally penetrate through the sliding rod and are internally used for inserting guide pins, the first guide holes are positioned on a first plane, the plane is a longitudinally extending plane, the clamping auxiliary plate is provided with a plurality of second guide holes, the second guide holes transversely penetrate through the clamping auxiliary plate and are used for inserting kirschner pins, and the second guide holes are positioned on a second plane, and the plane is a longitudinally extending plane. After the device is adopted, the Kirschner wire is intersected with the guide needle and is used as a dead point when being placed in, and the device has the advantages of being capable of being placed in quickly and accurately.

Description

Bone cutting guide plate around knee joint and bone cutting device

Technical Field

The utility model relates to the technical field of medical equipment, in particular to a bone cutting guide plate around a knee joint and a bone cutting device.

Background

Tibial Osteotomies (HTO) have evolved from 1965 to a safe, accurate and effective surgical technique for treating tens of thousands of knee osteoarthritis patients each year. The principle is that the proximal tibia osteotomy corrects the crown surface deformity of tibia and the lower limb force line is properly transferred to a normal side compartment, thereby obviously relieving the pressure of the suffering side compartment and achieving the purposes of relieving the arthritis symptom and prolonging the service life of the knee joint.

However, no modular or personalized 3D printed surgical guide currently has a predetermined hinge position and direction, and many studies have confirmed that the hinge position and direction will affect the tibial plateau caster angle after the osteotomy is opened or closed; an increase in the back tilt may result in limited extension of the knee, increased anterior cruciate ligament tension, and even fracture, whereas an increase in the posterior cruciate ligament tension may result in overstretching of the knee, thus first ensuring proper hinge position and orientation.

Conventional operations have the following drawbacks:

1. the steps are numerous, and the time consumption is long;

2. multiple perspectives are needed to increase radiation exposure for the patient and the operator;

3. the position and the direction of the hinge are determined according to the final entering position and the final entering direction of the saw blade in the osteotomy operation, and the hinge is determined to be inaccurate and uncontrollable;

4. the hinge is a linear osteotomy surface, stress concentration is carried out during the expansion, and especially hinge fracture can occur during violent operation or too fast expansion.

Disclosure of Invention

The utility model provides a knee joint surrounding osteotomy guide plate and an osteotome, which are used for solving the problems of complex operation steps, more exposure of X-ray radiation, long time consumption and the like caused by multiple perspective and measurement of the depth of a guide needle and a saw blade in the existing hinge determination uncontrollability in HTO operation.

In order to solve the technical scheme, the utility model adopts the following technical scheme:

the utility model provides an osteotomy guide around knee joint and osteotome, includes the centre gripping mainboard, set up the slide bar on the centre gripping mainboard, the centre gripping subplate is connected to the slide bar, the centre gripping subplate is in remove on the slide bar, the centre gripping subplate with the centre gripping mainboard sets up relatively, set up a plurality of first guide holes that vertically run through the slide bar on the slide bar, first guide hole is used for the interlude guide pin, set up on the centre gripping subplate and transversely run through a plurality of second guide holes of centre gripping subplate, the second guide hole is used for the interlude k shi needle, and the guide pin is fixed in the skeleton, after the skeleton is pressed from both sides to the osteotomy guide plate, k shi needle is put into the skeleton and is contacted with the guide pin through the second guide hole.

Preferably, the sliding rod is provided with fixed teeth, the fixed teeth and the first guide hole are positioned on the same side face, and the clamping auxiliary plate is engaged with the sliding rod through the engagement of the fixed teeth.

Preferably, a hand push handle is arranged at the end part of the clamping auxiliary plate, and the hand push handle is perpendicular to the clamping auxiliary plate; pushing the hand push handle, and moving the clamping auxiliary plate to the direction of the clamping main plate.

Preferably, the buffer auxiliary plate is arranged on the clamping auxiliary plate, and the buffer auxiliary plate is arranged opposite to the clamping main plate.

Preferably, the clamping main board is provided with a buffering main board, and the buffering main board and the buffering auxiliary board are arranged oppositely.

Preferably, a plurality of grooves are formed in the outer surface of the Kirschner wire, the grooves are uniformly distributed around the circumferential surface, and the interval angle is 30-40 degrees.

Preferably, the osteotomy device is matched with the osteotomy guide plate for use, the osteotomy device is provided with an osteotomy groove, the matching hole is formed in the osteotomy groove, the Kirschner wire passes through the osteotomy device through the matching hole, and the height and the direction of the osteotomy device are positioned through the position of the Kirschner wire.

Preferably, the width of the osteotomy groove is matched with the thickness of a saw blade used for subsequent osteotomies.

Preferably, the guide pin comprises an angle gauge matched with the guide pin, the guide pin is inserted on the angle gauge, and the angle gauge rotates by taking the guide pin as a rotation shaft.

Preferably, the guide pin surface is sleeved with a clamping ring, and the angle ruler is stacked on the clamping ring.

The utility model has the following beneficial effects:

1. the device is adopted to adjust the sequence of the hinge after the Kirschner wire is firstly put in, when the device is used, the hinge (the position and the direction of the guide pin are the position and the direction of the hinge) is firstly determined, and then the Kirschner wire is put in to determine the main osteotomy plane and perform a series of osteotomy operations;

2. when the device is used for placing the Kirschner wire at the back, the guide needle is used as the end point, so that the device can be placed quickly and accurately, multiple perspective adjustment and depth measurement are not needed, the time is saved, and the operation time is reduced;

3. the guide pin hole of the device is overlapped with the plane where the Kirschner wire is positioned, so that the blind operability is greatly improved;

4. after the guide pin is placed, a cylindrical cavity is formed, namely, the hinge is in a cylindrical cavity shape, so that the phenomenon of stress concentration at the edge of the wedge-shaped osteotomy block is reduced, and the occurrence probability of hinge fracture is reduced.

Drawings

FIG. 1 is a schematic view of a guide pin of the present utility model placed in a bone.

FIG. 2 is a schematic view of the apparatus of the present utility model.

FIG. 3 is a schematic diagram of the operation of the device of the present utility model with a guide pin.

FIG. 4 is a schematic view of a first plane and a second plane of the device of the present utility model.

FIG. 5 is a schematic view of a guide pin and Kirschner wire according to the utility model.

FIG. 6 is a schematic view of a Kirschner wire used in the utility model.

FIG. 7 is a schematic view of the angle of the upper bone-cutting surface in the present utility model.

FIG. 8 is a schematic view of the use of K-wire with horizontal section angle according to the present utility model.

FIG. 9 is a schematic view of the osteotomy device of the present utility model.

FIG. 10 is a schematic view of an osteotomy device according to the present utility model.

FIG. 11 is a schematic view of an angle ruler according to the present utility model.

Fig. 12 is a schematic view of the osteotomy face distraction of the present utility model.

Detailed Description

The present utility model will be described in further detail with reference to the drawings and examples, in order to make the objects, technical solutions and advantages of the present utility model more apparent.

It should be understood that the specific embodiments described herein are for purposes of illustration only and are not intended to limit the scope of the utility model.

The following is a description of the present device:

as shown in fig. 2, the device is a bone cutting guide plate and bone cutting device around knee joint, and comprises a clamping main plate 1, wherein a sliding rod 3 is arranged on the clamping main plate 1, a clamping auxiliary plate 2 is movably connected on the sliding rod 3, the clamping main plate 1 and the clamping auxiliary plate 2 are respectively arranged at one end of the sliding rod 3, the clamping main plate 1 and the clamping auxiliary plate 2 are oppositely arranged, a plurality of first guide holes 31 are arranged on the sliding rod 3, and guide pins 5 are inserted in the first guide holes 31.

A plurality of first guide holes 31 longitudinally penetrate the clamping main plate 1, are positioned on a first plane and are planes extending in the vertical direction, namely a plane indicated by a position B in the illustration 4, a second guide hole 21 transversely penetrates the clamping auxiliary plate 2 and is used for inserting kirschner wires (the diameter is generally 2.0 mm), a plurality of second guide holes 21 are positioned on a second plane and are planes extending in the vertical direction, namely a plane indicated by a position C in the illustration, and are also planes in which the kirschner wires are positioned at the same time, and the kirschner wires can contact the guide pins 5 through the second guide holes 21 to stop in the operation process.

Further, as shown in fig. 6, the device needs a specific guide pin 5, the diameter of the guide pin 5 is controlled to be between 4.5mm and 4.9mm, preferably 4.5mm, a plurality of grooves 51 are formed on the outer surface of the guide pin 5 along the circumferential direction, the grooves 51 are uniformly distributed along the circumferential surface, the spacing angle is controlled to be between 30 ° and 40 °, and the purpose of the arrangement is that no matter what angle a worker places the guide pin 5 into the first guide hole 31, the guide pin 5 always has a corresponding groove 51 aligned with the insertion direction of the osteotomy saw blade (the thickness is generally 1.27 mm), so that when the osteotomy saw blade touches the guide pin 5, the operator is given a touch feedback, and repeated perspective and depth measurement are avoided.

The device is also provided with an angle gauge 7 matched with the guide pin 5, as shown in fig. 11, the guide pin 5 is inserted on the angle gauge 7, the angle gauge 7 rotates by taking the guide pin 5 as a rotating shaft, the guide pin 5 is generally perpendicular to a bone surface, 7 clamping rings 52 are sleeved on the surface of the guide pin 5, the clamping rings are perpendicular to the center line of the guide pin, the angle gauge 7 is stacked on the clamping rings 52, and the clamping rings simultaneously play a supporting role on the angle gauge 7.

Further, as shown in fig. 3 and 5, by providing the push handle 4 on one side of the grip sub-plate 2, the buffer sub-plate 41 is provided on the other side of the grip sub-plate 2, and at the same time, the buffer main plate 11 is provided on one side of the grip main plate 1, and since the grip sub-plate 2 and the grip main plate 1 are provided opposite to each other, the buffer sub-plate 41 and the buffer main plate 11 are also provided opposite to each other. In the clamping process, as the clamping auxiliary plate 2 can move on the sliding rod 3, the hand pushing handle 4 is held by hand, the distance between the clamping main plate 1 and the clamping auxiliary plate 2 is adjusted in a hand pushing mode, so that bones are clamped or released, the contact area with the bones to be clamped is enlarged due to the arrangement of the buffer plate, and the operation of an operator is easy.

In the foregoing, the fixing teeth 32 are provided on the same side of the first guide hole 31 on the slide bar 3, and the mating teeth provided on the grip sub-plate 2 are engaged with the fixing teeth 32, so that the slide bar can be engaged with different fixing teeth according to the operation of the operator. Each fixed tooth is arranged between the two fixed teeth, and the clamping auxiliary plate is used for controlling the distance between the clamping auxiliary plate and the clamping main plate by engaging different fixed teeth, so that the clamping dimension is easier to control.

In addition, the device needs to be matched with the osteotomy device 6 for use, as shown in fig. 9 and 10, the osteotomy device 6 is provided with an osteotomy groove 61, the osteotomy groove 61 penetrates through the osteotomy device 6 from the middle position of the osteotomy device 6, two matching holes 63 are arranged in the osteotomy groove 61, and when the osteotomy device 6 is used, the kirschner wire placed in the bone penetrates through the two matching holes 63, so that the height and the direction of the osteotomy device 6 are positioned through the position of the kirschner wire.

The osteotomy guide 62, which is located above or below the right half side as shown in fig. 10, is provided in a layered manner with gaps between the osteotomy guide 62 and the horizontal osteotomy surface at angles of 110 °, 120 °, and 130 °.

The following is the method for using the device in the operation process:

high tibial osteotomies are suitable for young patients with active unicompartmental arthritis and tibial coronal line deformity. Although the success of surgery depends on the choice of patient, the clinical outcome depends on the exact surgical technique, since overcorrection and undercorrection can lead to adverse consequences, so that it is important to determine the hinges, adjust the coronal line accurately, and to avoid changes in the back tilt, the procedure comprises the steps of:

1. preoperative preparation: shooting full-length X-ray films of standing positions of the two lower limbs, measuring the proximal deformity angle of the tibia, and calculating the angle to be corrected or the distance for expanding the cortex.

2. Surgery:

preparation before osteotomy: the patient should be in supine position and the knee joint can be easily adjusted to 90 ° flexion and full extension.

The patient's posture should be such that the hip, knee and ankle joints are clearly discernible under intraoperative X-ray fluoroscopy. Placing the contralateral leg in a lower position from the hip joint helps reveal the medial proximal tibia. The sterile drape should not obscure the iliac crest so that the leg axis can be inspected during surgery. Sufficient space should be left for the legs to straighten out completely during surgery and evaluate the orthopedic effect.

Incision: anatomical landmarks (proximal medial articular line, medial collateral ligament with direction of progression and tibial tuberosity) are marked on the skin. A 6-8cm incision is made from the anterior edge toward the posterior superior side, which should terminate at the posterior medial corner of the medial tibial plateau.

The method comprises the following steps: exposing the goose foot dead point, retracting the goose foot at the proximal side by a sharp pry towards the distal end, cutting off or stripping the superficial distal fiber of the collateral ligament at the inner side, and exposing the rear edge of the tibia.

The legs were fully straightened and the knee position was adjusted under fluoroscopy until a full AP image was obtained. The medial and lateral condyles are aligned on the AP site. The leg is rotated until the patella is fully anterior (so that 1/3 of the fibular bone is typically covered by the tibia).

The osteotomy steps are as follows:

1. as shown in fig. 1, firstly, the electric drill for the X-ray fluoroscopy is used for drilling the guide pin 5 from the tibia anterior cortex to the tibia posterior cortex by combining the operation experience and the operation, and the step is to determine the space position of the hinge; then, the guide pin 5 is inserted into the first guide hole 31, and the bone is clamped by the bone cutting guide around the knee joint through the clamping main plate 1 and the clamping auxiliary plate 2.

2. Then, two additional kirschner wires 8 need to be inserted from the proximal end of the tibia to the upper side from the inside to the outside through the second guide hole 21 of the clamping auxiliary plate 2, as shown in fig. 3, 4 and 7, at this time, since the second guide hole 21 is arranged on the clamping auxiliary plate 2, the second guide hole 21 is positioned on the second plane, the first guide hole 31 is positioned on the first plane, and when the clamping auxiliary plate 2 and the clamping main plate 1 jointly act to clamp bones, when an operator drills into the two additional kirschner wires, the two kirschner wires placed by the second guide hole 21 can be directly determined to be positioned on the same plane, that is, the two kirschner wires are proved to be parallel until the two kirschner wires are contacted with the groove 51 of the guide pin 5 firstly placed by the first guide hole 31, that is, the end point of the osteotomy plane can be verified as the guide pin 5, that is, and the guide pin 5 determines the spatial position of the hinge, so that frequent perspective and depth measurement can be omitted.

3. Determining an osteotomy position:

after the positions of the guide needle 5 and the Kirschner wire 8 are determined on the bone of a patient through the steps, the osteotomy guide plate is taken down, the guide needle 5 and the Kirschner wire 8 are only reserved, the tibia osteotomy device 6 is used, the osteotomy groove 61 on the osteotomy device is internally provided with matching holes 63 matched with the two Kirschner wires, the distances between the two matching holes 63 and the distances between the two second guide holes are matched, and the Kirschner wires pass through the matching holes 63 one by one so as to position and direction of the osteotomy device 6; and 64 is a non-parallel kirschner wire fixing hole for fixing the osteotomy device 6 on a bone, as shown in fig. 9, and two other non-parallel kirschner wires are used for fixing the osteotomy device 6 on the bone surface through a non-parallel kirschner wire hole 64, an osteotomy saw blade can be inserted into an osteotomy groove 61 on an osteotomy guide plate to perform osteotomy on the main osteotomy surface of the tibia, the osteotomy groove 61 penetrates through the whole osteotomy device, and the osteotomy depth is limited by the contact of the saw blade with the guide pin 5.

4. Intercepting an uplink or downlink osteotomy face:

ascending osteotomy face: as shown in FIG. 10, in determining the upstream osteotomy face, there is an upstream or downstream osteotomy guide 62 on the osteotomy face, optionally at an angle of 100, 110 or 120, for use with the osteotomy 6. The upper bone cutting surface enables the whole patellar tendon stop point to be attached to the distal tibia, so that the patellar tendon stop point can be completely reserved, and normal stress of the patellar tendon is not disturbed; the descending osteotomy surface prevents the height of the patella from being affected, and does not cause or aggravate the low-level patella; the front bone contact of the osteotomy face can prevent the proximal osteotomy block from moving forward, tilting and rotating; increasing the contact area and promoting the bone healing. In this example, an ascending osteotomy guide plate is selected that forms an angle of 110 with the horizontal osteotomy face.

In this embodiment, the osteotomy guide 62 is detachable, as shown in fig. 10, and the bump 601 on the osteotomy device 6 is connected to and detached from the osteotomy guide 62 in a mortise and tenon structure, so that the osteotomy guide can be used according to the requirements of the operator. Attached to the upper surface of the osteotomy tool 6, operable to cut an upstream bone, and the lower surface operable to cut a downstream bone (attached to the lower surface not shown).

The tibia osteotome 6 and the extraction guide pin 5 are taken out, and the osteotomy region is slowly spread by using a laminated osteotome method: at least two osteotomes are used to obtain an initial distraction space. The bone chisel is removed and the bone distractor is carefully driven in with a hammer until it reaches the hinge point. The bone cutting depth can be read out on the spreader blade of the spreader. The screw is slowly rotated by the screwdriver, so that the osteotomy area is opened until the required opening angle is obtained, and the position of the lower limb coronal plane force line passing through the knee joint can be determined by combining X-ray fluoroscopy.

In the foregoing step of opening the osteotomy region, a linear shape is formed at the hinge in the past operation process, and the hinge has a concentrated shape stress, and when the osteotomy region is opened, there is a risk of fracture and the like, and hidden danger is brought to the rehabilitation of the patient in the future, so that the following corresponding improvements are made in the present implementation:

after the groove 51 is formed in the circumferential surface of the guide pin 5, the guide pin 5 is correspondingly placed into the groove 51 when the bone is cut by the bone cutting saw blade, namely, the tail end of the bone cutting is a cylindrical cavity (the shape of the cylindrical cavity at the hinge), which is formed by drilling the guide pin 5 into bone, as shown in fig. 12, in the drawing, A is the position of the hinge, the hinge is in the shape of the cylindrical cavity, the traditional hinge is in a linear shape, the phenomenon of stress concentration at the edge of the wedge-shaped bone cutting block is reduced, and the occurrence probability of hinge fracture is reduced.

5. Maintaining osteotomy height:

after the distraction tool is removed, a second gauge may be inserted to maintain the open position. The implant can be placed between two measuring devices, and the spreading forceps are placed at the back inner side to spread.

6. Inserting and fixing a steel plate:

the position of the plate is confirmed under fluoroscopy by subcutaneously inserting the prepared osteotomy plate. The solid portion of the fixation plate should cover the osteotomy region and the proximal locking screw should be positioned 1cm below the articular surface at the subchondral bone, with the remaining locking screws placed in sequence.

In addition, HTO surgery includes two categories, closed wedge osteotomies and open wedge osteotomies, the steps above being shown as open wedge osteotomies, in order to make the device have a more comprehensive auxiliary effect, and also applicable to closed wedge osteotomies, the device makes the following improvements:

in a closed wedge osteotomy, the operator is required to cut a wedge bone block and adjust the lower limb coronal plane force line, thus determining the wedge angle, as follows:

1. after the guide pin 5 is put into the tibia from the anterior cortex to the posterior cortex by using the electric drill, two other kirschner wires 8 need to be inserted from the proximal end of the tibia from the inside to the outside through the second guide hole 21, at this time, because the second guide hole 21 is arranged on the clamping auxiliary plate 2, the second guide hole 21 is positioned on the second plane, the first guide hole 31 is positioned on the first plane, and when the clamping auxiliary plate 2 and the clamping main plate 1 jointly act to clamp bones, therefore, when an operator inserts the other two kirschner wires, the two kirschner wires 8 are positioned on the second plane and can touch the guide pin positioned on the first plane, so that the electric drill can be directly used for drilling the two kirschner wires 8 until contacting the groove 51 of the guide pin 5 which is put into the first guide hole 31, namely, the end point of the osteotomy plane can be verified as the guide pin 5, namely, the guide pin 5 determines the spatial position of the hinge.

And taking down the clamping device, then matching with the bone cutter, cutting a wedge-shaped side line by the bone cutter, and adjusting the side line to the zero scale line of the angle ruler 7.

2. The guide pin 5 surface is provided with the snap ring 52 that is used for putting angle chi 7, is fixed in this snap ring 52 department with angle chi 7, and angle chi 7 can rotate around guide pin 5, again according to the wedge angle that will cut this moment, adjustment scale department, fixed second piece osteotome 6 cuts the bone knife utensil and cuts out wedge another boundary to play the purpose of confirming the wedge shape.

The tool is suitable for tibia, femur, humerus and other parts.

The above embodiments are only preferred embodiments of the present utility model, and are not intended to limit the present utility model, but any modifications, equivalent substitutions and improvements made within the spirit and principle of the present utility model should be included in the protection scope of the present utility model.

Claims (10)

1. The utility model provides a knee joint cuts bone conduction board around, its characterized in that, including centre gripping mainboard (1), set up slide bar (3) on centre gripping mainboard (1), centre gripping subplate (2) are connected to slide bar (3), centre gripping subplate (2) are in move on slide bar (3), centre gripping subplate (2) with centre gripping mainboard (1) set up relatively, set up a plurality of first guide holes (31) that vertically run through slide bar (3) on slide bar (3), first guide hole (31) are used for alternate guide pin (5), set up transversely on centre gripping subplate (2) a plurality of second guide holes (21) that run through centre gripping subplate (2), second guide hole (21) are used for alternate kirschner wire (8), are fixed in the skeleton when guide pin (5), cut bone conduction board clamp skeleton after, kirschner wire (8) are put into the skeleton and contact with guide pin (5) through second guide hole (21).

2. A knee joint surrounding osteotomy guide plate according to claim 1, wherein the slide bar (3) is provided with fixing teeth (32), the fixing teeth (32) are on the same side as the first guide hole (31), and the clamping sub-plate (2) is engaged with the slide bar by engaging with the fixing teeth (32).

3. A knee joint surrounding osteotomy guide as in claim 1, wherein the end of the clamping sub-plate (2) is provided with a handle (4), the handle (4) being perpendicular to the clamping sub-plate (2); pushing the hand push handle (4), and moving the clamping auxiliary plate (2) towards the clamping main plate (1).

4. A periknee osteotomy guide as in claim 3, wherein the clamping sub-plate (2) is provided with a cushioning sub-plate (41), the cushioning sub-plate (41) being disposed opposite the clamping main plate (1).

5. A knee joint circumference osteotomy guiding plate as in claim 4, wherein the clamping main plate (1) is provided with a cushioning main plate (11), the cushioning main plate (11) being disposed opposite the cushioning sub-plate (41).

6. A periknee osteotomy guide as in claim 1, wherein the outer surface of the k-wire (8) is provided with a plurality of grooves (51), the plurality of grooves (51) being evenly distributed around the circumferential surface at intervals of 30 ° to 40 °.

7. The bone cutting guide plate around knee joint according to claim 1, further comprising an angle gauge (7) matched with the guide needle (5), wherein the guide needle (5) is inserted on the angle gauge (7), and the angle gauge (7) rotates by taking the guide needle (5) as a rotation axis.

8. The knee joint surrounding osteotomy guide plate of claim 7, wherein the guide pin (5) has a snap ring (52) sleeved on the surface thereof, and the angle gauge (7) is stacked on the snap ring (52).

9. An osteotomy device, characterized in that the osteotomy device (6) is matched with the osteotomy guide plate according to any one of claims 1 to 8, the osteotomy device (6) is provided with an osteotomy groove (61), a matching hole (63) is arranged in the osteotomy groove (61), a kirschner wire (8) passes through the osteotomy device (6) through the matching hole (63), and the height and the direction of the osteotomy device (6) are positioned through the position of the kirschner wire (8).

10. An osteotomy device according to claim 9, wherein the width of the osteotomy groove (61) matches the thickness of a saw blade for subsequent osteotomies.

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