TWI798060B - percutaneous spinal guide - Google Patents
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Abstract
本發明關於一種經皮穿刺脊椎之導引裝置,包含一握持部、一用於導引穿刺針之導引管、一支柱、一固定部及一抵靠部;其中,該導引管係根據電腦預先規劃之脊椎穿刺路徑而指向待手術之椎節,該支柱係由握持部的底端向下延伸,該固定部形成在該支柱的底端且可緊密貼附待手術椎節之椎弓板,在該固定部的邊緣形成有可匹配地卡合該椎弓板之一彎勾部,該抵靠片係連接於該支柱以抵靠在患者之背部皮膚表面;藉由上述結構,本發明導引裝置可準確地引導骨穿刺針經皮穿刺患者背部而抵達欲治療之目標椎節,提高脊椎手術於鑽孔時的穩定性及精確度。The present invention relates to a guiding device for percutaneous spinal puncture, which includes a gripping part, a guiding tube for guiding a puncture needle, a pillar, a fixing part and an abutting part; wherein, the guiding tube is According to the spinal puncture path planned in advance by the computer, it points to the vertebrae to be operated. The pillar extends downward from the bottom end of the holding part. The fixing part is formed on the bottom end of the pillar and can be closely attached to the vertebrae to be operated. The lumbar plate is formed with a curved hook portion that can be matched with the lumbar plate on the edge of the fixed part, and the abutment piece is connected to the pillar to abut against the patient's back skin surface; by the above structure The guiding device of the present invention can accurately guide the bone puncture needle to percutaneously puncture the patient's back to reach the target vertebral segment to be treated, and improve the stability and accuracy of spinal surgery during drilling.
Description
本發明關於一種經皮穿刺脊椎之導引裝置,特別是指一種於應用於脊椎經皮穿刺之導引裝置,用以輔助醫師於微創術中將穿刺針沿一預設路徑正確插入脊椎體中。 The present invention relates to a guiding device for percutaneous spinal puncture, in particular to a guiding device for percutaneous spinal puncture, which is used to assist doctors to correctly insert the puncture needle into the vertebral body along a preset path during minimally invasive surgery .
因為骨質疏鬆、退化或外力均有可能導致脊椎體受到傷害,例如產生當傷害程度嚴重時,已經無法藉由單純的藥物或物理手段為患者進行治療,而必需建議患者採取脊椎手術。 Osteoporosis, degeneration, or external forces may cause vertebral injury. For example, when the injury is severe, it is no longer possible to treat the patient with simple medicine or physical means, and the patient must be advised to undergo spinal surgery.
傳統的脊椎手術會在患者的身上產生一較大的傷口,因此需審慎考量較多因素,例如失血量多、病患是否適合全身麻醉等;但微創手術則產生相對較小的傷口、出血量少、對肌肉破壞少,可為病患供另種較適宜的治療手段。舉例而言,經皮穿刺椎體成形術(percutaneous vertebroplasty)是屬於微創手術之一,其產生的傷口相對較小,在手術過程中,醫師基於病患影像的導引使用骨穿刺針經由皮下刺入發生骨折的椎體中,接著將骨水泥灌入至該椎體中,以達到強化椎體的目的,增加患者脊椎的穩定性。除此之外,經皮經椎弓根打入骨釘也是常見的手術之一,針對退化性脊椎病變或是脊椎創傷,可將椎弓螺釘穿過椎弓,使椎弓螺釘固定在椎體內部,以輔助後續的鋼條手術施作。 Traditional spine surgery will cause a large wound on the patient's body, so many factors need to be carefully considered, such as the amount of blood loss, whether the patient is suitable for general anesthesia, etc.; however, minimally invasive surgery produces relatively small wounds, bleeding Less amount, less muscle damage, can provide another more suitable treatment for patients. For example, percutaneous vertebroplasty (percutaneous vertebroplasty) is one of the minimally invasive procedures, which produces relatively small wounds. During the operation, the doctor uses a bone puncture needle to subcutaneously Pierce into the fractured vertebral body, and then pour bone cement into the vertebral body to achieve the purpose of strengthening the vertebral body and increase the stability of the patient's spine. In addition, percutaneous transpedicular bone screwing is also one of the common operations. For degenerative spondylopathy or spinal trauma, the vertebral screw can be passed through the vertebral arch to fix the vertebral screw inside the vertebral body , to assist the follow-up steel rod operation.
但人體脊椎各椎節的形狀因人而異,在手術過程中如何針對病患提供個人專屬的輔助工具,以降低手術風險、提高對目標椎節精準鑽孔,又 同時兼顧有醫護人員操作簡易,改良客製化用具已是脊椎手術器具之重要設計課題。 However, the shape of each vertebral segment of the human spine varies from person to person. How to provide individual auxiliary tools for patients during the operation to reduce surgical risks and improve the precision drilling of target vertebral segments? At the same time, taking into account the ease of operation for medical staff, improving customized appliances has become an important design topic for spinal surgery appliances.
本發明之主要目的在於提供一種「經皮穿刺脊椎之導引裝置」,於經皮穿刺脊椎的微創手術過程中,可輔助醫師在其操作穿刺針時沿著一預設路徑、角度將該針具正確插入脊椎體中,提高手術穩定度及準確度。 The main purpose of the present invention is to provide a "guiding device for percutaneous spinal puncture", which can assist the doctor to follow a preset path and angle when operating the puncture needle during the minimally invasive operation of percutaneous spinal puncture. The needle is correctly inserted into the vertebral body to improve the stability and accuracy of the operation.
為達成前述目的,本發明「經皮穿刺脊椎之導引裝置」包含有:一握持部;一導引管,係透複數連接條連接至該握持部的外壁面,其中,該導引管形成一中空通道,沿該導引管之軸向與該握持部之軸向分別延伸後形成有一夾角;一支柱,係由該握持部的底端向下同軸延伸;一固定部,係形成在該支柱的底端,該固定部為一彎曲片體,其底面用於緊密貼附待手術之椎弓板的表面,在該固定部其中一側的邊緣形成有至少一彎勾部,該彎勾部用於匹配地卡合待手術之該椎弓板;一抵靠片,係連接於該支柱的外壁面,該抵靠片用於抵靠在患者之背部皮膚表面。 In order to achieve the above-mentioned purpose, the "guiding device for percutaneous spinal puncture" of the present invention includes: a gripping part; a guiding tube, which is connected to the outer wall of the gripping part through a plurality of connecting strips, wherein the guiding The tube forms a hollow channel, extending along the axial direction of the guide tube and the axial direction of the holding part respectively to form an included angle; a pillar extends coaxially downward from the bottom end of the holding part; a fixing part, It is formed at the bottom end of the pillar, the fixing part is a curved piece, and its bottom surface is used to closely adhere to the surface of the lumbar plate to be operated, and at least one hook part is formed on the edge of one side of the fixing part , the hook portion is used to engage the lumbar plate to be operated on in a matching manner; an abutment piece is connected to the outer wall surface of the pillar, and the abutment piece is used to abut against the patient's back skin surface.
本發明之導引管根據電腦軟體計算出之較佳穿刺路徑,係指向預先規劃好之脊椎鑽孔位置,可用以引導骨穿刺針經皮穿刺患者背部而抵達欲治療之目標椎節,提高經皮脊椎手術於鑽孔時的穩定性及精確度。 The guide tube of the present invention is based on the optimal puncture path calculated by the computer software, which points to the pre-planned spinal drilling position, and can be used to guide the bone puncture needle to percutaneously puncture the patient's back to reach the target vertebral segment to be treated, improving the The stability and accuracy of drilling holes in cutaneous spine surgery.
該固定部基於不同患者的脊椎情況進行客製化的規劃及製作,其底面能緊密貼附在欲治療之脊椎表面,令導引裝置穩固地安置在脊椎上,提高醫護人員手持操作之穩定性,進而降低脊椎手術之安全顧慮。 The fixed part is customized according to the spine conditions of different patients. Its bottom surface can be closely attached to the surface of the spine to be treated, so that the guiding device can be firmly placed on the spine and improve the stability of the hand-held operation of the medical staff. , thereby reducing the safety concerns of spinal surgery.
1:經皮穿刺脊椎之導引裝置 1: Guide device for percutaneous spinal puncture
11:握持部 11: Grip
12:導引管 12: Guide tube
121:連接條 121: Connecting strip
122:中空通道 122: hollow channel
123:穿入口 123: through the entrance
124:穿出口 124: wear exit
13:支柱 13: Pillars
14:固定 14: fixed
141:彎勾部 141: curved hook
15:抵靠片 15: abutment sheet
20:導引環 20: guide ring
21:連接肋 21: Connecting ribs
22:圓孔 22: round hole
100:骨穿刺針 100: bone puncture needle
A:病變椎節 A: Diseased vertebrae
B:病變椎節 B: diseased vertebrae
圖1~3:本發明「經皮穿刺脊椎之導引裝置」第一實施例於不同觀視角度之立體外觀圖。 Figures 1-3: The three-dimensional appearance views of the first embodiment of the "guide device for percutaneous spinal puncture" of the present invention at different viewing angles.
圖4:本發明第一實施例之固定部的局部放大圖。 Fig. 4: A partial enlarged view of the fixing part of the first embodiment of the present invention.
圖5:圖1~4所示「經皮穿刺脊椎之導引裝置」第一實施例之應用狀態示意圖。 Fig. 5: Schematic diagram of the application state of the first embodiment of the "guide device for percutaneous spinal puncture" shown in Figs. 1-4.
圖6:本發明「經皮穿刺脊椎之導引裝置」第二實施例之立體外觀圖。 Fig. 6: A three-dimensional appearance view of the second embodiment of the "guide device for percutaneous spinal puncture" of the present invention.
圖7:圖6所示第二實施例之應用狀態示意圖。 Fig. 7: a schematic diagram of the application state of the second embodiment shown in Fig. 6 .
圖8:本發明「經皮穿刺脊椎之導引裝置」第三實施例之立體外觀圖。 Fig. 8: A three-dimensional appearance view of the third embodiment of the "guide device for percutaneous spinal puncture" of the present invention.
圖9:本發明第三實施例之固定部的局部放大圖。 Fig. 9: A partial enlarged view of the fixing part of the third embodiment of the present invention.
圖10:圖8所示第三實施例之應用狀態示意圖。 Fig. 10: A schematic diagram of the application state of the third embodiment shown in Fig. 8 .
本發明係有關於一種用於經皮穿刺脊椎手術之鑽孔導引裝置1(以下簡稱導引裝置),可以協助醫師對病變之腰椎脊椎注入人工骨泥、打骨釘,協助醫師決定於椎根(pedicle)之鑽孔位置、深度與方向,藉此有效導引骨穿刺針準確地進入至脊椎,而得以提高手術之安全性與成功率。 The present invention relates to a drilling guide device 1 (hereinafter referred to as the guide device) for percutaneous puncture spinal surgery, which can assist doctors to inject artificial bone mud and bone nails into the diseased lumbar spine, and assist doctors to determine the location of the vertebral root. The drilling position, depth and direction of the (pedicle) can effectively guide the bone puncture needle to enter the spine accurately, thereby improving the safety and success rate of the operation.
關於本發明導引裝置1之第一實施例,請參考圖1~3所示,本發明包含有:一握持部11,在本實施例中,該握持部11為一短柱體,提供醫師人員在操作導引裝置1時手持施力;
一導引管12,係位於該握持部11的一側並與其相距一間隔距離,該導引管12透過複數個連接條121連接至該握持部11的一側,在本實施例中具有二連接條121橫向地連接在握持部11與導引管12的外壁面,其中一連接條121連接在鄰近握持部11及導引管12頂端之外壁面,另一連接條121連接在鄰近握持部11與導引管12底端之外壁面。該導引管12的中心沿著軸向形成一中空通道122以供骨穿刺針插入,該中空通道122的兩端分別作為一穿入口123及一穿出口124;該導引管12與該握持部11非平行排列設置,具體而言,沿該導引管12之軸向與該握持部11之軸向分別向下延伸後可在同一平面上形成一投影角θ,該投影角θ小於90度,令該導引管12相對於握持部11略為傾斜,其中,該導引管12相對該握持部11的傾斜角度係依據為不同患者所規劃之穿刺路徑而定;一支柱13,係由該握持部11的底面向下同軸延伸,其中,在該支柱13的末端形成一固定部14,該固定部14為一彎曲片體,其底面能緊密貼附於腰椎椎節之椎弓板(lamina)的表面,如圖4所示,在該固定部14鄰近棘突(spinous process)一側的邊緣形成有一彎勾部141,該彎勾部141可匹配地卡合在椎弓板的上緣或下緣,在本實施例中,該彎勾部141用於卡合於椎弓板之下緣;一抵靠片15,係連接於該支柱13的外壁面,鄰近該握持部11的底端,其中該抵靠片15的底面為一彎曲弧面151,該彎曲弧面151的形狀可匹配貼附在患者的背部皮膚表面,使整體導引裝置1能夠更加平衡穩固的置放在椎節上,降低搖晃機率;較佳而言,該抵靠片15與該導引管12大致上分別位在該支柱13的相對兩側。
Regarding the first embodiment of the guiding
在製作上述導引裝置1時,可採用積層製造(3D列印)技術製作完成,醫師人員可藉由已知的手術規劃軟體計算出適合病患由外部刺入脊椎的一安全穿刺路徑。安全穿刺路徑確定後,決定了該導引管12相對於握持部11的傾
斜角度、相隔距離,因此可以得知兩連接條121所需的長度;該支柱13需具有一定的長度而使其底端的固定部14能夠貼附在欲治療之病變椎節;該抵靠片15則是當固定部14貼合於脊椎表面時,該抵靠片15恰好能夠支撐在患者背部的皮膚表面,為整體導引裝置1提供較佳的平衡效果。
When making the
請參考圖5所示,當本發明具體應用在脊椎手術時,病患係趴臥於手術台台面上,醫師人員在該患者背部切開一個足以置入固定部14之開口並剝開脊椎上方之軟組織後,露出計劃治療之病變椎節A,將導引裝置1之固定部14通過開口放置在該病變椎節A的椎弓板,而露出在外的該抵靠片15係抵頂在開口周圍的背部表面。因為該固定部14的底面形狀係對應該患者的椎弓板表面,因此該固定部14可以緊密貼附在預先計劃的唯一位置,並使該固定部14的彎勾部141卡合於該病變椎節A的下緣,完成該導引裝置1的放置作業。
Please refer to shown in Figure 5, when the present invention is specifically applied to spinal surgery, the patient is lying prone on the operating table, and the doctor cuts an opening enough to insert the
於導引裝置1放置完成後,該導引管12中心的通道122方向即為預設的穿刺路徑,如圖5所示,該導引管12位在患者的背部上方,醫師可以將一骨穿刺針100(例如K-pin)置入導引管12中,依據該導引管12指向的路徑經皮穿刺進入至該病變椎節A的椎根,使骨穿刺針100到達該病變椎節A以進行後續的治療作業,例如對該病變椎節注射人工骨泥或打入骨釘。
After the
再參考圖6、圖7所示,為本發明導引裝置1的第二實施例,與第一實施例的差異在於第二實施例進一步包含一導引環20。該導引環20透過一連接肋21連接在該支柱13底端之外壁面並且與該導引管12呈同軸對齊,換言之,該導引環20亦是位在預先規劃好之穿刺路徑上。於該導引環20的中心具有一圓孔22可供骨穿刺針100通過。
Referring again to FIG. 6 and FIG. 7 , it is the second embodiment of the guiding
當第二實施例在實際應用時,如圖7所示,該導引環20係位於該骨穿刺針100欲刺入椎根之位置。此實施例的特點在於該導引環20加強了該骨穿刺針100在脊節表面的導引定位作用,降低骨穿刺針100在穿刺過程中發生滑
脫錯位的機率,提高骨穿刺針100的移動穩定性,特別是在骨穿刺針100需要進入至患者體內相對較長的距離時,該導引環20更能強化輔助效果。
When the second embodiment is used in practice, as shown in FIG. 7 , the
另請參考圖8所示,為本發明導引裝置1的第三實施例,此導引裝置1係設計應用於相鄰的另一個病變椎節B;該導引裝置1亦具有與第一實施例相同的結構,包含有握持部11、導引管12、支柱13、固定部14及抵靠片15等。但要特別注意的是因為此導引裝置1係針對病變椎節B所設計,根據該病變椎節B之穿刺路徑而適應地調整改變,例如該導引管12相對於該握持部11的相對間距、夾角/該支柱的13的長度/該固定部14的形狀/該抵靠片15的形狀以及相對於支柱13的夾角角度等,皆會不同於第一實施例。
Please also refer to Fig. 8, which is the third embodiment of the guiding
請參考圖9及圖10所示,在此第三實施例中,該固定部14底面的形狀係對應緊密附於該病變椎節B之椎弓板的表面,而且固定部14邊緣所形成的彎勾部141係用於匹配地卡合在該病變椎節B之椎弓板的上緣,與前述第一實施例卡合在椎弓板下緣不同。同樣的,本實施例的導引裝置1應用於手術時,其固定部14也是通過患者背部劃開的開口放置在該病變椎節B的椎弓板,露出在外的該抵靠片15係支撐在開口周圍的背部表面。因為該固定部14的底面形狀係對應該病變椎節B的椎弓板表面,因此該固定部14可以緊密貼附在預先計劃的唯一位置,並使該固定部14的彎勾部141卡合於該病變椎節B的上緣,完成該導引裝置1的放置作業。
Please refer to Fig. 9 and Fig. 10, in this third embodiment, the shape of the bottom surface of the fixing
綜上所述,本發明所提供經皮穿刺脊椎之導引裝置,其導引管可指向預先規劃好之鑽孔位置,並且引導骨穿刺針經皮穿刺患者背部而精準抵達欲治療之目標椎節,提高脊椎手術於鑽孔時的穩定性及精確度。 To sum up, the guiding device for percutaneous spinal puncture provided by the present invention can point the guiding tube to the pre-planned drilling position, and guide the bone puncture needle to percutaneously puncture the back of the patient to reach the target vertebra to be treated accurately. Joint, improve the stability and accuracy of spinal surgery during drilling.
再者,本發明的結構相對簡單,適於針對不同患者的脊椎情況進行客製化的規劃及製作,令導引裝置能精準貼附在該患者患部椎節表面,符 合患者的病情需求,降低導引裝置產生晃動,提高醫護人員手持操作之穩定性,進而降低脊椎手術之安全顧慮。 Furthermore, the structure of the present invention is relatively simple, and is suitable for customized planning and production according to the vertebral conditions of different patients, so that the guiding device can be accurately attached to the surface of the vertebral joints of the affected part of the patient, and conforms to Meet the patient's condition needs, reduce the shaking of the guide device, improve the stability of the hand-held operation of the medical staff, and thereby reduce the safety concerns of spinal surgery.
雖然本發明已利用上述較佳實施例揭示,然其並非用以限定本發明,任何熟習此技藝者在不脫離本發明之精神和範圍之內,相對上述實施例進行各種更動與修改仍屬本發明所保護之技術範疇,因此本發明之保護範圍當視後附之申請專利範圍所界定者為準。 Although the present invention has been disclosed by using the above-mentioned preferred embodiments, it is not intended to limit the present invention. It is still within the scope of this invention for anyone skilled in the art to make various changes and modifications relative to the above-mentioned embodiments without departing from the spirit and scope of the present invention. The technical scope protected by the invention, therefore, the scope of protection of the present invention should be defined by the scope of the appended patent application.
1:經皮穿刺脊椎之導引裝置 1: Guiding device for percutaneous spinal puncture
11:握持部 11: Grip
12:導引管 12: Guide tube
121:連接條 121: Connecting strip
122:中空通道 122: hollow channel
123:穿入口 123: through the entrance
124:穿出口 124: wear exit
13:支柱 13: Pillars
14:固定 14: fixed
141:彎勾部 141: curved hook
15:抵靠片 15: abutment sheet
Claims (9)
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TW111114691A TWI798060B (en) | 2022-04-18 | 2022-04-18 | percutaneous spinal guide |
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TW111114691A TWI798060B (en) | 2022-04-18 | 2022-04-18 | percutaneous spinal guide |
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Citations (4)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
TWI481382B (en) * | 2012-08-31 | 2015-04-21 | Univ Nat Cheng Kung | Assistance device and guiding assembly for percutaneous surgery |
JP2019122494A (en) * | 2018-01-12 | 2019-07-25 | 浩太 須田 | Puncture instrument guide device |
CN111134798A (en) * | 2020-02-12 | 2020-05-12 | 山东航维骨科医疗器械股份有限公司 | Spine minimally invasive guider |
CN214157469U (en) * | 2020-11-06 | 2021-09-10 | 赣南医学院第一附属医院 | Lumbar puncture auxiliary support |
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Patent Citations (4)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
TWI481382B (en) * | 2012-08-31 | 2015-04-21 | Univ Nat Cheng Kung | Assistance device and guiding assembly for percutaneous surgery |
JP2019122494A (en) * | 2018-01-12 | 2019-07-25 | 浩太 須田 | Puncture instrument guide device |
CN111134798A (en) * | 2020-02-12 | 2020-05-12 | 山东航维骨科医疗器械股份有限公司 | Spine minimally invasive guider |
CN214157469U (en) * | 2020-11-06 | 2021-09-10 | 赣南医学院第一附属医院 | Lumbar puncture auxiliary support |
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