WO2012048480A1

WO2012048480A1 - Surgical tool for installing epiphysiodesis internal 8-shaped steel plate

Info

Publication number: WO2012048480A1
Application number: PCT/CN2010/078640
Authority: WO
Inventors: 喻洪流; 赵黎; 李海; 李继才
Original assignee: 上海交通大学医学院附属新华医院
Priority date: 2010-10-15
Filing date: 2010-11-11
Publication date: 2012-04-19
Also published as: CN101972166A; CN101972166B

Abstract

A surgical tool for installing epiphysiodesis internal 8-shaped steel plate includes an 8-shaped template (2), a pair of pincers (3) for the template and a double-aperture guiding apparatus (4). The double-aperture guiding apparatus (4) is provided with an angle adjusting device (41). The angle adjusting device (41) is provided with an angle adjusting knob (411), a scale plate (412) and a rotating shaft (414) which are connected by connecting bolts (415). An angle indicating needle (413) is fixed on the angle adjusting knob (411). The angle adjusting device (41) is fixed on a connecting block (416) of the double-aperture guiding apparatus (4) by four screw holes on the scale plate (412), thereby being fixed on a guiding sleeve (42) of the double-aperture guiding apparatus (4). The angle adjusting knob (411) is provided with a locating needle channel (4111), and the 8-shaped template (2) is provided with a locating needle hole (221). A locating needle (44) simultaneously passes through the locating needle channel (4111) and the locating needle hole (221) while locating the 8-shaped template (2).

Description

Surgical tool for installing an internal stenosis block with a built-in 8-shaped steel plate

Technical field

BACKGROUND OF THE INVENTION 1. Field of the Invention This invention relates to a medical device, and more particularly to a surgical tool for mounting a built-in 8-shaped steel plate for the treatment of ankle angulation of adolescent knee joints.

Background technique

Ankle horn deformity in adolescents is a relatively common set of lower extremity dysplasia, which usually includes coronal horns and sagittal horns, both of which can exist simultaneously. Coronal horn deformities mainly include idiopathic knee valgus, Blount disease and other osteophyte diseases as well as trauma and tumor-induced knee valgus. The sagittal angle is generally expressed as the knee joint fixed in the flexion position, which is often secondary to cerebral palsy, spina bifida and other neuromuscular diseases. Ankle horn deformity is clinically characterized by gait abnormalities, knee pain and dysfunction. In severe cases, hip and ankle joint abnormalities can be caused. Most of the conditions can heal in childhood. However, the pathological lower extremity angulation deformity can cause more severe dysfunction, and its treatment is fundamentally different from benign knee valgus.

The angle of the femur and tibia of the lower extremity in children has physiological changes from newborns, children to adolescents. The angle of the femur and tibia at the age of 15° is considered normal. After 18 months, the lower extremity gradually straightened, and then the lower extremity gradually became mild knee valgus due to posture and activity factors. From then on, under the body's own correction, to the mild knee outside the development. Turning is normal, FTA is generally in the range of 4 ° -6 °. The fundamental difference between physiology and pathology is that the correction process of the former is gradual and asymptomatic. Lower extremity deformities in children can be caused by factors such as trauma, infection, genes, tumors, metabolism, or external forces. Unexplained knee valgus was named idiopathic.

Therapies for these diseases have evolved in recent decades. The initial treatment was to perform a femoral or tibial wedge osteotomy after the child's growth and development was completed. This method is now mainly used for the correction of the tarsal closure of the knee joint in adult patients. In 1949, Blount proposed the use of osteophytes to limit the growth of one side of the tarsal plate to correct the imbalance of development on both sides, and created a precedent for the treatment of angular ankle deformity of the knee joint. Since this bone nail is widely used in the treatment of various types of knee deformity, but due to a series of frequent complications, such as bone nail displacement, fracture, etc., the correction effect is not ideal, so it has been a certain clinical application. Limitations, in 1998, Metaizeau et al proposed that the application of osteophyte screws can solve the problem that the nails are easily displaced and easily broken. However, this method directly passes through the seesaw and causes irreversible damage to the seesaw. The application is limited to age close. Adolescents with a mature age of skeletal, so its application is not wide. In China, 8-word steel plate is also used in this operation. However, the straight-line 8-shaped steel plate is currently used in China. After implantation, it will cause compression of the callus and may cause damage. In addition, the implant of the 8-shaped steel plate lacks special. With the supporting tools, the implantation process is time-consuming and laborious, the accuracy is poor, and it needs to be adjusted repeatedly, which increases the suffering of the patients.

Chinese Patent Document CN: 201316311Y, published on September 30, 2009, discloses a U-shaped fixing nail for orthopedic surgery. The utility model discloses a U-shaped fixing nail for orthopedic surgery. Made of two titanium alloy spiked legs and middle It is composed of a titanium alloy curved connecting piece, and the overall shape is inverted u-shaped for bone plate fixation and bone and joint deformity, and trauma surgery. However, the surgical tools for installing the 8-shaped steel plate with osteophyte block have not been reported yet.

Summary of the invention

SUMMARY OF THE INVENTION An object of the present invention is to provide a surgical tool for installing an internal 8-shaped steel plate for stopping an epiphyseal block in view of the deficiencies in the prior art.

In order to achieve the above object, the technical solution adopted by the present invention is: a surgical tool for installing a built-in 8-shaped steel plate with an osteophyte block, comprising an 8-word template, a template clamp and a guiding instrument, wherein the guiding device is provided with an angle adjusting device The angle adjusting device is provided with an angle adjusting knob, a scale plate and a rotating shaft, which are connected by a connecting screw, and the angle indicating pin is fixed on the angle adjusting knob by a screw, and the connected whole is fixed by four screw holes on the scale plate. On the double aperture guide connecting block, the double aperture guide connecting piece is fixed on the guiding sleeve of the double aperture guiding instrument, and the fastening bolt can fix the angle adjusting device at the exact position on the guiding sleeve.

The 8-word template is assemblable and includes two template orifice plates and a template pivot.

The distance from the center hole of the template orifice to the pivot hole is 6_10 mm.

The distance from the center hole of the template orifice to the pivot hole is 6 mm, 8 mm or 10 mm.

The 8-word template can be assembled into a symmetric 8-word template or an asymmetric 8-word template.

The distance between the center hole of the two template plate plates and the pivot hole of the symmetric 8-shaped template is 6 mm_6 mm, 8 mm-8 mm or 10 mm-10 mm, respectively, and the distance between the center hole of the two template plate plates and the pivot hole of the asymmetric 8-shaped template is respectively It is 6mm - 8mm, 8mm - 10mm or 6mm - 10mm.

The splayed surface of the stencil is provided with two grooves.

The clamp head has two protrusions which can be placed on the grooves of the two clamped faces of the 8-shaped template.

The two guiding channels of the guiding device have different apertures.

The advantages of the invention are:

1. The angle-adjustable dual-aperture guide of the present invention forms an angle between the drilling direction and the level of the epiphysis by an angle adjusting device on the guiding sleeve and two guiding holes of different apertures, so that the screw implantation direction is offset from the epiphysis. It not only acts as an epiphyseal block but also effectively prevents bone damage.

2. The invention uses a special assembly template to simulate the installation of the 8-shaped steel plate, so that the installation of the built-in 8-shaped steel plate is completed at one time, which can effectively shorten the operation time and reduce the suffering of the patient.

DRAWINGS

Figure 1 is a schematic view showing the structure of a figure 8 steel plate fixed by a screw and a nut.

Figure 2 is a schematic view showing the structure of a figure-eight steel plate fixed by a card slot screw and a snap spring.

Figure 3 is a left side view of the 8-shaped steel plate after assembly. Figure 4 is a schematic view showing the structure of a symmetrical 8-shaped steel plate of 6 mm - 6 mm.

Figure 5 is a schematic view showing the structure of an asymmetrical 8-shaped steel plate of 6 mm - 8 mm.

Figure 6 is a schematic view showing the structure of an 8-word template of a 8-shaped steel plate surgical tool.

Figure 7 is a schematic view showing the structure of a template clamp of a 8-shaped steel plate surgical tool

Figure 8 is a diagram showing the working state of the formwork clamp of the 8-shaped steel plate surgical tool.

Figure 9 is a schematic view showing the structure of an angle-adjustable double-aperture guide for a 8-shaped steel plate surgical tool. Figure 10 is a schematic view showing the structure of an angle adjusting device for a 8-shaped steel plate surgical tool.

Figure 11 is a partially enlarged schematic view showing a portion A of Figure 9;

Figure 12 is a view showing the state of use after the 8-shaped steel plate is fixed.

detailed description

The specific embodiments provided by the present invention are described in detail below with reference to the accompanying drawings.

The reference numerals and components referred to in the drawings are as follows:

1. 8-word steel plate I I. First single-sided orifice plate

12. Second single-sided orifice plate I I I. First hinge hole

121. Second hinge hole 13. Screw

131. Thread 14. Nut

15. Card slot screw 151. Card slot

16. circlip 17. pressure free angle

112. The first single side orifice notch 122. the second one side orifice notch

2. 8-word template 21. First template orifice

22. Second template orifice plate 221. Positioning pinhole

222. Template groove 23. Template pivot

3. Template clamp 31. Clamp head

311. Head protrusion 32. Clamp handle

4. Angle adjustable double aperture guide 41. Angle adjustment device

411. Angle adjustment knob 4111. Positioning needle channel

412. Scale plate 413. Angle indicator pin

414. Rotary shaft 415. Connecting screw

416. Double aperture guide connection block 417. Fastening bolt

42. Guide sleeve 421. Guide channel

43. Connecting device 44. positioning pin 5. Bone line 51. One side of the epiphysis line

52. The other side of the epiphysis line

Example 1

8-shaped steel plate fixed by screw and nut

Referring to Figure 1, Figure 1 is a schematic view showing the structure of a 8-shaped steel plate fixed by a screw and a nut. The 8-shaped steel plate 1 includes a first single-sided orifice plate 11, a second single-sided orifice plate 12, a screw 13 and a nut 14. The first-side orifice plate 1 and the single-sided orifice plate 2 are respectively designed first. The hinge hole 111 and the second hinge hole 121. The head of the screw 13 has a thread 131, and the nut 14 has a circular shape, is small in size, and is easy to install. Two single-sided orifice plates are joined by the screw 13 and the nut 14 through the first hinge hole 111 and the second hinge hole 121. When assembling, the first hinge hole 111 and the second hinge hole 121 are coaxial, and the screw 13 is inserted into the screw 13, and the nut 14 is screwed at the thread 131, and the 8-shaped steel plate 1 is assembled.

Example 2

8-shaped steel plate fixed by screw and circlip

Referring to Figure 2, Figure 2 is a schematic view showing the structure of a 8-shaped steel plate fixed by a slotted screw and a snap spring. The 8-shaped steel plate 1 includes a first single-sided orifice plate 11, a second single-sided orifice plate 12, a slotted screw 15 and a snap spring 16, and the first single-sided orifice plate 11 and the second single-sided orifice plate The first hinge hole 111 and the second hinge hole 121 are respectively designed on the 12th. The card slot screw 15 has a card slot 151 at the head. Two single-sided orifice plates are joined by the card slot screw 15 and the retaining spring 16 through the first hinge hole 111 and the second hinge hole 121. When assembling, the first hinge hole 111 and the second hinge hole 121 are coaxial, and the card slot screw 15 is inserted into the card slot 151, and the circlip 16 is mounted on the card slot 151.

It should be noted that the first single-sided orifice plate 11 of the 8-shaped steel plate 1 has a notch below the first hinge hole 111, that is, the first single-sided orifice plate notch 112, and the second single-sided orifice plate 12 is at the second hinge hole. There is also a notch under the 121, that is, the second single-sided orifice notch 122. After the assembly of the 8-shaped steel plate 1, the first single-sided orifice notch 112 and the second single-sided orifice notch 122 together form an arc-shaped gap. That is, the pressure-free angle 17, please refer to Fig. 3. Fig. 3 is a left side view of the assembled 8-shaped steel plate 1. The pressure-free angle 17 allows the 8 character steel plate 1 to have a sufficiently large gap in the hinge portion, and the steel plate is not in contact with the epiphysis when implanted, and does not cause compression of the epiphysis, thereby reducing damage.

Example 3

8-shaped steel plate combination of different sizes

The first one-side orifice plate 11 and the second one-side orifice plate 12 of the eight-shaped steel plate 1 respectively comprise three different sizes, that is, the distance from the center hole to the pivot hole is 6 mm, 8 mm and 10 mm, respectively. It is made up of 8 different sizes of 8 characters steel plate 1. The doctor selects different pairing combinations among the six combinations according to the actual size of the patient's epiphysis.

(1) Symmetrical 8 word steel plate 6mm-6 hidden combination Referring to Figure 4, Figure 4 is a schematic view showing the structure of a symmetrical 8-shaped steel plate of 6 mm - 6 mm. During installation, the first single-sided orifice plate 11 having a size of 6 mm and the second single-sided orifice plate 12 of 6 mm are selected and assembled according to the installation method of the first embodiment, and a symmetrical 8-shaped steel plate 6 mm-6 combination can be formed.

( 2 ) Symmetrical 8 word steel plate 8mm-8 combination

During installation, the first single-sided orifice plate 11 of 8 mm and the second single-sided orifice plate 12 of 8 mm are selected and assembled according to the installation method of the embodiment 1, and a symmetrical 8-shaped steel plate 8 mm_8 mm combination can be formed.

(3) Symmetrical 8 word steel plate 10mm- 10 combination

During installation, the first single-sided orifice plate 11 of 10 mm and the second single-sided orifice plate 12 of 10 mm are selected and assembled according to the installation method of the first embodiment, and a symmetrical 8-shaped steel plate 10 mm - 10 mm combination can be formed.

(4) Asymmetric 8-character steel plate 6mm-8 combination

Referring to Figure 5, Figure 5 is a schematic view showing the structure of a 6 mm-8 mm combination of asymmetrical 8-shaped steel plates. During installation, the first single-sided orifice plate 11 of size 6 mm and the second single-sided orifice plate 12 of 8 mm are selected and assembled according to the installation method of the first embodiment, and an asymmetric 8-shaped steel plate 6 mm_8 mm combination can be formed.

(5) Asymmetric 8-character steel plate 6mm-10 combination

When installing, the first single-sided orifice plate 11 of size 6 mm and the second single-sided orifice plate 12 of 10 mm are selected, and assembled according to the installation method of the first embodiment, and an asymmetric 8-shaped steel plate 6 mm_10 mm combination can be formed.

(6) Asymmetric 8-character steel plate 8mm-10 combination

During installation, the first single-sided orifice plate 11 of size 8 mm and the second single-sided orifice plate 12 of 10 mm are selected and assembled according to the installation method of the first embodiment, and an 8 mm_10 mm combination of asymmetrical 8-shaped steel plates can be formed.

Example 4

8-word steel surgical tool

The surgical tool with a built-in 8-shaped plate for osteophyte block is a set of special installation tools designed according to the size of 8-shaped steel plate 1 and 8-shaped template 2. It can ensure accurate and rapid implantation of 8-shaped steel plate 1 and can reduce Damage to the patient's epiphysis.

The surgical tool comprises: a 8 word template (Fig. 6), a template clamp (Fig. 7) and an angle adjustable double aperture guide (Fig. 9), the angle adjustable double aperture guide is equipped with an angle adjustment Device (Figure 10).

(1) 8 word template 2

Please refer to FIG. 6. FIG. 6 is a schematic structural view of an 8-word template of a 8-shaped steel plate surgical tool. The 8-shaped template 2 and the 8-shaped steel plate 1 have the same size specifications, and can also be disassembled and assembled, including the first template orifice plate 21, the second template orifice plate 22 and the template pivot 23, and the second template orifice plate 22 has two The positioning pinhole 221 has two template grooves 222 on the clamping surface. The assembly method of the 8-word template 2 is the same as that of the 8-shaped steel plate 1, and can be selected according to the specifications of the 8-shaped steel plate 1 required for the operation. The matching template is assembled into a symmetrical or asymmetrical template. The first template orifice plate 21 and the second template orifice plate 22 of the 8-word template 2 respectively comprise three different sizes, that is, the distance from the center hole to the pivot hole is 6 hidden, 8 hidden and 10 hidden, respectively. It is divided into 6 different types of 8 word templates 2, including symmetric 8 word template 6 hidden-6 hidden combination, symmetric 8 word template 8mm-8 hidden combination, symmetric 8 word template 10mm-10 hidden combination, asymmetric 8 word template 6mm_8 hidden combination, asymmetric 8 word template 6mm-10 _mm combination, asymmetric 8 word template 8mm-10mm combination. The doctor selects different combinations of the six combinations according to the actual size of the sides of the patient's epiphysis.

( 2 ) Template clamp 3

Referring to Figure 7, Figure 7 is a schematic view showing the structure of a template clamp of a 8-shaped steel plate surgical tool. As shown, the formwork clamp 3 includes a clamp head 31 and a clamp handle 32, and the end of the clamp head 31 has a head protrusion 311. Referring to Figure 8, Figure 8 is a diagram showing the working state of the template clamp of the 8-shaped steel plate surgical tool. As shown in the figure, the template clamp 3 is just parallel to the jaws of the template head 31 when it is bitten, and its distance is the distance between the two faces of the 8-word template 2 being clamped. The two head projections 311 of the caliper head 31 are placed just above the stencil recess 222 on the two gripped faces of the stencil 2.

(3) Angle adjustable double aperture guide 4

Referring to Figure 9, Figure 9 is a schematic view showing the structure of an angle-adjustable dual-aperture guide for a 8-shaped steel plate surgical tool. The angle-adjustable dual aperture guide 4 includes an angle adjustment device 41, two guide sleeves 42, a connecting device 43 and a positioning pin 44. The two guiding sleeves 42 and the connecting device 43 together form an "II"-shaped structure, and the two guiding sleeves 42 are respectively fixed with an angle adjusting device 41, and the inner portion of the guiding sleeve is hollow to form a guiding hole 421, two The guide holes 421 have different apertures and are convenient for use when the diameters of the holes are different.

To avoid damage to the callus tissue and accurate guiding of the borehole, the design utilizes an adjustment of the angle adjustment device 41 such that the centerline of the positioning needle 44 is at a defined angle to the centerline of the borehole. The angle adjusting device 41 has an angular scale and can be rotated to a suitable angle. Referring to Figure 10, Figure 10 is a schematic view showing the structure of an angle adjusting device for a 8-shaped steel plate surgical tool. The angle adjusting device 41 is provided with an angle adjusting knob 411, a scale plate 412 and a rotating shaft 414, which are connected by a connecting screw 415. The angle indicating pin 413 is fixed on the angle adjusting knob 411 by screws, and the connected whole passes through the scale plate 412. The upper four screw holes are fixed to the double aperture guide connection block 416 and are fixed to the guide sleeve 42 of the dual aperture guide by a double aperture guide connection block 416. The fastening bolts 417 allow the angle adjustment device 41 to be fixed in the exact position on the guide sleeve 42.

Referring to Figure 11, Figure 11 is a partially enlarged schematic view of a portion of Figure 9 . Before the operation, first select the 8-plate 1 and 8 template 2 of the appropriate size according to the degree of distortion on both sides of the patient's epiphysis line. When using, insert the positioning pin 44 on the exposed part of the exposed bone after the surgical incision, through 8 words. The positioning pinhole 221 on the template 2 is placed on the 8-shaped template 2, and the angle required for the punching is adjusted on the angle adjusting device 41, and the guiding sleeve of the guiding device is placed along the positioning pin 44 through the positioning pin channel 4111 on the angle adjusting device 41. The cylinder 42 is guided by the special drill bit through the guiding sleeve 42 Hole 421 is punched, and another hole is drilled in the same way. The 8-shaped template 2 is taken out, and the 8-shaped steel plate 1 is placed. After the screw is added, the screwdriver is fastened with a screwdriver, and the surgical incision is sewn.

Referring to Figure 12, Figure 12 is a view showing the operation state after the 8-shaped steel plate is fixed. It should be noted that the size specification of the 8-shaped steel plate 1 is determined by the degree of distortion of the epiphyseal line side 51 of the epiphyseal line 5 and the other side 52 of the epiphyseal line. In use, the pivot center line of the 8-shaped steel plate 1 and the epiphyseal line 5 are used. Basically in one plane, the 8-shaped steel plate 1 can minimize the repeated surgery caused by the fact that the fixed size cannot adapt to the actual bone condition of different patients, and the pain of the patient can be alleviated.

In the prior art, the double-aperture guide has no angle setting, and the angle between the guiding sleeve and the guide pin needs to be visually observed during the operation, and is adjusted by the intraoperative X-ray machine. The double aperture guiding instrument of the invention is equipped with an angle adjusting device, which can determine the required angle according to the preoperative measurement, and is directly drilled by the angle adjusting device on the guiding instrument after the adjustment to the angle. The direction of the screws on both sides of the jaws can be easily and precisely controlled as needed.

In the prior art, the two parts of the template have various specifications, but they cannot be assembled by themselves, so the two parts of the template are of the same specification. The two parts of the template of the invention have various specifications, and can be assembled by itself (through the connecting shaft) Fixed), so the two parts of the template can be different specifications. Both ends of the epiphysis for osteochondral dysplasia need to be implanted with different gauge (length) plates.

The prior art template clamps are only general clamps. When the template clamp of the present invention is bitten, the two jaws of the head are just parallel, and the distance is the distance between the two faces of the template being clamped. The two projections of the head are placed just above the grooves on the two gripped faces of the template. Increased stability when the jaw clamp template is added.

Claims

Rights request

1. A surgical tool for installing an internal 8 inch steel plate with an osteophyte block, comprising an 8-shaped template, a template clamp and a guiding device, wherein the guiding device is provided with an angle adjusting device, and the angle adjusting device It has an angle adjustment knob, a scale plate and a rotating shaft, which are connected by a connecting screw. The angle indicating pin is fixed on the angle adjustment knob by screws. The connected whole is fixed to the double aperture guide connecting piece through the four screw holes on the scale plate. Above, the double aperture guide connecting piece is fixed on the guiding sleeve of the double aperture guiding instrument, and the fastening bolt can fix the angle adjusting device at the exact position on the guiding sleeve.

2. The surgical tool according to claim 1, wherein the stencil is assemblable and includes two stencil orifices and a stencil pivot.

The surgical tool according to claim 1 or 2, wherein the distance between the central hole of the template orifice and the pivot hole is 6-10

4. The surgical tool according to claim 3, wherein the distance from the central hole of the template orifice to the pivot hole is 6 mm 8 mm or 10 mm

The surgical tool according to claim 4, wherein the 8-word template is assembled into a symmetric 8-word template or an asymmetric 8-word template.

The surgical tool according to claim 5, wherein the distance between the center hole of the two template plate and the pivot hole of the symmetric 8-shaped template is 6 mm-6 8 mm_8 or 10 -10, respectively. The distance between the center hole of the two template plate plates and the pivot hole is 6mm_8mm 8mm-10mm or 6mm_10mm

The surgical tool according to claim 6, wherein the anatomical surface of the stencil is provided with two grooves.

8. The surgical tool according to claim 7, wherein the caliper head has two protrusions which can be placed on the grooves on the two clamped faces of the stencil.

9. The surgical tool according to claim 8, wherein the two guide channels of the guide have different apertures.