WO2014190607A1

WO2014190607A1 - Screw implantation sighting device used for minimally invasive surgery

Info

Publication number: WO2014190607A1
Application number: PCT/CN2013/080177
Authority: WO
Inventors: 张英泽; 郑占乐
Original assignee: 河北医科大学第三医院
Priority date: 2013-05-28
Filing date: 2013-07-26
Publication date: 2014-12-04
Also published as: CN103263289B; CN103263289A

Abstract

A screw implantation sighting device used for minimally invasive surgery, belonging to the field of orthopedic medical instruments. The sighting device comprises: a sighting device front section (1), a sighting device rear section (2), and at least one positioning fork (13) abutting against the anterior superior iliac spine (c) or the anterior inferior iliac spine (d); the rear part of the sighting device front section (1) and the front part of the sighting device rear section (2) are movably connected; the front part and bottom surface of the sighting device front section (1) and the pelvis minor brim (e) fit together; a plurality of positioning through-holes are provided on sighting device front section (1); When the front part and bottom surface of the sighting device front section (1) and the pelvis minor brim (e) join, the extension line of the positioning through-holes is located in the posterior wall of the acetabulum (b); one end of the positioning fork (13) is mounted on the rear part of the sighting device rear section (2); the other end of the positioning fork (13) is bent toward one side of the sighting device rear section (2). The screw implantation sighting device used for minimally invasive surgery has a simple structure and is low in cost; using multi-point positioning to fix the sighting device makes the device precise in positioning and convenient in operation.

Description

Screw implant sight for minimally invasive surgery

Technical field

The present invention relates to the field of orthopedic medical devices, and more particularly to a screw implant sight for minimally invasive surgery. Background technique

The acetabulum is located in the middle and lower part of the lateral aspect of the hip. It consists of the humerus, the ischial body and the pubic symphysis. It is a hemispherical deep EJ, facing the front and the lower, and is associated with the femoral head. The acetabular fracture is a common orthopedics. Severe fractures, acetabular fractures are generally more impactful at the acetabulum. Therefore, acetabular fractures are usually accompanied by simultaneous fractures of the acetabular anterior column and acetabular posterior column. Because of the deep acetabular position, anatomy Complexity, difficulty in fixing fixation, and many complications have been difficult problems in the field of orthopedics.

At present, for acetabular fractures, fixation screws are generally used to fix the fracture site. In the operation, the needle insertion direction cannot be accurately quantified. The current acetabular posterior column implantation technique is mostly in the posterior or posterior acetabular column. After the reduction, the screws are implanted under fluoroscopy. Because of the need for repeated fluoroscopy during surgery, and the difficulty of accurate implantation, some hospitals use more expensive computer-aided facilities for navigation.

In carrying out the present invention, the inventors have found that the prior art has at least the following problems: Since it is expensive to use a computer-aided facility for navigation, it is difficult to widely spread in the treatment of acetabular fractures. Summary of the invention

In order to solve the problem of high price of computer aided facilities in the prior art, embodiments of the present invention provide a screw implant sight for minimally invasive surgery. The technical solution is as follows:

The present invention provides a screw-implanted sight for minimally invasive surgery, the sight comprising: a front section of the sight, a rear section of the sight, and at least one positioning against the anterior superior iliac spine or the anterior superior iliac spine a fork, the rear portion of the front portion of the sight is movably connected to the front portion of the rear portion of the sight, the front portion and the bottom surface of the front portion of the sight are adapted to the small pelvic rim, and the front portion of the sight is provided with a plurality of Positioning through holes, when the front and bottom surfaces of the front section of the sight are attached to the small pelvic rim An extension of the aperture is located in the posterior column of the acetabulum, one end of the positioning fork is mounted to the rear of the rear section of the sight, and the other end of the positioning fork is bent to the side of the rear section of the sight.

Specifically, a periosteal stripper is mounted on the front top surface of the front section of the sight, the periosteal stripper is a changeable shed structure, and the changeable shed structure is aimed from the front of the front section of the sight toward the aiming The rear of the front section of the unit is replaced.

Specifically, a rear portion of the front portion of the sight is provided with a slot, and a front portion of the rear portion of the sight is provided with a latch adapted to the slot.

Specifically, the sight further includes a length adjusting device, the length adjusting device includes a screw and a rotary bearing fixed on the rear portion of the sight, and the front portion of the sight is provided with a screw matched with the screw a hole, one end of the screw is inserted into the screw hole through the rotary bearing and the rear portion of the sight, and the other end of the screw is placed outside the rear portion of the sight.

Further, the sight further includes a screw knob, and the screw knob is disposed at the other end of the screw.

Specifically, a boss is disposed on a top surface of the front portion of the sight, and the positioning through hole penetrates the boss in a through direction.

Further, the positioning through holes are provided in three, and the three positioning through holes are arranged in a triangle shape on the boss.

Further, a positioning sleeve is disposed on the inner wall of the positioning through hole.

Optionally, the sight further includes an arc-shaped limiting plate disposed on a rear bottom surface of the rear portion of the sight, the inner arc of the curved limiting plate and the outer spur of the front sac The edge is adapted. The technical solution provided by the embodiment of the invention has the beneficial effects that the screw implant sight provided by the invention has the advantages of low cost, simple structure, and the front end of the sight is against the small pelvic margin when the sight is used, where For the first point, the rear part of the sight is caught on the outer edge of the anterior superior iliac spine. At this time, at least two points on the outer edge of the anterior superior iliac spine are attached to the posterior segment of the sight, and the positioning forks on both sides are respectively The upper spine and the anterior superior iliac spine are fixed, thus forming a multi-point positioning fix, so that the sight provided by the present invention has the advantage of accurate positioning. DRAWINGS

In order to more clearly illustrate the technical solution in the embodiment of the present invention, the following description will be made on the embodiment. The drawings to be used are described in detail, and the drawings in the following description are only some embodiments of the present invention, and those skilled in the art may, without any creative work, Other figures are obtained from these figures.

1 is a top plan view of a screw-implanted sight according to an embodiment of the present invention; FIG. 2 is a cross-sectional view of FIG. 1 taken along line A-A;

3 is a view showing a state of use of a screw-implanted sight provided by an embodiment of the present invention.

In the figure: 1-front of the sight, rear of the 2-beam, 3-arc limit plate, 4-pin, 5-slot, 6-screw, 7-screw, 8-rotary bearing, 9-screw Knob, 10-bolt, 11-position sleeve, 12- periosteal stripper, 13-guide pin, 14-inner arc, 15-position fork, a-acetabular anterior column, b-acetal posterior column, c- Anterior superior iliac spine, d-髂 anterior lower spine, e- small pelvic margin. detailed description

The embodiments of the present invention will be further described in detail below with reference to the accompanying drawings.

Example

The present invention provides a screw implant sight for minimally invasive surgery, as shown in Figures 1 and 3, the sight comprising: a front section of the sight 1, a rear section 2 of the sight and two respectively abutting The front upper spine c and the front lower spine d are annoying positioning forks 15, the rear of the front section 1 of the sight is connected to the front of the rear section 2 of the sight, and the front and bottom of the front section 1 of the sight are in phase with the small pelvic e Adaptation, the upper part of the front section of the sight is provided with a plurality of positioning through holes. When the front and bottom surfaces of the front section 1 of the sight are fitted with the small pelvic edge e, the extension line of the positioning through hole is located in the posterior column b of the acetabulum. One ends of the two positioning forks 15 are respectively mounted at the rear of the rear portion 2 of the sight, and the two positioning forks 13 are symmetrically disposed on both sides of the rear portion of the rear portion 2 of the sight, and the other ends of the two positioning forks 15 are respectively bent Both sides of the rear section 2 of the sight.

When the screw implant sight provided by this embodiment is in use, the front part of the front section 1 of the sight is pressed against the small pelvic edge e, here is the first point, and the rear section 2 of the sight is attached to the outer edge of the front anterior superior sac c At this time, at least two points of the outer edge of the anterior superior iliac crest are attached to the posterior segment 2 of the sight, and the two positioning forks 15 can respectively abut against the anterior superior iliac crest and the anterior superior iliac spine d, thereby forming Multi-point positioning and fixing make the sight fixed more secure, which can effectively avoid jitter during operation.

It should be noted that, in this embodiment, there may be two positioning forks 15, but not limited thereto. In other embodiments, there may be only one positioning fork 15 for abutting on the anterior superior iliac spine. c or marry before the lower spine d.

Alternatively, the width of the front portion 1 of the sight and the rear portion 2 of the sight may be 4 to 6 cm, respectively. In an embodiment of the invention, as shown in FIG. 2, a periosteal stripper 12 is mounted on the front surface of the front portion 1 of the sight, and the periosteal stripper 12 is a reversible shed structure. The front of the front section 1 of the sight is replaced by the rear of the front section 1 of the sight. The periosteal stripper 12 is used to separate the diaphragm and the small pelvis e. When the sight is used, the periosteal stripper 12 can hold the diaphragm. This not only protects the abdominal cavity and diaphragm, but also effectively expands the surgical field of view and facilitates the operation.

In combination with the above embodiment, in another embodiment of the embodiment of the invention, the rear portion of the front portion 1 of the sight is provided with a slot 5, and the front portion of the rear portion 2 of the sight is provided with a bolt 4 adapted to the slot 5. . The slot 5 extends along the length of the front section 1 of the sight. Similarly, the latch 4 extends along the length of the rear section 2 of the sight. A coarse adjustment of the length of the sight can be achieved by the cooperation of the slot 5 and the latch 4, wherein a material having a large frictional force, such as silicone rubber or rubber, can be attached to the contact surface of the slot 5 and the plug 4, which can increase The friction between the slot 5 and the latch 4 makes the connection between the two stronger.

In conjunction with the above embodiments, in another embodiment of the embodiment of the invention, the sight may further include a length adjusting device including a screw 6 and a rotary bearing 8 fixed to the rear portion 2 of the sight, the front portion of the sight 1 is provided with a screw hole 7 matched with the screw 6, and a rear portion 2 of the sight, one end of the screw 6 is inserted into the screw hole 7 through the rotary bearing 8 and the rear portion 2 of the sight, and in addition, the front portion 1 of the sight It is also possible to provide a screw hole 7 matching the screw 6, such that one end of the screw 6 passes through the screw bearing 7 of the rotary bearing 8 and the front section 1 of the sight and is inserted into the screw hole 7 of the rear section 2 of the sight, the other of the screw 6 One end is placed outside the rear section 2 of the sight. The length adjustment device enables precise adjustment of the length of the sight by thread adjustment, while also making the sight more stable.

Preferably, the sight further comprises a screw knob 9, and the screw knob 9 is provided at the other end of the screw 6, and the screw knob 9 is mounted to facilitate the rotation of the screw 6.

Preferably, as shown in Fig. 2, a boss 10 is provided on the top surface of the front section 1 of the sight. In the present embodiment, the boss 10 is defined by a first side and a second side. The angle between the first side and the top surface of the front section 1 of the sight is an acute angle (see Fig. 1), and the cross section of the boss 10 along the length of the sight is triangular. Further, the first side surface is semi-circular, and the second side surface is a curved surface. Positioning the through hole through the boss 10 and passing through the first side of the boss 10, the first side preferably being positioned with the through hole The through direction of 11 is vertical. If the boss 10 is not provided, the user does not easily see the positioning through hole provided on the top surface of the front section 1 of the sight during operation. By installing the boss 10, the positioning through hole is made by the front section 1 of the sight. The top surface extends to the first side of the boss 10 to facilitate the user to observe the positioning through hole on the boss 10 when the sight is used, and to accurately insert the guide pin 13 into the positioning through hole. It is easy to know that the boss 10 can also be a square or rectangular parallelepiped structure, as long as the boss 10 can be higher than the top surface of the front section 1 of the sight, and the positioning through hole can extend to one side of the boss 10, and the side It is on the same side as the user's line of sight.

Further, the positioning through holes are provided in three, and the three positioning through holes may be arranged in a triangle on the boss 10. Preferably, the three positioning through holes are arranged in an equilateral triangle on the boss 10, and in addition, three The positioning through holes may be longitudinally arranged on the boss 10 in the longitudinal direction of the front section 1 of the sight, or may be arranged laterally in the width direction of the front section 1 of the sight. For different human bodies, the shape of the pelvis is quite different. The three positioning through holes can ensure the accurate positioning of the sight. When the sight is used, the guide pins 13 are respectively placed in different positioning sleeves 11 for X-ray three-dimensional imaging. Therefore, the most accurate positioning sleeve 11 is selected and the needle is inserted. In addition, when the positioning through hole of the sight is actually processed, the pelvic model is first processed, and a sight adapted to the pelvic physiological curve is prepared for the pelvic model, and the unmachined positioning is performed. The through hole sight is fixed on the pelvis model, and then the positioning fork 15 is made according to the size of the pelvis model and the positioning fork 1 is fixed at the rear of the rear section 2 of the sight, and the laser drilling machine is used from the acetabular posterior column b direction. Reverse punching, and punching the front section 1 of the sight, that is, positioning the through hole, and then assembling the positioning sleeve 11 into the positioning through hole, that is, the mother model of the sight is obtained, and the three-dimensional model can be used to establish the three-dimensional shape. Graphics, mass production by mechanical processing or mold forming, and for the left and right acetabulum, should be divided into two types, mirroring each other, the aiming The device can be made of a material that can penetrate X-rays for easy intraoperative visualization. At the same time, the pelvic model can be used to make a sight that adapts to the physiological curve of the pelvis.

Preferably, the inner wall of the positioning through hole may further be provided with a positioning sleeve 11 which functions as a reinforcement.

Further, the positioning sleeve 11 can be a metal sleeve. In order to reduce the number of three-dimensional imaging of the X-ray, the damage caused by the X-ray radiation is reduced, and the operation cost of the patient can be saved. The positioning sleeve 11 is made of a metal material. Since the human acetabulum posterior column b has a certain size and the guide pin 13 is relatively thin, the human body within the same body type can completely ensure the extension of at least one positioning sleeve 11 even if the size and shape of the pelvis are different. The line can completely penetrate the posterior column b of the acetabulum. Further, the sight may further include a guide pin 13 having a diameter matching the inner diameter of the positioning sleeve 11, the guide pin 13 for passing through the positioning sleeve 11 and implanted into the acetabular posterior column b .

In conjunction with the above embodiment, in another embodiment of the embodiment of the invention, as shown in FIG. 2, the sight further includes an arc-shaped limiting plate 3 disposed on the bottom surface of the rear portion of the rear portion 2 of the sight, the arc The inner arc 14 arc of the shape limiting plate 3 is adapted to the outer edge of the anterior superior iliac spine c, wherein the inner arc 14 of the curved limiting plate 3 catches the outer edge of the anterior superior iliac crest, at this time The outer edge of the upper spine c is fitted to the inner arc 14 of the curved limiting plate 3, which can further fix the position of the sight to ensure accurate positioning. The operation procedure of the sight provided by the present invention is as follows: for the acetabular anterior column a and the posterior acetabular posterior column b, the acetabular anterior column a is first reset, and then the sight is inserted into the surgical incision of the acetabular anterior column a. Anterior segment 1; For patients with only acetabular posterior column b fracture, a small mouth of about 5 cm can be cut in the middle of the iliac crest, and the anterior segment 1 of the sight is inserted from the incision, and then the diaphragm is pushed up by the periosteal stripper 12 and Push the front section 1 of the sight all the way in until the front section 1 of the sight is located in the small pelvic rim e, so that the front part of the front section 1 of the sight is pressed against the small pelvis e, and then the screw 6 is rotated, so that the rear section 2 of the sight is continuously Cut in and move inward until the curved limiting plate 3 catches the outer edge of the anterior superior iliac crest and tightens. At this time, the two positioning forks 15 are pulled toward the anterior superior iliac crest and the anterior superior iliac spine d, and used The Kirschner wire fixes the positioning fork 15 with the anterior superior iliac spine c and the anterior superior iliac spine d, and then performs X-ray three-dimensional fluoroscopy to select the positioning sleeve 11 which is most suitable for the angle; finally, the guide needle 13 is placed in the positioning sleeve 11 , tighten the screws to complete the operation. The invention adopts a configuration adapted to the physiological curve of the small pelvic margin as the shape of the sight, adopts a multi-point positioning fixed sight, and adopts a positioning sleeve which is in line with the acetabular posterior column as a positioning device, and the positioning is accurate. Easy to operate. The sight provided by the invention can be inserted from the surgical incision of the acetabular anterior column without cutting the acetabular posterior column of the patient, thereby greatly reducing the iatrogenic injury to the patient, and secondly, the sight and the pelvic physiology of the human body. The curve is matched and closely attached to the human skeleton. At this time, the extension line of the positioning sleeve is located in the posterior column of the acetabulum, and the positioning is very accurate. Moreover, the multi-point positioning fixed sight can effectively avoid the shaking during the needle insertion operation. Finally, The invention has the advantages of simple structure, low cost and convenient operation, which can greatly shorten the operation time, reduce the inhalation amount of the patient's anesthetic drugs, and improve the safety of the operation. The above are only the preferred embodiments of the present invention, and are not intended to limit the present invention. Any modifications, equivalents, improvements, etc., which are within the spirit and scope of the present invention, should be included in the protection of the present invention. Within the scope.

Claims

claims

1. A screw implantation sight for invasive surgery, characterized in that the sight includes: a front sight segment (1), a rear sight segment (2) and at least one abutment against the anterior superior iliac spine ( c) or the positioning fork (13) on the anterior inferior iliac spine (d), the rear part of the front sight section (1) is movably connected to the front part of the rear sight section (2), the front sight section The front part and bottom surface of (1) are adapted to the small pelvic rim (e). Several positioning through holes are provided on the front part of the sight (1). When the front part and bottom surface of the front part of the sight (1) When fitting with the small pelvic rim (e), the extension line of the positioning through hole is located in the posterior acetabular column (b), and one end of the positioning fork (13) is installed on the rear section of the sight (2 ), the other end of the positioning fork (13) is bent toward one side of the sight rear section (2).

2. The sight according to claim 1, characterized in that a periosteum stripper (12) is installed on the front top surface of the front section (1) of the sight, and the periosteum stripper (12) is a reshaped The shed structure is arched from the front of the front sight section (1) to the rear of the front sight section (1).

3. The sight according to claim 1 or 2, characterized in that a slot (5) is provided at the rear of the front section (1) of the sight, and a slot (5) is provided at the front of the rear section (2) of the sight. There is a latch (4) that matches the slot (5).

4. The sight according to claim 1 or 2 or 3, characterized in that, the sight further includes a length adjustment device, the length adjustment device includes a screw (6) and a screw (6) fixed on the rear section of the sight ( 2), the front section of the sight (1) is provided with a screw hole (7) that matches the screw (6), and one end of the screw (6) passes through the rotating The bearing (8) and the rear sight section (2) are inserted into the screw hole (7), and the other end of the screw (6) is placed outside the rear sight section (2).

5. The sight according to claim 4, characterized in that the sight further includes a screw knob (9), and the screw knob (9) is provided at the other end of the screw (6).

6. The sight according to any one of claims 1 to 5, characterized in that a boss (10) is provided on the top surface of the front section (1) of the sight, and the positioning through hole is along the positioning through hole. The penetration direction penetrates the boss (10).

7. The sight according to claim 6, characterized in that there are three positioning through holes, and the three positioning through holes are arranged in a triangle on the boss (10).

8. The sight according to any one of claims 1 to 7, characterized in that a positioning sleeve (11) is provided on the inner wall of the positioning through hole.

9. The sight according to claim 8, characterized in that the positioning sleeve (11) is a metal sleeve.

10. The sight according to any one of claims 1 to 9, characterized in that the sight further includes an arc-shaped limiting plate ( 3), the curvature of the inner arc (14) of the arc-shaped limiting plate (3) matches the outer edge of the anterior superior iliac spine (c).