WO2017107883A1 - 一种寰枢椎后路专用钉棒固定器械 - Google Patents

一种寰枢椎后路专用钉棒固定器械 Download PDF

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Publication number
WO2017107883A1
WO2017107883A1 PCT/CN2016/110718 CN2016110718W WO2017107883A1 WO 2017107883 A1 WO2017107883 A1 WO 2017107883A1 CN 2016110718 W CN2016110718 W CN 2016110718W WO 2017107883 A1 WO2017107883 A1 WO 2017107883A1
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Prior art keywords
screw
nail
tail
groove
atlantoaxial
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PCT/CN2016/110718
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English (en)
French (fr)
Inventor
马向阳
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马向阳
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Priority claimed from CN201521079127.3U external-priority patent/CN205251669U/zh
Priority claimed from CN201521079131.XU external-priority patent/CN205251659U/zh
Priority claimed from CN201620746909.6U external-priority patent/CN206518589U/zh
Priority claimed from CN201610557989.5A external-priority patent/CN106037910B/zh
Priority claimed from CN201610560272.6A external-priority patent/CN106175898B/zh
Application filed by 马向阳 filed Critical 马向阳
Priority to US16/630,479 priority Critical patent/US20200289165A1/en
Publication of WO2017107883A1 publication Critical patent/WO2017107883A1/zh

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/7004—Longitudinal elements, e.g. rods with a cross-section which varies along its length
    • A61B17/7005—Parts of the longitudinal elements, e.g. their ends, being specially adapted to fit in the screw or hook heads
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/7004—Longitudinal elements, e.g. rods with a cross-section which varies along its length
    • A61B17/7007—Parts of the longitudinal elements, e.g. their ends, being specially adapted to fit around the screw or hook heads
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/701—Longitudinal elements with a non-circular, e.g. rectangular, cross-section
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7032—Screws or hooks with U-shaped head or back through which longitudinal rods pass
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7043—Screws or hooks combined with longitudinal elements which do not contact vertebrae with a longitudinal element fixed to one or more transverse elements which connect multiple screws or hooks
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7049—Connectors, not bearing on the vertebrae, for linking longitudinal elements together
    • A61B17/705—Connectors, not bearing on the vertebrae, for linking longitudinal elements together for linking adjacent ends of longitudinal elements

Definitions

  • the invention relates to the field of medical instruments, in particular to a special nail rod fixing device for posterior atlantoaxial.
  • the sacral vertebrae and the atlantoaxial independent nails not only have the advantages of small screw insertion angle, wide application to the crowd, high fixation strength, but also the effect of intraoperative lifting and restoring, which makes the treatment effect, safety and application of atlantoaxial dislocation. Sex and convenience have been significantly improved.
  • the nail rod fixation device used for atlantoaxial dislocation is not designed for the atlantoaxial vertebra alone, but is a common nail rod fixation device for the posterior cervical spine. Whether it is an imported or domestic device, the operation of the atlantoaxial dislocation in clinical treatment. In the process, it was found that there are various deficiencies in the design, and there is a need for further improvement and improvement. Therefore, it is necessary to improve the existing nail rod fixing instruments.
  • the invention provides a special fixation device for posterior atlantoaxial posterior nail, which improves the existing defects in the clinical application of the device, improves the scope of application, and adjusts the structure of the atlantoaxial axis to adapt
  • the operation of atlantoaxial dislocation resets improves the ability to reset and simplifies the operation.
  • the utility model relates to a special nail rod fixing device for posterior atlantoaxial, which comprises a lifting screw, a fulcrum screw, a variable section fixing rod, a lock nut and a nail tail transverse connection, wherein the variable section fixing rod connects the fulcrum screw and the lifting Pulling a screw, the stud tail is connected to two of the variable cross-section fixing rods, the fulcrum screw includes a first tail portion and a first head portion, and the pulling screw includes a second tail portion and a second head portion, The first tail portion and the second tail portion have a nail groove inside, a U-shaped groove structure is formed on the side surface, an internal thread is arranged in the nail groove, and a lock nut is connected inside the nail groove, and the variable cross-section fixed rod is worn.
  • the U-shaped groove is fixed by the lock nut, and the bottom of the nail groove of the fulcrum screw is 2-6 mm higher than the bottom of the nail groove of the pulling screw.
  • the fulcrum screw and the height of the bottom of the nail groove of the lifting screw are identical, and the design of the present application makes the height of the bottom of the nail groove of the fulcrum screw thicker than the conventional height, which is 2-6 mm higher.
  • the design is caused by the partial dislocation of some patients.
  • the traditional thickness is small for the lifting and pulling. At this time, if you need to lift a large distance, you need to bend the fixing rod to form a certain angle. It is difficult and difficult to fix, and it is very easy to cause damage to the patient.
  • the thickness of the bottom of the nail groove is increased, and the lifting distance can be correspondingly increased while the other structures are not adjusted, thereby improving the effect of the resetting and pulling. , reduce operational risks.
  • variable-section fixing rod is provided with an anti-rotation connection portion that cooperates with the U-shaped groove, and the anti-rotation connection portion has a plane and/or a curved surface that fits with the U-shaped groove, and the conventional fixing rod
  • the whole is cylindrical, and the fixed rod and the U-shaped groove are in point contact, and it is easy to rotate. Especially in the case where the fixed rod has a bend, the rotation is extremely easy to occur, resulting in difficulty in fixing and complicated operation.
  • the anti-rotation connection portion is provided, and the fixing rod is not all cylindrical, but the anti-rotation portion is prevented from rotating by the change of the cross-section of the fixing rod, and the above-mentioned problem is solved, and the anti-rotation connection portion has the U a plane and/or a curved surface to which the groove is fitted, for example, the anti-rotation connection portion has a rectangular structure (ie, a flat surface), and at this time, the connection portion cannot be rotated in the U-shaped groove to form
  • the locking is fixed, and since the bottom of the U-shaped groove is a curved curved surface, the connecting portion of the connecting portion and the bottom portion of the U-shaped groove can be set as a curved surface, and the locking can be formed, whether The flat surface or the curved surface can make the point contact of the traditional structure become a surface contact, greatly expanding the contact area and preventing the rotation.
  • the second tail portion is a long arm nail groove, and an annular groove is provided in a middle portion of the outer wall.
  • the traditional structure is a short arm nail groove.
  • the existing screws of the posterior cervical instrument are short-arm multi-axis screws, and the operation of the upper rod is very difficult, especially for severe cases of atlantoaxial dislocation, it is often necessary to use a nail-pressing device in a small space to assist the operation. .
  • the long-arm multi-axis lifting screw of the atlas using the gradually tightening nut to complete the lifting and locking of the atlas and locking the rod, simplifying the upper rod and resetting operation.
  • the second tail portion is divided into upper and lower portions by the annular groove, and when a higher tail portion is required, normal use That is, when only half to half of the height is required to be used, the user can cut off the upper structure from the annular groove, and the long arm structure design expands the use situation, improving practical performance and convenience.
  • the lifting screw is a second head that is a multi-axis screw that is tapered at a tip end of the second tail.
  • the nail preparation of the atlas pedicle and the screwing of the screw are difficult, especially when the height of the posterior arch of the atlas is too small, even if the nail path is prepared smoothly when the hand drill is open, tapping during the tapping or screwing It is also prone to cleft palate in the inferior wall during the infusion process.
  • the taper or the screw slides downwards, and it is difficult to enter the correct nail path.
  • it is often necessary to repeatedly adjust the screw to accurately screw in the screw which is not only time-consuming and laborious, but also has the risk of damaging the venous plexus and the spinal cord.
  • the first head of the fulcrum screw is a single-axis screw or a multi-axis screw fixed to the tip end of the first tail portion, and a single-axis or multi-axis screw is selected according to different use requirements.
  • the tail traverse includes a lock nut, a cross nut and a lateral connecting plate, and the connecting plate is provided with elliptical openings on both sides thereof, and one end of the lock nut is screwed to the first tail or The second tail portion, after the other end passes through the opening, is fixed by the cross-connect nut.
  • This design allows the tail-to-tail cross-connection to be directly fixed to the fulcrum screw and/or the lifting screw Instead of fixing it to the fixing rod with a similar fixing structure, the fixing effect is enhanced and it is more convenient to operate and implement.
  • the connecting plate comprises a straight plate and a curved plate for different situations.
  • the atlantoaxial posterior special nail rod fixation instrument of the present invention has a biomechanical stability comparable to that of Magerl screw fixation, and also overcomes the above-mentioned deficiencies of Magerl screw technology, and its advantages are manifested. in:
  • the atlas and the atlantoaxial nerve are placed separately.
  • the anatomic reduction of the atlantoaxial vertebra is not required before operation, and the atlantoaxial reduction can be promoted by the nail stick during the operation.
  • the angle of the nail is small. Whether it is cervical kyphosis or short neck or obese patients, the nail can be successfully placed.
  • the atlas and the pivot can select flexible and flexible screw fixation techniques according to the individual anatomy of the patient.
  • the atlas part can be fixed with the pedicle screw and the lateral vertebral block screw; when the transverse vertebral foramen is too large, it is not suitable for the pivot.
  • the atlantoaxial posterior special nail rod fixing device of the invention completely overcomes the defects that the conventional instrument fixing rod is easy to rotate, the screw is easy to deviate from the correct nail channel, and the short arm screw causes the fixing rod to be inserted, which not only improves the operation of the surgery. It is safe and easy to operate, and it also improves the lifting and resetting ability of the existing nail rod system through the design of the fulcrum screw with the nail groove heightening.
  • FIG. 1 is a schematic view showing the overall assembly structure of a special nail rod fixing device for posterior atlantoaxial approach of the present invention
  • FIG. 2 is a schematic structural view of a fulcrum screw of the present invention
  • FIG. 3 is a schematic structural view of a lifting screw of the present invention.
  • FIG. 4 is a schematic structural view of a variable cross-section fixing rod of the present invention.
  • Figure 5 is a schematic cross-sectional view showing another two kinds of anti-rotation joint portions of the present invention.
  • Fig. 6 is a schematic view showing the lifting and resetting of the special fixation device for the posterior atlantoaxial artery of the present invention.
  • a special fixation device for the posterior atlantoaxial posterior nail including the lifting screw 2, the fulcrum screw 1, the variable cross-section fixing rod 3, the lock nut 4 and the nail tail cross-connection 5,
  • the section fixing rod 3 is connected with the fulcrum screw 2 and the lifting screw 1
  • the nail tail traverse 5 is connected with two variable section fixing rods 4.
  • the fulcrum screw 1 includes a first tail portion 11 and a first head portion 12, and the lifting screw 2 includes a second
  • the tail portion 21 and the second head portion 22 have a nail groove inside the first tail portion 11 and the second tail portion 21, a U-shaped groove structure is formed on the side surface, an internal thread is arranged in the nail groove, and a lock nut 4 is connected inside the nail groove.
  • the section fixing rod 3 passes through the U-shaped groove and is fixed by the lock nut 4, and the bottom of the nail groove of the fulcrum screw 1 is 2-6 mm higher than the bottom of the nail groove of the lifting screw, see H in FIG. 2, the height of the specific lifting, According to the actual situation, in the preparation of the product, one specification can be set every 2mm.
  • the variable-section fixing rod 3 is provided with an anti-rotation connection portion 31 which cooperates with the U-shaped groove, and the anti-rotation connection portion 31 has a plane (shown as a side surface) in the U-shaped groove, and/or a curved surface (Fig. 4) It is shown as upper or lower part.
  • the second head 22 of the pull screw is a multi-axis screw that is tapered at the tip end of the second tail portion 21.
  • the first head 12 of the fulcrum screw 1 is a uniaxial screw or a multi-axis screw that is tapered at the tip end of the first tail portion 11.
  • the hole is opened at the bottom of the nail groove of the first tail portion 11 or the second tail portion 21, and then the multi-axis screw is passed through, and the nail tail cross-connection includes the lock rod nut 51 and the transverse connection.
  • the nut 52 and the lateral connecting plate 53 are provided with elliptical openings on both sides of the connecting plate 53.
  • One end of the locking rod nut 51 is screwed to the first tail portion 11 or the second tail portion 21, and the other end passes through the opening hole and is connected by the transverse connection.
  • the nut 52 is fixed.
  • the connecting plate 53 includes a straight plate and a curved plate for different situations.
  • first tail portion 11 or the second tail portion 21 to which the connecting plate 53 is connected is provided with the lock nut 51 in the stud traverse 5, One end is screwed into the nail groove of the first tail portion 11 or the second tail portion 21 to fix the variable-section fixing rod 3, and the original lock nut 4 is replaced at this time, and the function of the lock nut 4 is completed.
  • both the orthostatic position, the cervical lateral position and the overextended and flexed lateral X-ray film, the atlantoaxial CT and the cervical vertebra MRI were examined to evaluate fracture displacement, atlantoaxial dislocation, and spinal cord compression. Screw fixing method.
  • the tracheal intubation was anesthetized, the prone position was taken, the cervical spine was moderately flexed, and the skull traction was maintained during the operation.
  • Attached to Li The atlas and the vertebral vertebrae were fixed with pedicle screws. After the nailing point was determined, the drill hole was opened, and the hand drilled the hand to prepare the nail path.
  • the diameter of the 3.0 and 3.5 mm taper taps were attacked.
  • the silk and the atlas are placed into the lifting screw, and the uniaxial fulcrum screw is placed into the vertebral column.
  • the fulcrum screw with a height of 2 mm or 4 mm is selected according to the degree of dislocation, and the automatic anti-rotational cross-section fixing rod is trimmed and bent, and the elliptical portion is placed into the vertebral body.
  • the cylindrical part is placed into the nail groove of the sacral lifting screw, tighten the nut of the pivot fulcrum screw, fix the direction of the fixed section fixing rod, and then tighten the nut of the sacral lifting screw to complete Pull reset.
  • the nail groove of the extension part of the sacral spine lifting screw is broken, and the sacral nail tail is placed into the nail tail.
  • Grinding to remove the C 1 posterior arch of the C 2 posterior arch and C 2 lamina prepare the bone graft of the bone, and take the bone graft of the cancellous bone of the autologous tibia (the non-fusion fixation does not require the preparation of the bone graft and the bone graft, and the fracture of the odontoid
  • the internal fixation can be removed in the second stage to restore the atlantoaxial rotation function). Place a vacuum drainage and stratify the suture to complete the operation.
  • the drainage tube was removed 48 hours after operation, and X-ray, CT and MRI were performed 1 week after operation to understand the fracture reduction, atlantoaxial dislocation and reduction of spinal cord compression.
  • the atlantoaxial posterior nail fixation was successfully performed, including 3 cases of non-fusion fixation and 3 cases of fusion fixation (Table 1).
  • the operation time was 60-150 min (mean 95 min)
  • the intraoperative blood loss was 30-80 mL (mean 50 mL)
  • the screw is placed into the nail path smoothly, no slippage and offset occur; the fixing rod is placed once in place, and the nut is prevented from rotating after the nut is locked. It is not necessary to hold the rod clamp and other anti-rotation tools to help maintain the direction;
  • the nail groove of the vertebral screw does not need to be assisted by the device such as nail pressing rod.
  • the atlantoaxial vertebra After tightening the nut of the lifting screw of the sacral spine, the atlantoaxial vertebra is self-resetting, and the intraoperative perspective shows that the reduction is satisfactory; the transverse connection of the nail tail is successfully placed once without bending. And repeated adjustments have no effect on the bone graft space of the atlantoaxial. Postoperative X-ray and CT examination showed good internal fixation position, satisfactory atlantoaxial dislocation and reduction; 2 cases of ASIA grade D were restored to E grade.

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Abstract

一种寰枢椎后路专用钉棒固定器械，包括提拉螺钉（2）、支点螺钉（1）、变截面固定棒（3）、锁紧螺母（4）和钉尾横连（5），变截面固定棒（3）连接支点螺钉（1）与提拉螺钉（2），钉尾横连（5）连接2根变截面固定棒（3），支点螺钉（1）包括第一尾部（11）和第一头部（12），提拉螺钉（2）包括第二尾部（21）和第二头部（22），第一尾部（11）和第二尾部（21）内部具有钉槽，侧面开设有U型槽结构，钉槽内设有内螺纹，钉槽内部连接有锁紧螺母（4），变截面固定棒（3）穿过U型槽并通过锁紧螺母（4）固定，支点螺钉（1）的钉槽底部比提拉螺钉（2）的钉槽底部高2-6mm。采用上述结构的固定棒不仅提高了手术的安全性，便于操作，而且通过垫高钉槽底部加高2-6mm，提高了钉棒系统的提拉复位能力。

Description

一种寰枢椎后路专用钉棒固定器械 技术领域
本发明涉及医疗器械领域，特别是指一种寰枢椎后路专用钉棒固定器械。
背景技术
后路经寰枢侧块关节螺钉(Magerl螺钉)固定技术自1979年成功研制以来，一直被作为寰枢椎固定的金标准术式，但寰枢椎后路侧块螺钉技术(Goel-Harms技术)问世后，由寰椎螺钉联合枢椎螺钉组成的短节段钉棒固定逐渐取代Magerl螺钉，成为寰枢椎后路固定的首选方法，被认为是新的金标准术式，该技术分别在寰椎、枢椎独立置钉，不仅具有螺钉进钉角度小，适用人群广，固定强度高等优势，而且能够发挥术中提拉复位等功效，使得寰枢椎脱位的治疗效果、安全性、适用性和便利性得以明显提高。
然而，目前寰枢椎脱位使用的钉棒固定器械并非为寰枢椎单独设计，而是颈椎后路通用的钉棒固定器械，无论是进口还是国产的器械，在临床治疗寰枢椎脱位的操作过程中均发现其设计存在多种不足，有进一步改进和完善的必要，为此，需要对现有的钉棒固定器械进行改进。
发明内容
本发明提出一种寰枢椎后路专用钉棒固定器械，针对现有的器械临床应用中存在的不足，进行了改进，提升了适用的范围，同时针对寰枢椎的结构进行了调整，适应寰枢椎脱位复位的操作，提升复位能力，并简化手术操作。
一种寰枢椎后路专用钉棒固定器械，包括提拉螺钉、支点螺钉、变截面固定棒、锁紧螺母和钉尾横连，所述变截面固定棒连接所述支点螺钉与所述提拉螺钉，所述钉尾横连连接2根所述变截面固定棒，所述支点螺钉包括第一尾部和第一头部，所述提拉螺钉包括第二尾部和第二头部，所述第一尾部和所述第二尾部内部具有钉槽，侧面开设有U型槽结构，所述钉槽内设有内螺纹，所述钉槽内部连接有锁紧螺母，所述变截面固定棒穿过所述U型槽并通过所述锁紧螺母固定，所述支点螺钉的钉槽底部比所述提拉螺钉的钉槽底部高2-6mm。传统的 结构中，支点螺钉与提拉螺钉的钉槽底部高度是一致的，本申请的设计，使得所述支点螺钉的钉槽底部的高度较传统的高度加厚，高出了2-6mm，这一设计，源于部分病人脱位情形较为严重，传统的厚度对于复位提拉的距离小，此时，如需要提拉较大距离，则需要折弯固定棒使其形成一定的角度，这一操作的难度大，而且不易固定，非常容易对患者造成损伤，本发明中，增加钉槽底部的厚度，能够在其他结构不做调整的情况下，提拉距离实现相应的增加，提升复位提拉的效果，降低操作风险。
进一步，所述变截面固定棒上设有与所述U型槽配合的防旋转连接部，所述防旋转连接部具有与所述U型槽贴合的平面和/或曲面，传统的固定棒整体均为圆柱状，固定棒与U型槽为点接触，容易发生旋转的情况，尤其是在固定棒有折弯的情况下，旋转极易发生，造成固定难度大，操作复杂。本发明中，设置有防旋转连接部，固定棒不全为圆柱形，而是在防旋转部通过固定棒的截面变化实现防旋转，解决了上述问题，所述防旋转连接部具有与所述U型槽贴合的平面和/或曲面，如，所述防旋转连接部截面为矩形结构(即为贴合的平面)，此时，所述连接部在所述U型槽中无法旋转，形成锁死固定，由于所述U型槽底部为弧形曲面，从而，可以将所述连接部与所述U型槽底部接触部设置为贴合的曲面，也能够形成锁死的固定，无论是贴合的平面，还是曲面，都能够使传统结构的点接触变为面接触，极大的扩大接触面积，防止旋转。
进一步，所述第二尾部为长臂钉槽，外壁中部设有环形凹槽。传统的结构为短臂钉槽，而临床中，当寰枢椎发生脱位时，寰椎向前滑移，造成寰椎螺钉和枢椎螺钉的钉槽不在同一冠状面上，需要借助钉棒提拉才能实现复位。然而，现有颈椎后路器械的螺钉均为短臂的多轴螺钉，上棒操作非常困难，尤其是对于寰椎枢脱位严重病例，往往需要在狭小的空间内使用提钉压棒装置辅助操作。为此，我们设计了寰椎的长臂多轴提拉螺钉，利用逐渐旋紧螺母完成寰椎的提拉复位和锁紧固定棒，简化了上棒和复位操作。此外，本发明中，通过在所述第二尾部外壁中部设有环形凹槽，从而将所述第二尾部由所述环形凹槽划分为上下两个部分，当需要较高尾部时，正常使用即可，当仅需要使用到一半至一半以下高度时，使用者可以从所述环形凹槽处掰断上部结构，这种长臂结构设计扩大了使用的情形，提升实用性能和便利性。
进一步，所述提拉螺钉为第二头部为连接在所述第二尾部的尖端呈锥形的多轴螺钉。寰椎椎弓根的钉道准备和螺钉的拧入困难，尤其是进钉点处的寰椎后弓高度过小时，即便钉道在手钻开路时准备顺利，丝锥攻丝过程中或螺钉拧入过程中也容易出现下壁骨质的劈裂，导 致丝锥或螺钉向下方滑出，难以进入之前的正确钉道，术中往往需要反复多次调整方能准确拧入螺钉，不仅耗时费力，而且存在损伤静脉丛和脊髓的风险。为此，我们将螺钉头部的螺纹设计成锥形螺纹，螺钉的前端直径变小，便于自行进入正确的钉道，增加了手术的便利性和安全性
进一步，所述支点螺钉的第一头部为固定在所述第一尾部的尖端呈锥形的单轴螺钉或多轴螺钉，根据不同的使用需求，选择单轴或多轴螺钉。
进一步，所述钉尾横连包括锁棒螺母、横连螺母和横向的连接板，所述连接板两侧设有椭圆形开孔，所述锁棒螺母一端通过螺纹连接所述第一尾部或所述第二尾部，另一端穿过所述开孔后，由所述横连螺母固定，这一设计使所述钉尾横联直接固定到所述支点螺钉和/或所述提拉螺钉上，而不用类似传统的固定结构固定到固定棒上，提升了固定的效果，并且更加便于操作和实施。
进一步，所述连接板包括直板和弧形板，用于不同的情形。
本发明的所述寰枢椎后路专用钉棒固定器械，寰枢椎后路钉棒固定具有与Magerl螺钉固定相当的生物力学稳定性，同时还克服了Magerl螺钉技术的上述不足，其优势体现在：
1.寰椎和枢椎单独置钉，术前不要求寰枢椎解剖复位，术中还可通过钉棒提拉，促进寰枢椎复位。
2.进钉角度小，无论是颈椎后凸还是短颈、肥胖患者，均可成功置钉。
3.可在直视下进，不需要X线反复透视。
4.寰椎和枢椎可根据患者的个体解剖情况分别选择灵活多样的螺钉固定技术。当寰椎后弓解剖高度不够、不适合寰椎椎弓根螺钉固定时，可选用寰椎部分经椎弓根螺钉、寰椎侧块螺钉固定；当枢椎横突孔过大不适合行枢椎椎弓根螺钉固定时，可选用枢椎椎板螺钉、枢椎侧块螺钉、C2/3经关节螺钉固定等；寰椎和枢椎的左右两侧也均可选择不同的螺钉固定技术，通过不同螺钉固定技术的灵活组合实现寰枢椎的钉棒固定。上述优势使得寰枢椎脱位的复位和固定效果以及人群适用范围得以明显提高。
本发明的所述寰枢椎后路专用钉棒固定器械，彻底克服了传统器械固定棒易旋转、螺钉易偏离正确钉道、短臂螺钉导致固定棒置入困难等不足，不仅提高了手术的安全性，便于操作，而且还通过钉槽加高的枢椎支点螺钉设计，提高了既有钉棒系统的提拉复位能力，优势明显。
附图说明
为了更清楚地说明本发明实施例或现有技术中的技术方案，下面将对实施例或现有技术描述中所需要使用的附图作简单地介绍，显而易见地，下面描述中的附图仅仅是本发明的一些实施例，对于本领域普通技术人员来讲，在不付出创造性劳动性的前提下，还可以根据这些附图获得其他的附图。
图1为本发明寰枢椎后路专用钉棒固定器械整体组装结构示意图；
图2为本发明支点螺钉的结构示意图；
图3为本发明提拉螺钉的结构示意图；
图4为本发明变截面固定棒的结构示意图；
图5为本发明防旋转连接部的另2种截面示意图；
图6为本发明寰枢椎后路专用钉棒固定器械提拉复位示意图。
具体实施方式
下面将结合本发明实施例中的附图，对本发明实施例中的技术方案进行清楚、完整地描述，显然，所描述的实施例仅仅是本发明一部分实施例，而不是全部的实施例。基于本发明中的实施例，本领域普通技术人员在没有作出创造性劳动前提下所获得的所有其他实施例，都属于本发明保护的范围。
如图1-图6所示，一种寰枢椎后路专用钉棒固定器械，包括提拉螺钉2、支点螺钉1、变截面固定棒3、锁紧螺母4和钉尾横连5，变截面固定棒3连接支点螺钉2与提拉螺钉1，钉尾横连5连接2根变截面固定棒4，支点螺钉1包括第一尾部11和第一头部12，提拉螺钉2包括第二尾部21和第二头部22，第一尾部11和第二尾部21内部具有钉槽，侧面开设有U型槽结构，钉槽内设有内螺纹，钉槽内部连接有锁紧螺母4，变截面固定棒3穿过U型槽并通过锁紧螺母4固定，支点螺钉1的钉槽底部比提拉螺钉的钉槽底部高2-6mm，见附图2中的H，具体提升的高度，根据实际情况选取，而产品的制备中，可以依据每2mm设置一个规格。变截面固定棒3上设有与U型槽配合的防旋转连接部31，防旋转连接部31具有与U型槽贴合的平面(图4中展示为侧面)，和/或曲面(图4中展示为上部或下部)，根据实际的需要，也可以设计成全部是平面，如图5中的B，或者3个侧面为平面，仅底部为曲面，如图 5中的A。第二尾部21外壁中部设有环形凹槽23。提拉螺钉的第二头部22为连接在第二尾部21的尖端呈锥形的多轴螺钉。支点螺钉1的第一头部12为固定在第一尾部11的尖端呈锥形的单轴螺钉或多轴螺钉。对于多轴螺钉的连接方式，采用的是在第一尾部11或者第二尾部21的钉槽底部开孔，然后让多轴螺钉穿过即可，钉尾横连包括锁棒螺母51、横连螺母52和横向的连接板53，连接板53两侧设有椭圆形开孔，锁棒螺母51一端通过螺纹连接第一尾部11或第二尾部21，另一端穿过开孔后，由横连螺母52固定。连接板53包括直板和弧形板，用于不同的情形，需要说明的是，连接有连接板53的第一尾部11或者第二尾部21，由于钉尾横连5中含有锁棒螺母51，其一端拧入第一尾部11或者第二尾部21的钉槽中，固定住变截面固定棒3，此时即取代了原锁紧螺母4，完成了锁紧螺母4的功能。
本产品的使用效果实验如下：
一般资料：
本组6例患者，男4例，女2例，年龄5～36岁，平均年龄17岁。齿突陈旧性骨折畸形愈合寰枢椎脱位1例，齿突新鲜骨折并寰枢椎脱位2例，游离齿突并寰枢椎脱位3例。6例患者均有枕颈部不适，其中2例患者四肢肌力下降，余4例运动感觉正常，美国脊髓损伤学会(American Spinal Injury Association，ASIA)分级D级2例、E级4例(见表1)。入院后均摄张口正位、颈椎正侧位和过伸过屈侧位X线片，寰枢椎CT、颈椎MRI平扫等检查，评估骨折移位、寰枢椎脱位、脊髓压迫情况，制定螺钉固定方式预案。
手术步骤：
气管插管全麻，取俯卧位，颈椎适度前屈，术中维持颅骨牵引。取颈后正中长约6～8cm纵切口，由枕后隆凸至C2棘突骨膜下剥离，显露枕骨、C1后弓、C2侧块，保留颈半棘肌在C2棘突的附丽。寰椎和枢椎均采用椎弓根螺钉固定，确定进钉点后，磨钻开口，手钻徒手准备钉道，探针探触四壁完整后，直径3.0、3.5mm锥形丝攻依次攻丝，寰椎置入提拉螺钉，枢椎置入单轴支点螺钉，根据脱位程度选取垫高2mm或4mm的支点螺钉，修剪、折弯自动防旋变截面固定棒，椭圆部分置入枢椎支点螺钉的钉槽内，圆柱部分置入寰椎提拉螺钉的钉槽内，拧紧枢椎支点螺钉的螺母，变截面固定棒的方向自行固定，再拧紧寰椎提拉螺钉的螺母，完成提拉复位。透视复位满意后折断寰椎提拉螺钉加长部分的钉槽，寰椎钉尾置入钉尾横连。磨钻去除C1后弓、C2椎板的骨皮质准备植骨床，取自体髂骨松质骨颗粒植骨(非融合固定无须准备植骨床和取髂骨植骨，待齿突骨折愈合后可二期取出内固定，以恢复寰枢椎旋转功能)。放置负压引流，分层缝合完成手术。
术后48h拔除引流管，术后1周行X线、CT及MRI复查，了解骨折复位情况、寰枢椎脱位复位情况以及脊髓受压解除情况等。
结果：
本组6例患者均成功施行寰枢椎后路钉棒复位固定术，其中非融合固定3例、融合固定3例(表1)。手术时间60～150min(平均95min)，术中出血量30～80mL(平均50mL)，无脊髓及椎动脉损伤。术中螺钉置入钉道顺利，无滑出、偏移发生；固定棒置入一次到位，锁紧螺母后自行防止旋转，无须持棒钳及其它防旋转工具辅助维持方向；固定棒置入寰椎螺钉的钉槽无须提钉压棒等装置辅助，旋紧寰椎提拉螺钉的螺母后寰枢椎自行复位，术中透视显示复位满意；钉尾横连均一次成功置入，无须折弯及反复调整，对寰枢椎间的植骨空间亦无影响。术后X线片、CT复查显示内固定位置良好，寰枢椎脱位复位满意；2例ASIA分级D级者均恢复至E级。
表1：
Figure PCTCN2016110718-appb-000001
以上所述仅为本发明的较佳实施例而已，并不用以限制本发明，凡在本发明的精神和原则之内，所作的任何修改、等同替换、改进等，均应包含在本发明的保护范围之内。

Claims (7)

  1. 一种寰枢椎后路专用钉棒固定器械，其特征在于：包括提拉螺钉、支点螺钉、变截面固定棒、锁紧螺母和钉尾横连，所述变截面固定棒连接所述支点螺钉与所述提拉螺钉，所述钉尾横连连接2根所述变截面固定棒，所述支点螺钉包括第一尾部和第一头部，所述提拉螺钉包括第二尾部和第二头部，所述第一尾部和所述第二尾部内部具有钉槽，侧面开设有U型槽结构，所述钉槽内设有内螺纹，所述钉槽内部连接有锁紧螺母，所述变截面固定棒穿过所述U型槽并通过所述锁紧螺母固定，所述支点螺钉的钉槽底部比所述提拉螺钉的钉槽底部高2-6mm。
  2. 如权利要求1中所述寰枢椎后路专用钉棒固定器械，其特征在于：所述变截面固定棒上设有与所述U型槽配合的防旋转连接部，所述防旋转连接部具有与所述U型槽贴合的平面和/或曲面。
  3. 如权利要求1中所述寰枢椎后路专用钉棒固定器械，其特征在于：所述第二尾部为长臂钉槽，且外壁中部设有环形凹槽。
  4. 如权利要求1中所述寰枢椎后路专用钉棒固定器械，其特征在于：所述提拉螺钉为第二头部为连接在所述第二尾部的尖端呈锥形的多轴螺钉。
  5. 如权利要求1中所述寰枢椎后路专用钉棒固定器械，其特征在于：所述支点螺钉的第一头部为固定在所述第一尾部的尖端呈锥形的单轴螺钉，或连接在所述第一尾部的尖端呈锥形的多轴螺钉。
  6. 如权利要求1中所述寰枢椎后路专用钉棒固定器械，其特征在于：所述钉尾横连包括锁棒螺母、横连螺母和横向的连接板，所述连接板两侧设有椭圆形开孔，所述锁棒螺母一端通过螺纹连接所述第一尾部或所述第二尾部，另一端穿过所述开孔后，由所述横连螺母固定。
  7. 如权利要求6中所述寰枢椎后路专用钉棒固定器械，其特征在于：所述连接板包括直板和弧形板。
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CN201521079127.3U CN205251669U (zh) 2015-12-23 2015-12-23 一种用于脊柱内固定的螺钉装置
CN201521079131.XU CN205251659U (zh) 2015-12-23 2015-12-23 一种椎体滑脱复位装置
CN201610557989.5 2016-07-15
CN201620746909.6U CN206518589U (zh) 2016-07-15 2016-07-15 一种寰枢椎后路复位系统
CN201610557989.5A CN106037910B (zh) 2016-07-15 2016-07-15 一种寰枢椎后路复位系统
CN201620746909.6 2016-07-15
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CN201620760760 2016-07-18
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CN115227367B (zh) * 2022-06-28 2024-06-25 北京航空航天大学 一种寰枢椎后路内固定系统连接棒的设计方法
CN118203400B (zh) * 2024-05-20 2024-08-02 四川大学华西医院 一种牵拉复位装置

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