WO2018076530A1 - 一种髋臼锉磨和臼杯假体植入定位导向装置及其定位方法 - Google Patents

一种髋臼锉磨和臼杯假体植入定位导向装置及其定位方法 Download PDF

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Publication number
WO2018076530A1
WO2018076530A1 PCT/CN2016/112723 CN2016112723W WO2018076530A1 WO 2018076530 A1 WO2018076530 A1 WO 2018076530A1 CN 2016112723 W CN2016112723 W CN 2016112723W WO 2018076530 A1 WO2018076530 A1 WO 2018076530A1
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Prior art keywords
acetabular
joint
cup
acetabulum
positioning
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PCT/CN2016/112723
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English (en)
French (fr)
Inventor
邬培慧
廖威明
傅明
盛璞义
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中山大学附属第一医院
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Priority to US15/577,349 priority Critical patent/US11071556B2/en
Publication of WO2018076530A1 publication Critical patent/WO2018076530A1/zh

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/1742—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the hip
    • A61B17/1746—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the hip for the acetabulum
    • A—HUMAN NECESSITIES
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    • A61B2017/00398—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like using powered actuators, e.g. stepper motors, solenoids
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Definitions

  • the invention relates to the technical field of medical instruments, in particular to an acetabular abrasion and a cup prosthesis implantation positioning guiding device and a positioning method thereof in total hip arthroplasty.
  • the intraoperative cup prosthesis implantation position should restore the normal rotation center of the hip as much as possible and maintain the abduction angle. And the anteversion angle is in the safe range, and at the same time, sufficient bone bone coverage of the host bone- ⁇ cup can be obtained to obtain better prolonged survival rate of the prosthesis, and reduce postoperative prosthesis loosening, prosthesis impact, joint dislocation and other complications.
  • the most commonly used methods for acetabular grinding and cup placement in clinical total hip arthroplasty are the coronal plane in which the surgeon enters the direction of the acetabular and cup and the direction of the ground and the patient's body.
  • the angle formed by the direction and the original anatomy of the reference acetabulum are used to subjectively determine the angular direction and the depth of the prosthesis installation position.
  • Intraoperative operation the patient's surgical position, pelvic position, pelvic and acetabular structure lesions and anatomical variations and other factors will affect and cause the acetabular grinding direction and the direction and position deviation of the cup, resulting in the surgeon's Subjective judgments are not able to honed the acetabulum and implant the cup prosthesis at the desired angle and position.
  • the computer-aided navigation and positioning technology quantifies the data of the acetabular shape and the installation angle and the depth of the cup prosthesis through individualized surgical design and real-time navigation, and determines whether there is information error according to the specific conditions during the operation. A positioning technique that is corrected in time. Computer-aided navigation and positioning technology can significantly improve the accuracy of the positioning of the cup prosthesis in hip replacement surgery, but this technique is not required because of the high requirements on the equipment and the time-consuming operation.
  • 3D printing personalized osteotomy guide positioning technology is based on preoperative pelvic CT or MR image reconstruction, computer-aided design to determine the position and angle of the cup installation, using 3D printing technology to construct the patient's personalized positioning and guiding module, through the operation of 3d
  • the printed personalized positioning guide module is matched with a specific area of the articular surface to determine the intraoperative honing direction.
  • the positioning guide module needs to fit the articular surface area, the guiding module must be removed when honing the acetabulum to honing the bone of the articular surface, so that it is difficult to achieve real-time assisted positioning and assist in judging the depth of the honing. Therefore, it is difficult to ensure the accuracy of its auxiliary positioning.
  • the present invention is directed to the deficiencies in the prior art, and provides an acetabular wear and a cup prosthesis implantation positioning guide device and a positioning method thereof in total hip arthroplasty.
  • An acetabular and sac-prosthesis implant positioning guide device includes a sleeve handle and a plurality of sliding arms slidably disposed on the sleeve handle, and each of the sliding arms is respectively connected with a positioning component, and each positioning component It can be adjusted and locked with respect to the sliding arm, and the sleeve handle is provided with a hollow inner cavity.
  • the positioning assembly comprises a clamping joint and a supporting head, and one end of the clamping joint is rotatably connected with the sliding arm to form a first movable joint, and the other end of the clamping joint is rotatably connected with the supporting head, and comprises a second movable joint on which the joint lock nut for locking the first movable joint and the second movable joint is disposed.
  • the two ends of the clamping joint are respectively provided with a first joint socket and a second joint socket, and the end of the sliding arm is provided with a first rotating ball head that cooperates with the first joint socket, and one end of the supporting head A second rotating ball head mated with the second joint socket is provided.
  • the joint locking nut is rotatably disposed on the clamping joint, and in the released state, the first movable joint and the second movable joint are freely rotatable, and in the locked state, the first movable joint, the first The two active joints are fixed.
  • the other end of the support head is provided with a positioning groove for abutting the outer edge of the acetabulum.
  • the sleeve handle is provided with a plurality of sliding slots
  • the upper end of the sliding arm is provided with a sliding portion matched with the sliding slot, and further comprises a locking for clamping the sliding portion in the sliding slot bolt.
  • the sleeve handle is composed of a main body arm and a main rod locking block which cooperate to form a sleeve, and the two are connected by an opening and closing connection.
  • the sliding stroke of the sliding portion in the sliding slot is 60 mm.
  • the clamping joint is composed of a first clamping block and a second clamping block that cooperate with each other, and a mounting hole for mounting the joint locking nut is disposed in a middle portion.
  • a method for locating an acetabular mill and a cup prosthesis positioning guide device in total hip arthroplasty includes the following steps:
  • S1 determine the optimal position of the personalized implantation of the cup prosthesis: according to the pelvic CT or MRI scan data, combined with the three-dimensional modeling image analysis software, according to the patient's acetabular bone mass distribution and lesion characteristics, the measurement and analysis of the optimal cup.
  • the size and placement angle and position of the prosthesis enable it to achieve both the ideal containment area of the autologous bone and the safe angular range and position of the cup, thus ensuring good initial stability of the cup prosthesis. It can also minimize the risk of prosthesis impact and improve joint stability;
  • the first model is a hip implanted with a directional cup with a directional guide according to an optimized surgical procedure.
  • the second model is the acetabular model after honing according to the optimized surgical plan, that is, the acetabular model with partial bone removal;
  • the invention has the advantages of simple structure, convenient preparation and easy use, combined with three-dimensional pre-operative analysis and rapid prototyping technology, high personalization accuracy and clinical applicability, and high cost performance;
  • the present invention can effectively solve the technical threshold and costly problem of personalized and accurate implantation of the cup prosthesis for total hip arthroplasty, and shorten the learning curve of the surgeon;
  • the invention realizes the personalized and accurate cup prosthesis implantation, and does not depend on the previous need to fit the articular surface area according to the positioning guiding module, so it is not necessary to remove the guiding module when honing the acetabulum, realizing real-time Auxiliary positioning, as well as the ability to assist in determining the depth of the honing, thus ensuring the accuracy of its assisted positioning.
  • FIG. 1 is a schematic view showing the structure of an acetabular mill and a cup prosthesis implantation positioning guide according to the present invention.
  • FIG. 2 is a schematic view showing another perspective of the acetabular mill and the cup prosthesis implantation positioning guide of the present invention.
  • Figure 3 is a schematic view showing the structure of the sleeve handle of the present invention.
  • Figure 4 is a schematic view showing the structure of the clamp joint of the present invention.
  • Figure 5 is a schematic view showing the structure of the support head of the present invention.
  • Figure 6 is a schematic view showing the structure of a sliding arm of the present invention.
  • the embodiment provides an acetabular wear and a cup prosthesis implant positioning guide device, including a sleeve handle 1 and a plurality of sliding arms 2 slidably disposed on the sleeve handle 1 .
  • Each of the sliding arms 2 is respectively connected with a positioning assembly, and each positioning assembly is rotatably adjustable and fixed with respect to the sliding arm 2, and the sleeve handle 1 is provided with a hollow inner cavity 3.
  • the invention has the advantages of simple structure, convenient preparation and easy use, combined with three-dimensional preoperative analysis and rapid prototyping technology, high personalization accuracy and clinical applicability, and high cost performance; on the basis of three-dimensional preoperative analysis and 3d printing model, It can effectively solve the technical threshold and cost of personalization and accurate implantation of the cup prosthesis in total hip arthroplasty, shorten the surgeon's learning curve; on the basis of achieving personalized and precise cup prosthesis implantation, it does not depend on In the past, according to the positioning guide module, it is necessary to fit the articular surface area, so it is not necessary to remove the guiding module when honing the acetabulum, real-time auxiliary positioning, and can help determine the depth of the honing, thus ensuring the accuracy of the auxiliary positioning. .
  • the positioning assembly comprises a clamping joint 4 and a support head 5, one end of the clamping joint 4 is rotatably connected with the sliding arm 2 to constitute a first movable joint, and the other end of the clamping joint 4 and the supporting head 5 rotatably connected to form a second movable joint on which the joint lock nut 6 for locking the first movable joint and the second movable joint is disposed.
  • the first movable joint and the second movable joint are independent movable mechanisms, and the angle and the direction between the sliding arm 2 and the sliding arm 2 can be flexibly adjusted, so that the ideal self-supporting area of the bone can be obtained, and the cup can be obtained in the cup.
  • Safe angular range and position which not only ensures the initial stability of the cup prosthesis, but also minimizes the risk of prosthesis impact and improves Use the stability of the process.
  • the two ends of the clamping joint 4 are respectively provided with a first joint socket 44 and a second joint socket 45.
  • the end of the sliding arm 2 is provided with a first rotating ball head 21 that cooperates with the first joint socket 44.
  • One end of the support head 5 is provided with a second rotating ball head 51 that cooperates with the second joint socket 45.
  • the joint lock nut 6 is rotatably disposed on the clamping joint 4, and can be flexibly rotated to adjust the direction and facilitate the joint locking.
  • the nut 6 is locked and fixed; in the released state, the first rotating ball head 21 is freely rotated inside the first joint socket 44, and the second rotating ball head 51 is freely rotated inside the second joint socket 45, that is, the first activity
  • the joint and the second movable joint are freely rotatable.
  • the locked state the first rotating ball head 21 is fixedly clamped inside the first joint socket 44, and the second rotating ball head 51 is fixedly clamped to the second joint socket 45.
  • the other end of the support head 5 is provided with a positioning groove 52 for abutting against the outer edge of the acetabulum, and the positioning groove 52 is used to greatly improve the firmness of abutting the outer edge of the acetabulum and prevent Sliding and slipping to improve the stability of the process.
  • the sleeve handle 1 is provided with a plurality of sliding slots 7 , and the upper end of the sliding arm 2 is provided with a sliding portion 22 that cooperates with the sliding slot 7 , and the sliding portion 22 can slide up and down along the sliding slot 7
  • the distance is adjusted to the position of the positioning assembly on the sliding arm 2.
  • the sliding of the sliding arm 2 is formed to be 60 mm, and the locking bolt 23 for clamping the sliding portion 22 in the sliding slot 7 is further included. After the sliding portion 22 is adjusted to the desired position, it is locked and fixed by the locking bolt 23.
  • the sleeve handle 1 is composed of a main body arm 11 and a main rod locking block 12 which are combined to form a sleeve, and the two are connected by an opening and closing connection member 8, and the sleeve handle 1 is opened for insertion.
  • Directional indicator rod and acetabular grinding rod practical.
  • the clamping joint 4 is composed of a first clamping block 41 and a second clamping block 42 which are matched with each other, and a mounting hole 43 for mounting the joint locking nut 6 is arranged in the middle portion, and the nut 6 can be easily locked by the joint.
  • the first clamping block 41 and the second clamping block 42 are adjusted to achieve the purpose of loosening or locking the movable joints.
  • the embodiment provides a method for positioning an acetabular mill and a cup prosthesis implantation positioning guide in total hip arthroplasty, comprising the following steps:
  • S1 determine the optimal position of the personalized implantation of the cup prosthesis: according to the pelvic CT or MRI scan data, combined with the three-dimensional modeling image analysis software, according to the patient's acetabular bone mass distribution and lesion characteristics, the measurement and analysis of the optimal cup.
  • the size and placement angle and position of the prosthesis enable it to achieve both the ideal containment area of the autologous bone and the safe angular range and position of the cup, thus ensuring good initial stability of the cup prosthesis. It can also minimize the risk of prosthesis impact and improve joint stability;
  • the first model is a hip implanted with a directional cup with a directional guide according to an optimized surgical procedure.
  • the second model is the acetabular model after honing according to the optimized surgical plan, that is, the acetabular model with partial bone removal;
  • the tips of the four support heads 5 are first matched with the outer edges of the acetabulum of the second model, so that the tips of the four support heads 5 simultaneously contact the edges of the outer acetabulum to determine the direction of the acetabulum
  • the orientation direction of the cup prosthesis direction indicator rod is the same, and then the acetabulum is pushed in the direction of the honing, so that the acetabulum is in contact with the bottom of the acetabular fossa of the second model, which is the acetabulum.
  • Honing the planned position then setting the position of the retaining ring on the acetabular grinding rod at the other end of the acetabular mill and cup placement positioning guide sleeve, making it just the port on the sleeve handle 1 Contact or reserve a certain distance that can be further deepened, so that when the acetabular arm is ground to the planned depth, the retaining ring on the honing rod will contact the port of the sleeve, thereby hindering the deepening of the deep Honing

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Abstract

一种全髋关节置换术中髋臼锉磨和臼杯假体植入定位导向装置，该装置包括一套筒把手（1）以及可滑动设置在该套筒把手（1）上的若干滑动臂（2），套筒把手（1）设置有中空内腔（3），各滑动臂（2）上分别连接有一定位组件，各定位组件可相对于滑动臂（2）转动调节并予以锁紧固定。还公开了一种髋臼锉磨和臼杯假体植入定位导向装置在全髋关节置换术中的定位方法。

Description

一种髋臼锉磨和臼杯假体植入定位导向装置及其定位方法 技术领域
本发明涉及医疗器械技术领域，具体涉及一种全髋关节置换术中髋臼锉磨和臼杯假体植入定位导向装置及其定位方法。
背景技术
人工全髋关节置换手术的首要目标之一是获得稳定的髋关节和稳固的关节假体，术中臼杯假体植入位置是应能尽可能恢复髋关节正常旋转中心，并维持外展角和前倾角在安全范围，同时获得充分的宿主骨-臼杯骨性覆盖，才能获得更好的假体远期生存率，降低术后假体松动，假体撞击，关节脱位等并发症。
目前临床上人工全髋关节置换术中最为常用的髋臼锉磨和臼杯植入定位方法，是术者根据髋臼锉磨和臼杯打入方向与地面方向和患者身体所处的冠状面方向所成的夹角大小以及参考髋臼原本解剖结构进行主观判断假体安装位置的角度方向和磋磨深度。术中操作时，患者的手术体位，骨盆位置、骨盆和髋臼结构的病变和解剖变异等多种因素都会影响并引起髋臼锉磨方向和臼杯植入方向和位置偏差，致使术者的主观判断不能够按照期望的角度和位置锉磨髋臼和植入臼杯假体。由于传统的臼杯定位技术潜在误差风险较高，尤其对于髋臼结构存在严重畸形和病变的患者，临床研究也证实了这一观点。因此，利用常规的髋臼锉磨装置和定位方法出现偏差的潜在风险较高，容易导致术后臼杯假体植入位置偏差，影响手术疗效。计算机辅助导航定位技术和3D打印个性化导板定位技术是辅助髋臼锉磨定位的两种新兴技术。
计算机辅助导航定位技术是通过个体化的手术设计和实时导航，对髋臼形态和臼杯假体安装角度和磋磨深度等数据进行量化，并根据术中具体情况确定是否存在信息误差，并进行及时修正的一种定位技术。计算机辅助导航定位技术能够显著提高髋关节置换手术的臼杯假体定位精确度，但该技术因对设备要求高，术中操作费时而不能广泛应用。3D打印个性化截骨导板定位技术是根据术前骨盆CT或MR影像重建，借助计算机辅助设计，确定臼杯安装位置和角度，采用3D打印技术构建患者个性化定位导向模块，术中通过将3d打印的个性化定位导向模块与关节面特定区域贴合匹配从而确定术中锉磨方向。然而，由于定位导向模块需要贴合关节面区域，在锉磨髋臼时必须取下导向模块，才能锉磨关节面的骨质，因此难以实现实时辅助定位，以及辅助判断锉磨的深度。因此，难以确保其辅助定位的准确性。
故研发一套高性价比的个性化髋臼锉磨和臼杯植入导向定位装置和定位方法，使之具备较高的个性化精确度和临床适用性，提高臼杯假体植入的精确度，改善术后效果，是目前人 工髋关节置换手术的重要难点之一。
发明内容
本发明针对现有技术中的不足，提供一种全髋关节置换术中髋臼锉磨和臼杯假体植入定位导向装置及其定位方法。
本发明通过以下技术方案实现该目的：
一种髋臼锉磨和臼杯假体植入定位导向装置，包括一套筒把手以及可滑动设置在该套筒把手上的若干滑动臂，各滑动臂上分别连接有一定位组件，各定位组件可相对于滑动臂转动调节并予以锁紧固定，所述套筒把手设置有中空内腔。
其中，所述定位组件包括夹紧关节和支撑头，所述夹紧关节的一端与滑动臂可转动连接，构成第一活动关节，所述夹紧关节的另一端与支撑头可转动连接，构成第二活动关节，所述夹紧关节上设置有用于锁定第一活动关节和第二活动关节的关节锁定螺母。
其中，所述夹紧关节的两端分别设置有第一关节窝、第二关节窝，所述滑动臂的末端设置有与第一关节窝配合的第一转动球头，所述支撑头的一端设置有与第二关节窝配合的第二转动球头。
其中，所述关节锁定螺母可转动设置在夹紧关节上，松开状态下，所述第一活动关节、第二活动关节均可自由转动，锁紧状态下，所述第一活动关节、第二活动关节均固定不动。
进一步的，所述支撑头的另一端设置有用于与髋臼外口边缘抵接的定位槽。
其中，所述套筒把手上设置有若干滑槽，所述滑动臂的上端设置有与所述滑槽配合的滑动部，还包括用于将所述滑动部卡紧固定在滑槽内的锁定螺栓。
作为优选的，所述套筒把手由配合构成一套筒的主体臂和主杆锁紧块构成，二者通过一开合连接件连接。
其中，所述滑动部在滑槽中的滑动行程为60mm。
其中，所述夹紧关节由相互配合的第一夹紧块、第二夹紧块构成，中部设置有用于安装关节锁定螺母的安装孔。
一种髋臼锉磨和臼杯假体植入定位导向装置在全髋关节置换术中的定位方法，包括以下步骤：
S1、确定臼杯假体个性化植入的最佳位置：根据骨盆CT或MRI扫描数据，结合三维建模图像分析软件，根据患者髋臼骨量分布情况及病变特点，测量分析优选的臼杯假体的大小和植入角度和位置，使之既能获得理想的自体骨的包容面积，又能够在臼杯安全的角度范围和位置，这样既能保证良好的臼杯假体初始稳定性，又能兼顾最大程度降低假体撞击的风险，提高关节稳定性；
S2、按照1：1的比例快速成型术前设计的臼杯植入方案的三维模型：包括两个模型，第一个模型为按照优化手术方案植入带方向指示杆的臼杯假体的髋臼模型，第二个模型为按照优化手术方案锉磨后的髋臼模型，即锉去部分骨质的髋臼模型；
S3、确定各滑动臂的位置及定位组件中各个活动关节的转动角度：将髋臼锉磨及臼杯植入定位导向装置的套筒套入快速打印成型的第一个模型的臼杯假体方向指示杆，且使得连接有滑动臂的一端朝向髋臼模型，解锁各滑动臂上的锁定螺栓及其定位组件的各个活动关节，根据术中髋臼显露的范围，调节各个支撑头尖端的位置，使之既能充分利用显露的空间，又接触到模型中髋臼外口边缘，然后锁紧固定各活动关节，保证支撑头定位尖端与髋臼外口边缘接触后能够稳固定位，这样四个支撑头在髋臼外口边缘所确定的位置对应于臼杯假体方向指示杆的方向；
S4、确定髋臼锉磨的深度：将髋臼锉磨及臼杯植入定位导向装置从第一个模型取出后，插入髋臼锉磨杆，髋臼锉磨杆安装优选大小型号的髋臼锉；首先将四个支撑头的尖端与第二个模型的髋臼外口边缘相匹配，使四个支撑头的尖端同时接触髋臼外口的边缘，从而确定髋臼锉的方向与第一个模型中臼杯假体方向指示杆的方向一致，然后顺着锉磨方向推压髋臼锉，使髋臼锉与第二个模型的髋臼窝底部接触，该位置即为髋臼锉锉磨的计划位置，然后在髋臼锉磨及臼杯植入定位导向装置套筒的另一端的髋臼锉磨杆设定卡位环的位置，使其刚好与套筒把手上端口相接触或预留一定的可进一步锉深的距离，这样当髋臼锉锉磨到计划的深度后，锉磨杆上的卡位环就会与套筒的端口相接触，从而阻碍继续向深部锉磨；
S5、真实髋臼锉磨和臼杯植入：按照常规全髋关节置换手术的手术入路，充分显露髋臼开口的骨性边缘，将调节后的髋臼锉磨及臼杯植入定位导向装置的四个支撑头的尖端与髋臼骨性外口边缘相匹配，使四个支撑头的尖端同时接触髋臼骨性外口的边缘，从而确定髋臼锉的方向与第一个模型中臼杯假体方向指示杆的方向一致，选择合适型号的髋臼锉，然后顺着锉磨方向推压髋臼锉并进行锉磨，直至锉磨杆上的卡环与套筒把手的端口相接触，锉磨完成。
相对于现有技术，本发明的有益效果为：
1、本发明结构简单、制备方便、容易使用，结合三维术前分析和快速成型技术，具备较高的个性化精确度和临床适用性，性价比高；
2、本发明在三维术前分析和3d打印模型的基础上，可有效解决全髋关节置换个性化精确植入臼杯假体的技术门槛和成本过高的问题，缩短手术医生学习曲线；
3、本发明在实现个性化精确臼杯假体植入的基础上，不依赖于以往的根据定位导向模块需要贴合关节面区域，所以在锉磨髋臼时无须取下导向模块，实现实时辅助定位，以及能够辅助判断锉磨的深度，因此，能够确保其辅助定位的准确性。
附图说明
图1为本发明的髋臼锉磨和臼杯假体植入定位导向装置的结构示意图。
图2为本发明的髋臼锉磨和臼杯假体植入定位导向装置的另一视角的结构示意图。
图3为本发明的套筒把手的结构示意图。
图4为本发明的夹紧关节的结构示意图。
图5为本发明的支撑头的结构示意图。
图6为本发明的滑动臂的结构示意图。
图中：1-套筒把手，11-主体臂，12-主杆锁紧块，2-滑动臂，21-第一转动球头，22-滑动部，23-锁定螺栓，3-中空内腔，4-夹紧关节，41-第一夹紧块，42-第二夹紧块，43-安装孔，44-第一关节窝，45-第二关节窝，5-支撑头，51-第二转动球头，52-定位槽，6-关节锁定螺母，7-滑槽，8-开合连接件。
具体实施方式
以下结合附图及具体实施例对本发明进行详细描述。
实施例1。
如图1所示，本实施例提供一种髋臼锉磨和臼杯假体植入定位导向装置，包括一套筒把手1以及可滑动设置在该套筒把手1上的若干滑动臂2，各滑动臂2上分别连接有一定位组件，各定位组件可相对于滑动臂2转动调节并予以锁紧固定，所述套筒把手1设置有中空内腔3。
本发明结构简单、制备方便、容易使用，结合三维术前分析和快速成型技术，具备较高的个性化精确度和临床适用性，性价比高；在三维术前分析和3d打印模型的基础上，可有效解决全髋关节置换个性化精确植入臼杯假体的技术门槛和成本过高的问题，缩短手术医生学习曲线；在实现个性化精确臼杯假体植入的基础上，不依赖于以往的根据定位导向模块需要贴合关节面区域，所以在锉磨髋臼时无须取下导向模块，实现实时辅助定位，以及能够辅助判断锉磨的深度，因此，能够确保其辅助定位的准确性。
其中，所述定位组件包括夹紧关节4和支撑头5，所述夹紧关节4的一端与滑动臂2可转动连接，构成第一活动关节，所述夹紧关节4的另一端与支撑头5可转动连接，构成第二活动关节，所述夹紧关节4上设置有用于锁定第一活动关节和第二活动关节的关节锁定螺母6。
所述第一活动关节、第二活动关节均为独立的活动机构，可灵活调整与滑动臂2之间的角度及方向，使之既能获得理想的自体骨的包容面积，又能够在臼杯安全的角度范围和位置，这样既能保证良好的臼杯假体初始稳定性，又能兼顾最大程度降低假体撞击的风险，提高使 用过程中的稳定性。
其中，所述夹紧关节4的两端分别设置有第一关节窝44、第二关节窝45，所述滑动臂2的末端设置有与第一关节窝44配合的第一转动球头21，所述支撑头5的一端设置有与第二关节窝45配合的第二转动球头51，所述关节锁定螺母6可转动设置在夹紧关节4上，可灵活转动调整方向并方便通过关节锁定螺母6予以锁紧固定；松开状态下，所述第一转动球头21在第一关节窝44内部自由转动，第二转动球头51在第二关节窝45内部自由转动，即第一活动关节、第二活动关节均可自由转动，锁紧状态下，所述第一转动球头21固定卡紧在第一关节窝44内部，第二转动球头51固定卡紧在第二关节窝45内部，所述第一活动关节、第二活动关节均固定不动。
进一步的，所述支撑头5的另一端设置有用于与髋臼外口边缘抵接的定位槽52，通过该定位槽52有利于大大提高与髋臼外口边缘抵接的牢固性，防止因为晃动而发生滑动，提高使用过程的稳定性。
其中，所述套筒把手1上设置有若干滑槽7，所述滑动臂2的上端设置有与所述滑槽7配合的滑动部22，所述滑动部22可沿滑槽7上下滑动一定的距离实现对滑动臂2上定位组件位置的调整，作为优选的，滑动臂2的滑动形成为60mm，还包括用于将所述滑动部22卡紧固定在滑槽7内的锁定螺栓23，待调整滑动部22至所需位置后，通过该锁定螺栓23予以锁紧固定。
作为优选的，所述套筒把手1由配合构成一套筒的主体臂11和主杆锁紧块12构成，二者通过一开合连接件8连接，打开所述套筒把手1以便放入方向指示杆和髋臼锉磨杆，实用性强。
其中，所述夹紧关节4由相互配合的第一夹紧块41、第二夹紧块42构成，中部设置有用于安装关节锁定螺母6的安装孔43，通过所述关节锁定螺母6可以方便的对第一夹紧块41与第二夹紧块42进行调整，以达到松开或者锁紧各活动关节的目的。
实施例2。
本实施例提供一种髋臼锉磨和臼杯假体植入定位导向装置在全髋关节置换术中的定位方法，包括以下步骤：
S1、确定臼杯假体个性化植入的最佳位置：根据骨盆CT或MRI扫描数据，结合三维建模图像分析软件，根据患者髋臼骨量分布情况及病变特点，测量分析优选的臼杯假体的大小和植入角度和位置，使之既能获得理想的自体骨的包容面积，又能够在臼杯安全的角度范围和位置，这样既能保证良好的臼杯假体初始稳定性，又能兼顾最大程度降低假体撞击的风险，提高关节稳定性；
S2、按照1：1的比例快速成型术前设计的臼杯植入方案的三维模型：包括两个模型，第一个模型为按照优化手术方案植入带方向指示杆的臼杯假体的髋臼模型，第二个模型为按照优化手术方案锉磨后的髋臼模型，即锉去部分骨质的髋臼模型；
S3、确定各滑动臂2的位置及定位组件中各个活动关节的转动角度：将髋臼锉磨及臼杯植入定位导向装置的套筒套入快速成型的第一个模型的臼杯假体方向指示杆，且使得连接有滑动臂的一端朝向髋臼模型，解锁各滑动臂2上的锁定螺栓23及其定位组件的各个活动关节，根据术中髋臼显露的范围，调节各个支撑头5尖端的位置，使之既能充分利用显露的空间，又接触到模型中髋臼外口边缘，然后锁紧固定各活动关节，保证支撑头5的定位尖端与髋臼外口边缘接触后能够稳固定位，这样四个支撑头5在髋臼外口边缘所确定的位置对应于臼杯假体方向指示杆的方向；
S4、确定髋臼锉磨的深度：将髋臼锉磨及臼杯植入定位导向装置从第一个模型取出后，插入髋臼锉磨杆，髋臼锉磨杆安装优选大小型号的髋臼锉；首先将四个支撑头5的尖端与第二个模型的髋臼外口边缘相匹配，使四个支撑头5的尖端同时接触髋臼外口的边缘，从而确定髋臼锉的方向与第一个模型中臼杯假体方向指示杆的方向一致，然后顺着锉磨方向推压髋臼锉，使髋臼锉与第二个模型的髋臼窝底部接触，该位置即为髋臼锉锉磨的计划位置，然后在髋臼锉磨及臼杯植入定位导向装置套筒的另一端的髋臼锉磨杆设定卡位环的位置，使其刚好与套筒把手1上端口相接触或预留一定的可进一步锉深的距离，这样当髋臼锉锉磨到计划的深度后，锉磨杆上的卡位环就会与套筒的端口相接触，从而阻碍继续向深部锉磨；
S5、真实髋臼锉磨和臼杯植入：按照常规全髋关节置换手术的手术入路，充分显露髋臼开口的骨性边缘，将调节后的髋臼锉磨及臼杯植入定位导向装置的四个支撑头5的尖端与髋臼骨性外口边缘相匹配，使四个支撑头5的尖端同时接触髋臼骨性外口的边缘，从而确定髋臼锉的方向与第一个模型中臼杯假体方向指示杆的方向一致，选择合适型号的髋臼锉，然后顺着锉磨方向推压髋臼锉并进行锉磨，直至锉磨杆上的卡环与套筒把手1的端口相接触，锉磨完成。
所属领域的普通技术人员应当理解：以上任何实施例的讨论仅为示例性的，并非旨在暗示本公开的范围(包括权利要求)被限于这些例子；在本发明的思路下，以上实施例或者不同实施例中的技术特征之间也可以进行组合，并存在如上所述的本发明的不同方面的许多其它变化，为了简明它们没有在细节中提供。因此，凡在本发明的精神和原则之内，所做的任何省略、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 (10)

  1. 一种髋臼锉磨和臼杯假体植入定位导向装置，其特征在于，包括一套筒把手以及可滑动设置在该套筒把手上的若干滑动臂，各滑动臂上分别连接有一定位组件，各定位组件可相对于滑动臂转动调节并予以锁紧固定，所述套筒把手设置有中空内腔。
  2. 根据权利要求1所述的髋臼锉磨和臼杯假体植入定位导向装置，其特征在于，所述定位组件包括夹紧关节和支撑头，所述夹紧关节的一端与滑动臂可转动连接，构成第一活动关节，所述夹紧关节的另一端与支撑头可转动连接，构成第二活动关节，所述夹紧关节上设置有用于锁定第一活动关节和第二活动关节的关节锁定螺母。
  3. 根据权利要求2所述的髋臼锉磨和臼杯假体植入定位导向装置，其特征在于，所述夹紧关节的两端分别设置有第一关节窝、第二关节窝，所述滑动臂的末端设置有与第一关节窝配合的第一转动球头，所述支撑头的一端设置有与第二关节窝配合的第二转动球头。
  4. 根据权利要求3所述的髋臼锉磨和臼杯假体植入定位导向装置，其特征在于，所述关节锁定螺母可转动设置在夹紧关节上，松开状态下，所述第一活动关节、第二活动关节均可自由转动，锁紧状态下，所述第一活动关节、第二活动关节均固定不动。
  5. 根据权利要求3所述的髋臼锉磨和臼杯假体植入定位导向装置，其特征在于，所述支撑头的另一端设置有用于与髋臼外口边缘抵接的定位槽。
  6. 根据权利要求1所述的髋臼锉磨和臼杯假体植入定位导向装置，其特征在于，所述套筒把手上设置有若干滑槽，所述滑动臂的上端设置有与所述滑槽配合的滑动部，还包括用于将所述滑动部卡紧固定在滑槽内的锁定螺栓。
  7. 根据权利要求1所述的髋臼锉磨和臼杯假体植入定位导向装置，其特征在于，所述套筒把手由配合构成一套筒的主体臂和主杆锁紧块构成，二者通过一开合连接件连接。
  8. 根据权利要求6所述的髋臼锉磨和臼杯假体植入定位导向装置，其特征在于，所述滑动部在滑槽中的滑动行程为60mm。
  9. 根据权利要求1所述的髋臼锉磨和臼杯假体植入定位导向装置，其特征在于，所述夹紧关节由相互配合的第一夹紧块、第二夹紧块构成，中部设置有用于安装关节锁定螺母的安装孔。
  10. 一种髋臼锉磨和臼杯假体植入定位导向装置在全髋关节置换术中的定位方法，其特征在于，包括以下步骤：
    S1、确定臼杯假体个性化植入的最佳位置：根据骨盆CT或MRI扫描数据，结合三维建模图像分析软件，根据患者髋臼骨量分布情况及病变特点，测量分析优选的臼杯假体的大小和植入角度和位置，使之既能获得理想的自体骨的包容面积，又能够在臼杯安全的角度范围和位置，这样既能保证良好的臼杯假体初始稳定性，又能兼顾最大程度降低假体撞击的风险， 提高关节稳定性；
    S2、按照1：1的比例快速成型术前设计的臼杯植入方案的三维模型：包括两个模型，第一个模型为按照优化手术方案植入带方向指示杆的臼杯假体的髋臼模型，第二个模型为按照优化手术方案锉磨后的髋臼模型，即锉去部分骨质的髋臼模型；
    S3、确定各滑动臂的位置及定位组件中各个活动关节的转动角度：将髋臼锉磨及臼杯植入定位导向装置的套筒套入快速打印成型的第一个模型的臼杯假体方向指示杆，且使得连接有滑动臂的一端朝向髋臼模型，解锁各滑动臂上的锁定螺栓及其定位组件的各个活动关节，根据术中髋臼显露的范围，调节各个支撑头尖端的位置，使之既能充分利用显露的空间，又接触到模型中髋臼外口边缘，然后锁紧固定各活动关节，保证支撑头定位尖端与髋臼外口边缘接触后能够稳固定位，这样四个支撑头在髋臼外口边缘所确定的位置对应于臼杯假体方向指示杆的方向；
    S4、确定髋臼锉磨的深度：将髋臼锉磨及臼杯植入定位导向装置从第一个模型取出后，插入髋臼锉磨杆，髋臼锉磨杆安装优选大小型号的髋臼锉；首先将四个支撑头的尖端与第二个模型的髋臼外口边缘相匹配，使四个支撑头的尖端同时接触髋臼外口的边缘，从而确定髋臼锉的方向与第一个模型中臼杯假体方向指示杆的方向一致，然后顺着锉磨方向推压髋臼锉，使髋臼锉与第二个模型的髋臼窝底部接触，该位置即为髋臼锉锉磨的计划位置，然后在髋臼锉磨及臼杯植入定位导向装置套筒的另一端的髋臼锉磨杆设定卡位环的位置，使其刚好与套筒把手上端口相接触或预留一定的可进一步锉深的距离，这样当髋臼锉锉磨到计划的深度后，锉磨杆上的卡位环就会与套筒的端口相接触，从而阻碍继续向深部锉磨；
    S5、真实髋臼锉磨和臼杯植入：按照常规全髋关节置换手术的手术入路，充分显露髋臼开口的骨性边缘，将调节后的髋臼锉磨及臼杯植入定位导向装置的四个支撑头的尖端与髋臼骨性外口边缘相匹配，使四个支撑头的尖端同时接触髋臼骨性外口的边缘，从而确定髋臼锉的方向与第一个模型中臼杯假体方向指示杆的方向一致，选择合适型号的髋臼锉，然后顺着锉磨方向推压髋臼锉并进行锉磨，直至锉磨杆上的卡环与套筒把手的端口相接触，锉磨完成。
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