WO2019091286A1 - 颞颌关节口内牵开器 - Google Patents

颞颌关节口内牵开器 Download PDF

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Publication number
WO2019091286A1
WO2019091286A1 PCT/CN2018/111770 CN2018111770W WO2019091286A1 WO 2019091286 A1 WO2019091286 A1 WO 2019091286A1 CN 2018111770 W CN2018111770 W CN 2018111770W WO 2019091286 A1 WO2019091286 A1 WO 2019091286A1
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WO
WIPO (PCT)
Prior art keywords
temporomandibular joint
connecting rod
retractor according
main connecting
wire
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PCT/CN2018/111770
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English (en)
French (fr)
Inventor
李龙江
张健华
刘丰畅
张文轲
Original Assignee
南京畅丰生物科技有限公司
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Application filed by 南京畅丰生物科技有限公司 filed Critical 南京畅丰生物科技有限公司
Priority to US16/762,824 priority Critical patent/US11266396B2/en
Publication of WO2019091286A1 publication Critical patent/WO2019091286A1/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
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/025—Joint distractors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/24—Surgical instruments, devices or methods, e.g. tourniquets for use in the oral cavity, larynx, bronchial passages or nose; Tongue scrapers

Definitions

  • the invention belongs to the technical field of medical instruments, and in particular relates to a surgical instrument for maxillofacial surgery.
  • Mandibular condyle fracture is a fracture with a higher incidence in maxillofacial fractures. After the condyle fracture, it will affect the occlusion function, and the mouth is limited. If the operation is not performed in time, the fracture site is displaced by the traction force of the muscle, which may cause more serious consequences such as facial deformity and cause greater harm to the patient.
  • Chinese Patent No. 201410353406 discloses a mandibular condyle reduction distractor, the instrument includes an upper and lower support portion which conforms to the shape of the human lower jaw and the zygomatic arch, and the upper and lower ends of the upper and lower support portions are hinged with the struts, and the struts are threaded. Connected to the central axis, the struts are moved on the central axis by a worm gear mechanism to achieve the function of the support.
  • the structure of the device takes up a large space, and a large incision is required to perform the operation, and the operation of the operator is inconvenient, and the degree of distraction cannot be visually seen from the outside, which affects the efficiency of the operation.
  • the object of the present invention is to provide a temporomandibular joint intraoral retractor that is small in size, convenient and accurate to operate, and accurate and stable in operation.
  • the present invention is implemented by the following technical solutions: including a distracting mechanism, a main connecting rod and an operating mechanism, and the distracting mechanism and the main connecting rod are integrally bent, and one end of the distracting mechanism is a supporting end, and the other end is
  • the main connecting rods are connected, and the supporting end is internally provided with a pulling hook in a stowed state, and the operating mechanism is disposed at the end of the main connecting rod, and the operating mechanism can open the pulling hook to the outside of the expanding mechanism and move up and down in the supporting end .
  • the expansion mechanism has a slender shape and an outer diameter smaller than a gap between the lower jaw and the upper end of the jaw for easy access to the target position.
  • the operating mechanism is connected to the hook by wire drawing and controls the movement of the hook by pulling the wire.
  • the support end of the distracting mechanism is further provided with a pin shaft movable up and down in the support end, and the hook is hinged on the pin shaft.
  • the wire is inserted into the hook through the ball end of the end.
  • an elastic member capable of resetting the hook is further disposed inside the support end of the distracting mechanism.
  • the elastic member is a spring disposed under the hook.
  • the surface of the support end of the distracting mechanism is provided with a slot, and the hook is opened from the slot to the outside of the distracting mechanism.
  • top of the support end is a support slope.
  • the support position of the slope is the skull base of the human skull.
  • the support bevel is provided with an irregular convex structure similar to a diamond face.
  • the bending angle of the expansion mechanism and the main connecting rod as a whole makes the direction in which the lower jaw is extended to be vertically downward.
  • the position of the distraction mechanism is the sigmoid notch of the mandible of the human skull.
  • the wire drawing is a steel wire.
  • the operating mechanism includes a first slider sleeved on the end of the main connecting rod and a first rotating handle sleeved outside the first slider, the first slider being slidable on the end of the main connecting rod, And forming a thread drive with the first rotating handle, and the wire is connected to the first slider.
  • the end of the main connecting rod is a waist shaft
  • the first slider is matched with the waist shaft to ensure that the first slider moves in a straight line without rotating.
  • a scale scale is disposed behind the first slider.
  • an adjusting screw for adjusting the tension of the wire is provided between the first slider and the wire.
  • the adjusting screw is an outer hexagon.
  • main connecting rod is further provided with a first fixed handle.
  • the operating mechanism includes a second rotating handle sleeved on the end of the main connecting rod and a third slider inserted inside the end of the main connecting rod, and the second rotating handle forms a threaded transmission with the end of the main connecting rod
  • the third slider is connected to the bottom of the second rotating handle, and the wire is connected to the third slider.
  • the wire is closed end to end within the retractor, the operating mechanism comprising a second slider coupled to the wire.
  • the wire is tensioned by pins which are respectively disposed at both ends of the inside of the retractor.
  • the operating mechanism includes a second fixed handle disposed at an end of the main connecting rod and a movable handle hinged to the second fixed handle, the wire being coupled to one end of the movable handle.
  • the temporomandibular joint intraoral retractor of the present invention has a small volume, and the overall structure is designed as a small-sized elbow, and the bending angle conforms to the human body structure, and only a small incision can enter the patient's oral cavity. It reduces the pain of the patient and does not leave scars on the face; the instrument supports the skull base and vertically opens the lower jaw, which is more in line with the facial muscles, and the work is more reliable; the operating mechanism is outside the human mouth, which is convenient to operate, and A scale is designed at the end of the instrument to visually show the extent of internal expansion.
  • FIG. 1 is a schematic view showing the overall structure of a first embodiment of the present invention.
  • Fig. 2 is a schematic view showing the operation state of the embodiment 1 of the present invention.
  • Figure 3 is a schematic view showing the working state of the hook of the present invention.
  • FIG. 4 is a schematic view of a rotary handle according to Embodiment 1 of the present invention.
  • Fig. 5 is a schematic view showing the operation mode of the embodiment 2 of the present invention.
  • Fig. 6 is a schematic view showing the operation mode of the embodiment 3 of the present invention.
  • Fig. 7 is a schematic view showing the operation mode of the embodiment 4 of the present invention.
  • Figure 8 is a side elevational view (including the mandible) of a human skull of the present invention.
  • Figure 9 is a front elevational view of a human skull in accordance with an embodiment of the present invention.
  • Figure 10 is a side view of a human skull (without the mandible) of the subject of the present invention.
  • the present invention is a temporomandibular joint intraoral retractor for maxillofacial surgery.
  • the temporomandibular joint intraoral retractor has an overall elongated shape and a curved tubular shape, including a distracting mechanism 1 , a main connecting rod 2 , a first rotating handle 3 , and The first fixed handle 4.
  • the distracting mechanism 1 has a bent shape and a slender shape, and the outer diameter is smaller than the gap between the lower jaw and the upper end of the jaw.
  • the bending angle conforms to the human body structure, facilitating the instrument to enter the target area and allowing the mandibular distraction direction to approach the vertical direction. under.
  • One end is a support end for fitting the skull base of the human body, and the other end is connected to the main connecting rod 2.
  • the top of the support end is a support bevel 7 that fits the skull base of the human body.
  • the support inclined surface 7 is provided with an irregular convex structure similar to a diamond surface to increase the friction between the contact surfaces, so that the device can be more stable during operation.
  • the expansion mechanism 1 should be small enough to reduce the size of the surgical incision and facilitate the adjustment of the working position.
  • the support end surface of the distracting mechanism 1 is provided with a slot, and the inside is provided with a pin 8, a hook 5, a wire 9 and a spring 14, and the pin 8 is movable up and down in the support end, and the hook 5 is hinged on the pin 8.
  • the wire drawing 9 is used to pull the hook 5 to move, and is required to have sufficient strength, such as a steel wire, which is inserted into the hook 5 through the end ball head 10 to prevent the hook 5 from interfering with the wire drawing 9 when rotating.
  • the hook 5 In the initial state, the hook 5 is hidden in the support end. At this time, if the wire 9 is pulled, the hook 5 can be rotated around the pin 8 and the head of the hook 5 is gradually opened from the support end surface slot to the expansion mechanism 1. . When the hook 5 is rotated 90° around the pin 8, the pulling of the wire 9 is continued. At this time, the pulling hook 5 will drive the pin 8 to move downward in the supporting end, and the movement track can be controlled by the shape of the groove of the supporting end surface. It can be seen that pulling the wire drawing 9 can realize the two movements of the hook 5 rotation and the straight line.
  • the spring 14 is mounted below the hook 5 and allows the wire 9 to pass therethrough, the function of which is to give the hook 5 an upward force to reset the hook 5 when the wire 9 is untensioned.
  • the spring 14 can also be replaced with a resilient member such as a rubber band, and the mounting position can be specifically determined according to the implementation of the elastic force.
  • one end of the main connecting rod 2 is connected to the distracting mechanism 1, and the other end is sequentially mounted with a first fixed handle 4 and a first rotating handle 3.
  • the first fixed handle 4 functions to facilitate the holding of the instrument during operation.
  • the end of the main connecting rod 2 is designed as a waist-shaped shaft, and the first slider 12 is sleeved on the waist shaft to slidably engage the end of the main connecting rod 2, such that the first slider 12 can be at the waist
  • the shaft slides freely but cannot rotate.
  • the wire 9 extends from the support end of the expansion mechanism 1 into the main connecting rod 2, and is extended from the end of the main connecting rod 2 to the first slider 12.
  • the first rotating handle 3 is sleeved outside the first slider 12, and the inside of the first rotating handle 3 is fixed with a drum 13.
  • the surface of the first slider 12 is provided with a thread and is screwed with the drum 13, and the transmission ensures a reasonable force and can be self-locking.
  • the adjusting screw 11 is screwed between the first slider 12 and the wire 9 for adjusting the tension of the wire 9 by the thread.
  • the adjusting screw 11 has an outer hexagon shape and can be adjusted using a matching sleeve.
  • the scale scale 6 is mounted behind the first slider 12, and is hidden inside the first rotary handle 3 in the initial position, and slides with the first slider 12 during operation. When the scale scale 6 slides out of the outside of the first rotary handle 3, the corresponding sliding distance can be observed, as shown in FIG.
  • the temporomandibular joint intraoral retractor of the present embodiment is used in such a manner that the operator holds the handle portion of the instrument and extends the instrument into the patient's oral cavity through the maxillary end 404 and the mandibular branch.
  • the surgical gap 403 between 402 is up to the vicinity of the target surgical field, and the position of the instrument is adjusted so that the support bevel 7 at the top of the distraction mechanism 1 is attached to the patient's skull base 405 and remains stable, and the end of the main connecting rod 2 is held outside the patient's mouth.
  • the operator holds the first fixed handle 4 of the instrument and rotates the first rotating handle 3, thereby pulling the drawing 9 to open the hook 5 of the instrument to the outside of the distracting mechanism 1 to hook the sigmoid of the patient's mandible.
  • the track portion 401 continues to rotate the first rotating handle 3 to open the lower jaw portion to a suitable position, and the degree of opening can be observed through the scale 6 extending from the rear end of the instrument, and the operation can be performed at this time.
  • the first rotating handle 3 is rotated in the opposite direction, so that the hook 5 is restored to the support end hidden in the distracting mechanism 1, and the instrument is taken out to complete the use.
  • Another embodiment of the present invention which operates substantially the same as the embodiment 1, has a distracting mechanism 1 and a main connecting rod 2 which are substantially identical to those of the embodiment 1, and differs mainly in the manner in which the hook 5 is moved.
  • the end of the instrument is used to realize the movement of the hook 5 by using a wire 9 that is closed end to end, that is, the wire 9 is closed end to end in the instrument, and the hook 5 is mounted on the wire 9 at the two ends of the instrument ( That is, the top of the distraction mechanism 1 and the end of the main connecting rod 2) use the pin 101 to tension the wire 9.
  • the second slider 100 is disposed adjacent to the end of the main connecting rod 2, and the second slider 100 is connected to the wire drawing 9. By pushing or pulling the second sliding block 100, the drawing 9 can be moved up and down in the closed state of the end to the end, and the hook 5 can also be made. Produce exercise.
  • Another embodiment of the present invention which operates substantially the same as the embodiment 1, has the same expansion mechanism 1 and the main connecting rod 2 as the first embodiment, except that the first rotating handle 3 and the first A fixed handle 4 is provided, but a second fixed handle 201 is provided at the end of the main connecting rod 2, and a movable handle 200 is hinged on the second fixed handle 201 by a hinge 202, and the drawing 9 is connected to one end of the movable handle 200.
  • the wire drawing 9 is pulled by the other end of the movable handle 200 by a lever principle, as shown in FIG.
  • One embodiment of the present invention which operates substantially the same as the first embodiment, has the same expansion mechanism 1 and main connecting rod 2 as the first embodiment, except that the implementation of the rotary handle is different.
  • the end of the main connecting rod 2 is a connecting shaft 303, and the outer surface of the connecting shaft 303 is provided with a thread.
  • a second rotating handle 302 is sleeved on the outside of the connecting shaft 303, and the second rotating handle 302 forms a threaded transmission with the connecting shaft 303.
  • the bottom of the second rotating handle 302 is provided with a sleeve 300.
  • the bottom of the sleeve 300 is connected to a third slider 301 inserted into the interior of the connecting shaft 303, and the wire 9 is connected to the third slider 301.

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  • Life Sciences & Earth Sciences (AREA)
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  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
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Abstract

一种颞颌关节口内牵开器，包括撑开机构（1）、主连接杆（2）和操作机构，撑开机构（1）和主连接杆（2）整体为弯折状，撑开机构（1）一端为支撑端，另一端与主连接杆（2）相连，支撑端内部设有一个处于收起状态的拉钩（5），操作机构设置在主连接杆（2）的末端，操作机构能够使拉钩（5）张开至撑开机构（1）之外并在支撑端内上下移动。颞颌关节口内牵开器体积较小，整体结构设计成小尺寸弯管，弯折角度符合人体结构，只需做较小切口即能进入病人口腔内部，减少病人痛苦，且不会在脸上留下疤痕。

Description

颞颌关节口内牵开器 技术领域
本发明属于医疗器械技术领域，具体涉及一种颌面外科用的手术器械。
背景技术
下颌骨髁突骨折是在颌面部骨折中发生率较高的一种骨折。髁突骨折后，会对咬合功能产生影响，张口受限。如不及时手术，骨折部位受到肌肉的牵引力位移后，可能造成面部畸形等较严重的后果，对病人造成的危害较大。
一般而言，下颌骨髁突骨折常见有两种手术方式。一种是在人面部做手术切口，充分暴露骨折断端，对髁突进行复位固定。此方法有可能会损伤面部神经，且术后会在人面部留下明显的疤痕，对病人影响较大。另一种方法是用手牵拉下颌，使下颌关节暴露出间隙，找出髁突断端进行复位。由于手的牵引力较不稳定，且施力点不易控制，使得关节间隙不易暴露，可能会导致手术时间延长，手术风险增加。
中国专利201410353406公开了一种下颌骨髁突复位撑开器，该器械包括与人体下颌、颧弓形状相吻合的上下撑合部，上下撑合部前后两端铰接有撑杆，撑杆通过螺纹与中轴连接，通过一个蜗轮蜗杆机构使撑杆在中轴上移动，实现撑合的功能。但是，该器械结构占用空间较大，需做较大切口才能进行手术，且不方便手术人员的把持操作，无法从外部直观的看出撑开的程度，影响手术的效率。
发明内容
本发明目的是提供一种体积小、方便准确操作且工作准确稳定的颞颌关节口内牵开器。
具体地说，本发明是采用以下技术方案实现的：包括撑开机构、主连接杆和操作机构，撑开机构和主连接杆整体为弯折状，撑开机构一端为支撑端，另一端与主连接杆相连，支撑端内部设有一个处于收起状态的拉钩，操作机构设 置在主连接杆的末端，所述操作机构能够使拉钩张开至撑开机构之外并在支撑端内上下移动。撑开机构的外形细长，其外径小于下颌支与上颌末端之间的间隙，方便进入目标位置。
进一步而言，操作机构通过拉丝连接至拉钩并通过拉动拉丝控制拉钩的运动。
进一步而言，所述撑开机构的支撑端内部还设有能在支撑端内上下移动的销轴，拉钩铰接在销轴上。
进一步而言，所述拉丝通过端部的球头嵌入在拉钩中。
进一步而言，所述撑开机构的支撑端内部还设有能使拉钩复位的弹性件。
进一步而言，所述弹性件为设在拉钩下方的弹簧。
进一步而言，所述撑开机构的支撑端的表面设有开槽，拉钩从开槽中张开至撑开机构之外。
进一步而言，所述支撑端的顶部为支撑斜面。斜面的支撑位置为人体头骨的颅底部位。
进一步而言，所述支撑斜面设有类似钻石面的不规则的凸面结构。
进一步而言，所述撑开机构和主连接杆整体的弯折角度使下颌撑开的方向接近垂直向下。撑开机构的作用位置为人体头骨下颌的乙状切迹部位。
进一步而言，所述拉丝为钢丝。
进一步而言，所述操作机构包括套在主连接杆的末端上的第一滑块以及套在第一滑块外的第一旋转手柄，第一滑块能够在主连接杆的末端上滑动，并与第一旋转手柄形成螺纹传动，拉丝连接在第一滑块上。
进一步而言，所述主连接杆的末端为腰形轴，第一滑块与腰形轴相匹配，从而保证第一滑块沿直线移动而不转动。
进一步而言，所述第一滑块的后方设有刻度标尺。
进一步而言，在第一滑块和拉丝之间设有用于调整拉丝张紧度的调节螺钉。
进一步而言，所述调节螺钉为外六角形。
进一步而言，所述主连接杆上还设有第一固定手柄。
进一步而言，所述操作机构包括套在主连接杆的末端上的第二旋转手柄以及插入在主连接杆的末端内部的第三滑块，第二旋转手柄与主连接杆的末端形成螺纹传动，第三滑块与第二旋转手柄下方相连，拉丝连接在第三滑块上。
进一步而言，所述拉丝在牵开器内部首尾相连闭合，所述操作机构包括与拉丝相连的第二滑块。
进一步而言，所述拉丝通过销钉张紧，所述销钉分别设在牵开器内部的两端。
进一步而言，所述操作机构包括设在主连接杆的末端的第二固定手柄以及铰接在第二固定手柄上的活动手柄，拉丝连接在活动手柄的一端。
本发明的有益效果如下：本发明的颞颌关节口内牵开器，体积较小，整体结构设计成小尺寸弯管，弯折角度符合人体结构，只需做较小切口即能进入病人口腔内部，减少病人痛苦，且不会在脸上留下疤痕；器械以颅底作为支撑，垂直撑开下颌，更符合面部肌肉受力情况，工作更加可靠；操作机构在人口腔外部，方便操作，兼之在器械末端设计有刻度，可以直观的看出内部撑开的程度。
附图说明
图1是本发明实施例1的整体结构示意图。
图2是本发明实施例1的工作状态示意图。
图3是本发明拉钩的工作状态示意图。
图4是本发明实施例1的旋转手柄示意图。
图5是本发明实施例2的操作方式示意图。
图6是本发明实施例3的操作方式示意图。
图7是本发明实施例4的操作方式示意图。
图8是本发明实施对象人体头骨的侧视图(包含下颌骨)。
图9是本发明实施对象人体头骨的正视图。
图10是本发明实施对象人体头骨的侧视图(不含下颌骨)。
图中的标号：1——撑开机构，2——主连接杆，3——第一旋转手柄，4——第一固定手柄，5——拉钩，6——刻度标尺，7——支撑斜面，8——销轴，9——拉丝，10——球头，11——调节螺钉，12——第一滑块，13——转筒，14——弹簧，100——第二滑块，101——销钉，200——活动手柄，201——第二固定手柄，202——铰链，300——套管，301——第三滑块，302——第二旋转手柄，303——连接轴，401——下颌乙状切迹，402——下颌支，403——手术间隙，404——上颌末端，405——颅底。
具体实施方式
下面结合实施例并参照附图对本发明作进一步详细描述。
实施例1：
本发明的一个实施例，为一种颌面外科用的颞颌关节口内牵开器。参照图1、图2、图3和图4，该颞颌关节口内牵开器，其整体外形呈细长的弯管状，包括撑开机构1、主连接杆2、第一旋转手柄3和第一固定手柄4。
撑开机构1为弯折状，外形细长，其外径小于下颌支与上颌末端之间的间隙，弯折角度符合人体结构，方便器械进入目标区域且可以使下颌撑开的方向接近垂直向下。其一端为支撑端，用于贴合人体颅底，另一端与主连接杆2相连。支撑端的顶部是一个贴合人体颅底的支撑斜面7。为了增加支撑的稳定性，本实施例中，支撑斜面7上设有类似钻石面的不规则的凸面结构，以增加接触面之间的摩擦力，可以使本器械在工作时更加稳定。撑开机构1要足够小，这样可以减小手术切口大小，方便调整工作位置
撑开机构1的支撑端表面设有开槽，内部设有销轴8、拉钩5、拉丝9和弹簧14，销轴8可在支撑端内上下移动，拉钩5铰接在销轴8上。拉丝9用于拉动拉钩5运动，要求具有足够的强度，如采用钢丝，其通过端部的球头10嵌入在拉钩5中，避免拉钩5在转动时与拉丝9有干涉。
初始状态时拉钩5藏于支撑端内，此时若拉动拉丝9则可使拉钩5绕销钉8 转动并逐渐使拉钩5的头部从支撑端表面开槽中张开到撑开机构1之外。当拉钩5绕销钉8旋转90°后继续拉动拉丝9，此时拉钩5将带动销轴8在支撑端内向下运动，运动轨迹可以由支撑端表面开槽的形状来进行控制。可见，拉动拉丝9即可实现拉钩5旋转和直线两种运动。
弹簧14安装于拉钩5的下方，并使拉丝9从其中穿过，其作用是给予拉钩5一个向上的力，在拉丝9不受拉力时，使拉钩5进行复位。弹簧14也可以用橡皮筋等具有弹性的零件替代，安装位置可根据弹力的实现方式具体确定。
参照图1、图2，主连接杆2的一端与撑开机构1相连，另一端依次安装有第一固定手柄4和第一旋转手柄3。第一固定手柄4的作用是方便操作时把持器械。
参照图4，主连接杆2的末端设计成腰形轴，在腰形轴上套有第一滑块12与主连接杆2的末端滑动配合，这样的设计使得第一滑块12可以在腰形轴上自由滑动但无法转动。拉丝9从撑开机构1的支撑端内一直贯穿到主连接杆2之中，并从主连接杆2的末端伸出连接在第一滑块12上。
第一旋转手柄3套在第一滑块12外部，第一旋转手柄3的内部固定有转筒13。第一滑块12的表面设有螺纹，与转筒13形成螺纹传动，传动保证受力合理且可以自锁。当转动第一旋转手柄3时，转筒13一并旋转，从而驱动第一滑块12沿主连接杆2轴向滑动，使得拉丝9被拉动。
调节螺钉11通过螺纹连接在第一滑块12和拉丝9之间，用于通过螺纹调节拉丝9的张紧程度。本实施例中，调节螺钉11为外六角形，可使用配套的套筒进行调节。
刻度标尺6安装在第一滑块12的后方，初始位置时隐藏于第一旋转手柄3内部，工作时随第一滑块12滑动。当刻度标尺6滑出到第一旋转手柄3外部时，即能观察到相应的滑动距离，如图2所示。
参照图8、图9和图10，本实施例的颞颌关节口内牵开器的使用方式为：手术人员握持器械的手柄部位，将器械伸入病人口腔内部，通过上颌末端404 与下颌支402之间的手术间隙403直至目标手术区域附近，并调整器械位置使撑开机构1顶部的支撑斜面7与病人颅底405贴合并保持稳定，主连接杆2的末端保持在病人的口腔外部。然后，手术人员握持器械的第一固定手柄4，转动第一旋转手柄3，从而拉动拉丝9使器械的拉钩5张开至撑开机构1之外从而勾住病人的下颌骨的乙状切迹部位401，再继续旋转第一旋转手柄3使下颌部位撑开到合适的位置，其撑开程度可以通过器械后端伸出的刻度标尺6进行观察，此时可以进行手术。手术结束后，往相反的方向转动第一旋转手柄3，使拉钩5复原至藏于撑开机构1的支撑端内，抽出器械，完成使用。
实施例2：
本发明的另一个实施例，其工作原理与实施1基本相同，具有和实施例1基本相同的撑开机构1和主连接杆2，所不同的主要是使拉钩5运动的操作方式。
如图5所示，本实施例中使用一个首尾相连闭合的拉丝9来实现拉钩5的运动，即拉丝9在器械中首尾相连闭合，拉钩5安装在拉丝9上，分别在器械的两端(即撑开机构1的顶部和主连接杆2的末端)使用销钉101张紧拉丝9。在靠近主连接杆2的末端附近位置设置第二滑块100与拉丝9相连，通过推动或拉动第二滑块100即可实现拉丝9在首尾相连闭合状态下的上下移动，也可以使拉钩5产生运动。
实施例3：
本发明的另一个实施例，其工作原理与实施1基本相同，具有和实施例1基本相同的撑开机构1和主连接杆2，所不同的主要是其没有采用第一旋转手柄3和第一固定手柄4，而是在主连接杆2的末端设有第二固定手柄201，并在第二固定手柄201上通过铰链202铰接一个活动手柄200，拉丝9连接在活动手柄200的一端上，通过转动活动手柄200的另一端运用杠杆原理拉动拉丝9，如图6所示。
实施例4：
本发明的一个实施例，其工作原理与实施1基本相同，具有和实施例1基 本相同的撑开机构1和主连接杆2，所不同的主要是其旋转手柄的实现方式不同。
如图7所示，主连接杆2的末端为连接轴303，连接轴303的外表面设有螺纹。在连接轴303的外部套有第二旋转手柄302，第二旋转手柄302与连接轴303形成螺纹传动。第二旋转手柄302的底部设有套筒300，套筒300的底部与插入连接轴303内部的第三滑块301相连，拉丝9连接在第三滑块301上。当旋转第二旋转手柄302时，第二旋转手柄302将推动套管300，从而使第三滑块301产生移动，实现拉丝9的拉动。
虽然本发明已以较佳实施例公开如上，但实施例并不是用来限定本发明的。在不脱离本发明之精神和范围内，所做的任何等效变化或润饰，同样属于本发明之保护范围。因此本发明的保护范围应当以本申请的权利要求所界定的内容为标准。

Claims (21)

  1. 一种颞颌关节口内牵开器，包括撑开机构、主连接杆和操作机构，其特征在于：撑开机构和主连接杆整体为弯折状，撑开机构一端为支撑端，另一端与主连接杆相连，支撑端内部设有一个处于收起状态的拉钩，操作机构设置在主连接杆的末端，所述操作机构能够使拉钩张开至撑开机构之外并在支撑端内上下移动。
  2. 根据权利要求1所述的颞颌关节口内牵开器，其特征在于：所述操作机构通过拉丝连接至拉钩并通过拉动拉丝控制拉钩的运动。
  3. 根据权利要求2所述的颞颌关节口内牵开器，其特征在于：所述撑开机构的支撑端内部还设有能在支撑端内上下移动的销轴，拉钩铰接在销轴上。
  4. 根据权利要求2所述的颞颌关节口内牵开器，其特征在于：所述拉丝通过端部的球头嵌入在拉钩中。
  5. 根据权利要求2所述的颞颌关节口内牵开器，其特征在于：所述撑开机构的支撑端内部还设有能使拉钩复位的弹性件。
  6. 根据权利要求5所述的颞颌关节口内牵开器，其特征在于：所述弹性件为设在拉钩下方的弹簧。
  7. 根据权利要求2所述的颞颌关节口内牵开器，其特征在于：所述撑开机构的支撑端的表面设有开槽，拉钩从开槽中张开至撑开机构之外。
  8. 根据权利要求2所述的颞颌关节口内牵开器，其特征在于：所述支撑端的顶部为支撑斜面。
  9. 根据权利要求8所述的颞颌关节口内牵开器，其特征在于：所述支撑斜面设有类似钻石面的不规则的凸面结构。
  10. 根据权利要求2所述的颞颌关节口内牵开器，其特征在于：所述撑开机构和主体连杆整体的弯折角度使下颌撑开的方向接近垂直向下。
  11. 根据权利要求2所述的颞颌关节口内牵开器，其特征在于：所述拉丝为钢丝。
  12. 根据权利要求2～11任一所述的颞颌关节口内牵开器，其特征在于：所 述操作机构包括套在主连接杆的末端上的第一滑块以及套在第一滑块外的第一旋转手柄，第一滑块能够在主连接杆的末端上滑动，并与第一旋转手柄形成螺纹传动，拉丝连接在第一滑块上。
  13. 根据权利要求12所述的颞颌关节口内牵开器，其特征在于：所述主连接杆的末端为腰形轴，第一滑块与腰形轴相匹配。
  14. 根据权利要求12所述的颞颌关节口内牵开器，其特征在于：所述第一滑块的后方设有刻度标尺。
  15. 根据权利要求12所述的颞颌关节口内牵开器，其特征在于：在第一滑块和拉丝之间设有用于调整拉丝张紧度的调节螺钉。
  16. 根据权利要求15所述的颞颌关节口内牵开器，其特征在于：所述调节螺钉为外六角形。
  17. 根据权利要求12所述的颞颌关节口内牵开器，其特征在于：所述主连接杆上还设有第一固定手柄。
  18. 根据权利要求2～11任一所述的颞颌关节口内牵开器，其特征在于：所述操作机构包括套在主连接杆的末端上的第二旋转手柄以及插入在主连接杆的末端内部的第三滑块，第二旋转手柄与主连接杆的末端形成螺纹传动，第三滑块与第二旋转手柄下方相连，拉丝连接在第三滑块上。
  19. 根据权利要求2～11任一所述的颞颌关节口内牵开器，其特征在于：所述拉丝在牵开器内部首尾相连闭合，所述操作机构包括与拉丝相连的第二滑块。
  20. 根据权利要求19所述的颞颌关节口内牵开器，其特征在于：所述拉丝通过销钉张紧，所述销钉分别设在牵开器内部的两端。
  21. 根据权利要求2～11任一所述的颞颌关节口内牵开器，其特征在于：所述操作机构包括设在主连接杆的末端的第二固定手柄以及铰接在第二固定手柄上的活动手柄，拉丝连接在活动手柄的一端。
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