CN202386776U - Adjustable percutaneous bone joint set screw three-dimensional guider - Google Patents

Abstract

An adjustable three-dimensional guide for percutaneous bone joint screw placement, including first and second arc-shaped racks, first and second linear racks, the first arc-shaped rack and the second linear rack are located in the same plane , the second arc-shaped rack is connected to the first straight-line rack and is located in the same plane, and it is vertical. The curvature radii of the first and second arc-shaped racks are equal and their centers coincide. The first arc-shaped rack and the second A first connector is arranged between the arc-shaped racks and is connected in rotation; the first and second arc-shaped racks are respectively meshed with the first and second gears on the first connector, and the first linear rack and the second There is a second connector slidingly connected between the linear racks; the first and second linear racks mesh with the third and fourth gears on the second connector, and the first arc-shaped rack is connected with a guide sleeve And its axis passes through point O , the second linear rack is connected with a positioning sleeve and its axis is perpendicular, the guide sleeve and the positioning sleeve are coplanar with the first arc rack and the second linear rack.

Description

Adjustable three-dimensional guider for percutaneous bone joint screw placement

Technical field:

The utility model relates to a surgical instrument, which relates to an orthopedic surgical instrument, in particular to an adjustable three-dimensional guider for placing nails in percutaneous bone joints. the

Background technique:

The application of Kirschner wire fixation, or the application of Kirschner guide screws, is very common in orthopedic surgery. There are various types of guides used in open surgery to guide Kirschner wires, and the accuracy is high; while the guides used in closed percutaneous bone puncture needles have also been reported, but the accuracy is not high, and they have not been widely promoted. In today's era of rapid development of surgical technology, percutaneous minimally invasive surgery has been widely recognized and vigorously promoted. Percutaneous screw fixation refers to skin incision of about 5-10mm, under the protection of the sleeve, puncture reaches the bone surface, drills into the bone circular needle, or inserts the hollow screw along the bone circular needle. For example: closed reduction and cannulated screw internal fixation for femoral neck fractures, sacroiliac joint screw fixation, closed reduction and internal fixation for supracondylar humeral fractures, placement of additional blocking nails in intramedullary nailing for limb fractures, etc. How to accurately penetrate the guide needle through the skin is still very difficult; most of them need to be drilled repeatedly until the position is suitable. Even experienced doctors will inevitably reach a satisfactory position after repeated repetitions. The patient is exposed to X-rays many times, and the quality of the bone is destroyed, so that the fixation is not firm. The more accurate method is to apply computer navigation technology at present, but this equipment is expensive, the technology is difficult to master, and cannot be widely promoted. So be badly in need of some cheap and good quality, easy to operate, high accuracy, easy to popularize the simple and easy guide. for example:

Example 1. Femoral neck fracture is a common clinical fracture type, and it is currently called "unresolved fracture". Can occur at any age, mostly in the elderly. Fractures are divided into non-displaced fractures and displaced fractures. The current treatment method is generally recognized as: patients under 60 years old, regardless of non-displaced or displaced fractures, are treated with reduction and internal fixation; fractures over 80 years old are treated with internal fixation. Joint replacement; for patients under the age of 60-80, the treatment is controversial. At present, it is generally believed that reduction and internal fixation should be used for non-displaced fractures, and joint replacement should be used for displaced fractures. the

Reduction and internal fixation are divided into open reduction and closed reduction; open internal fixation and percutaneous internal fixation, so "closed reduction + percutaneous internal fixation" is currently the most minimally invasive, highly technically demanding operation that should be widely promoted . The vast majority of patients can achieve closed reduction on a traction bed, and a small number of comminuted fractures require open reduction. And percutaneous internal fixation: percutaneous nail fixation means that the skin is cut to about 5-8mm, under the protection of the sleeve, the puncture reaches the bone surface, drills into the bone circular needle, or inserts the hollow screw along the bone circular needle . At present, only with the assistance of computer and CT, can navigation be used to accurately locate, and only a very small number of hospitals in China have this equipment with a price of 4 million yuan. For the reduction and fixation of femoral neck fractures, the currently recognized curative effect is better fixation with three hollow compression screws through the skin. The three screws are distributed in the middle and lower part of the femoral neck, forming an inverted triangle and parallel to each other. The three screws are spread as far as possible. , close to the medial cortical bone of the femoral neck. Such fixation is beneficial to increase the stability of the fracture after reduction, reduce the redisplacement of the fracture, promote bone union, and reduce nonunion and avascular necrosis of the femoral head. At present, most of the clinical operations are open reduction and internal fixation, which requires incision of the muscle fascia tissue to expose the drill hole position; in order to accurately and successfully place the screw during the operation, it is often necessary to repeatedly drill the hole and see through it to reach a suitable position. Too many drilling holes destroy the blood supply in the femoral neck and cause bone loss, which reduces the firmness of fracture fixation and is also one of the iatrogenic factors that cause fracture nonunion and femoral head necrosis; excessive X-ray irradiation , causing harm to both patients and doctors. To achieve one-time accurate nail placement, it can only be achieved through computer navigation assistance at present, and only a few hospitals in China are equipped with it, so it cannot be popularized. To quickly and accurately place the nails, it is difficult to open the nails, but it is even more difficult to close the nails. At present, there are many simple closure guides at home and abroad, but the clinical effect is not good. the

Example 2. For percutaneous screw fixation of sacroiliac joint dislocation, because the sacrum can accommodate screws is small, and there are important nerves, blood vessels and other tissues around, the accuracy of screw placement is more required, and it often needs to be operated under navigation or CT , It is difficult to operate with bare hands. If there is a fixed guide, the accuracy of the operation can be increased, the operation time can be shortened, and the number of X-ray exposures can be reduced. the

Utility model content:

The purpose of this utility model is to provide a three-dimensional guider with simple structure and adjustable percutaneous bone joint nail placement, which can quickly and accurately drill bone circular needles through the skin, minimize the trauma of surgery on patients, and reduce X-ray exposure The number of times, reduce the damage to bone tissue, and shorten the recovery time after surgery. the

The utility model adopts the following technical solutions:

An adjustable three-dimensional guide for percutaneous bone joint screw placement, comprising: a first arc-shaped rack, a second arc-shaped rack, a first linear rack and a second linear rack, the first arc The rack is located in the same plane as the second linear rack, the second arc rack is connected to the first linear rack and located in the same plane, and the first arc rack, the second linear rack The plane where the rack is located is perpendicular to the plane where the second arc-shaped rack and the first linear rack are located, the radius of curvature of the first arc-shaped rack and the second arc-shaped rack are equal, and the first arc-shaped rack It coincides with the center of curvature of the second curved rack at the same point O,

A first connector is provided between the first arc-shaped rack and the second arc-shaped rack, and the first arc-shaped rack is connected to the first connector in rotation and sliding, and the second arc-shaped rack is connected to the first connector Rotating sliding connection; the first arc-shaped rack meshes with the first gear on the first connector, when the first gear is rotated, the first arc-shaped rack and the first connector rotate relatively; the second arc-shaped tooth The bar meshes with the second gear on the first connector. When the second gear is turned, the second arc-shaped rack rotates relative to the first connector.

A second connector is provided between the first linear rack and the second linear rack, and the first arc rack is slidably connected to the second connector, and the second linear rack is slidably connected to the second connector connection; the first linear rack meshes with the third gear provided on the second connector, when the third gear is rotated, the first linear rack and the second connector move in relative translation; the second linear rack and The fourth gear on the second connector meshes. When the fourth gear is rotated, the fourth gear will translate relative to the second connector.

A guide sleeve is connected to one end of the first arc-shaped rack, and the central axis of the guide sleeve passes through the arc curvature center of the first arc-shaped rack, and a positioning sleeve is connected to one end of the second straight-line rack. The two linear racks are perpendicular to the central axis of the positioning sleeve,

The guide sleeve and the positioning sleeve are located in the plane where the first arc-shaped rack and the second linear rack are located. the

Compared with the prior art, the utility model has the following advantages:

1. Incision and fixation need to cut the skin, iliotibial band, muscle and periosteum to about 60mm; while percutaneous internal fixation requires three small incisions (about 8mm) for the skin incision and the iliotibial band, no incision is needed for the muscle and periosteum. All operations are completed in the sleeve, and the operation sleeve can compress the muscles to stop bleeding. Significantly reduce tissue damage, bleeding, and operation time. the

2. Reduce postoperative local scar formation, less postoperative pain, and less postoperative bleeding. the

3. When performing percutaneous internal fixation without the guidance of a guide, surgeons often drill into the femoral neck with a round bone needle based on experience to find a suitable position. Even experienced doctors need an average of 5-10 repetitions Drilling is required to find a suitable location, and even more inexperienced doctors. Repeated drilling damages the bone in the femoral head, reduces postoperative femoral head compression capacity, delays bone healing time, and increases the number of X-ray irradiation and measurement. This guide minimizes the number of holes to be drilled. the

4. Precisely place the screws in the femoral neck, so that the three screws are distributed in the best position, which can make the fracture of the patient the most stable after operation, and the patient can go to the ground to bear the weight early. the

5. The guide is operated under the sleeve, which makes it easy to drill holes on the cylindrical bone surface, and there is no need to worry about drilling slippage when drilling on the inclined and arc-shaped surfaces of the bone. the

6. Using this guide to operate, the complex nail placement process becomes simple, making it easy for inexperienced doctors to master. the

The utility model provides the operation of an adjustable three-dimensional guider for percutaneous bone joint nail placement: after fractures and dislocations are closed and reset, a round bone needle is percutaneously drilled for fixation as usual, and after positive and lateral X-ray fluoroscopy, if If the location is good, this guide is not necessary. If the fixed position of the bone circular needle is not good, use the bone circular needle as a reference, draw the correct needle insertion diagram on the X-ray fluoroscopy image, and calculate the distance, angle, depth and other values between the correct needle insertion point and the needle . Adjust the three-dimensional guide in vitro according to the data, insert the three-dimensional guide into the drilled bone needle and fix it, drill into the correct bone needle through the sleeve on the three-dimensional guide, and then adjust the three-dimensional guide to drill into the other bone circular needle. the

The utility model used the adjustable three-dimensional guide for percutaneous bone joint screw placement to perform closed reduction of femoral neck fractures. In more than 30 cases of percutaneous internal fixation, the compression screws were accurately implanted in the femoral neck, and the one-time success rate reached 95%. There is no need to cut the affected part, peel off the muscle fascia tissue to reveal the drilling position; no need to repeatedly drill and see through, so as to achieve fast and accurate nail placement. It was also used in 4 cases of sacroiliac joint screw fixation, and the insertion of additional blocking nails in intramedullary nail fixation of limb fractures. the

The utility model is a simple three-dimensional adjustment guide, which is simple in structure, light in weight and can meet the precise positioning of surgery, the distance error is within 1 mm, and the angle error is within 1 degree, which can fully meet the needs of surgery. the

Description of drawings:

Fig. 1 is the front view of the utility model. the

Fig. 2 is a top view of the utility model. the

Fig. 3 is an enlarged sectional view of part A of the present utility model. the

Figure 4 is an anteroposterior X-ray perspective schematic diagram, in the figure, e is the Kirschner wire, and f is the actual needle insertion line. the

Fig. 5 is a schematic diagram of lateral X-ray perspective, in the figure, e is the Kirschner wire, and f is the actual needle insertion line. the

Detailed ways:

An adjustable three-dimensional guide for percutaneous bone joint screw placement, comprising: a first arc-shaped rack 1, a second arc-shaped rack 3, a first linear rack 4 and a second linear rack 5, the The first arc rack 1 and the second linear rack 5 are located in the same plane, and the second arc rack 3 is connected to the first linear rack 4 and located in the same plane, and the first arc The plane where the rack 1 and the second linear rack 5 are located is perpendicular to the plane where the second arc-shaped rack 3 and the first linear rack 4 are located, and the first arc-shaped rack 1 and the second arc-shaped rack 3 have the same radius of curvature, and the centers of curvature of the first curved rack 1 and the second curved rack 3 coincide at the same point O,

A first connector 11 is provided between the first arc-shaped rack 1 and the second arc-shaped rack 3, and the first arc-shaped rack 1 and the first connector 11 are rotationally and slidingly connected, and the second arc-shaped rack 3 is connected with the first connector 11 in rotation and sliding; the first arc-shaped rack 1 meshes with the first gear 7 provided on the first connector 11, when the first gear 7 is rotated, the first arc-shaped rack 1 and The first connector 11 rotates relatively; the second arc-shaped rack 3 meshes with the second gear 8 provided on the first connector 11, and when the second gear 8 is rotated, the second arc-shaped rack 2 is connected with the first Device 11 rotates relatively,

A second connector 12 is provided between the first linear rack 4 and the second linear rack 5, and the first arc rack 1 is slidably connected to the second connector 12, and the second linear rack 5 Sliding connection with the second connector 12; the first linear rack 4 meshes with the third gear 9 provided on the second connector 12, when the third gear 9 is rotated, the first linear rack 4 and the second The connector 12 is relatively translated; the second linear rack 5 meshes with the fourth gear 10 provided on the second connector 12, and when the fourth gear 10 is rotated, the fourth gear 10 and the second connector 12 are relatively translated,

One end of the first arc-shaped rack 1 is connected with a guide sleeve 2 and the central axis of the guide sleeve 2 passes through the arc curvature center of the first arc-shaped rack 1, and one end of the second linear rack 5 is connected with The positioning sleeve 6 and the second linear rack 5 are perpendicular to the central axis of the positioning sleeve 6,

The guide sleeve 2 and the positioning sleeve 6 are located in the plane where the first arc-shaped rack 1 and the second linear rack 5 are located. the

In this example,

On the first arc-shaped rack 1, the second arc-shaped rack 3, the first linear rack 4 and the second linear rack 5, the first angle scale scale mark and the second angle scale scale mark are respectively arranged. line, the first ruler scale mark and the second ruler scale mark, the first connector 11 is provided with a first angle scale scale mark line observation window and a second angle scale scale line observation window, in the second The connector 12 is provided with a first ruler scale mark line observation window and a second ruler scale mark line observation window. the

Any one of the first linear rack 4 and the second linear rack 5 is perpendicular to the first arc rack 1, the plane where the second linear rack 5 is located and the second arc rack. The intersection line of the plane where the bar 3 and the first linear rack 4 are located is parallel, and any other linear rack in the first linear rack 4 and the second linear rack 5 is perpendicular to the first arc-shaped teeth The intersection line of the plane where the bar 1 and the second linear rack 5 are located and the plane where the second arc rack 3 and the first linear rack 4 are located is perpendicular. the

With reference to the accompanying drawings, the lower mold will give a more detailed description of the specific implementation of the present utility model:

The first arc rack 1 is a part of the circumference with O as the center, the outer arc edge is the gear, the scale is degrees, the starting point is at the center of the guide sleeve 2, the guide sleeve 2 is located on the radius line, and the guide sleeve The extension line of 2 passes through the center O. The first arc rack 1 and the guide sleeve 2 are located on the same plane. the

The second arc tooth bar 3 and the first linear tooth bar 4 are located on the same plane, and the second arc tooth bar 3 is also a part of the circumference with O as the center of circle, and the inner arc edge is a gear, and the scale is length (mm ), the starting point is in the center and extends to both sides; the first linear rack 4 is a straight inner gear rack, the scale is length (mm), the starting point is in the center, and extends to both sides; the second arc rack 3 and the first A linear rack 4 is connected as a complete body. the

5 is the second linear rack, the scale is the length (mm), and the starting point is in the center of the positioning sleeve 6, extending to one side; the second linear rack 5 and the positioning sleeve 6 are located on the same plane and connected at right angles . the

7 is the first gear, 8 is the second gear, the first gear 7 and 8 are conjoined and the centers of rotation of the two are vertical, 9 is the third gear and 10 is the fourth gear, the third gear 9 and the fourth gear 10 It is connected and the centers of rotation of the two are vertical. the

The plane formed by the first arc-shaped rack 1 and the guide sleeve 2 is perpendicular to the plane formed by the second arc-shaped rack 3 and the first linear rack 4, and the second arc-shaped rack 3 and the first linear rack The plane formed by 4 is perpendicular to the plane formed by the second linear rack 5 and the positioning sleeve 6, so that the plane formed by the first arc-shaped rack 1 and the guide sleeve 2 and the second linear rack 5 and the positioning sleeve The planes formed by 6 are parallel or the same plane. the

The radians of the first arc-shaped rack 1 and the second arc-shaped rack 3 are all circles with point O as the center of the circle, the radii are not equal, and the planes located are perpendicular to each other, that is to say, point O is the center of the sphere. A fraction of a sphere of radius. The O point is always in front of the O point in the center of the first linear tooth bar 4 . When arbitrarily adjusting the first gear 7 and the second gear 8, the extension line at the center of the guide sleeve 2 always passes through the center of the sphere O. Adjust the fourth gear 10 and the third gear 9 gear columns, and the point O moves in the horizontal and vertical directions. the

Example 1: Closed reduction and internal fixation of femoral neck fracture

1. Put the patient on the orthopedic traction bed, and perform closed reduction of the femoral neck fracture with the assistance of X-ray fluoroscopy. the

2. After successful reduction, drill a Kirschner wire with a diameter of 3 mm into the bone at a level of about 2 cm below the greater trochanter of the affected limb, as vertically as possible to the femoral shaft, to a depth of 2 cm. the

3. For femoral neck anteroposterior perspective, draw the actual needle entry line below the femoral neck on the fluoroscopy screen. At the intersection point A of the Kirschner wire and the outer edge of the cortical bone, draw a vertical line to this point and intersect the actual needle entry line at point B. Measure the distance from AB to D, measure the length X of the 20mm long Kirschner wire entering the bone on the screen, X/20 is the positive magnification factor after fluoroscopy, measure the angle α between the Kirschner wire and the actual needle line, and the actual level Displacement D'=D*X/20mm. the

4. Lateral fluoroscopy of the femoral neck, draw the actual needle entry line in the center of the femoral neck on the fluoroscopy screen, at the intersection point a of the Kirschner wire and the outer edge of the cortical bone, draw a vertical line to this point and intersect the actual needle entry line at point b, Measure the ab distance as d, measure the length Y of the 20mm long Kirschner wire entering the bone on the screen, Y/20 is the lateral magnification factor after fluoroscopy, measure the angle β between the Kirschner wire and the actual needle line, and the actual level Displacement d'=d*Y/20mm. the

5. According to the measured value, first adjust the horizontal position value: rotate the fourth gear 10 to displace the second linear rack 5 horizontally by D', and rotate the first gear 7 to rotate the first arc rack 1 by an angle of α; Then adjust the vertical position value: rotate the third gear 9 to displace the first linear rack 4 horizontally by d', rotate the second gear 8 to rotate the second arc rack 3 by an angle of β; pay attention to the up and down direction at this time. the

6. Insert 6 of the three-dimensional guide, make point C close to the cortical bone, and keep the first arc-shaped rack 1 and the second arc-shaped rack 2 on the horizontal plane. Insert the drill bit sleeve into the guide sleeve 2, cut a small incision in the skin, and bring the drill bit sleeve to the bone cortex, and perform frontal and lateral perspective to confirm whether the direction of the drill bit is on the actual line. If there is any change, fine-tune it appropriately. Drill the drill into the femoral neck. After the satisfactory position is seen through fluoroscopy, the channel is enlarged and hollow screws are screwed in. the

Claims (3)

1. An adjustable three-dimensional guide for percutaneous bone joint screw placement, characterized in that it includes: a first arc-shaped rack (1), a second arc-shaped rack (3), a first linear rack (4) ) and the second linear rack (5), the first arc rack (1) and the second linear rack (5) are located in the same plane, the second arc rack (3) and The first linear rack (4) is connected and located in the same plane, and the plane where the first arc rack (1) and the second linear rack (5) are located is the same plane as the second arc rack (3), The plane where the first linear rack (4) is located is perpendicular, the radius of curvature of the first arc rack (1) and the second arc rack (3) are equal, and the first arc rack (1) coincides with the center of curvature of the second curved rack (3) at the same point O , A first connector (11) is provided between the first arc-shaped rack (1) and the second arc-shaped rack (3), and the first arc-shaped rack (1) and the first connector (11) Rotating and sliding connection, the second arc-shaped rack (3) is connected in rotating and sliding with the first connector (11); the first arc-shaped rack (1) is connected with the first gear ( 7) Mesh, when the first gear (7) is rotated, the first arc-shaped rack (1) and the first connector (11) rotate relatively; the second arc-shaped rack (3) and the first connector The second gear (8) on (11) meshes, when the second gear (8) is rotated, the second arc-shaped rack (3) rotates relative to the first connector (11), A second connector (12) is provided between the first linear rack (4) and the second linear rack (5), and the first arc rack (1) and the second connector (12) Sliding connection, the second linear rack (5) is slidingly connected to the second connector (12); the first linear rack (4) is connected to the third gear (9) on the second connector (12) Mesh, when the third gear (9) is rotated, the first linear rack (4) and the second connector (12) will translate relatively; the second linear rack (5) and the second connector (12) ) meshes with the fourth gear (10), when the fourth gear (10) is rotated, the fourth gear (10) will move relative to the second connector (12), A guide sleeve (2) is connected to one end of the first arc-shaped rack (1), and the central axis of the guide sleeve (2) passes through the arc curvature center of the first arc-shaped rack (1), and on the second straight line One end of the gear rack (5) is connected with a positioning sleeve (6) and the second linear gear rack (5) is perpendicular to the central axis of the positioning sleeve (6), The guide sleeve (2) and the positioning sleeve (6) are located in the plane where the first arc-shaped rack (1) and the second linear rack (5) are located. 2. The adjustable three-dimensional guide for percutaneous bone joint screw placement according to claim 1, characterized in that, in the first arc-shaped rack (1), the second arc-shaped rack (3), and the first linear The rack (4) and the second linear rack (5) are respectively provided with a first angle scale scale mark, a second angle scale scale mark line, a first ruler scale mark line and a second ruler scale mark line , on the first connector (11) there is a first angle scale scale line observation window and a second angle scale scale line observation window, on the second connector (12) there is a first ruler scale line observation window Observation window and second ruler scale marking observation window. 3. The adjustable three-dimensional guide for percutaneous bone joint screw placement according to claim 1 or 2, characterized in that any one of the first linear rack (4) and the second linear rack (5) The plane where the linear rack and the first curved rack (1) and the second linear rack (5) are located perpendicular to each other and the plane where the second curved rack (3) and the first linear rack (4) are located The intersection lines of the planes are parallel, and any other linear rack among the first linear rack (4) and the second linear rack (5) is perpendicular to the first curved rack (1), the second The intersection line of the plane where the linear rack (5) is located and the plane where the second arc rack (3) and the first linear rack (4) are located is perpendicular.

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