阅读说明：本技术 一种内侧髌骨韧带手术入路定位装置以及方法 (Medial patella ligament surgery access positioning device and method ) 是由 苏帆 朱伟民 崔家鸣 黄兰兵 靳兴汉 谢都 黄勇 林焯琛 陈菲 傅子财 于 2019-09-23 设计创作，主要内容包括：本发明公开了一种内侧髌骨韧带手术入路定位装置以及方法,该装置包括解剖止点定位装置以及克氏针定位装置,该解剖止点定位装置根据基于内收肌腱止点确定的参考止点加以固定,该克氏针定位装置上安装用于引入克氏针的套筒,该解剖止点定位装置上设置联动的角度测定组件以及长度测定组件,该长度测定组件通过弹性伸缩件连接至克氏针定位装置,拉动该克氏针定位装置使该长度测定组件拉伸至设定长度,并使该角度测定组件转动设定角度,从而将该套筒根据手术入路定位在解剖止点上。借助本发明的手术入路定位装置可根据患者个体差异定制适应的手术入路,准确确定解剖止点以及旋转角度以避免人为误差,同时减少术后并发症的发生率以及缩短手术时间。(The invention discloses a medial patellar ligament surgery approach positioning device and a medial patellar ligament surgery approach positioning method, the device comprises an anatomy dead point positioning device and a Kirschner wire positioning device, the anatomy dead point positioning device is fixed according to a reference dead point determined based on an adductor tendon dead point, a sleeve for leading in a Kirschner wire is installed on the Kirschner wire positioning device, a linkage angle measuring component and a length measuring component are arranged on the anatomy dead point positioning device, the length measuring component is connected to the Kirschner wire positioning device through an elastic telescopic piece, the Kirschner wire positioning device is pulled to stretch the length measuring component to a set length, the angle measuring component is rotated to a set angle, and the sleeve is positioned on the anatomy dead point according to the surgery approach. The surgical access positioning device can customize and adapt surgical access according to individual difference of patients, accurately determine the anatomical stop point and the rotation angle to avoid human errors, and simultaneously reduce the incidence rate of postoperative complications and shorten the surgical time.)

1. The utility model provides a medial patella ligament surgery approach positioner, its characterized in that, is including dissecting dead point positioner and kirschner wire positioner, dissect dead point positioner and fix according to the reference dead point based on adduction tendon dead point is confirmed, the sleeve that the installation is used for introducing the kirschner wire rotates on the kirschner wire positioner, dissect the angle survey subassembly and the length survey subassembly that sets up the linkage on the dead point positioner, the length survey subassembly is connected to through elastic expansion piece the kirschner wire positioner, the pulling the kirschner wire positioner makes the length survey subassembly is tensile to setting length, and makes the angle survey subassembly rotates the angle of settlement, thereby will the sleeve is according to the surgery approach location on dissecting the dead point.

2. The medial patellar ligament surgical access positioning device of claim 1, wherein the reference insertion point is a fixed metal insertion point marker.

3. The medial patellar ligament surgical approach positioning device according to claim 1, wherein the angle measurement component comprises a rotating wheel and a pointer, the dissection dead point positioning device further comprises a first scale plate, a reference dead point positioning hole is formed in the first scale plate, the rotating wheel is fixed on the scale plate and penetrates through the center of the reference dead point positioning hole, the pointer is rotatably mounted on the rotating wheel, and a first angle scale is arranged on the periphery of the reference dead point positioning hole.

4. The medial patellar ligament surgical approach positioning device according to claim 3, wherein the pointer is provided with length scales, the elastic expansion piece is sleeved on the pointer, and one end of the elastic expansion piece is fixed on the rotating wheel.

5. The medial patellar ligament surgical approach positioning device according to claim 4, wherein the length measurement component comprises an index member, the index member comprises a fixing portion and a collar, the fixing portion is connected to the other end of the elastic expansion member, and the collar is sleeved on the pointer.

6. The medial patellar ligament surgical access positioning device according to claim 1, wherein the k-wire positioning device comprises a second scale plate, a second angle scale is arranged on the second scale plate, and a first connecting portion is arranged at the center of the second angle scale.

7. The medial patellar ligament surgical access positioning device of claim 6, wherein the sleeve is provided with a second connection portion, the second connection portion cooperating with the first connection portion to rotatably mount the sleeve on the second scale plate.

8. The medial patellar ligament surgical access positioning device according to any of claims 1-7, wherein a distance, an offset angle, and a femoral rotation angle of the reference insertion point and an anatomical insertion point are measured based on a CT fluoroscopy head image, pulling the k-wire positioning device stretches the length measuring component to the distance, rotates the angle measuring component by the offset angle, and rotates the sleeve onto the femoral rotation angle to accurately determine the surgical access of the anatomical insertion point.

9. A medial patellar ligament surgery approach positioning method is characterized by comprising the following steps:

determining adductor tendon insertion points as reference insertion points, and fixing metal insertion point marks at the reference insertion points;

determining the midpoint position of the medial edge of the patella of the patient as a reference midpoint, and fixing a metal midpoint mark at the reference midpoint;

carrying the metal dead point mark and the metal midpoint mark to obtain a perspective view combination of the affected knee through CT fluoroscopy;

determining an image correction point of an anatomical dead point according to the perspective combination, and measuring the distance, the deviation angle and the femur rotation angle of the image correction point and a reference dead point based on a measurement scale;

and determining the surgical approach of the anatomical stop point by using a medial patellar ligament surgical approach positioning device according to the distance, the deviation angle and the femur rotation angle, wherein the medial patellar ligament surgical approach positioning device comprises the anatomical stop point positioning device and a Kirschner wire positioning device.

10. The medial patellar ligament surgical access positioning method of claim 9, wherein the perspective view combination comprises a first perspective view and a second perspective view, the first and second perspective views being compounded, the step of determining the trochlear trajectory and its center of rotation further comprising:

the first perspective view and the second perspective view are transparentized and overlapped in the same scale and the same position;

establishing a coordinate system based on the reference dead point image and the reference midpoint image;

establishing a pulley track by using the sliding surfaces in the first perspective view and the second perspective view, determining a rotation center by using the pulley track as an equal length point on a circumference, and setting the rotation center as an image correction point;

measuring the distance value between the image correction point and the reference stop point image;

measuring the deviation angle of the image correction point;

measuring the rotation angle of the femur of the affected knee according to the horizontal line and a connecting line behind the medial condyle and the lateral condyle of the femur;

the reference dead point image is connected with the image correction point to form a first connecting line, the reference midpoint image is connected with the image correction point to form a second connecting line, and the deviation angle is an included angle between the first connecting line and the second connecting line.

Technical Field

The invention relates to the technical field of medical instruments, in particular to a medial patellar ligament surgical access positioning device and method.

Background

The knee joint is a synovial joint composed of a distal femur, a proximal tibia and a patella. The fracture of the patellofemoral ligament on the inner side of the knee, which is often caused by the fracture of the patella femoral ligament on the patient suffering from sports accidents or direct violence, can be damaged by tearing or fracture of the ligament due to sports accidents or external trauma, and the ligament reconstruction operation is required to be completed through knee arthroscopic surgery.

Common injuries to the knee include patellar dislocation. Patella dislocation is manifested by a significant lateral dislocation of the knee joint patella, often accompanied by rupture of the medial patellofemoral ligament. Over hundreds of thousands of teenagers dislocate the patella after movement/trauma every year, the injury can not be self-healed, the patellofemoral joint is unstable for a long time and is accompanied with arthralgia and limited movement, and even long-term arthritis is caused.

Arthroscopic knee surgery uses specialized surgical instruments to probe and treat the joint. The arthroscopic knee joint surgery needs at least two surgical incisions, inserts an arthroscopic metal tube with a lighting device into a joint cavity through a surgical approach, enlarges the internal structure of the joint cavity on a monitor, and observes the pathological change condition and the part in the joint cavity.

In knee joint surgery, a kirschner wire is a commonly used positioning material for orthopedics, and is used for primary positioning and temporary fixation.

However, in the operation, the accuracy of the kirschner wire implantation cannot be ensured only by performing positioning and marking on the body surface by a doctor or advancing the kirschner wire at an anatomical point by adopting an visual inspection mode, so that a great error exists in the operation access position. Complete parallelism is difficult to achieve when the K-wire is implanted without the aid of special instruments. Therefore, how to improve the accuracy of the parallel implantation of the kirschner wire, how to reduce the excessive exposure of the patient to X-rays in the operation, how to shorten the operation time, and how to improve the curative effect of the operation becomes a technical problem to be solved urgently in the current orthopedic operation.

Therefore, existing techniques for locating surgical access anatomical stops for the medial patellar ligament still remain to be improved.

Disclosure of Invention

Aiming at the technical problems, the invention provides a medial patella ligament surgery access positioning device and method which can customize and adapt to the surgical access according to individual differences of patients, accurately determine an anatomical stop point and a rotation angle so as to avoid human errors, reduce the incidence rate of postoperative complications and shorten the surgery time.

In a first aspect, the technical solution provided by the embodiments of the present invention is: the utility model provides a medial patella ligament surgery approach positioner, including dissecting dead point positioner and kirschner wire positioner, should dissect dead point positioner and fix according to the reference dead point that confirms based on adductor tendon dead point, the last sleeve that is used for introducing the kirschner wire of rotation installation of this kirschner wire positioner, set up angle survey subassembly and the length survey subassembly of linkage on this dissect dead point positioner, this length survey subassembly is connected to this kirschner wire positioner through elastic expansion piece, pull this kirschner wire positioner and make this length survey subassembly stretch to setting length, and make this angle survey subassembly rotate and set for the angle, thereby pass the location of establishing a way on dissecting the dead point according to the operation with this sleeve.

For fluoroscopic visualization, the metal dead center mark is fixed on the reference dead center.

The angle measuring component comprises a rotating wheel and a pointer, the dissection dead point positioning device further comprises a first scale plate, a reference dead point positioning hole is formed in the first scale plate, the rotating wheel is fixed on the scale plate and penetrates through the center of the reference value point positioning hole, the pointer is rotatably installed on the rotating wheel, and first angle scales are arranged on the periphery of the reference dead point positioning hole.

The pointer is provided with length scales, the elastic telescopic piece is sleeved on the pointer, and one end of the elastic telescopic piece is fixed on the rotating wheel.

Preferably, the length measuring assembly includes a pointer member, the pointer member includes a fixing portion and a collar, the fixing portion is connected to the other end of the elastic expansion member, and the collar is sleeved on the pointer.

Drawings

One or more embodiments are illustrated by way of example in the accompanying drawings, which correspond to the figures in which like reference numerals refer to similar elements and which are not to scale unless otherwise specified.

FIG. 1 is a front view of a medial patellar ligament surgical access positioning device according to an embodiment of the present invention;

FIG. 2 is a schematic structural view of an anatomical stop location device of a medial patellar ligament surgical access location device according to an embodiment of the present invention;

FIG. 3 is a schematic structural diagram of a Kirschner wire positioning device of a medial patellar ligament surgical access positioning device according to an embodiment of the invention;

FIG. 4 is a schematic view of an anatomical stop point inference for a medial patellar ligament surgical access positioning device according to an embodiment of the present invention;

FIG. 5 is a first perspective view and a second perspective view of a medial patellar ligament surgical approach positioning method in accordance with an embodiment of the present invention;

FIG. 6 is a perspective composite image schematic view of a medial patellar ligament surgical approach positioning method according to an embodiment of the present invention;

FIG. 7 is a schematic view of the angle of rotation of the femur of the medial patellar ligament surgical approach positioning method of the present invention;

FIG. 8 is a schematic view of body surface markings of a medial patellar ligament surgical approach positioning method according to an embodiment of the present invention;

FIG. 9 is a schematic structural diagram of a pointer of the medial patellar ligament surgical approach positioning device according to the embodiment of the invention; and

fig. 10 is a flowchart of a medial patellar ligament surgical approach positioning method according to an embodiment of the present invention.

When the Kirschner wire positioning device is specifically implemented, the Kirschner wire positioning device comprises a second scale plate, a second angle scale is arranged on the second scale plate, and a first connecting part is arranged at the center of the second angle scale.

The sleeve is provided with a second connecting portion, and the second connecting portion is matched with the first connecting portion to rotatably install the sleeve on the second scale plate.

When the perspective image is analyzed, the distance, the deviation angle and the femur rotation angle between the reference stop point and the anatomical stop point are measured based on the CT perspective head image, the Kirschner wire positioning device is pulled to enable the length measuring component to be pulled to the distance, the angle measuring component is rotated to the deviation angle, and the sleeve is rotated to the femur rotation angle so as to accurately determine the surgical approach of the anatomical stop point.

In a second aspect, the technical solution provided by the embodiment of the present invention is: the medial patellar ligament surgery access positioning method comprises the following steps:

determining adductor tendon insertion points as reference insertion points, and fixing metal insertion point marks at the reference insertion points;

determining the midpoint position of the medial edge of the patella of the patient as a reference midpoint, and fixing a metal midpoint mark at the reference midpoint;

carrying the metal dead point mark and the metal midpoint mark to obtain a perspective view combination of the affected knee through CT fluoroscopy;

determining an image correction point of an anatomical dead point according to the perspective combination, and measuring the distance, the deviation angle and the femur rotation angle of the image correction point and a reference dead point based on a measurement scale;

and determining the surgical approach of the anatomical stop point by using a medial patellar ligament surgical approach positioning device according to the distance, the deviation angle and the femur rotation angle, wherein the medial patellar ligament surgical approach positioning device comprises the anatomical stop point positioning device and a Kirschner wire positioning device.

The perspective view combination includes a first perspective view and a second perspective view. Compounding the first perspective view and the second perspective view, and the step of determining the track of the tackle and the rotation center thereof further comprises the following steps of:

the first perspective view and the second perspective view are transparent and overlapped in the same scale and the same position;

establishing a coordinate system based on the reference dead point image and the reference midpoint image;

establishing a pulley track by using the sliding surfaces in the first perspective view and the second perspective view, determining a rotation center by using the pulley track as an equal length point on a circumference, and setting the rotation center as an image correction point;

measuring the distance value between the image correction point and the reference stop point image;

measuring the deviation angle of the image correction point;

measuring the rotation angle of the femur of the affected knee according to the horizontal line and the connecting line behind the medial and lateral condyles of the femur;

the reference dead point image is connected with the image correction point to form a first connecting line, the reference midpoint image is connected with the image correction point to form a second connecting line, and the deviation angle is an included angle between the first connecting line and the second connecting line.

The beneficial effects of the embodiment of the invention are as follows: the medial patella ligament surgery approach positioning device of the embodiment determines the distance, the deviation angle and the femur rotation angle of an anatomical stop point relative to a reference stop point through a CT perspective view, and sets a linkage anatomical stop point positioning device and a Kirschner wire positioning device, a sleeve used for guiding a Kirschner wire is rotatably mounted on the Kirschner wire positioning device, the Kirschner wire positioning device is pulled to stretch a length measuring component to a predetermined distance, the angle measuring component is rotated to a predetermined deviation angle, the sleeve is rotated to a predetermined femur rotation angle to accurately guide the Kirschner wire, the Kirschner wire is accurately placed, artificial errors are avoided, treatment recovery of patella is facilitated, the incidence rate of postoperative complications is reduced, and the surgery time is shortened.

According to the medial patellar ligament surgery approach positioning method, a doctor firstly positions and preliminarily determines a reference dead point and a reference midpoint through a manipulation, fixes a metal mark at the reference dead point and the reference midpoint, obtains a first perspective view and a second perspective view of an affected knee through CT (computed tomography) fluoroscopy by carrying the metal dead point mark and the metal midpoint mark, and determines a correction dead point of the surgery approach closest to an anatomical dead point through analyzing knee joint image data in the first perspective view and the second perspective view, so that the optimal position of a surgery approach channel is found, and subsequent surgery operation can be performed smoothly. The positioning method of the embodiment is not influenced by the height and body weight index of the patient, and can analyze and calculate the adaptive surgical access point closest to the anatomical dead point according to different patients in an image radiography mode, so that the surgical success rate is improved on the basis of the minimum surgical wound, the incidence rate of postoperative complications is reduced, the surgical time is shortened, and the surgical time can be shortened by one third through empirical statistics.

In the medial patellar ligament surgery approach positioning method, a metal dead point mark and a metal midpoint mark are arranged on the body surface of a patient before fluoroscopy; after a three-dimensional reconstruction perspective view of a CT instrument, position parameters of an anatomical stop relative to a reference stop are measured on the perspective view, the distance and the angle between the anatomical stop of an operative approach and the reference stop and the rotation angle of the femur of the Kirschner wire are respectively measured, the guiding and the accurate embedding of the Kirschner wire are realized by combining an operative approach positioning device, and the minimally invasive characteristic of the operation is improved so as to facilitate the treatment and the recovery of the patella.