阅读说明：本技术 用于胸腰椎置钉手术的辅助置钉装置 (auxiliary nail placing device for thoracolumbar vertebra nail placing operation ) 是由 陈卫 董涛 黄鸿 于 2019-09-10 设计创作，主要内容包括：本发明公开了一种用于胸腰椎置钉手术的辅助置钉装置,由金属棘突定位叉和经皮置钉导板组成,金属棘突定位叉卡接在置钉处棘突上,经皮置钉导板固定套设在金属棘突定位叉上并贴附于置钉处皮肤表面,经皮置钉导板上设有克氏针定位孔,导向克氏针经克氏针定位孔经皮植入。金属棘突定位叉由定位叉、限位台、第一克氏针导向柱、紧固螺母和克氏针导向孔组成。经皮置钉导板由导向连接板、贴附板、螺母限位柱和第二克氏针导向柱组成。经皮置钉导板经限位台安装孔和克氏针导向柱安装孔套设在限位台和第一克氏针导向柱上,紧固螺母经螺母限位柱将经皮置钉导板与金属棘突定位叉固定连接。解决了传统手术存在出血过多、术后感染风险以及伤口愈合慢的问题。(the invention discloses an auxiliary nail placing device for thoracolumbar nail placing operation, which consists of a metal spinous process positioning fork and a percutaneous nail placing guide plate, wherein the metal spinous process positioning fork is clamped on the spinous process at the nail placing position, the percutaneous nail placing guide plate is fixedly sleeved on the metal spinous process positioning fork and attached to the surface of the skin at the nail placing position, a Kirschner wire positioning hole is formed in the percutaneous nail placing guide plate, and a guide Kirschner wire is implanted percutaneously through the Kirschner wire positioning hole. The metal spinous process positioning fork consists of a positioning fork, a limiting table, a first Kirschner wire guide column, a fastening nut and a Kirschner wire guide hole. The percutaneous nail placing guide plate consists of a guide connecting plate, an attaching plate, a nut limiting column and a second Kirschner wire guide column. The percutaneous nail placing guide plate is sleeved on the limiting table and the first Kirschner wire guide column through the limiting table mounting hole and the Kirschner wire guide column mounting hole, and the fastening nut fixedly connects the percutaneous nail placing guide plate with the metal spinous process positioning fork through the nut limiting column. Solves the problems of excessive bleeding, postoperative infection risk and slow wound healing existing in the traditional operation.)

1. An auxiliary nail placing device for thoracolumbar nail placing operation is characterized by comprising a metal spinous process positioning fork and a percutaneous nail placing guide plate, wherein the metal spinous process positioning fork is clamped on the spinous process at the nail placing position, the percutaneous nail placing guide plate is detachably sleeved on the metal spinous process positioning fork and attached to the surface of skin (13) at the nail placing position, a Kirschner wire positioning hole (9) is formed in the percutaneous nail placing guide plate, and a guide Kirschner wire is implanted percutaneously through the Kirschner wire positioning hole (9).

2. The auxiliary nail placing device for the thoracolumbar nail placing operation is characterized in that the metal spinous process positioning fork consists of a positioning fork (1), a limiting table (2), a first kirschner wire guide column (3), a fastening nut (4) and a kirschner wire guide hole (5), wherein an opening of the positioning fork (1) faces downwards and is fixed on the spinous process where the nail is placed in a spanning mode, and the first kirschner wire guide column (3) is fixedly connected with the top end of the positioning fork (1) through the limiting table (2); one end of the first Kirschner wire guide column (3) connected with the limiting table (2) is provided with an external thread matched with the fastening nut (4), and the first Kirschner wire guide column (3) is in threaded connection with the fastening nut (4) through the external thread on the first Kirschner wire guide column; the Kirschner wire guide hole (5) is positioned in the center of the metal spinous process positioning fork, and sequentially penetrates through the vertical through holes of the first Kirschner wire guide column (3), the limiting table (2) and the positioning fork (1) from the center of the top end of the first Kirschner wire guide column (3).

3. the auxiliary nail-placing device for thoracolumbar nailing operation according to claim 2, wherein the metal spinous process positioning fork is fixed by a positioning kirschner wire (14) in the kirschner wire guide hole (5), and the positioning kirschner wire (14) is percutaneously implanted at the spinous process center (15).

4. The auxiliary nail placing device for thoracolumbar vertebra nail placing operation according to claim 2, wherein the limiting table (2) is of a regular polygonal column structure;

The outer diameter of the first Kirschner wire guide column (3) is smaller than the diameter of an excircle of the limiting table (2).

5. The auxiliary screw placing device for thoracolumbar screw placing operation according to any one of claims 1 to 4, wherein the percutaneous screw placing guide plate is composed of a guide connecting plate (6), an attaching plate (8), a nut limiting column (10) and a second Kirschner wire guide column (11); both ends are fixed with second kirschner wire guide post (11) respectively through a direction connecting plate (6) about attaching board (8), are equipped with kirschner wire locating hole (9) that run through it from the top down on second kirschner wire guide post (11), on nut spacing post (10) vertical fixation attached board (8), from the bottom up is equipped with spacing platform mounting hole (7) and kirschner wire guide post mounting hole (12) in proper order in attaching board (8), and kirschner wire guide post mounting hole (12) extend to nut spacing post (10) top.

6. the auxiliary screw-placing device for thoracolumbar screw-placing operation according to claim 5, characterized in that the shape of the limiting table mounting hole (7) corresponds to the shape of the limiting table (2), and the Kirschner wire guide column mounting hole (12) corresponds to the end of the first Kirschner wire guide column (3) provided with the external thread;

The percutaneous nail placing guide plate is sleeved on the limiting table (2) and the first Kirschner wire guide column (3) of the metal spinous process positioning fork through a limiting table mounting hole (7) and a Kirschner wire guide column mounting hole (12) in the attaching plate (8); the fastening nut (4) is limited by a nut limiting column (10) and fixedly connects the percutaneous nail placing guide plate with the metal spinous process positioning fork.

7. The auxiliary nail-placing device for thoracolumbar vertebra nail-placing operation according to claim 5, characterized in that said attachment plate (8) has an oval structure with a major diameter corresponding to the length of the spinous process and a minor diameter corresponding to the width of the spinous process.

8. The auxiliary nail placing device for thoracolumbar vertebra nail placing operation according to claim 5, wherein the Kirschner wire positioning hole (9) comprises a central Kirschner wire positioning hole located at the center of the second Kirschner wire guide post (11) and a plurality of spare Kirschner wire positioning holes located around the central Kirschner wire positioning hole, and the spare Kirschner wire positioning holes are 2-3 mm away from the center of the central Kirschner wire positioning hole.

9. The auxiliary nail placing device for thoracolumbar vertebra nail placing operation according to claim 8, wherein the number of the standby kirschner wire positioning holes is 4-8.

10. The auxiliary nail placing device for thoracolumbar nail placing operation according to any one of claims 1 to 4 or 6 to 9, wherein the metal spinous process positioning fork is provided with a plurality of models, and the percutaneous nail placing guide plate is individually designed according to different vertebral bodies and is formed by 3D printing.

Technical Field

the invention belongs to the field of medical equipment, and relates to an auxiliary nail placing device for thoracolumbar vertebra nail placing operation.

Background

traditional thoracolumbar surgery needs to make a longitudinal incision on the posterior of a target vertebral body, peels off soft tissues layer by layer, exposes vertebral plates and articular processes, can effectively determine a nail placement target point, but also faces risks of excessive bleeding in the surgery and postoperative infection, and the wound is slow to heal, so that extra mental and physical burdens are added to a patient. The existing thoracolumbar minimally invasive surgery is generally that the screw is placed under the robot navigation assistance or the screw is placed by hands of a doctor with rich experience: the former has expensive equipment cost and low popularization rate; the latter has high requirements on doctors, and the nail placement needs to be frequently observed by means of perspective in the operation.

Disclosure of Invention

The invention aims to provide an auxiliary nail placing device for thoracolumbar vertebra nail placing operation, which solves the problems of excessive bleeding, postoperative infection risk and slow wound healing of a vertebral plate and a joint protruding nail exposed by making a longitudinal incision on the posterior of a target vertebral body in the traditional operation, the problem of high equipment cost of robot navigation auxiliary nail placing and the problem that the requirement of the doctor on nail placing by hands of the doctor is high and the nail placing condition needs to be frequently observed by means of perspective.

The invention adopts the technical scheme that the auxiliary nail placing device for thoracolumbar nail placing operation consists of a metal spinous process positioning fork and a percutaneous nail placing guide plate, wherein the metal spinous process positioning fork is clamped on the spinous process at the nail placing position, the percutaneous nail placing guide plate is detachably sleeved on the metal spinous process positioning fork and attached to the surface of the skin at the nail placing position, the percutaneous nail placing guide plate is provided with a Kirschner wire positioning hole, and a guide Kirschner wire is implanted percutaneously through the Kirschner wire positioning hole.

Furthermore, the metal spinous process positioning fork consists of a positioning fork, a limiting table, a first kirschner wire guide column, a fastening nut and a kirschner wire guide hole; the opening of the positioning fork is downward and fixed on the spinous process of the nail placing part in a crossing manner, and the first kirschner wire guide column is fixedly connected with the top end of the positioning fork through the limiting table; one end of the first Kirschner wire guide column, which is connected with the limiting table, is provided with an external thread matched with the fastening nut, and the first Kirschner wire guide column is in threaded connection with the fastening nut through the external thread on the first Kirschner wire guide column; the Kirschner wire guide hole is positioned in the center of the metal spinous process positioning fork, and sequentially penetrates through the vertical through hole of the first Kirschner wire guide column, the limiting table and the positioning fork from the center of the top end of the first Kirschner wire guide column.

Furthermore, the metal spinous process positioning fork is fixed through a positioning kirschner wire in a kirschner wire guide hole, and the positioning kirschner wire is implanted at the center of the spinous process through the skin.

Furthermore, the limiting table is of a regular polygon prism structure;

The outer diameter of the first Kirschner wire guide column is smaller than the diameter of an excircle of the limiting table.

Furthermore, the percutaneous nail placing guide plate consists of a guide connecting plate, an attaching plate, a nut limiting column and a second Kirschner wire guide column; the left end and the right end of the attaching plate are respectively fixed with a second Kirschner wire guide post through a guide connecting plate, the second Kirschner wire guide post is provided with a Kirschner wire positioning hole which penetrates through the second Kirschner wire guide post from top to bottom, the nut limiting post is vertically fixed on the attaching plate, a limiting platform mounting hole and a Kirschner wire guide post mounting hole are sequentially arranged in the attaching plate from bottom to top, and the Kirschner wire guide post mounting hole extends to the top end of the nut limiting post.

Furthermore, the shape of the mounting hole of the limiting table corresponds to that of the limiting table, and the mounting hole of the Kirschner wire guide column corresponds to that of the end, provided with the external thread, of the first Kirschner wire guide column;

The percutaneous nail placing guide plate is sleeved on the limiting table and the first Kirschner wire guide column of the metal spinous process positioning fork through a limiting table mounting hole and a Kirschner wire guide column mounting hole in the attaching plate; the fastening nut is limited by the nut limiting column, and the percutaneous nail placing guide plate is fixedly connected with the metal spinous process positioning fork.

Furthermore, the attaching plate is of an oval structure, the major diameter of the attaching plate corresponds to the length of the spinous process, and the minor diameter of the attaching plate corresponds to the width of the spinous process.

furthermore, the Kirschner wire positioning hole comprises a central Kirschner wire positioning hole positioned at the center of the second Kirschner wire guide column and a plurality of standby Kirschner wire positioning holes positioned around the central Kirschner wire positioning hole, and the distance between the standby Kirschner wire positioning hole and the center of the central Kirschner wire positioning hole is 2-3 mm.

Furthermore, the number of the standby kirschner wire positioning holes is 4-8.

Furthermore, the metal spinous process positioning fork is provided with a plurality of models, and the percutaneous nail placing guide plate is designed individually and formed by 3D printing according to different vertebral bodies.

the invention has the advantages that the metal spinous process positioning fork is used for pre-positioning, and then the percutaneous screw placing guide plate is fixed, so that the screw feeding position and direction of the pedicle screw on the skin are determined, the percutaneous minimally invasive screw placing is realized, the requirement on doctors is relatively low, and the robot navigation assistance is not needed. This put nail location auxiliary device only need make a little incision in the position of the location kirschner wire of implanting, shows the spinous process to carry out the implantation of metal spinous process location fork, need not great incision, bleeding is few, postoperative resumes soon, the infection risk is low. Only two intraoperative perspectives are needed, and the fluoroscopy is less and fast. The problems that the traditional operation is performed on the posterior of a target vertebral body to make a longitudinal incision to expose vertebral plates and protruding joint nails, excessive bleeding exists, postoperative infection risks exist, healing of wounds is slow, the equipment cost of the robot navigation auxiliary nail placement device is high, and the problem that a doctor needs to observe the nail placement condition frequently by means of perspective due to high requirements of the doctor on manual nail placement is solved.

Drawings

In order to more clearly illustrate the embodiments of the present invention or the technical solutions in the prior art, the drawings used in the description of the embodiments or the prior art will be briefly described below, it is obvious that the drawings in the following description are only some embodiments of the present invention, and for those skilled in the art, other drawings can be obtained according to the drawings without creative efforts.

Fig. 1 is a front view of a metal spinous process positioning prong of the present invention.

Fig. 2 is a left side view of the metal spinous process positioning prong of the present invention.

Fig. 3 is a cross-sectional view a-a of the metal spinous process positioning prong of the present invention.

Figure 4 is a bottom view of the percutaneous staple guide of the present invention.

Figure 5 is a top view of the percutaneous staple guide of the present invention.

Figure 6 is a front view of the percutaneous staple guide of the present invention.

Figure 7 is a cross-sectional view B-B of the percutaneous staple guide of the present invention.

Fig. 8 is a top view of the spacing block of the present invention.

Fig. 9 is a schematic view of the initial positioning of the k-wire of the present invention.

Fig. 10 is a schematic view of the positioning of the guide positioning mechanism of the present invention.

FIG. 11 is a schematic view of the positioning of the auxiliary stapling apparatus of the present invention.

FIG. 12 is a schematic view of the staple placement position determined using the auxiliary staple placement device of the present invention.

In the drawing, 1, a positioning fork, 2, a limiting table, 3, a first Kirschner wire guide column, 4, a fastening nut, 5, a Kirschner wire guide hole, 6, a guide connecting plate, 7, a limiting table mounting hole, 8, an attaching plate, 9, a Kirschner wire positioning hole, 10, a nut limiting column, 11, a second Kirschner wire guide column, 12, the Kirschner wire guide column mounting hole, 13, a nail placing position skin, 14, a positioning Kirschner wire and 15, the center of a spinous process are arranged.

Detailed Description

The technical solutions in the embodiments of the present invention will be clearly and completely described below with reference to the drawings in the embodiments of the present invention, and it is obvious that the described embodiments are only a part of the embodiments of the present invention, and not all of the embodiments. All other embodiments, which can be derived by a person skilled in the art from the embodiments given herein without making any creative effort, shall fall within the protection scope of the present invention.

A supplementary nail device of putting for chest lumbar vertebrae nail operation of putting, it constitutes to put nail baffle by metal spinous process location fork and percutaneous, as shown in fig. 1~2, metal spinous process location fork is by the location fork 1 of joint on the spinous process, spacing platform 2, first kirschner wire guide post 3, fastening nut 4 and kirschner wire guiding hole 5 are constituteed, the top of location fork 1 and the bottom fixed connection of spacing platform 2, the top of spacing platform 2 and the 3 bottom fixed connection of first kirschner wire guide post, spacing platform 2 is regular polygon prism structure, this embodiment is hexagonal prism structure, as shown in fig. 8. The diameter of the first Kirschner wire guide column 3 is smaller than the diameter of the circumscribed circle of the limiting table 2. The lower half part of first kirschner wire guide post 3 is equipped with the external screw thread supporting with fastening nut 4, and first kirschner wire guide post 3 is through external screw thread and the 4 threaded connection of fastening nut on it. As shown in fig. 3, which is a cross-sectional view taken along the line a-a of the metal spinous process positioning fork, it can be seen from fig. 3 that the kirschner wire guide hole 5 is located at the center of the metal spinous process positioning fork, and the kirschner wire guide hole 5 is a vertical through hole which sequentially penetrates through the first kirschner wire guide post 3, the limiting table 2 and the positioning fork 1 from top to bottom from the center of the top end of the first kirschner wire guide post 3.

The percutaneous nail placing guide plate is structurally shown in figures 4-7 and comprises a guide connecting plate 6, an attaching plate 8, a nut limiting column 10 and a second Kirschner wire guide column 11. The attaching plate 8 is an oval structure, the major diameter of which corresponds to the length of the spinous process and the minor diameter of which corresponds to the width of the spinous process, and the main purpose is to determine whether the percutaneous nail guide plate is accurately placed above the spinous process through perspective in the operation and also to be used as an adjustment reference. The left end and the right end of the attaching plate 8 are respectively fixed with a second kirschner wire guide column 11 through a guide connecting plate 6. A plurality of Kirschner wire positioning holes 9 penetrating through the second Kirschner wire guide column 11 from top to bottom are formed in the Kirschner wire positioning hole 9, each Kirschner wire positioning hole 9 comprises a central Kirschner wire positioning hole located in the center of the second Kirschner wire guide column 11 and standby Kirschner wire positioning holes located around the central Kirschner wire positioning hole, the distance between each standby Kirschner wire positioning hole and the center of the central Kirschner wire positioning hole is 2-3 mm, and the distance mainly depends on the allowable deviation range of pedicle screw implantation; 4-8 spare Kirschner wire positioning holes are generally designed according to the designable space range. As shown in fig. 6, the nut limiting column 10 is vertically fixed on the attaching plate 8, as shown in fig. 7, a limiting table mounting hole 7 and a kirschner wire guide column mounting hole 12 are sequentially arranged in the attaching plate 8 from bottom to top, and the kirschner wire guide column mounting hole 12 extends to the top end of the nut limiting column 10. The shape of the limiting table mounting hole 7 corresponds to the shape of the limiting table 2, and the shape of the Kirschner wire guide column mounting hole 12 corresponds to the shape of the end (the end provided with the external thread) of the first Kirschner wire guide column 3 connected with the limiting table 2.

The metal spinous process positioning fork is fixed through a positioning kirschner wire 14 in the kirschner wire guide hole 5, the percutaneous nail placing guide plate is sleeved on the limiting table 2 and the first kirschner wire guide column 3 of the metal spinous process positioning fork through a limiting table mounting hole 7 and a kirschner wire guide column mounting hole 12 in the attaching plate 8, and the fastening nut 4 is limited through a nut limiting column 10 to fixedly connect the percutaneous nail placing guide plate and the metal spinous process positioning fork.

The design method of the auxiliary nail placing device for the thoracolumbar vertebra nail placing operation comprises the following steps:

Step 1, extracting image data, and performing three-dimensional reconstruction on a target vertebral body and skin tissues at a nail placing position;

step 2, simulating the implantation position of the pedicle screw, and extending outwards to the surface of the skin 13 at the screw placement position;

Step 3, marking the position of the center 15 of the spinous process, designing and positioning the kirschner wire 14, and enabling the metal spinous process positioning fork to penetrate through the positioning kirschner wire 14 through the kirschner wire guide hole 5 in the metal spinous process positioning fork to be fixed on the spinous process;

Step 4, designing a percutaneous screw placing guide plate by taking the metal spinous process positioning fork as a fixed point, attaching the percutaneous screw placing guide plate to the surface of the skin 13 at the screw placing position, designing a second kirschner wire guide column 11 according to the preset pedicle screw implanting position and implanting direction, and finally completing the design of the percutaneous screw placing guide plate;

And 5, designing a plurality of models and sizes of the metal spinous process positioning fork according to clinical requirements, and carrying out personalized design and 3D printing forming on the percutaneous nail placing guide plate according to different vertebral bodies of different patients.

The use method of the auxiliary nail placing device for the thoracolumbar nail placing operation comprises the following steps:

Step S1, implanting a positioning k-wire 14 at the center 15 of the spinous process through intraoperative fluoroscopy in advance percutaneously, as shown in fig. 9;

Step S2, making a small incision at the implanted position of the positioning kirschner wire 14, exposing the spinous process, implanting the metal spinous process positioning fork along the positioning kirschner wire 14 through the kirschner wire guide hole 5 of the positioning kirschner wire positioning fork, and fixing the positioning fork 1 on the spinous process in a crossing manner, as shown in fig. 10;

Step S3, placing the percutaneous nail placing guide plate on the surface of the skin 13 at the nail placing position along the first kirschner wire guide post 3 of the metal spinous process positioning fork, and carrying out rotation limit on the percutaneous nail placing guide plate through the mutual limit action of the limit table mounting hole 7 on the percutaneous nail placing guide plate and the limit table 2 on the metal spinous process positioning fork; the percutaneous nail placing guide plate is highly limited and fastened through the nut limiting column 10 and the fastening nut 4 on the percutaneous nail placing guide plate, as shown in fig. 11;

Step S4, the guiding kirschner wire is placed into the skin and vertebral plate along the central kirschner wire positioning hole of the second kirschner wire guiding post 11 of the percutaneous screw placement guiding plate until the inside of the vertebral body, and is verified through intraoperative perspective, if there is a deviation, the guiding kirschner wire positioning hole around the central kirschner wire positioning hole can be selected according to the actual situation to be corrected, after the guiding kirschner wire is determined to be correctly implanted, the fastening nut 4, the percutaneous screw placement guiding plate and the metal spinous process positioning fork are sequentially removed, and the pedicle screw implantation is performed with the guiding kirschner wire as the guiding, as shown in fig. 12.

it is to be noted that, in the present invention, relational terms such as first and second, and the like are used solely to distinguish one entity or action from another entity or action without necessarily requiring or implying any actual such relationship or order between such entities or actions. Also, the terms "comprises," "comprising," or any other variation thereof, are intended to cover a non-exclusive inclusion, such that a process, method, article, or apparatus that comprises a list of elements does not include only those elements but may include other elements not expressly listed or inherent to such process, method, article, or apparatus. Without further limitation, an element defined by the phrase "comprising an … …" does not exclude the presence of other identical elements in a process, method, article, or apparatus that comprises the element.

the above description is only for the preferred embodiment of the present invention, and is not intended to limit the scope of the present invention. Any modification, equivalent replacement, or improvement made within the spirit and principle of the present invention shall fall within the protection scope of the present invention.