CN102499752B - In vitro aiming device for minimally invasive screw internal fixation of femoral neck fracture - Google Patents

Abstract

The invention discloses an external collimator suitable for minimally invasive internal fixation surgery with femoral neck fracture screws. The spatial position and angle adjustment mechanism between the central column of the orthopedic traction frame; the positioning plate is provided with a first positioning pin and a second positioning pin, wherein the first positioning pin and the second positioning pin are in the same plane; the second positioning pin on the rotating disk The end of the two positioning pins is provided with a third positioning pin coplanar with the second positioning pin; the engraved line and characters corresponding to the rotation angle of the rotating disc are marked on the circumferential side wall of the upper rotating disc, and one of the sleeves The side wall is provided with an opening through which the internal fixing nail communicates with the front and rear nozzles of the casing. The invention overcomes the technical defect of causing a large amount of radiation to medical personnel existing in the existing collimator, and can quickly and accurately determine the insertion position of the hollow guide pin on the body surface.

Description

An external aimer for femoral neck fracture screw minimally invasive internal fixation surgery

technical field

The invention relates to a medical device, in particular to an external collimator for femoral neck fracture screw minimally invasive internal fixation surgery.

Background technique

Proximal femoral fractures (including femoral neck fractures and intertrochanteric fractures) are common in adults. Epidemiological surveys have found that in recent decades, with the increase in the average life expectancy of human beings, the incidence of proximal femur fractures has shown an obvious upward trend. Fractures have high morbidity and mortality rates. About 15% to 20% of patients die within two years after fractures. One year later, the mortality rate of patients returns to the same level as that of the same age group.

The purpose of internal fixation surgery for proximal femoral fractures is to obtain a firm and stable internal fixation so that the patient can get up and move around in a short time. Early mobilization is beneficial for patients to prevent postoperative pulmonary complications, venous embolism, and bedsores.

At home and abroad, it has been advocated that internal fixation of such proximal femoral fractures should be actively performed. For intertrochanteric fractures, DHS (chute pressurized goose head nail) system internal fixation is generally performed. For femoral neck fractures, tensile hollow compression screw surgery is generally performed under the age of 60, which can give patients a chance for fracture healing. When carrying out this type of operation, a C-arm X-ray machine for radiographic imaging is generally used, combined with an aimer, to place a hollow guide pin that restricts the drilling path of the fixation nail into the predetermined position of the femoral neck, thereby completing a series of surgical operations. step. At present, the surgeon generally raises the buttocks of the affected side slightly during the operation, and uses the aimer to insert the guide needle based on experience. Often, the guide needle cannot be placed in the predetermined position quickly and accurately, and repeated operations are required, which prolongs the operation time. Increased surgical blood loss and increased surgical trauma, but also make patients and medical workers absorb too much unnecessary radiation dose.

Contents of the invention

The technical problem to be solved by the present invention is to provide an external collimator for femoral neck fracture screw minimally invasive internal fixation surgery that can quickly and accurately determine the body surface insertion position of the hollow guide pin.

In order to solve the above technical problems, the present invention provides the following technical solutions:

An external collimator for femoral neck fracture screw minimally invasive internal fixation surgery, which is used in conjunction with an orthopedic traction frame and a C-arm X-ray machine. The femoral neck fracture screw minimally invasive internal fixation surgical external collimator includes

The central column of the orthopedic traction frame is set on the orthopedic traction frame;

Positioning plate, the middle part of the positioning plate is provided with the first elongated bar hole and the rotating disk arranged on the first elongated bar hole, and one end of the first elongated bar hole length direction on the positioning plate is fixed with the first positioning plate. The second positioning pin is fixed on the rotating disc, wherein the first positioning pin and the second positioning pin are in a parallel plane with a certain distance from the positioning plate; the end of the second positioning pin on the rotating disc is provided with a sleeve , a rotating shaft is sleeved in the sleeve, the axial direction of the rotating shaft is consistent with the straight line direction of the second positioning pin, and the third positioning pin coplanar with the second positioning pin is arranged on the rotating shaft; the rotating disc includes an upper rotating disc, The lower rotating disc and the connecting rod between the two, the first elongated bar holes are equidistantly clamped between the upper rotating disc and the lower rotating disc, and the diameter of the connecting rod is less than or equal to that of the first strip Aperture diameter of the bar hole;

The spatial position and angle adjustment mechanism is connected between the positioning plate and the central column of the orthopedic traction frame;

Wherein the rotating shaft is connected with the second locating pin as a whole, and a sleeve is arranged on the upper rotating disk, and the second locating pin is sleeved in the sleeve, and the axial direction of the sleeve is consistent with the straight line direction of the second locating pin, and the sleeve It is integrated with the sleeve; the circumferential side wall of the upper rotary disc is marked with engraved lines and characters corresponding to the rotation angle of the rotary disc, and the side wall of the sleeve tube is provided with the front and rear of the connecting sleeve. The internal fixation pin of the nozzle passes through the opening.

The first elongated holes are equidistantly clamped between the upper and lower revolving disks, that is, the elongated holes are arranged between the upper and lower revolving disks, and the gap between the upper and lower revolving disks is The spacing is equal to the thickness of the elongated bar hole, so that the elongated bar hole can constrain the height position of the rotating disc (no matter how the rotating disc is adjusted, its height position relative to the positioning plate is constant, and the second position is guaranteed accordingly. The positioning pin is always in a parallel plane with a certain distance from the positioning plate), and it can also make the rotating disk slide in the first long strip hole (compared with the interference fit, the rotating disk under the premise of "equidistant clamping") The sliding friction in the elongated bar hole is small).

The rod diameter of the connecting rod is less than or equal to the aperture of the first elongated hole, if the rod diameter of the connecting rod is larger than the aperture of the first elongated hole, the rotating disk will be stuck in the first elongated hole and cannot rotate Also unable to swipe.

The end of the second positioning pin on the rotating disk is provided with a sleeve, and a rotating shaft is sleeved in the sleeve. The axial direction of the rotating shaft is consistent with the straight line direction of the second positioning pin. the third positioning pin. In this way, the rotation axis can be regarded as the extension of the second positioning pin in the linear direction; the rotation axis is provided with a third positioning pin coplanar with the second positioning pin, if the third positioning pin is directly connected to the rotation shaft, then the third positioning pin The connection position between the three positioning pins and the rotating shaft can be regarded as the intersection position of the straight line where the third positioning pin is located and the line where the second positioning pin is located; if the third positioning pin is indirectly connected to the rotating shaft in a certain way, the intersection point The position should also be located on the axial extension line of the rotary shaft; add the feature that the rotary shaft itself can rotate (the third positioning pin on the rotary shaft will also rotate in corresponding space), so it can be rotated by the second and third pins. The positioning pin defines a plane forming an arbitrary angle with the parallel plane.

Further, the spatial position and angle adjustment mechanism includes

Lifting rod, one end of which is sleeved in the central column of the orthopedic traction frame, and the central column of the orthopedic traction frame is hollow cylindrical;

The horizontal swivel plate is provided with a second strip-shaped hole in the middle of the horizontal swivel plate, and one end in the length direction of the second strip-shaped hole on the horizontal swivel plate is provided with a swivel positioning hole; the second strip-shaped The bar holes are equidistantly clamped at the other end of the elevating rod, and the rod diameter at the other end of the elevating rod is smaller than or equal to the aperture of the second elongated bar hole;

The fine-tuning screw, one end of which is provided with a fine-tuning positioning bar hole corresponding to the screwing positioning hole, and the screwing positioning hole and the fine-tuning positioning bar hole are fixed together by locking the positioning bolt; the other end of the fine-tuning screwing plate Hinged with the positioning plate.

The lifting rod belongs to the height adjustment mechanism,

The second elongated hole in the horizontal swivel plate is equidistantly clamped on the other end of the lifting rod, and the diameter of the other end of the elevating rod is smaller than or equal to the aperture of the second elongated hole. The horizontal swivel plate and the lifting rod adopt a design similar to the first long strip hole of the rotating disk, so that the horizontal rotating plate can rotate and slide relative to the lifting rod. The horizontal swivel plate belongs to the positioning adjustment mechanism of the horizontal distance.

The spatial position of the positioning plate is basically determined by the lifting rod and the horizontal rotary plate, but the spatial orientation of the positioning plate itself, that is, the spatial angle, needs to be adjusted by fine-tuning the rotary joint. The other end of the fine-tuning rotary plate is hinged with the positioning plate to further increase the adjustability of the positioning plate in the space angle; since the rotation angle of the horizontal rotary plate is relatively large and it is inconvenient to fine-tune, it can be manually arranged after the spatial orientation of the positioning plate. Then align the screw connection positioning hole and the fine-tuning positioning bar hole, and then fix it by locking the positioning bolt;

Further, the end of the second positioning pin refers to the end of the second positioning pin away from the orthopedic traction frame.

Since the second positioning pin includes an end away from the orthopedic traction frame and an end close to the orthopedic traction frame; if the sleeve and the rotating shaft are arranged at the end close to the orthopedic traction frame, the third positioning pin is closer to the human body than the second positioning pin , it is inconvenient to manually adjust the axis of rotation (susceptible to the influence of human tissue); what's more, the third positioning pin may be between the legs of a person, and this position will be inconvenient to detect due to the blocking of human tissue; due to the choice of the present invention The end away from the orthopedic traction frame can avoid the influence of the human body itself on the specific operation as far as possible.

Further, the other end of the length direction of the first elongated bar hole on the positioning plate is fixed with a fourth positioning pin, and the fourth positioning pin is in a fixed position with the positioning plate together with the first positioning pin and the second positioning pin. In a parallel plane of the spacing, and the fourth positioning pin is parallel to the first positioning pin.

Further, the third locating pin is arranged in the third locating pin constraint, and the third locating pin constraint is hinged on the rotation shaft.

Now combine the specific working principle of the external collimator for femoral neck fracture screw minimally invasive internal fixation surgery of the present invention to illustrate its technical effect. Assume that the insertion position of the first hollow guide wire is a distance a away from the central axis of the femoral neck on the anterior view, and a distance b away from the central axis of the femoral neck on the lateral view; the insertion position of the second hollow guide wire It is the distance a away from the central axis of the femoral neck on the frontal view, and the distance c away from the central axis of the femoral neck on the lateral view (three internal fixation screws are usually placed in conventional surgery, in order to select the position of two of them conveniently) should be on the same straight line as the frontal image), the following operations are now used to locate this position and the insertion angle that the corresponding hollow guide wire should maintain. (The lateral image and the frontal image are medical imaging terms)

Step 1. First place the patient on the orthopedic traction frame to reduce the fracture, then use the central column of the orthopedic traction frame as a fixed position, adjust the spatial position of the positioning plate through the spatial position and angle adjustment mechanism, so that the first positioning pin approaches from the upper side The femoral part of the human body requires the first positioning pin to enter the area where the C-arm X-ray machine can be irradiated, adjust (rotate or slide) the rotating disk so that the second positioning pin points roughly to the position of the acetabulum or the femoral head, and the second positioning pin is required Also enter the area where the C-arm X-ray machine can be irradiated; use the C-arm X-ray machine to take an orthographic image near the femoral head, and then adjust the three-dimensional space position of the first and second positioning pins through the above adjustment method according to the image, Until the two positioning pins are displayed as a straight line on the anterior view, and the distance between the straight line and the mid-axis of the femoral neck is a; thus the first plane parallel to the mid-axis of the femoral neck is determined (and the parallel distance is a), That is to say, a parallel plane with a certain distance from the positioning plate is adjusted to a plane parallel to the central axis of the femoral neck.

Step 2. Adjust the irradiation head of the C-arm X-ray machine so that the irradiation head is convenient for taking lateral images near the femoral head. The position of the second positioning pin remains unchanged, and the third positioning pin Enter the area that can be irradiated (due to the influence of spatial factors such as the position of the C-arm X-ray machine, the position of the medical staff, and the position of the orthopedic traction frame, it is necessary to use the hinge relationship to adjust the angular relationship between the third positioning pin and the second positioning pin , so as not to affect the operation of medical staff), use the irradiation head of the C-arm X-ray machine to take a lateral image near the femoral head, and adjust the spatial positions of the second and third positioning pins according to the lateral image, and the third positioning pin The adjustment is mainly based on the rotation of the screw shaft until the second and third positioning pins are displayed as a straight line on the image, and the distance between the straight line and the central axis of the femoral neck is b; thus the first position parallel to the central axis of the femoral neck is determined. The two surfaces (and the parallel spacing is b), that is, the surfaces determined by the second and third positioning pins after adjustment.

Because the second positioning pin is in the above-mentioned two planes parallel to the central axis of the femoral neck at the same time, and these two planes parallel to the central axis of the femoral neck are neither the same nor parallel, (a spatial straight line is determined by the two different planes ) Therefore, the straight line direction of the second positioning pin is parallel to the central axis of the femoral neck, and the body surface position pointed by the second positioning pin is the desired distance a from the central axis of the femoral neck on the anterior view, and the distance a from the central axis of the femoral neck on the lateral view. The body surface position of the femoral neck central axis distance b, the spatial angle of the second positioning pin should also be the spatial angle that the hollow guide wire should adopt (in practice, it is advisable for the hollow guide pin to be parallel to the femoral neck central axis).

Step 3: Take out the integrated second positioning pin and the rotating shaft from the sleeve and the sleeve, and put the first hollow guide pin matching the sleeve into the sleeve (from the above, it can be seen that the hollow The direction of the guide pin should be consistent with the direction of the cannula and the second positioning pin, that is, point to the preset insertion position), and then insert the internal fixation nail into the human body through the hollow guide pin; then take out the first hollow guide pin, Slide the rotating disk along the first long strip hole (sliding does not affect the parallel relationship between the axial direction of the sleeve and the central axis of the femoral neck), and the inserted internal fixation nail will come out from the opening through which the internal fixation screw passes; repeat step 2 Step until the second and third positioning pins are displayed as a straight line on the lateral image, and the distance between the straight line and the mid-axis of the femoral neck is c; thus the third plane parallel to the mid-axis of the femoral neck (and parallel to The distance is c), similarly, the position where the second hollow guide pin and the internal fixation nail should be placed can be determined from the first and third planes parallel to the central axis of the femoral neck, and subsequent operations can be performed.

The external collimator for femoral neck fracture screw minimally invasive internal fixation surgery of the present invention can also be provided with a fourth positioning pin, but it replaces the second positioning pin in the first step to determine the first plane parallel to the central axis of the femoral neck, regardless of rotation. No matter how the disk rotates or slides, the second positioning pin should be on the first plane parallel to the central axis of the femoral neck, which does not affect the determination of the second plane parallel to the central axis of the femoral neck, nor does it affect the final technical effect.

When determining the second surface, the second and third positioning needles should adopt the principle of "two intersection lines determine a surface" instead of the method of parallel determination. The positioning pin is placed on the opposite side of the femur (the crotch or the outer femur of the other leg). When taking images, there are occlusions of human tissue, so it is inconvenient to compare whether the two positioning pins are on the same line, and the span is large. After using the positioning plate, it is necessary to adopt a structure similar to the positioning plate to achieve this effect, and the structure is relatively complicated. , the cost increases; the second is to set the second and third positioning pins on the same side of the femur and parallel. According to the above, the distance between the second and third positioning pins will be quite small, and it is also inconvenient to compare the two positioning pins on the view. Whether the needles are in the same straight line.

When determining the placement position of the second hollow guide wire, it is only necessary to determine the third plane parallel to the mid-axis of the femoral neck. Since the first surface has been determined before and the second hollow guide pin is in the same plane as the first hollow guide pin, in the third step, it is only necessary to slide the rotating disk along the first long strip hole, and pass It is enough to observe whether the predetermined distance is reached on the lateral image; in order to avoid slipping due to misoperation and rotating the rotating disk at the same time, so that the space direction of the second hollow guide pin is out of alignment, it is specially marked and rotated on the circumferential side wall of the rotating disk. The engraved lines and characters corresponding to the rotation angle of the disk are equivalent to the function of the scale of the protractor. Observe the relative positional relationship between the reticle and the positioning plate when determining the placement position of the first hollow guide pin. The relative positional relationship between them is used to judge whether the rotation angle of the rotating disk changes.

Practical application of the external collimator for femoral neck fracture screw minimally invasive internal fixation surgery of the present invention only needs two or three times of radiation imaging to determine a surface, and the entire guiding and positioning process only needs to be imaged 5 to 7 times, so it can be safe, effective, Accurate and fast positioning.

Description of drawings

Fig. 1 is a view of the use state of the external collimator and the traction frame of the minimally invasive internal fixation surgery of the femoral neck fracture screw of the present invention.

Fig. 2 is a schematic structural view of the traction frame corresponding to Fig. 1 (the central column of the orthopedic traction frame is drawn).

Fig. 3 is a schematic structural view of an embodiment of an external collimator for cannulated screw internal fixation of proximal femoral fractures according to the present invention (the central column of the orthopedic traction frame is not drawn).

FIG. 4 is a partially enlarged schematic diagram corresponding to FIG. 3 .

Fig. 5 is a structural schematic diagram of the reversed external sight device for cannulated screw internal fixation of proximal femur fracture corresponding to Fig. 3 .

Fig. 6 is a schematic structural view of the external collimator for hollow screw internal fixation of proximal femur fracture of the present invention corresponding to Fig. 3 when the first, second and third positioning pins are in the same straight line.

Fig. 7 is a schematic diagram of the structure of the external collimator for hollow screw internal fixation of proximal femur fracture of the present invention in the state corresponding to Fig. 6 when the locking positioning bolt is removed.

Fig. 8 is a schematic structural diagram of the upper rotary disk corresponding to Fig. 2 .

Detailed ways

As shown in Fig. 1 to Fig. 8, a kind of femoral neck fracture screw minimally invasive internal fixation surgery in vitro sight, used in conjunction with orthopedic traction frame, C-arm X-ray machine, described femoral neck fracture screw minimally invasive internal fixation surgery in vitro sight includes

The central column 1 of the orthopedic traction frame is set on the orthopedic traction frame 2;

Positioning plate 9, the middle part of positioning plate 9 is provided with the first elongated bar hole 21 and the rotating disk 5 that is located on the first elongated bar hole 21, the first elongated bar hole 21 length direction on the positioning plate 9 One end is fixed with a first positioning pin 7, and the rotating disk 5 is fixed with a second positioning pin 10, wherein the first positioning pin 7 and the second positioning pin 10 are in a parallel plane with a certain distance from the positioning plate 9; The end of the second positioning pin 10 on the rotating disk 5 is provided with a sleeve 22, and a rotating shaft 13 is sleeved in the sleeve 22. The axial direction of the rotating shaft 13 is consistent with the straight line direction of the second positioning pin 10. There is a third positioning pin 8 coplanar with the second positioning pin 10; the rotating disk 5 includes an upper rotating disk, a lower rotating disk 14 and a connecting rod between the two, and the second positioning needle 10 is located on the upper rotating disk; The first elongated hole 21 is equidistantly clamped between the upper turntable and the lower turntable 14, and the diameter of the connecting rod is less than or equal to the diameter of the first elongated hole 21;

Wherein the other end of the first elongated bar hole 21 length direction on the positioning plate 9 is fixedly provided with the fourth positioning pin 6, and the fourth positioning pin 6 is in the same position as the first positioning pin 7 and the second positioning pin 10. The plate 9 is in a parallel plane with a certain distance, and the fourth positioning pin 6 is parallel to the first positioning pin 7; the end of the second positioning pin 10 refers to the end of the second positioning pin 10 away from the orthopedic traction frame 2; The third locating pin 8 is arranged in the third locating pin constraint 12 , and the third locating pin constraint 12 is hinged on the rotating shaft 13 .

The spatial position and angle adjustment mechanism is connected between the positioning plate 9 and the central column 1 of the orthopedic traction frame.

Among them, the spatial position and angle adjustment mechanism can take various forms, as a specific implementation mode, such as:

Spatial position and angle adjustment mechanism includes

Lifting rod 3, one end of which is socketed in the central column 1 of the orthopedic traction frame, and the central column 1 of the orthopedic traction frame is hollow cylindrical;

The horizontal rotary plate 4 is provided with a second elongated bar hole 23 in the middle of the horizontal rotary plate 4, and one end of the second elongated bar hole 23 in the length direction of the horizontal rotary plate 4 is provided with a rotary positioning hole 31; The second elongated hole 23 is equidistantly clamped on the other end of the elevating rod 3, and the rod diameter at the other end of the elevating rod 3 is less than or equal to the aperture of the second elongated hole 23;

Fine-tuning screw 24, one end is provided with the fine-tuning positioning bar hole corresponding to described screwing positioning hole 31, and screwing positioning hole 31 and fine-tuning positioning bar hole are fixed together by locking positioning bolt 11; The other end of the plate 24 is hinged to the positioning plate 9 .

Wherein the rotating shaft 13 is connected with the second locating pin 10 as a whole, and a sleeve 33 is arranged on the upper turntable, and the second locating pin 10 is sleeved in the sleeve 33, and the axial direction of the sleeve 33 is aligned with the second locating pin. 10 in the same direction as the straight line, and the sleeve 33 is integrated with the sleeve 22; the encircling side wall of the upper turntable is marked with engraved lines and characters corresponding to the rotation angle of the turntable (Fig. 1 to Fig. 8 are not drawn Out), the side wall of the sleeve 33 is provided with an internal fixation nail passing opening 34 that communicates with the front and rear nozzles of the sleeve 33.

The central column 1 should be set on the orthopedic traction frame 2 at a position corresponding to the mid-span of the human body.

For those skilled in the art, under the premise of not departing from the structure of the present invention, some deformations and improvements can also be made, as these should also be regarded as the protection scope of the present invention, and these will not affect the effect and improvement of the implementation of the present invention. Patent utility.

Claims (4)

1. a fracture of femoral neck screw Wicresoft internal fixation operation vitro gunsight, be used in conjunction with bone traction frame, C type arm X-ray machine, it is characterized in that, described fracture of femoral neck screw Wicresoft internal fixation operation vitro gunsight comprises:

The bone traction frame gin pole, be located on bone traction frame;

Location-plate, the location-plate middle part is provided with the first strip cylindrical void and is located at the rotation disc on the first strip cylindrical void, on location-plate, an end of the first strip cylindrical void length direction is installed with the first positioning needle, be installed with the second positioning needle on rotation disc, wherein the first positioning needle and the second positioning needle are co-located on in location-plate becomes to determine a parallel plane of spacing; On rotation disc, the end of the second positioning needle is provided with sleeve, socket one rotating shaft in sleeve, and rotating shaft axially consistent with the rectilinear direction of the second positioning needle, rotating shaft is provided with three positioning needle coplanar with the second positioning needle; Rotation disc comprises capstan, lower capstan and connecting rod between the two, and described the first strip cylindrical void equidistant clip is held between capstan and lower capstan, and the bar footpath of described connecting rod is less than or equal to the aperture of the first strip cylindrical void;

Locus and angle adjusting mechanism, be connected between location-plate and bone traction frame gin pole;

Wherein rotating shaft and the second positioning needle are connected as a single entity, and upper capstan is provided with sleeve pipe, and described the second positioning needle is socketed in sleeve pipe, sleeve pipe axially consistent with the rectilinear direction of the second positioning needle, and sleeve pipe and described sleeve are connected as a single entity; The hoop sidewall of upper capstan is marked with the groove corresponding with the rotation disc anglec of rotation and character, and described sleeve pipe one sidewall is provided with the internal fixation nail that is communicated with the forward and backward mouth of pipe of sleeve pipe and walks opening;

The first above-mentioned strip cylindrical void equidistant clip is held between capstan and lower capstan, and the strip cylindrical void is located between capstan and lower capstan, and the spacing between upper capstan and lower capstan equals the thickness of strip cylindrical void.

2. fracture of femoral neck screw as claimed in claim 1 Wicresoft internal fixation operation vitro gunsight, is characterized in that, the end of described the second positioning needle refers to the end of the second positioning needle away from bone traction frame.

3. fracture of femoral neck screw as claimed in claim 1 Wicresoft internal fixation operation vitro gunsight, it is characterized in that, on described location-plate, the other end of the first strip cylindrical void length direction is fixed with the 4th positioning needle, described the 4th positioning needle and the first positioning needle, the second positioning needle one are in together with in location-plate becomes to determine a parallel plane of spacing, and the 4th positioning needle parallels with the first positioning needle.

4. fracture of femoral neck screw as claimed in claim 1 Wicresoft internal fixation operation vitro gunsight, is characterized in that, described the 3rd positioning needle is located in the 3rd positioning needle attaching means, and described the 3rd positioning needle attaching means is hinged on rotating shaft.

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