CN103800109A - Improved Halo frame and method for assisting in lower cervical vertebrae unilateral zygopophysis blocage reduction using improved Halo frame - Google Patents

Abstract

The invention discloses an improved Halo frame, which includes a brace vest, a head ring and an adjustable bracket, the head ring is connected with the brace vest through an adjustable bracket, and the adjustment bracket includes 8 screws, wherein A , A` is the front screw, B, B` is the rear screw, A, A`, B, B` correspond to the lower part of the bracket is a spherical shaft, and the A, A`, B, B` screws are respectively facing On the left and right sides of the support vest, C and C' are the screws on the front, D and D' are the screws on the back, and the head ring has some fixing screws. The invention also discloses a method for using the Halo frame to assist the interlocking reduction of the unilateral articular process of the lower cervical spine. Adopting the present invention can effectively complete the reset of the interlocked unilateral articular process of the lower cervical spine, and at the same time can effectively avoid damage to the spinal cord, and can effectively avoid damage to the human body caused by the fixing screws of the head ring and the screws on the adjusting bracket during use; the air permeability is strong , will not cause skin inflammation and ulceration, and its materials can meet the needs of nuclear magnetic resonance.

Description

Improved Halo frame and its method for assisting interlocking reduction of unilateral articular process of lower cervical spine

technical field

The invention relates to a method for using a medical device, in particular to a method for assisting the interlocking reduction of the unilateral articular process of the lower cervical spine with an improved Halo frame.

Background technique

The Halo-vest frame is a three-dimensional strong cervical external fixation frame, which has the characteristics of lightness, safety, firm fixation, and high reduction rate. Because it is self-controlled traction, you can get up and move around after surgery, which solves the pain of long-term bed rest for patients with skull traction. The synergistic effect of traction and immobilization does not restrict the early activities of the patient, which is conducive to early rehabilitation.

The Halo-vest frame is currently the only external fixation brace that can maintain the stability of the cervical spine in three dimensions. It can maintain the stability of the cervical spine during emergency transport, early diagnosis and treatment, preoperative, intraoperative, postoperative, and early rehabilitation training, and is beneficial to the survival of the cervical spine. Spinal nerve function recovery, intervertebral bone fusion and spinal fracture healing. After Halo-vest fixation, the patient can move freely, which solves the inconvenience caused by the patient lying on the bed and traction.

There are several deficiencies in the use of the existing Halo-vest frame. First, the bracket of the Halo-vest frame is made of metal material, which is not suitable for MRI examination, which limits the review of patients with cervical spinal cord injury; secondly, the vest of the bracket is airtight and long. Wearing it for a long time will cause inflammation or even ulceration of the skin on the patient's back; third, the end of the screw under the adjustment bracket protrudes toward the chest and back, which is easy to cause pressure sores on the human skin and even deep tissues; fourth, the fixation of the head ring of the traditional Halo-vest frame The screw is outside and is too close to the temple of the human head. The temple is the weakest part of the human skull. Therefore, fixing the screw may cause serious trauma to the person.

The injury mechanism of cervical unilateral articular process interlocking is that the cervical spine suffers from axial rotational violence in the state of flexion and side bending, which makes the lower joint of the upper vertebral body of the injured segment jump to the front of the upper articular process of the lower vertebral body and then connects muscles and ligaments. Intervertebral discs and other soft tissues squeeze each other under the elastic recovery action to cause interlocking; or collide with each other and separate under the action of violence to cause fracture or dislocation. These injuries are all injuries involving the three columns of the cervical spine, and the intervertebral discs, anterior and posterior longitudinal ligaments, joint capsules, interspinous, supraspinous ligaments, and ligamentum flavum of the dislocated segment are all damaged to varying degrees. Spinal fusion is required to stabilize the injured segment after reduction, and at the same time complete nerve decompression or avoid delayed spinal cord injury caused by segmental instability caused by dislocation.

At present, the treatment methods for unilateral articular process locking of the lower cervical spine are mainly closed reduction with skull traction and open reduction with surgery. Closed reduction of lower cervical articular process locking by cranial traction is a commonly used method in most hospitals in China. The effect of skull traction on bilateral lower cervical articular process locking is better, but the success rate of unilateral articular process locking is only 22%. %. The reasons for the failure of closed reduction were analyzed. Skull traction transmits traction force through ropes, and the neck is mostly in a fixed flexion position, which cannot correct the rotational deformity of unilateral articular process interlocking. The traditional Halo frame assisted closed reduction method, or by pulling the skull fixation ring, the force is broken down by the bracket behind the fixation ring, which is far inferior to skull traction; or by stretching the threaded rods on both sides upwards, the stretching distance is limited, and It is also in a fixed position, and the rotation cannot be corrected. Most of the reductions are unsuccessful. When there are facet fractures, soft tissue embedded, and old interlocking, the difficulty of reduction is increased; moreover, during the closed reduction process of skull traction, the patient The neck is basically in a certain fixed flexion position. The spinal cord may be stretched along with the vertebral body and rear facet joints. There is a large intervertebral disc herniation in front of the spinal cord. Excessive traction may aggravate the compression of the spinal cord . Surgical reduction includes posterior reduction, anterior reduction and combined anterior and posterior reduction. The disadvantage of posterior reduction is that if there is traumatic intervertebral disc herniation in front of the spinal cord, posterior reduction may aggravate spinal cord injury, which is very dangerous. Reduction surgery significantly increases the trauma to the patient.

Patients with unilateral articular process locking of the lower cervical spine are mostly incomplete paraplegia. Successful surgery can achieve better results, and safe and effective reduction is the key to successful surgery. However, its injury mechanism includes both corrective flexion and rotation factors, and clinical reduction is more difficult than bilateral articular process locking. Due to the uncontrollable rotation of the skull, the success rate of closed reduction is low, and it is difficult to achieve safe reduction with conventional Halo frame fixation.

Contents of the invention

The technical problem to be solved by the present invention is to provide an improved Halo frame, including a brace vest, a head ring and an adjustable bracket, the head ring is connected with the brace vest through an adjustable bracket, and the adjustment bracket includes 8 screws, among them, A, A` are screws for front and bottom, B, B` are screws for back and down, A, A`, B, B` correspond to the lower part of the bracket is a spherical shaft, said A, A`, B , B`screws are facing the left and right sides of the brace vest, C, C` are the screws on the front, D, D` are the screws on the back, and the head ring has several universal connectors, located on the head ring The distance between the fixing screws on the side of A, A` and C, C` is 3~6cm.

Further, the head ring and the adjustment bracket are made of carbon fiber.

Further, the brace vest is provided with several ventilation holes.

Furthermore, the brace vest is composed of a waterproof and breathable material, and the waterproof and breathable material mainly consists of three layers: PP spunbonded non-woven fabric, PE polymer breathable film, and PP spunbonded non-woven fabric. The function of spunbonded non-woven fabric is mainly to enhance the tensile force and hydrostatic pressure and protect the middle layer (breathable film). The real breathability mainly depends on the middle layer PE polymer breathable film.

The method of using the above-mentioned Halo frame to assist the interlocking reduction of the unilateral articular process of the lower cervical spine includes the following steps:

Correction of flexion dislocations:

1) Loosen the bolts A, A`, B, B`, D, D`, lift up the two bolts connected to the support rod corresponding to DD` at the same time, then tighten DD`, so that the rear end of the cervical spine is lifted;

2) Loosen the bolt CC`, lift and tighten the two bolts connected to the support rod corresponding to CC` at the same time, so that the front end of the cervical spine is lifted;

3) Use X-ray fluoroscopy to observe the reset situation and repeat steps 1 and 2 until the X-ray fluoroscopy shows that the inferior articular process of the upper cervical vertebra is aligned with the supravertebral notch of the next cervical vertebra;

To correct a rotational dislocation:

4) Release CC` and DD` at the same time, depress the normal side of the cervical spine, and lift up the side with the articular process, so that the lower articular process of the previous cervical vertebra is inserted into the subvertebral notch of the next cervical vertebra. Complete the reset.

When resetting, it should be ensured that the adjustment range of the Halo frame is not too large during operation, so as to avoid further damage caused by excessive flexion and extension of the cervical spine, specifically:

The lifting distance of the bolts in the step 1 is 2-3 cm.

The lifting distance of the bolts in the step 2 is 2-4cm.

The distance of pressing down in step 4 is 2 to 3 cm.

The lifting distance in step 4 is 1-2 cm.

Further, after the cervical spine is reset, if the cervical traction height is low, the Halo-vest bracket can be removed directly, otherwise, the height of the head ring and the brace vest will be gradually reduced according to the steps opposite to steps 1 and 2 to restore the cervical spine to normal height and curvature.

After C-arm X-ray fluoroscopy showed successful reduction, the Halo-vest stent was removed, general anesthesia was performed immediately with tracheal intubation, and anterior cervical decompression, fusion and internal fixation were performed. For patients with mild vertebral body injury, simple intervertebral discectomy + intervertebral fusion plate internal fixation was performed; for patients with severe vertebral body injury, subtotal vertebral body resection + titanium cage bone graft plate internal fixation was performed.

Furthermore, postoperative routine treatment, wearing a neck collar for 8 to 12 weeks.

It should be noted that the closed reduction method of the present invention is carried out in the patient's awake state, and the patient's vital signs can be closely observed during the reset in the awake state. Protect the nerve function. If the patient experiences numbness in the limbs, severe and intractable neck or upper limb pain during the closed reduction process and cannot tolerate it, the closed reduction should be abandoned and surgical reduction and internal fixation should be used as the basis for adjusting the open reduction. Secondary spinal cord injury.

Implement the present invention, have following beneficial effect:

The improved Halo frame of the present invention can effectively avoid damage to the human body caused by the fixing screws of the head ring and the screws on the adjusting bracket; it has strong air permeability and will not cause skin pressure sores to fester during use, and its material can also meet the needs of nuclear magnetic resonance . The dislocated articular process can be effectively stretched through multiple flexion-extension activities. When the C-arm fluoroscopy shows that the reset has reached "tip-to-tip", by depressing the healthy side, the articular process on the affected side can be naturally oriented. The upper back is tilted and rotated to obtain a reset; during multiple flexion-extension processes, the articular process and the vertebral body are at the opposite edge, the range of motion is large during the flexion-extension process, and the spinal cord is at the center Position, according to the principle that the axis is relatively stable during the rolling process, the change of the spinal cord is the smallest during the reset process, so the possibility of spinal cord damage is the smallest. In the process of correcting the rotational displacement, the peripheral bone Structure and facet joints are equivalent to the periphery of the bearing, and the dural sac and spinal cord inside are equivalent to the fixed axis of the bearing. During the process of rotation and reduction, the central axis is relatively stable, so the spinal cord can be protected from damage. At the same time, the reduction is completed under the monitoring of the middle perspective, which can effectively reduce the secondary spinal cord injury.

Description of drawings

Fig. 1 is the structural representation of the improved Halo frame of the present invention;

Figure 2 is a schematic diagram of the interlocking of the right articular process of cervical vertebra C5-6;

Fig. 3 is a schematic diagram of the lower articular process of the upper cervical vertebra aligning with the supravertebral notch of the next cervical vertebra during the reduction process;

Fig. 4 is a schematic diagram of the completion of reduction by interlocking of the facet joints;

Fig. 5 is a schematic diagram of cervical curvature recovery.

Detailed ways

In order to make the purpose, technical solution and advantages of the present invention clearer, the present invention will be further described below in conjunction with the accompanying drawings.

As shown in Fig. 1, the Halo frame that the present invention adopts is improved on the basis of traditional structure, comprises brace vest 1, head ring 2 and adjustable support 3, and described head ring 2 is connected with adjustable support 3 The brace vest 1 is connected, and the adjustment bracket 3 includes eight screws 5, wherein A, A' represent the front and lower screws, B, B' represent the rear and lower screws, and C, C' represent the front and upper screws , D, D` represent the screws on the back.

This embodiment also includes a connector 4, which may be a universal connector formed by connecting two unidirectional connector shafts, or may be a spherical shaft connection as shown in the figure. Its function is to prevent the screw 41 from directly contacting the skin of the human body, and prevent the edge or sharp point of the screw 41 from squeezing the skin and causing damage. Two or four connectors are installed on the front and back of the brace vest 1, and two or four connectors are used to connect the adjustment bracket 3 and the head ring 2, so as to realize the adjustment of the head ring 2, the adjustment bracket 3 and the support bracket. Flexible adjustment of vest 1.

The connector 4 used in this embodiment is not limited to the solution shown in the figure, and may also be other universal connection devices with similar functions commonly used by those skilled in the art or on the market.

Preferably, in this embodiment, the brace vest is provided with several ventilation holes.

The method of using the Halo frame described in Figure 1 to assist in the reduction of the unilateral articular process locking of the lower cervical spine (as shown in Figure 2) includes the following steps:

1) Loosen the bolts A, A`, B, B`, D, D`, lift up the two bolts connected to the support rod corresponding to DD` at the same time, then tighten DD`, so that the rear end of the cervical spine is lifted;

2) Loosen the bolt CC`, lift and tighten the two bolts connected to the support rod corresponding to CC` at the same time, so that the front end of the cervical spine is lifted;

3) Use X-ray fluoroscopy to observe the reset situation and repeat steps 1 and 2 until the X-ray fluoroscopy shows that the inferior articular process of the upper cervical vertebra is aligned with the supravertebral notch of the next cervical vertebra, as shown in Figure 3;

4) Release CC` and DD` at the same time, depress the normal side of the cervical spine, and lift up the side with the articular process, so that the lower articular process of the previous cervical vertebra is inserted into the subvertebral notch of the next cervical vertebra. Complete the reset, as shown in Figure 4.

When resetting, it should be ensured that the adjustment range of the Halo frame is not too large during operation, so as to avoid further damage caused by excessive flexion and extension of the cervical spine, specifically:

The lifting distance of the bolts in the step 1 is 2-3 cm.

The lifting distance of the bolts in the step 2 is 2-4cm.

The distance of pressing down in step 4 is 2 to 3 cm.

The lifting distance in step 4 is 1-2 cm.

Further, after the cervical spine is reset, if the cervical traction height is low, the Halo-vest bracket can be removed directly, otherwise, the height of the head ring and the brace vest will be gradually reduced according to the steps opposite to steps 1 and 2 to restore the cervical spine to normal height and curvature, as shown in Figure 5.

Example

From May 2009 to May 2013, a total of 12 cases were treated and adopted (2 cases were transformed into unilateral lock during the process of closed reduction of bilateral facet lock). Among them, there were 7 males and 5 females; their age ranged from 22 to 56 years (mean, 34 years). Causes of injury were high in 5 cases, traffic accident in 4 cases, fall in 2 cases, and heavy object in 1 case. Segments involved by lesions: 5, 1, 4, and 2 cases at C6-7, C5-6, C4-5, and C3-4, respectively. The neurological evaluation was performed according to the Frankel score on admission, including 2 cases of grade E, 2 cases of grade D, 4 cases of grade C, 2 cases of grade B, and 2 cases of grade A. Combined injuries: 7 cases of vertebral fractures, 4 cases of articular process fractures, 3 cases of spinous process lamina fractures, 1 case of atlantoaxial subluxation; 3 cases of craniocerebral trauma; 3 cases of intervertebral disc rupture at the injured segment; MR showed spinal cord There were 9 cases of abnormal signal; the time from injury to admission was 1 hour to 32 days, with an average of 4 days; the distance from closed reduction to injury was 1 day to 35 days.

The above-mentioned 12 patients with unilateral articular process interlocking of the lower cervical spine adopt the assisted reduction method of the present invention using the improved Halo frame, and the minimum time required for reduction is 40 minutes, and the longest time is 110 minutes (average 65 minutes). After successful closed reduction, 8 cases underwent anterior simple discectomy + intervertebral fusion plate fixation, and 4 cases underwent anterior subtotal vertebral body resection + titanium cage bone grafting plate fixation. All cases were successfully operated, and no operation-related complications occurred. Frankel score showed that there was no significant difference in neurological function score between the day before operation and the day after operation, indicating that closed reduction and surgery did not lead to aggravation of spinal cord nerve damage.

All 12 cases were followed up from 3 months to 24 months after operation (average 19.9 months). All cases were not followed up 2 years after operation. One of the 2 cases with Frankel grade A had no recovery of neurological function in postoperative follow-up, and the other cases showed an improvement of average grade 2 neurological function. One case showed syringomyelia. The specific neurological function score results are shown in Table 1.

Table 1 Neurological Frankel score results

Franke Grading A B C D. E. Preoperative 2 2 4 2 2 The day after surgery 1 2 5 2 2 last follow-up 1 0 2 3 6

X-ray films showed that all 12 cases achieved solid bony fusion; the intervertebral height, physiological curvature, and stability of the cervical spine recovered well; no complications such as plate and screw loosening, slippage, and fracture occurred. It works well in restoring and maintaining the physiological curvature of the cervical spine.

In this group, 12 consecutive cases were reset by this method, and no case of reset failure has been found. Among them, 4 cases were combined with articular process fracture, which was also successful. Clinical practice has proved that the improved reset technique is reliable. The main reason is that the Halo frame assisted reduction, which can not only correct the flexion dislocation with distraction, but also effectively control the rotation.

The above description is a preferred embodiment of the present invention, and it should be pointed out that for those skilled in the art, without departing from the principle of the present invention, some improvements and modifications can also be made, and these improvements and modifications are also considered Be the protection scope of the present invention.

Claims (9)

1. an improvement Halo frame, comprise brace vest, headring and adjustable support, described headring couples together by adjustable support and described brace vest, it is characterized in that, described adjusting support comprises 8 screws, wherein A, A` is front lower screw, B, B` is the screw under rear, A, A`, B, the support below that B` is corresponding is spherical rotating shaft, described A, A`, B, B` screw is respectively towards the left and right sides of brace vest, C, C` is front upper screw, D, D` is the screw on rear, described headring has some joint couplings, be positioned at described headring A, A` and C, the hold-down screw spacing of C` mono-side is 3 ~ 6cm.

2. Halo frame according to claim 1, is characterized in that, described headring and adjusting support are that carbon fibre or titanium alloy form.

3. Halo frame according to claim 1, is characterized in that, described brace vest offers several air-vents.

4. right to use requires the method that described in 1, the auxiliary lower unilateral cervical facet of Halo frame resets, and it is characterized in that, said method comprising the steps of:

The dislocation of rectification flexing:

1) unclamp bolt A, A`, B, B`, D, D`, upwards tighten DD` after lifting by being connected to two pieces of bolts corresponding with DD` on support bar simultaneously;

2) unclamp bolt CC`, after being connected to two pieces of bolts lifting simultaneously corresponding with CC` on support bar, tighten;

3) operate by X-ray examination observation reset case repeating step 1 step 2, until show that by X-ray examination the inferior articular process of a cervical vertebra in articular process aims at the superior vertebral notch of next cervical vertebra;

Correct rotatory dislocation

4) unclamp CC` and DD` simultaneously, under the normal side direction of cervical vertebra, force down, suffer from a side of articular process and lift, make cervical vertebra reposition.

5. method according to claim 1, is characterized in that, the distance of the lifting of bolt described in step 1 is 2 ~ 3cm.

6. method according to claim 1, is characterized in that, the distance of the lifting of bolt described in step 2 is 2 ~ 4cm.

7. method according to claim 1, is characterized in that, the distance pressing down in step 4 is 2 ~ 3cm.

8. according to the method described in claim 1 or 4, it is characterized in that, the distance of lifting in step 4 is 1 ~ 2cm.

9. method according to claim 1, is characterized in that, cervical vertebra completes after reset according to the height that reduces gradually described headring and described brace vest with step 1,2 contrary steps and makes cervical vertebra reply normal height and curvature.

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