CN104644254B - Cervical vertebra fracture dislocation anterior approach reduction internal fixation system - Google Patents

Abstract

An anterior reduction and internal fixation system for cervical fracture and dislocation, comprising a reducer and a matching fixed steel plate, the reducer includes a column, a fixed vertebral body screw, and a movable vertebral body screw, and the fixed vertebral body screw is fixed and installed on the column through a fixing seat The movable vertebral body nail is installed on the column through the movable seat. The movable vertebral body nail can move up and down relative to the fixed vertebral body nail, and can also move left and right, and can also rotate around the movable seat. The fixed steel plate is installed outside the resetter. The present invention can not only adjust the vertical position of the movable vertebral body nail on the upright column and the horizontal position relative to the upright column, but also can adjust the angle of the movable vertebral body nail relative to the upright column, so that the lower cervical spine fracture and dislocation can be reset through the anterior approach of the cervical spine And fixation, especially suitable for patients with complex articular process interlocking type of vertebral dislocation, the reduction and fixation is safe and reliable, and can reduce the difficulty of operation at the same time.

Description

An anterior reduction and internal fixation system for cervical fracture and dislocation

technical field

The invention relates to a medical device, in particular to an anterior reduction and internal fixation system for cervical vertebra fracture and dislocation.

Background technique

With the development of social economy and the change of people's lifestyle, the incidence of acute trauma such as traffic accident injury, high fall injury and sports injury continues to rise. Due to the characteristics of the anatomical structure of the cervical spine, cervical spine trauma is the most dangerous of all kinds of trauma, with a high mortality rate and many sequelae such as high paraplegia. Among them, cervical spine fracture and dislocation is a common type of cervical spine injury, which may cause high paraplegia or even death due to compression of the spinal cord nerves, and often requires surgical reduction and fixation.

The human cervical spine is composed of 7 vertebrae, among which the 3rd-7th vertebrae are more consistent in shape, so the 3rd-7th vertebrae of the cervical spine are often called the lower cervical vertebrae. Each cervical vertebra is composed of two parts: the vertebral body and the posterior vertebral arch. The vertebral body is an oval columnar body, connected to the vertebral body is the vertebral arch, and the two together form the vertebral foramen. All the vertebral foramina connect to form the spinal canal, which contains the cervical spinal cord. The vertebral artery runs through the vertebral artery foramen in the vertebral arch, and finally enters the brain through the foramen magnum to participate in the blood supply to the back of the brain. Although the cervical vertebrae have the smallest volume in the entire spine, they are the segment with the greatest flexibility, the highest frequency of activities, and relatively heavy loads.

Viewed from the front view, the vertebrae of the lower cervical spine are symmetrical and neatly arranged, and the vertebral bodies are connected by intervertebral discs and hook vertebral joints. Viewed from the side, the vertebrae of the lower cervical spine are evenly arranged and in an orderly sequence, and the vertebrae are connected by intervertebral discs, facet joints, and supraspinous interspinous ligaments. Among them, the facet joint is composed of the inferior articular process of the upper vertebra and the superior articular process of the upper joint, and the former covers the latter in an imbricate shape, as shown in Figures 1 and 2.

In the case of a fracture-dislocation of the lower cervical spine, the relationship between the individual vertebrae changes, the neat rows of the sequence are disrupted, especially the facet joints. With the displacement of the vertebrae, the soft tissues of the surrounding intervertebral discs, joint capsules, ligaments, and tendons are also damaged to varying degrees, as shown in Figure 3. Fracture and dislocation of the lower cervical spine often occurs in the following situations, not only the vertebral body is displaced, but also the facet joint behind the vertebral body is also misaligned: the lower facet joint of the upper vertebra no longer covers the upper facet facet of the lower vertebrae, that is, the joint Sudden lock (as shown in Figure 4). Facet locks can be unilateral or bilateral.

At present, the treatment method for fracture and dislocation of the lower cervical spine needs to be determined according to the degree of dislocation, the patient's expectation, whether there is articular process locking, and other factors. For mild cervical dislocation without facet locking, try conservative treatment such as cranial traction for reduction. However, the reduction rate of traction is low, and the traction time may be as long as several months, which makes the patients miserable. Surgical treatment of lower cervical dislocation, especially cervical dislocation with facet joint locking, currently there is no reduction and fixation system dedicated to the anterior cervical spine at home and abroad, and it is impossible to complete the reduction and fixation of the cervical spine only through the anterior cervical approach. At present, both at home and abroad, the combination of anterior and posterior approaches is used to perform the release and decompression of the dislocated vertebral body through the anterior approach, and to expose the interlocked articular process through the posterior approach, and to resect or pry the articular process to complete the vertebral body reduction. Finally, fix the cervical spine through the posterior or anterior approach depending on the situation. This kind of operation is not only extremely traumatic, but also requires extremely high surgical skills of the surgeon; at the same time, the stability of the cervical spine will be affected to a certain extent due to the resection of the rear interlocked articular process. During the process, there is a risk of aggravated dislocation and spinal cord injury.

Contents of the invention

The present invention aims to provide an anterior reduction and internal fixation system for cervical fracture and dislocation, which can complete the reduction and fixation of the lower cervical dislocation through the anterior approach of the cervical spine, especially for patients with complicated joint interlocking vertebral dislocations, the reduction and fixation is safe and reliable, At the same time, it can also reduce the operation difficulty of the operation.

An anterior reduction and internal fixation system for fracture and dislocation of the cervical spine, comprising a reducer and a matching fixed steel plate, the reducer includes a column, a fixed vertebral body nail, and a movable vertebral body screw; a rack is provided on one side of the column; The fixed cone nail is vertically fixed and installed on the column through the fixed seat; the movable vertebral nail is installed on the column through the movable seat; the vertical adjustment gear on the movable seat engages with the rack on the column, and the vertical adjustment knob It is connected with the vertical adjustment gear; the movable seat is equipped with a horizontal rack seat, and the horizontal rack is movably installed in the horizontal rack seat. On the horizontal rack, the horizontal adjustment knob is connected with the horizontal adjustment gear, the horizontal rack seat is installed on the movable seat through the rotating shaft, and the horizontal rack seat can rotate around the axis of the rotating shaft; an angle adjustment gear is installed on the movable seat , the angle adjustment gear meshes with the gear or ring gear fixedly installed on the horizontal rack seat, and the angle adjustment knob is connected with the angle adjustment gear; the fixed steel plate is arranged outside the reset device, and the fixed steel plate is rectangular, with screw holes at the four corners , there is a gap in the middle of the upper and lower edges for the passage of fixed vertebral body nails and movable vertebral body nails.

Further, a vertical positioning claw is installed on the movable seat, and the claw head of the vertical positioning claw can be snapped into the tooth groove of the column rack. The position of the movable seat on the column can be fixed by vertically locating the claws.

Further, a horizontal positioning claw is installed on the horizontal rack seat, and the claw head of the horizontal positioning claw can be snapped into the tooth groove of the horizontal rack. The position of the horizontal rack on the horizontal rack seat can be fixed by the horizontal positioning claw.

Further, positioning pins are provided on the horizontal rack seat, and pin holes are provided on the movable seat. By inserting the positioning pin into the pin hole, the rotation angle of the horizontal rack seat relative to the movable seat is fixed.

Further, the horizontal rack is provided with a through hole in the longitudinal direction, and the movable vertebral body nail passes through the through hole and is fixed on the horizontal rack by a nut at the tail.

Further, part of the fixed steel plate is hollowed out, which is convenient for observing the position of the bone graft block or the titanium mesh.

Further, the fixed steel plate is a titanium alloy steel plate, and there is a gap in the middle of the upper and lower edges.

The present invention can not only adjust the vertical position of the movable vertebral body nail on the upright column and the horizontal position relative to the upright column, but also can adjust the angle of the movable vertebral body nail relative to the upright column, so the reduction and restoration of the lower cervical vertebral dislocation can be completed through the anterior approach of the cervical spine. Fixation is especially suitable for patients with complex interlocking vertebral dislocations. The reduction and fixation are safe and reliable, and can reduce the difficulty of operation at the same time.

Description of drawings

Figure 1 is a schematic front view of the normal lower cervical spine.

Figure 2 is a schematic side view of the normal lower cervical spine.

Figure 3 is a schematic diagram of a simple dislocation of the lower cervical spine.

Fig. 4 is a schematic diagram of interlocking of the articular process of the lower cervical vertebrae.

Fig. 5 is a schematic diagram of the structure of the present invention.

Fig. 6 is a schematic left view of the structure shown in Fig. 5 .

Fig. 7 is a structural schematic diagram of the inventive resetter.

Fig. 8 is a schematic diagram of the partial structure of the horizontal adjustment gear and the horizontal rack in the present invention.

Fig. 9 is a schematic diagram of the use of the present invention.

In the figure: 1-fixed vertebral body nail, 2-upright column, 3-angle adjustment gear, 4-gear or ring gear, 5-horizontal rack, 6-movable vertebral body nail, 7-horizontal adjustment gear, 8-movable seat , 9-fixed steel plate, 10-fixed seat, 11-angle adjustment knob, 12-horizontal rack seat, 13-horizontal adjustment knob, 14-vertical adjustment gear, 15-vertical adjustment knob, 16-vertical positioning claw, 17 -Horizontal positioning jaws, 18-rotation shaft, 19-hollowout.

detailed description

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

As shown in Figures 5-8, an anterior reduction and internal fixation system for cervical fracture and dislocation of the present invention includes a reducer and a matching fixed steel plate 9, and the reducer includes a column 2, a fixed vertebral body screw 1, and a movable vertebral body screw 6. There is a rack on one side of the column 2; the fixed cone nail 1 is vertically fixed and installed on the column 2 through the fixed seat 10; the movable vertebral body nail 6 is installed on the column 2 through the movable seat 8 ; The vertical adjustment gear 14 is engaged with the rack on the column 2 on the movable seat 8, and the vertical adjustment knob 15 is connected with the vertical adjustment gear 14; the horizontal rack seat 12 is installed on the movable seat 8, and the horizontal rack 5 Movably installed in the horizontal rack seat 12, the movable seat 8 is equipped with a horizontal adjustment gear 7 meshing with the horizontal rack 5, the movable vertebral body nail 6 is installed on the horizontal rack 5, the horizontal adjustment knob 13 and the horizontal adjustment gear 7 Connected; the horizontal rack seat 12 is installed on the movable seat 8 through the rotating shaft 18, and the horizontal rack seat 12 can rotate around the axis of the rotating shaft 18; an angle adjustment gear 3 is installed on the movable seat 8, and the angle adjustment gear 3 Meshes with the gear or ring gear 4 fixedly installed on the horizontal rack seat 12, the angle adjustment knob 11 is connected with the angle adjustment gear 3; the fixed steel plate 9 is arranged outside the reset device, and the fixed steel plate 9 is rectangular, with screws at the four corners Each hole has a gap in the center of the upper and lower edges for the passage of the fixed vertebral body nail 1 and the movable vertebral body nail 6.

Through the angle adjustment knob 11, the rotation angle of the movable vertebral nail 6 around the movable seat 8 on the column 2 can be adjusted.

Through the vertical adjustment knob 15, the vertical adjustment gear 14 can be driven to move up and down along the rack on the column 2, thereby adjusting the vertical position of the movable vertebral body nail 6.

Through the horizontal adjustment knob 13, the horizontal adjustment gear 7 can be rotated to drive the horizontal rack 5 to move left and right in the horizontal rack seat 12, thereby adjusting the position of the movable vertebral body nail 6 in the horizontal direction.

Further, a vertical positioning claw 16 is installed on the movable seat 8 , and the claw head of the vertical positioning claw 16 can be snapped into the tooth groove of the column 2 rack. The position of the movable seat 8 on the column 2 can be fixed by vertically positioning the claw 16 .

Further, the horizontal positioning claw 17 is installed on the horizontal rack seat 12 , and the claw head of the horizontal positioning claw 17 can be snapped into the tooth groove of the horizontal rack 5 . The position of the horizontal rack 5 on the horizontal rack seat 12 can be fixed by the horizontal positioning claw 17 .

Further, positioning pins are provided on the horizontal rack seat 12 , and pin holes are provided on the movable seat 8 . By inserting the positioning pin into the pin hole, the rotation angle of the horizontal rack seat relative to the movable seat is fixed.

Further, the horizontal rack 5 is provided with a through hole in the longitudinal direction, and the movable vertebral body nail 6 passes through the through hole and is fixed on the horizontal rack 5 by a nut at the tail.

Further, part of the fixed steel plate 9 is hollowed out, which is convenient for observing the position of the bone graft block or the titanium mesh.

Further, the fixed steel plate 9 is a titanium alloy steel plate with a gap in the middle of the upper and lower edges.

The present invention is mainly aimed at patients with lower cervical dislocation, especially patients with complex articular process interlocking type of vertebral dislocation. When used:

If the patient is anteriorly fixed with simple dislocation of the lower cervical spine, first place the fixed vertebral body nail 1 of the reducer into the normal vertebral body, then place the movable vertebral body nail 6 into the dislocated vertebral body, and adjust the space between the movable seat 8 and the fixed seat 10 After the distance is appropriate, put the fixed vertebral body screw 1 and the movable vertebral body screw 6 into the fixed seat 10 and the movable seat 8 respectively and fix the screws properly with nuts, and then adjust the movable vertebral body screw 6 horizontally to reset the dislocated vertebral body. After interstitial bone grafting, the movable seat 8 is moved vertically toward the fixed column 10 to pressurize the intervertebral space, and a steel plate is placed for fixation.

If the patient suffers from fracture and dislocation of the lower cervical spine with articular process locking, as shown in Figure 9, the first step is to place the restorer fixed vertebral body nail 1 into the normal vertebral body, and then place the movable vertebral body nail 6 into the facet facet joint lock. Lock the dislocated vertebral body, after adjusting the distance between the movable seat 8 and the fixed seat 10, place the fixed vertebral body screw 1 and the movable vertebral body screw 6 into the fixed seat 10 and the movable seat 8 respectively and fix the screws properly with nuts, As shown in Figure 9a; in the second step, the movable vertebral body nail 6 is rotated first, so that the movable vertebral body nail 6 rotates an angle around the movable seat 8 from the horizontal position, and the joints of the facet joints are unlocked, as shown in Figure 9b; The third step is to horizontally adjust the movable vertebral body nail 6 to reset the vertebral body, as shown in Figure 9c; the fourth step is to move the movable seat 8 to the direction of the fixed column 10 to pressurize the intervertebral space after bone grafting in the intervertebral space. As shown in Figure 9d; the fifth step is to place a fixed steel plate, as shown in Figure 9e.

The invention can complete the reduction and fixation of cervical dislocation only through the simple anterior cervical approach, has small operation trauma, is easy to operate, is safe and reliable, reduces the cost of patients, and has wide application prospects.

Certainly, the present invention also can have other various embodiments, without departing from the spirit and essence of the present invention, those skilled in the art can make various corresponding changes and deformations according to the present invention, but these corresponding changes All changes and modifications should belong to the scope of protection of the appended claims of the present invention.

Claims (7)

1. An anterior reduction and internal fixation system for cervical fracture and dislocation, characterized in that: it comprises a resetter and a supporting fixed steel plate (9), and the resetter includes a column (2), a fixed vertebral body nail (1), a movable vertebral body body nail (6); one side of the column (2) is provided with a rack; the fixed vertebral body nail (1) is vertically fixed and installed on the column (2) through the holder (10); the movable vertebra The body nail (6) is installed on the column (2) through the movable seat (8); the vertical adjustment gear (14) is arranged on the movable seat (8) to mesh with the rack on the column (2), and the vertical adjustment knob (15 ) is connected with the vertical adjustment gear (14); a horizontal rack seat (12) is installed on the movable seat (8), and the horizontal rack (5) is movably installed in the horizontal rack seat (12), and the movable seat ( 8) The horizontal adjustment gear (7) is installed on the top to mesh with the horizontal rack (5), the movable vertebral nail (6) is installed on the horizontal rack (5), the horizontal adjustment knob (13) and the horizontal adjustment gear (7) connected; the horizontal rack seat (12) is installed on the movable seat (8) through the rotating shaft (18), and the horizontal rack seat (12) can rotate around the axis of the rotating shaft (18); on the movable seat (8) An angle adjustment gear (3) is installed, and the angle adjustment gear (3) meshes with a gear or ring gear (4) fixedly installed on the horizontal rack seat (12), and the angle adjustment knob (11) is engaged with the angle adjustment gear ( 3) connected; the fixed steel plate (9) is set outside the reset device, the fixed steel plate (9) is rectangular, with screw holes at the four corners, and a gap in the middle of the upper and lower edges for the fixed vertebral body nail (1) and the movable vertebral body. The body nail (6) passes through. 2. The anterior reduction and internal fixation system for cervical fracture and dislocation according to claim 1, characterized in that: a vertical positioning claw (16) is installed on the movable seat (8), and the claw of the vertical positioning claw (16) The head can be snapped into the tooth groove of the column (2) rack. 3. The anterior reduction and internal fixation system for cervical fracture and dislocation according to claim 1, characterized in that: a horizontal positioning claw (17) is installed on the horizontal rack seat (12), and the horizontal positioning claw (17) The claw head can snap into the tooth groove of horizontal rack (5). 4. The anterior reduction and internal fixation system for cervical fracture and dislocation according to claim 1, characterized in that: the horizontal rack seat (12) is provided with positioning pins, and the movable seat (8) has pin holes. 5. The anterior reduction and internal fixation system for cervical fracture and dislocation according to claim 1, characterized in that: said horizontal rack (5) has a through hole along the longitudinal direction, through which said movable vertebral body nail (6) passes The through hole is fixed on the horizontal rack (5) by the nut at the tail. 6. The anterior reduction and internal fixation system for cervical fracture and dislocation according to claim 1, characterized in that: the fixing plate (9) is partially hollowed out. 7. The anterior reduction and internal fixation system for cervical fracture and dislocation according to claim 1, characterized in that: the fixed steel plate (9) is a titanium alloy steel plate.