CN109350177B - Proximal tibial osteotomy guide device - Google Patents
Proximal tibial osteotomy guide device Download PDFInfo
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- CN109350177B CN109350177B CN201811462171.0A CN201811462171A CN109350177B CN 109350177 B CN109350177 B CN 109350177B CN 201811462171 A CN201811462171 A CN 201811462171A CN 109350177 B CN109350177 B CN 109350177B
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B17/16—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1732—Guides or aligning means for drills, mills, pins or wires for bone breaking devices
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B17/16—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
- A61B17/1764—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the knee
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/06—Measuring instruments not otherwise provided for
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/06—Measuring instruments not otherwise provided for
- A61B2090/061—Measuring instruments not otherwise provided for for measuring dimensions, e.g. length
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- Life Sciences & Earth Sciences (AREA)
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- General Health & Medical Sciences (AREA)
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- Surgical Instruments (AREA)
- Prostheses (AREA)
Abstract
胫骨近端切骨引导装置，切骨导向模块的内表面和外表面与胫骨近端前侧表面相适应呈弧形，上表面垂直于内表面；内表面和外表面之间开有平行于上表面的第一通槽和第二通槽，两通槽的间距等于预设的内侧胫骨平台的切骨厚度；内表面上对齐内侧胫骨平台的部位有垂直的钉样突起；切骨导向模块的上表面上远离钉样突起的一侧设有带刻度的螺柱；测量笔针通过长槽套在螺柱上，测量笔针紧固在螺柱上的螺母上，测量笔针前端指向并接触外侧胫骨平台，测量笔针与第二通槽的距离等于预设的外侧胫骨平台的切骨厚度；带孔插片可相对滑动地插入第一通槽，钉入内侧胫骨平台的骨面的带帽固定钉穿过垂直钉孔。
The proximal tibia osteotomy guide device has an arc-shaped inner surface and an outer surface that are adapted to the front surface of the proximal tibia. The upper surface is perpendicular to the inner surface; there is a gap between the inner surface and the outer surface that is parallel to the upper surface. The first through-slot and the second through-slot on the surface, the distance between the two through-slots is equal to the preset bone cutting thickness of the medial tibial platform; there is a vertical nail-like protrusion on the inner surface at the position aligned with the medial tibial platform; the bone cutting guide module There is a stud with a scale on the side away from the nail-like protrusion on the upper surface; the measuring pen needle is put on the stud through the long slot, the measuring pen needle is fastened to the nut on the stud, and the front end of the measuring pen needle points and contacts For the lateral tibial platform, the distance between the measuring pen needle and the second slot is equal to the preset bone thickness of the lateral tibial platform; the perforated insert can be relatively slidably inserted into the first slot and nailed into the band of the bone surface of the medial tibial platform. Cap fasteners pass through the vertical nail holes.
Description
Technical Field
The invention relates to a guiding device for guiding accurate bone of proximal tibia in artificial knee joint replacement operation.
Background
The artificial knee joint replacement operation is one of effective methods for treating the advanced knee joint injury, has been widely developed in the field of joint surgery at present, and is mainly applied to the advanced joint diseases such as knee joint degenerative arthritis, rheumatoid arthritis, traumatic arthritis, ankylosing spondylitis and the like, and has remarkable effect. In the artificial knee joint replacement operation, the tissues such as diseased bones, cartilages and the like with proper thickness at the distal femur and the proximal tibia need to be resected, so as to install the correspondingly matched joint prosthesis, and the accuracy of the bone cutting direction and the accuracy of the bone cutting thickness are directly related to the success or failure of the operation. In order to achieve the above purpose, the distal femur and proximal tibia are provided with bone cutting guide systems, which are used for obtaining correct bone cutting according to the operation principle and the adjustment of osseous marks, the working principle of the common proximal tibia bone cutting extramedullary positioning rod guide system is as follows: the proximal tibia osteotomy should be perpendicular to the normal lower limb force line, and the osteotomy backward inclination angle is close to the proximal tibia backward inclination angle of the patient, generally 3-7 °. Since the lower limb force line and the retroverted angle of the osteotomy cannot be seen by the naked eye of the operator, the line connecting the 1/3 boundary point in the tibial tuberosity and the middle point of the ankle joint (or the tibialis anterior tendon at the ankle joint) is approximately regarded as coinciding with the lower limb force line according to experience in the operation. A common method for determining the backward inclination of the tibia is as follows: the near end of the positioning rod is separated from the shank front skin by 2 fingers, and the far end of the positioning rod is separated from the shank front skin by 3 fingers; and a positioning method II: the locating bar is parallel to the anterior tibial plateau and then the distal end of the locating bar is advanced, each 1cm of advancement representing an increase in posterior slope of 1 °. However, in clinical practice, errors frequently occur in the proximal tibial osteotomy guiding system, which are due to: 1. individual differences exist in the bony landmarks; 2. the operator completely depends on naked eyes to judge the direction in the operation, and the accuracy is not enough; 3. the direction and thickness of the bone cut required by the patient need to be adjusted correspondingly according to different conditions and development degrees. In addition, existing proximal tibial osteotomy extra-medullary guide systems sometimes interfere with the surgical procedure and are difficult to install for patients with stiff joint extension. In order to achieve proper extramedullary positioning, it is sometimes difficult to install the osteotomy guide module in a desired operative position for the operator, particularly in patients with tibial rotation deformities relative to the femur. In summary, existing proximal tibial osteotomy extra-medullary guiding systems are not sufficiently accurate to position and sometimes interfere with the surgical procedure of the operator.
The proximal tibial osteotomy belongs to a key step in artificial knee replacement surgery, and some doctors take the proximal tibial osteotomy as an initial step of osteotomy, which has remarkable influence on subsequent ligament balancing and flexion-extension gap balancing operations, so that how to realize correct and accurate proximal tibial osteotomy relates to success and failure of surgery.
Disclosure of Invention
The invention aims to solve the defects of insufficient positioning accuracy and sometimes operation interference of an operator of the existing tibia proximal bone-cutting extramedullary guiding system, and provides a tibia proximal bone-cutting positioning rod-free guiding device capable of completely individuating artificial knee joint replacement operation according to preoperative image measurement data.
The correct proximal tibial osteotomy procedure involves a proper posterior oblique osteotomy angle and precise tibial medial and lateral plateau osteotomy thicknesses. The retroversion angle is between 3 deg. and 7 deg., and is generally close to the proximal osseous retroversion angle of the patient's tibia. The medial tibial plateau is relatively flat, the lateral plateau is slightly raised, and the backward inclination angle of the medial tibial plateau is selected on the lateral X-ray to represent the backward inclination bone cutting angle relatively correctly. The proximal tibia osteotomy direction is perpendicular to the lower limb force line on the coronal plane, the osteotomy thickness of the inner tibia platform and the outer tibia platform in the direction is measured on the normal X-ray, the osteotomy thickness of the outer tibia platform is 8mm, the osteotomy thickness of the inner tibia platform is 2mm under the condition that cartilage is not worn or little and no outer joint deformity exists, and the wear degree of the articular cartilage of the inner tibia and the outer tibia platform can be properly adjusted by matching with the distal femur osteotomy thickness. If there is an extraarticular deformity, the osteotomy thickness of the medial and lateral platforms changes as measured on the orthotopic X-ray.
The invention relates to a proximal tibia osteotomy guiding device, which is characterized in that: comprises a bone cutting guide module 1, a perforated inserting sheet 2, a capped fixing nail 3 and a measuring pen needle 4;
the bone cutting guide module 1 is hexahedral and comprises an inner surface 5 close to a human body, an outer surface 6 opposite to the inner surface, an upper surface 9 and a lower surface, wherein the inner surface 5 and the outer surface 6 are in an arc shape corresponding to the front surface of the proximal tibia, and the upper surface 9 is perpendicular to the inner surface 5; a first through groove 71 parallel to the upper surface 9 and a second through groove 72 parallel to the first through groove 71 are formed between the inner surface 5 and the outer surface 6, and the distance between the first through groove 71 and the second through groove 72 is equal to the preset bone cutting thickness of the medial tibia plateau; both the first through groove 71 and the second through groove 72 are parallel to the upper surface 9;
the part of the inner surface 5 opposite to the Ji Nace tibial plateau is provided with a nail-like protrusion 8, and the nail-like protrusion 8 is vertical to the inner surface 5;
the upper surface 9 of the bone cutting guide module 1 is provided with a stud 10 at one side far away from the nail-like protrusion 8, the stud 10 is provided with a tangential surface 11, and the tangential surface 11 is marked with scales;
the measuring pen needle 4 parallel to the upper surface 9 is sleeved on the stud 10 through an elongated slot, the nut 12 is meshed on the stud 10, the measuring pen needle 4 is fastened on the nut 12, the front end of the measuring pen needle 4 points to and contacts with the central bone surface of the outer tibia platform, and the distance between the measuring pen needle 4 and the second through slot 72 on the bone cutting guide module 1 is equal to the preset bone cutting thickness of the outer tibia platform;
the perforated insert 2 can be inserted into the first through groove 71 in a relatively sliding manner, the front part of the perforated insert 2 is provided with a vertical nail hole 15, and the cap-equipped fixing nail 3 nailed into the bone surface of the medial tibial plateau passes through the vertical nail hole 15; a through hole for the passage of a spike for fixing the bone cutting guide module 1 on the proximal front surface of the tibia is arranged between the inner surface and the outer surface of the bone cutting guide module 1.
Preferably, the nut 12 comprises a pair of nuts between which the apertured insert 2 is clamped.
Preferably, the through holes have a plurality of groups, and the connection line of each group of through holes on the outer surface 6 and the connection line of each group of through holes on the inner surface 5 are parallel to the upper surface 9.
The azimuth expression of the invention adopts the direction expression of a human body in medicine. The bone cutting guide module is an outer surface on the side far away from the bone surface, and an inner surface on the side close to the bone surface. The surface of the bone cutting guide module facing the human body head side is an upper surface, and the surface facing the human body tail side is a lower surface. The side of the bone cutting guide module far away from the midline of the human body is the outer side, and the side close to the midline of the human body is the inner side.
The technical conception of the invention is as follows: the invention discloses a novel proximal tibia osteotomy technology in artificial knee joint replacement operation. The technique is different from the traditional tibia proximal end bone cutting technique, a positioning rod is not needed, the accurate value of tibia proximal end bone cutting can be obtained according to image data before operation, and the placement bone cutting guide module is not limited by the placement position because the positioning rod is not needed, so that the operation is simple and convenient.
The invention has the advantages that:
1. a positioning rod is not needed, so that errors are reduced, and the operation is simplified;
2. according to preoperative image measurement and the bone anatomy of a patient, the proximal tibia osteotomy is more accurate;
3. for special cases where the positioning rod is difficult to use, the proximal tibia osteotomy can be more conveniently performed, and the placement of the osteotomy guiding module is not limited.
Drawings
Fig. 1a is an isometric view of the present invention.
Fig. 1b is an isometric view of another view of the invention.
Fig. 1c is an isometric view of another view of the invention.
Fig. 1d is an isometric view of another view of the invention.
Fig. 2a is a schematic diagram of the operation of the present invention in a forward view.
Fig. 2b is a schematic diagram of the operation of another view of the present invention.
Fig. 2c is a schematic diagram of the operation of another view of the present invention.
Detailed Description
The technical scheme of the invention is further described below with reference to the accompanying drawings.
The invention relates to a proximal tibia bone cutting guiding device, which comprises a bone cutting guiding module 1, a hole inserting sheet 2, a cap fixing nail 3 and a measuring pen needle 4, wherein the bone cutting guiding module 1 is hexahedral and comprises an inner surface 5 close to a human body, an outer surface 6 opposite to the inner surface, an upper surface 9, a lower surface, an inner surface 5 and an outer surface 6. A first through groove 71 parallel to the upper surface 9 and a second through groove 72 parallel to the first through groove 71 are formed between the inner surface 5 and the outer surface 6, and the distance between the first through groove 71 and the second through groove 72 is equal to the preset bone cutting thickness of the medial tibia plateau; both the first through groove 71 and the second through groove 72 are parallel to the upper surface 9.
In this embodiment, the widths of the first through groove 71 and the second through groove 71 are both 2mm, and the distance between them is 2mm.
The part of the inner surface 5 opposite to the Ji Nace tibial plateau is provided with a nail-like protrusion 8, the nail-like protrusion 8 is vertical to the inner surface 5, and the diameter of the nail-like protrusion 8And 10mm long.
The upper surface and the lower surface of the bone cutting guide module 1 are parallel to each other, one side of the upper surface 9 of the bone cutting guide module 1, which is far away from the nail-like protrusion 8, is provided with a stud 10, the stud 10 is provided with a tangential surface 11, the tangential surface 11 is marked with scales, and the diameter of the stud is as followsThe height is 50mm.
The measuring pen needle 4 parallel to the upper surface 9 is sleeved on the stud 10 through the long groove, the nut 12 is meshed on the stud 10, the measuring pen needle 4 is fastened on the nut 12, the front end of the measuring pen needle 4 points to and contacts with the central bone surface of the lateral tibia platform, and the distance between the measuring pen needle 4 and the second through groove 72 on the bone cutting guide module 1 is equal to the preset bone cutting thickness of the lateral tibia platform. The stylus 4 can be moved back and forth by means of an elongated slot.
The perforated insert 2 can be inserted into the first through groove 71 in a relatively sliding manner, the front part of the perforated insert 2 is provided with a vertical nail hole 15, and the cap-equipped fixing nail 3 nailed into the bone surface of the medial tibial plateau passes through the vertical nail hole 15; a through hole for the passage of a spike for fixing the bone cutting guide module 1 on the proximal front surface of the tibia is arranged between the inner surface and the outer surface of the bone cutting guide module 1.
The nut 12 comprises a pair of nuts between which the apertured tab 2 is clamped. The measuring pen needle 4 is lifted by adjusting the height of the nut 12 so as to adjust the scale on the screw rod to the preset bone cutting thickness of the lateral tibia plateau.
The through holes have a plurality of groups, and the connection line of each group of through holes on the outer surface 6 and the connection line of each group of through holes on the inner surface 5 are parallel to the upper surface 9. The vertical spacing between the sets of through holes can be used for fine tuning of the thickness of the cut bone.
In this embodiment, the bone cutting guide module 1 is provided with 2 groups of 3 straight forward and backward through holes and 1 oblique forward and backward through hole on the inner surface and the outer surface, and the two through holes are symmetrically distributed. The bone cutting guide module 1 is divided into a special left knee and a special right knee according to the left side and the right side of a human body.
The inserted sheet 2 with holes is a wedge-shaped sheet, the far end is semicircular, and the thickness is 1.6-2.0 mm from far to near, and the width is 15mm. The distal portion of the strap Kong Chapian has a diameter at the middle thereofThe round hole, the hole inserting piece 2 can pass through the front and back first through groove 71 and the second through groove 72 on the bone cutting guide module 1. The capped staple 3 is a diameter +.> The round nail with the cap, which is 10mm long, has the diameter of 3.5mm and can pass through the vertical nail hole 15 at the front end of the inserted sheet 2 with the hole. The insertion sheet 2 with holes is wedge-shaped and can be cut into bonesThe first through slot 71 on the guide module 1 is snapped back.
The azimuth expression of the invention adopts the direction expression of a human body in medicine. The bone cutting guide module is an outer surface on the side far away from the bone surface, and an inner surface on the side close to the bone surface. The surface of the bone cutting guide module facing the human body head side is an upper surface, and the surface facing the human body tail side is a lower surface. The side of the bone cutting guide module far away from the midline of the human body is the outer side, and the side close to the midline of the human body is the inner side.
Measuring a lower limb force line in an image system before an operation, then marking a proximal tibia osteotomy line perpendicular to the lower limb force line, and measuring the thickness of the resected bone required by the tibial plateau on the inner side and the outer side of the knee joint according to the osteotomy line direction. The bone cutting guide module is arranged in front of the proximal end of the tibia in the operation, and the position of the bone cutting guide module on the inner side and the outer side of the proximal end of the tibia can be freely adjusted according to the convenience of the operation of an operator. The method comprises the steps of inserting the perforated inserting sheet into a first through groove of a bone cutting guide module, placing the perforated inserting sheet in parallel on the surface of a tibia inner side platform, and fixing the perforated inserting sheet by using a round nail with a cap through a round hole on the inserting sheet so as to enable the perforated inserting sheet to represent the natural back inclination angle of a bone cutting near the tibia. The front surface of the hammering bone cutting guide module is fixed to the surface of tibia through the nail-shaped protrusions on the inner side surface of the hammering bone cutting guide module along the direction of inserting sheets. Removing the fixing nails and the straps Kong Chapian, rotating the adjusting nuts below the measuring pen needles, adjusting the bone cutting thickness of the outer tibia platform (according to the measured value on the imaging system before the operation), rotating the bone cutting guide module by taking the fixing nails on the inner side of the bone cutting guide module as the shaft, enabling the front ends of the measuring pen needles to point to and contact with the central bone surface of the outer tibia platform, determining the final position of the bone cutting guide module at the proximal tibia at the moment, fixing the bone cutting guide module on the proximal tibia front surface through the fixing straight nails and the inclined nails through the corresponding fixing nail holes of the bone cutting guide module, and performing proximal tibia cutting through the second through grooves of the bone cutting guide module.
The embodiments described in the present specification are merely examples of implementation forms of the inventive concept, and the scope of protection of the present invention should not be construed as being limited to the specific forms set forth in the embodiments, and the scope of protection of the present invention and equivalent technical means that can be conceived by those skilled in the art based on the inventive concept.
Claims (1)
1. Proximal tibial osteotomy guide device, its characterized in that: comprises a bone cutting guide module (1), a belt Kong Chapian (2), a capped fixing nail (3) and a measuring pen needle (4);
the bone cutting guide module (1) is hexahedral and comprises an inner surface (5) close to a human body, an outer surface (6) opposite to the inner surface, an upper surface (9) and a lower surface, wherein the inner surface (5) and the outer surface (6) are in an arc shape corresponding to the front side surface of the proximal end of the tibia, and the upper surface (9) is perpendicular to the inner surface (5); a first through groove (71) parallel to the upper surface (9) and a second through groove (72) parallel to the first through groove (71) are formed between the inner surface (5) and the outer surface (6), and the distance between the first through groove (71) and the second through groove (72) is equal to the preset bone cutting thickness of the medial tibia platform;
the part of the inner surface (5) opposite to the Ji Nace tibia plateau is provided with a nail-like protrusion (8), and the nail-like protrusion (8) is vertical to the inner surface (5);
one side of the upper surface (9) of the bone cutting guide module (1) far away from the nail-like protrusion (8) is provided with a stud (10), the stud (10) is provided with a tangential surface (11), and the tangential surface (11) is marked with scales;
the measuring pen needle (4) parallel to the upper surface (9) is sleeved on the stud (10) through the long groove, the nut (12) is engaged on the stud (10), the measuring pen needle (4) is fastened on the nut (12), the front end of the measuring pen needle (4) points to and contacts with the central bone surface of the outer tibia platform, and the distance between the measuring pen needle (4) and the second through groove (72) on the bone cutting guide module (1) is equal to the preset bone cutting thickness of the outer tibia platform;
the belt Kong Chapian (2) can be inserted into the first through groove (71) in a relatively sliding manner, the front part of the belt Kong Chapian (2) is provided with a vertical nail hole (15), and the cap fixing nail (3) which is nailed into the bone surface of the medial tibial plateau passes through the vertical nail hole (15); a through hole for the passage of a spike for fixing the bone cutting guide module (1) on the front surface of the proximal end of the tibia is arranged between the inner surface and the outer surface of the bone cutting guide module (1);
the nut (12) comprises a pair of nuts between which the strap Kong Chapian (2) is clamped; the through holes are provided with a plurality of groups, and the connecting line of each group of through holes on the outer surface (6) and the connecting line of each group of through holes on the inner surface (5) are parallel to the upper surface (9).
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201811462171.0A CN109350177B (en) | 2018-12-03 | 2018-12-03 | Proximal tibial osteotomy guide device |
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201811462171.0A CN109350177B (en) | 2018-12-03 | 2018-12-03 | Proximal tibial osteotomy guide device |
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| Publication Number | Publication Date |
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| CN109350177A CN109350177A (en) | 2019-02-19 |
| CN109350177B true CN109350177B (en) | 2023-11-07 |
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| CN201811462171.0A Expired - Fee Related CN109350177B (en) | 2018-12-03 | 2018-12-03 | Proximal tibial osteotomy guide device |
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Citations (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| RU2187975C1 (en) * | 2000-12-05 | 2002-08-27 | ООО НПО "Остеомед" | Method for setting knee joint prostheses |
| CN204708929U (en) * | 2015-04-10 | 2015-10-21 | 北京大学第三医院 | The deep guide plate arrangement of a kind of Total knee arthroplasty proximal tibia |
| CN206365915U (en) * | 2016-10-10 | 2017-08-01 | 北京大学第三医院 | A kind of proximal tibia bone cutting positioner |
-
2018
- 2018-12-03 CN CN201811462171.0A patent/CN109350177B/en not_active Expired - Fee Related
Patent Citations (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| RU2187975C1 (en) * | 2000-12-05 | 2002-08-27 | ООО НПО "Остеомед" | Method for setting knee joint prostheses |
| CN204708929U (en) * | 2015-04-10 | 2015-10-21 | 北京大学第三医院 | The deep guide plate arrangement of a kind of Total knee arthroplasty proximal tibia |
| CN206365915U (en) * | 2016-10-10 | 2017-08-01 | 北京大学第三医院 | A kind of proximal tibia bone cutting positioner |
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| CN109350177A (en) | 2019-02-19 |
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