CN110537953B - Percutaneous punching temporal bone styloid process shortening device - Google Patents
Percutaneous punching temporal bone styloid process shortening device Download PDFInfo
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- 230000008569 process Effects 0.000 title claims abstract description 58
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- 238000004904 shortening Methods 0.000 title claims abstract description 11
- 238000004080 punching Methods 0.000 title claims abstract description 10
- 238000005520 cutting process Methods 0.000 claims abstract description 66
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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
- A61B17/1657—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
- A61B17/1659—Surgical rasps, files, planes, or scrapers
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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
- A61B17/1662—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans for particular parts of the body
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Abstract
The invention discloses a percutaneous perforation temporal bone styloid process shortening device, which comprises a sleeve, a percutaneous perforation device matched with the sleeve for perforation and a cutting device for shortening the styloid process. Compared with the traditional operation mode of external incision and fracture of the neck and the external diameter of the neck, the system adopts the punching and cutting modes, has small operation wound, quick recovery, short operation time, reduces the operation difficulty of operators and provides good illumination of the wound area. And has little damage to surrounding tissues and little complications.
Description
Technical Field
The invention relates to a device for temporal bone styloid process truncation.
Background
Temporal bone styloid process refers to a thin and long bony protrusion of the temporal bone below the anterior inferior, which is normally located below the ear by several millimeters to 2.5 cm. The neurite syndrome, also known as excessive neurite length, eagle syndrome, and neurite neuralgia. The styloid syndrome is a general term for symptoms such as pharyngeal foreign body sensation, pharyngalgia or reflex aural pain, head and neck pain, salivary gland and the like caused by long styloid process (more than 2.5 cm) or abnormal stimulation of adjacent vascular nerves due to azimuth and morphology. Is common in adults. The onset is slow, the medical history is different, the pain of tonsil area and tongue root area is usually single-sided, the pain is not severe, and the pain can radiate to ears or necks and aggravate when swallowing. Foreign body sensation or obstruction in the pharynx is more common, mostly on one side, more obvious when swallowing, and sometimes aggravated during speaking, turning around or at night. Cough can also be caused, pain can radiate upward from one side of the mandibular angle to the head, neck or face when the carotid artery is compressed or rubbed. Sometimes, there may be symptoms of neurasthenia such as tinnitus, salivation, insomnia, etc.
For patients with symptoms and symptoms obvious in symptoms, the stem process syndrome is the only treatment mode of the operation cutting short stem process. The operation method comprises 1, passing through the tonsil path 2 of the oropharynx and passing through the external diameter path of the neck. The tonsil path through the oropharynx has the problems that firstly, the tonsil of a patient needs to be removed, secondly, the bleeding amount of the operation is large, the tissue damage to the patient is serious, the complications such as bleeding after the operation, severe pain of the pharyngeal portion and the like are more, and the operation is not easy due to the narrow operation of the oral cavity, so that the effective truncated styloid process cannot be achieved. The external diameter of the neck is the current common operation mode, the patient takes the general anesthesia in the supine position, makes an incision with the length of 4-6 cm at the front edge of the sternocleidomastoid muscle 2cm away from the mandibular edge, then uses the curved forceps to prop open subcutaneous tissue, searches the styloid process in the interstitial tissue at the lower edge of the parotid gland and the upper edge of the rear abdomen of the two abdominal muscles, peels off the muscle tissue attached to the styloid process, and the needle holder clamps the root of the styloid process to break the styloid process. The problem of the external diameter path of the neck is that the incision is 1, the incision is longer, and the external diameter path of the neck is positioned on the neck, thereby affecting the beauty of the patient. 2. Because the position of the styloid process is deep, the current shadowless lamp in the operating room can not achieve effective lighting conditions, the lighting direction and the body position need to be repeatedly changed, 3, the styloid process needs to be separated through the neck to reach important tissues such as parotid gland, internal carotid artery and facial nerve, if the neck anatomical structure is not familiar, the important tissues are easily damaged in the process of searching the styloid process, so that serious complications 4 are caused, the muscle tissues 5 attached to the styloid process can be rapidly and effectively stripped, peripheral blood vessels and nerves are easily stabbed when the styloid process is broken by using a needle holder, so that serious complications are caused, 6, the current operation mode has high requirements on operators, and a plurality of people are required to cooperate.
Disclosure of Invention
In view of this, the present invention provides a percutaneous punch temporal bone styloid process shortening device that truncates the styloid process after percutaneous punching.
In order to solve the technical problems, the technical scheme of the invention is as follows: a percutaneous perforation temporal bone styloid process shortening device comprises a sleeve, a percutaneous perforation device matched with the sleeve for perforation, and a cutting device for shortening the styloid process.
As an improvement, the two ends of the sleeve are opened, and the front end of the sleeve is provided with an inclined plane; an internal thread sleeve coaxial with the sleeve is fixedly arranged in the sleeve. The cannula firstly serves as a passageway for access by other devices and secondly protects other tissues from damage during the cutting operation. In addition, the inclined plane of the front end of the sleeve is used for smoothly inserting the neck tissues and primarily stripping the tissues attached to the styloid process.
As an improvement, the percutaneous punching device comprises a sharp puncturing head, wherein a threaded column is arranged behind the puncturing head and is in fit connection with an internal thread sleeve in the sleeve. The piercing head is used to pierce neck tissue, prevent tissue from being embedded in the hollow cannula, and guide the cannula into place.
As an improvement, the cutting device comprises an external thread sleeve which is matched with the internal thread sleeve of the sleeve and is provided with two open ends; a rotary sleeve is arranged in the external thread sleeve, and a plurality of telescopic cutting blades are arranged on the inner ring surface of the rotary sleeve; the lower end of the external thread sleeve is provided with a positioning baffle. The function of the knife edge is to radially cut the styloid process, and the knife edge can be kept to be tightly attached to the styloid process all the time due to the fact that the knife edge is telescopic. The external thread sleeve is matched with the internal thread sleeve for positioning and determining the cutting position.
As an improvement, the cutting blade comprises a blade and a telescopic rod arranged at the tail end of the blade; the telescopic rod comprises an inner sleeve and an outer sleeve which are sleeved with each other, the tail end of the outer sleeve is fixed on the inner annular surface of the rotary sleeve, and a pre-tightening spring is arranged at the rear end of the inner sleeve inside the outer sleeve. The pretension spring pushes the inner sleeve out so that the blade remains against the knob.
Preferably, the cutting blade comprises a blade, and a connecting rod is fixedly connected to the tail end of the blade; the rotary sleeve is characterized by also comprising a mounting seat fixed on the inner ring surface of the rotary sleeve, and the front end of the mounting seat is provided with a small hole; the connecting rod extends into the mounting seat through the small hole, and a pre-tightening spring is sleeved on the part of the connecting rod positioned in the mounting seat; the connecting rod and the inner wall of the mounting seat are provided with spring seats. The pretension spring pushes the inner sleeve out so that the blade remains against the knob.
As an improvement, the number of the cutting blades is three which are uniformly distributed along the circumference, and the cutting blades are provided with inner arc-shaped cutting edges; or the number of the cutting blades is 4 which are uniformly distributed along the circumference, and the cutting blades are provided with sharp working parts. The contact area between the inner arc-shaped cutting edge and the styloid process is large, and the cutting speed is high. Whereas the sharp working portion cuts more thoroughly. The two cutting edges can be selected according to requirements and can also be matched for use.
As an improvement, the upper end of the rotary sleeve is provided with a cross beam, and the cross beam is connected with a driving rod which is vertically arranged. The driving rod is connected with the power device to drive the rotary sleeve to rotate for cutting.
As an improvement, the tissue stripping device also comprises a tissue stripping device, wherein the tissue stripping device comprises an external thread sleeve which is matched with the internal thread sleeve of the sleeve and is provided with two openings at two ends; a sliding sleeve capable of sliding up and down along the inner cavity of the external thread sleeve is arranged in the external thread sleeve, a steel rope for stripping tissues attached to the styloid is arranged in the sliding sleeve, one end of the steel rope is a fixed end connected to the inner ring surface of the sliding sleeve, and the other end of the steel rope is a movable end extending out of the sleeve; the middle part of the steel rope is folded and then is bound by a rope buckle to form a rope loop, and the movable end can be pulled to control the size of the rope loop; even a plurality of pull ropes are arranged on the inner ring surface of the sliding sleeve, the rear ends of the pull ropes are connected with the inner ring surface of the sliding sleeve, and the front ends of the pull ropes are connected to the rope rings. The tissue stripping device carries out secondary fine stripping on the tissue attached to the stalk, the stalk is sleeved with the rope loop formed by the steel rope loop from top to bottom, and the tissue attached to the stalk is naturally stripped completely, so that the later shortening is facilitated.
The invention has the advantages that:
compared with the traditional operation mode of external incision and fracture of the neck and the external diameter of the neck, the system adopts the punching and cutting modes, has small operation wound, quick recovery, short operation time, reduces the operation difficulty of operators and provides good illumination of the wound area.
1. Because the wound is positioned on the neck, the scar in the wound area after the minimally invasive perforation is small, and the beautifying effect is greatly improved.
2. The sleeve is arranged to avoid unnecessary damage to peripheral tissues caused by operation of operators, and meanwhile, the process of sleeving the styloid process into the sleeve realizes primary stripping of tissues attached to the styloid process, and then, a tissue stripping device is used for secondary fine stripping. Avoiding the obstruction of tissues in the operation process and avoiding accidental injury.
3. The whole punching, puncturing and sleeving processes can be accurately guided by B ultrasonic, so that ineffective styloid process searching of a conventional path is avoided, and damage to blood vessels, nerves and muscles in the searching process is avoided
4. The cutting device is operated in the sleeve, so that the styloid process can be effectively shortened and timely discharged, the damage probability of the opposite nerve and the cervical blood vessel in the conventional process of breaking the styloid process is avoided, and the occurrence of operation complications is effectively avoided.
5. The operation difficulty of operators is reduced, and three persons are required to cooperatively operate in the traditional mode; after the truncating system provided by the invention is adopted, the whole operation is only operated by a single person, the operation time can be greatly shortened after the skilled operation, and the operation labor load of operators is reduced.
Drawings
Fig. 1 is a schematic structural view of a sleeve and a cutting device.
Fig. 2 is a schematic structural view of a sleeve and tissue dissection device.
Fig. 3 is a schematic view of the cutting blade in example 1.
Fig. 4 is a schematic view of the cutting blade in example 2.
Fig. 5 is a top view of the tissue stripping device.
Fig. 6 is a schematic view of a lancing head.
Fig. 7 is a schematic cutting view.
FIG. 8 is a schematic view of tissue dissection.
The marks in the figure: 1 sleeve, 2 internal thread sleeve, 3 external thread sleeve, 4 rotation sleeve, 5 cutting blade, 6 actuating lever, 7 support sleeve, 8 sliding sleeve, 9 steel cable, 10 stalk are protruding.
11 Blades, 12 inner sleeve, 13 outer sleeve, 14 pre-tension springs.
21 Blade, 22 mount, 23 connecting rod, 24 pretension spring.
31 Fixed end, 32 movable end, 33 rope fastener, 34 stay cord, 35 connecting rod.
41 Piercing head, 42 screw thread post
Detailed Description
In order to make the technical scheme of the present invention better understood by those skilled in the art, the present invention will be further described in detail with reference to the following specific embodiments.
Example 1 as shown in fig. 1 to 8, the percutaneous hole punching device comprises a cannula 1 and a percutaneous hole punching device which is matched with the cannula 1, a cutting device for cutting short the styloid process and a tissue peeling device for peeling off the tissue attached on the styloid process.
The two ends of the sleeve 1 are opened, and the front end of the sleeve is provided with an inclined plane; the inclined plane is gentle, and the angle between the inclined plane and the axis is 80-85 degrees. The sleeve 1 is internally and fixedly provided with the internal thread sleeve 2 coaxial with the sleeve, and the internal thread sleeve 2 can be connected with the sleeve 1 in an external thread mode, so that the sleeve is more convenient to replace. The cannula 1 not only serves as a passage for other devices into and out of the body, but also serves as a barrier to avoid damage to blood vessels and nerves outside the styloid process 10. In addition, the cannula 1 may also perform preliminary dissection of tissue attached to the knob 10 during the telescoping of the knob 10.
The percutaneous perforating device comprises a sharp puncturing head 41, wherein a threaded column 42 is arranged behind the puncturing head 41, and the threaded column 42 is in matched connection with the internal thread sleeve 2 in the sleeve 1. When the percutaneous perforation is performed, if bleeding occurs, the electric coagulation gun is needed to stop bleeding. The electrocoagulation gun comprises a cylindrical working electrode and a loop electrode which are used for electrifying hemostasis. High frequency current flows between the work machine and the return pole. Because the tissue has certain impedance, the high-frequency current can generate heat when flowing through the tissue, and the heat can shrink and dehydrate tissue spiral protein to close blood vessels, thereby realizing the hemostatic function. Because the electrocoagulation gun is the prior art, the application is not described in detail.
The tissue stripping device comprises an external thread sleeve 3 which is matched with the internal thread 2 of the sleeve 1 and is provided with two open ends; a sliding sleeve 8 capable of sliding up and down along the inner cavity of the external thread sleeve 3 is arranged in the external thread sleeve 3, a steel rope 9 for stripping tissues attached to the styloid process is arranged in the sliding sleeve 8, one end of the steel rope 9 is a fixed end 31 connected to the inner ring surface of the sliding sleeve 8, and the other end of the steel rope is a movable end 32 extending out of the sleeve 1; the middle part of the steel rope 9 is folded and then is bound by a rope buckle 33 to form a rope loop, and the movable end 32 can be pulled to control the size of the rope loop; even a plurality of pull ropes 34 are arranged on the inner ring surface of the sliding sleeve 8, the rear ends of the pull ropes 34 are connected with the inner ring surface of the sliding sleeve 8, and the front ends of the pull ropes are connected with the rope ring. The upper end face of the sliding sleeve 8 is fixed with a connecting rod 35, and the movable end of the steel rope can extend out of the sleeve 1 through the hollow connecting rod 35. The rope fastener 33 is provided with a small hole, and the fixed end 31 and the movable end 32 of the steel rope 9 respectively pass through the small hole to form a rope loop.
The cutting device comprises an external thread sleeve 3 (which can be used commonly with the external thread sleeve 3 of the tissue stripping device) with two openings matched with the internal thread 2 of the sleeve 1; a rotary sleeve 4 is arranged in the external thread sleeve 3, and a plurality of telescopic cutting blades 5 are arranged on the inner annular surface of the rotary sleeve 4; the lower end of the external thread 3 sleeve is provided with a positioning baffle. The positioning baffle is used for positioning and preventing the rotary sleeve 4 from slipping. The upper end of the rotary sleeve 4 is provided with a cross beam, and a driving rod 6 which is vertically arranged is connected to the cross beam.
The driving rod 6 is used for connecting a driving device to drive the rotating sleeve 4 to rotate, and the driving device can be selected manually or electrically. For radial movement of the driving rod 6, a supporting sleeve 7 can be sleeved on the driving rod 6, and the outer diameter of the supporting sleeve 7 is consistent with the inner diameter of the sleeve 1.
Embodiment 1 as shown in fig. 3, the number of the cutting blades 5 is three, and the cutting blades 5 are provided with inner arc-shaped cutting edges. The cutting blade comprises a blade 11 and a telescopic rod arranged at the tail end of the blade 11; the telescopic rod comprises an inner sleeve 12 and an outer sleeve 13 which are sleeved with each other, the tail end of the outer sleeve 13 is fixed on the inner ring surface of the rotary sleeve 4, and a pre-tightening spring 14 is arranged at the rear end of the inner sleeve 12 inside the outer sleeve 13. The cutting blade 5 with the structure has strong cutting capability and high cutting speed.
Example 2 as shown in fig. 4, the number of cutting blades 5 was 4 uniformly distributed along the circumference, and the cutting blades 5 had sharp working portions. The cutting blade 5 comprises a blade 21, and a connecting rod 23 is fixedly connected to the tail end of the blade 21; the rotary sleeve 4 further comprises a mounting seat 22 fixed on the inner ring surface of the rotary sleeve 4, and a small hole is formed at the front end of the mounting seat 22; the connecting rod 23 extends into the mounting seat 22 through a small hole, and a part of the connecting rod 23 positioned in the mounting seat is sleeved with a pre-tightening spring 24; the connecting rod 23 and the inner wall of the mounting seat 22 are provided with spring seats. The cutting blade 5 with the structure can extend to the center of the rotary sleeve 4, so that the cutting is more thorough.
The cutting blades in example 1 and example 2 may be used alone or in combination. Firstly, the cutting blade 5 with the inner arc-shaped cutting edge is used for preliminary cutting, and then the sharp cutting blade 5 is used for thoroughly cutting. And efficiency and effect are both considered.
In order to further facilitate the use, the application also comprises a fixing device, wherein the fixing device comprises a base which is used for being fixed on an operating table, a mechanical arm is arranged on the base, the mechanical arm is provided with a plurality of joints, and each joint is connected by a universal joint. The front end of the mechanical arm is provided with a hoop, and the sleeve is clamped through the hoop to finish positioning. The mechanical arm can be locked for positioning through bolts. Thus, the sleeve is not required to be held by an extra hand, and the operation can be completed by one person.
In use, the percutaneous punch is first mounted on the sleeve 1. The method is that the screw thread column 42 is directly screwed into the internal thread sleeve 2, and the puncture head 41 extends out of the sleeve 1. The length of the extension can be adjusted according to practical conditions. Under the guidance of the B ultrasonic, the neck tissue is pierced by the piercing head 41 to reach just above the styloid process 10. The percutaneous punch is then removed. For easy assembly and disassembly, the rear end of the threaded post 42 may also be provided with a connecting rod for driving the threaded post 42 to rotate.
After the percutaneous perforating device is taken out, the sleeve 1 is pushed to go deep to completely sleeve the styloid process 10 in the sleeve 1. The bevel at the front end of the sleeve 1 is used to strip off the human tissue attached to the styloid process 10. After the knob 10 is completely sleeved into the sleeve 1, the knob is completely isolated from external tissues, so that the operation is convenient.
If bleeding occurs, the electric coagulation gun can be used for stopping bleeding. After stopping bleeding, the external thread sleeve 3 is screwed into the internal thread sleeve 2. The tissue stripping device is then inserted into the external thread sleeve 3 by the connecting rod 35, and the movable end 32 of the steel rope 9 is pulled to tighten the rope loop before insertion. When in detection, the stalk 10 is sleeved in the rope loop, and the rope loop is opened by utilizing the diameter change of the stalk 10. The sliding sleeve 8 is slid to the bottom (the positioning block) so as to peel off the tissues on the styloid process 10. The sliding sleeve 8 can be pulled out after one stripping, the rope loop is tightened again, and the rope loop is reeved in the direction until the tissue is stripped cleanly. The pull cord 34 maintains the balance of the loop and also prevents the loop from being pulled off the cord lock 33 when the movable end 32 is pulled.
After tissue stripping is finished, the position of the external thread sleeve 3 can be adjusted, the screwing depth can be determined according to the cutting position, namely, the positioning baffle at the lower end of the external thread sleeve 3 is arranged slightly below the cutting position, and the operation is guided by the visual operation of the endoscope system. Then the rotary sleeve 4 is put into the external thread sleeve 3, and the cutting blade is spread by the knob 10 in the putting process. The rotary sleeve 4 is driven to rotate by the driving rod 6, so that the cutting blade 5 is driven to cut the styloid process 10. The two cutting blades 5 have better matching use effect. The truncated styloid process falls above the cutting blade 5, which is convenient for direct taking out and avoids residue in the body.
The application truncates the temporal bone styloid process by cutting off the styloid process to replace the existing breaking mode, and has small wound and controllable truncating length. For protection of the sleeve, the surrounding tissue may also be protected from unnecessary damage. The whole operation process is greatly simplified, and the number of the operators involved is reduced from three to one.
The foregoing is merely a preferred embodiment of the present invention, and it should be noted that the above-mentioned preferred embodiment should not be construed as limiting the invention, and the scope of the invention should be defined by the appended claims. It will be apparent to those skilled in the art that various modifications and adaptations can be made without departing from the spirit and scope of the invention, and such modifications and adaptations are intended to be comprehended within the scope of the invention.
Claims (4)
1. A percutaneous punch temporal bone styloid process truncating device, which is characterized in that: comprises a cannula, a percutaneous perforating device matched with the cannula for perforation, and a cutting device for cutting short styloid process;
the two ends of the sleeve are open, and the front end of the sleeve is provided with an inclined plane; an internal thread sleeve coaxial with the sleeve is fixedly arranged in the sleeve;
the percutaneous punching device comprises a sharp puncturing head, wherein a threaded column is arranged behind the puncturing head and is in fit connection with an internal thread sleeve in the sleeve;
The cutting device comprises an external thread sleeve matched with the internal thread sleeve of the sleeve and provided with two openings at two ends; a rotary sleeve is arranged in the external thread sleeve, and a plurality of telescopic cutting blades are arranged on the inner ring surface of the rotary sleeve; the lower end of the external thread sleeve is provided with a positioning baffle;
The number of the cutting blades is three evenly distributed along the circumference, and the cutting blades are provided with inner arc-shaped cutting edges; or 4 cutting blades are uniformly distributed along the circumference, and each cutting blade is provided with a sharp working part;
the tissue stripping device comprises an external thread sleeve which is matched with the internal thread sleeve of the sleeve and is provided with two openings at two ends; a sliding sleeve capable of sliding up and down along the inner cavity of the external thread sleeve is arranged in the external thread sleeve, and a rope sleeve for stripping tissues attached to the styloid process is arranged in the sliding sleeve; the rope sleeve comprises a steel rope, one end of the steel rope is a fixed end connected to the inner ring surface of the sliding sleeve, and the other end of the steel rope is a movable end extending out of the sleeve; the middle part of the steel rope is folded and then is bound by a rope buckle to form a rope loop, and the movable end can be pulled to control the size of the rope loop; the sliding sleeve is characterized in that a plurality of pull ropes are further arranged on the inner ring surface of the sliding sleeve, the rear ends of the pull ropes are connected with the inner ring surface of the sliding sleeve, and the front ends of the pull ropes are connected to the rope rings.
2. A percutaneous punch temporal bone styloid process shortening device according to claim 1, wherein: the cutting blade comprises a blade and a telescopic rod arranged at the tail end of the blade; the telescopic rod comprises an inner sleeve and an outer sleeve which are sleeved with each other, the tail end of the outer sleeve is fixed on the inner annular surface of the rotary sleeve, and a pre-tightening spring is arranged at the rear end of the inner sleeve inside the outer sleeve.
3. A percutaneous punch temporal bone styloid process shortening device according to claim 1, wherein: the cutting blade comprises a blade, and the tail end of the blade is fixedly connected with a connecting rod; the rotary sleeve is characterized by also comprising a mounting seat fixed on the inner ring surface of the rotary sleeve, and the front end of the mounting seat is provided with a small hole; the connecting rod extends into the mounting seat through the small hole, and a pre-tightening spring is sleeved on the part of the connecting rod positioned in the mounting seat; the connecting rod and the inner wall of the mounting seat are provided with spring seats.
4. A percutaneous punch temporal bone styloid process shortening device according to claim 1, wherein: the upper end of the rotary sleeve is provided with a cross beam, and a driving rod which is vertically arranged is connected to the cross beam.
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CN201910551859.4A CN110537953B (en) | 2019-06-24 | 2019-06-24 | Percutaneous punching temporal bone styloid process shortening device |
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CN201910551859.4A CN110537953B (en) | 2019-06-24 | 2019-06-24 | Percutaneous punching temporal bone styloid process shortening device |
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