CN110680494A - Three-dimensional adjustable locking nail guider for long bone intramedullary nail - Google Patents
Three-dimensional adjustable locking nail guider for long bone intramedullary nail Download PDFInfo
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- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
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- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/72—Intramedullary devices, e.g. pins or nails
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
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Abstract
本发明公开了一种长骨髓内钉三维可调锁钉导向器,将长骨髓内钉远端的三维变形分解为两个互相垂直平面内的变形分步解决,髓内钉的变形即为远端锁钉孔的位移,锁钉孔在一个平面内的位移通过固定导向臂和调节导向臂的铰接转动来实现导向孔与锁钉孔的重新精确瞄准,在另一个平面内通过调整导向孔与相应锁钉孔的距离和方向来实现本平面内的精确瞄准;当两个平面内都对应好,则可以做到所有导向孔精确瞄准;本发明提供的一种长骨髓内钉三维可调锁钉导向器,可以做到精准锁钉,解决髓内钉锁钉困难问题,并能缩短手术时间,减少X线对病人和医生的辐射,减少出血,减低感染比例,有利于病人康复。
The invention discloses a three-dimensional adjustable locking nail guide for a long intramedullary nail, which decomposes the three-dimensional deformation of the distal end of the long intramedullary nail into two deformations in two mutually perpendicular planes and solves it step by step. The displacement of the end locking nail hole, the displacement of the locking nail hole in one plane is achieved by the hinged rotation of the fixed guide arm and the adjustment guide arm to achieve the re-accurate re-alignment of the guide hole and the lock nail hole, and in another plane by adjusting the guide hole and the lock nail hole. The distance and direction of the corresponding locking nail holes can be used to achieve accurate aiming in this plane; when the two planes are well corresponding, all the guide holes can be accurately aimed; a long intramedullary nail three-dimensional adjustable lock provided by the present invention The nail guide can accurately lock the nail, solve the difficult problem of intramedullary nail locking, shorten the operation time, reduce the radiation of X-rays to the patient and the doctor, reduce the bleeding, reduce the infection rate, and facilitate the recovery of the patient.
Description
技术领域technical field
本发明具体涉及一种长骨髓内钉三维可调锁钉导向器,属于骨科创伤医疗器械技术领域。The invention particularly relates to a three-dimensional adjustable locking nail guide for a long intramedullary nail, which belongs to the technical field of orthopedic trauma medical instruments.
背景技术Background technique
髓内钉属医疗器械中的骨科内固定器械,结构具有髓内钉杆,在髓内钉杆近端设有近端锁定螺钉孔,在髓内钉杆远端设有远端锁定螺钉孔,是长骨骨干骨折的首选内固定,与钢板相比有独特优势。使用时,为了防止骨折的两部分产生旋转,需要用数枚螺钉横向穿过骨干及髓内钉给予锁定,医生会在髓内钉插入骨髓腔之前将一个钻孔导向器与髓内钉结合在一起,理论上导向器的导向孔正对髓内钉的锁定螺钉孔,这样钻头穿过导向孔可以正对锁定螺钉孔钻入,不过由于髓内钉插入骨髓腔后经常会受长骨形状影响而变形,往往导致钻头在实际应用的时候并不能对准锁定螺钉孔,从而出现锁钉困难。The intramedullary nail belongs to the orthopaedic internal fixation device in the medical device. The structure has an intramedullary nail rod. The proximal end of the intramedullary nail rod is provided with a proximal locking screw hole. It is the preferred internal fixation for long bone diaphyseal fractures, and has unique advantages compared with steel plates. In use, in order to prevent rotation of the two parts of the fracture, several screws are required to pass laterally through the diaphysis and the intramedullary nail for locking. At the same time, theoretically, the guide hole of the guide is facing the locking screw hole of the intramedullary nail, so that the drill bit can be drilled through the pilot hole facing the locking screw hole. Deformation often results in that the drill bit cannot be aligned with the locking screw hole in actual application, resulting in difficulty in locking the nail.
以股骨髓内钉为例,目前,解决锁钉困难的技术方案有磁力导航髓内钉,该磁力导航髓内钉有磁力导航装置,手术时,髓内钉植入人体后,在髓内钉内插入磁性物质,髓内钉锁定螺钉孔处磁性较大,当导向孔在调整中对准锁定螺钉孔的时候,能检测到磁力的大小变化,会有声音或者通过显示屏图像提示,此时固定导向器,然后钻孔;还有一种是芯钻系统,该芯钻系统有一根较细的软钻,在高速转动下从髓内钉的内部由锁定螺钉孔钻出,最终垂直穿出骨头及软组织,提示锁定螺钉的位置,然后再根据提示位置逆向钻孔锁定。还有报道激光导向等,目前不成熟,并未见到临床应用。Take the femoral intramedullary nail as an example. At present, the technical solution to solve the difficulty of locking the nail is the magnetic navigation intramedullary nail. The magnetic navigation intramedullary nail has a magnetic navigation device. Insert a magnetic substance, the magnetism of the locking screw hole of the intramedullary nail is relatively large. When the guide hole is aligned with the locking screw hole during adjustment, the change in the magnitude of the magnetic force can be detected, and there will be a sound or an image prompt on the display screen. The guide is fixed, and then drilled; there is also a core drilling system, which has a thin soft drill that is drilled through the locking screw hole from the inside of the intramedullary nail under high rotation, and finally penetrates vertically out of the bone and soft tissue, prompt the position of the locking screw, and then reverse drilling and locking according to the prompt position. There are also reports of laser guidance, etc., which are currently immature and have not seen clinical applications.
以上解决方案都有一定的局限性,并且由于种种原因市场占有率低,目前,百分之九十以上的市场份额都在用普通的交锁髓内钉,虽然有远端锁钉导向器及压杆装置,但是由于髓内钉的变形不是恒定的,有时候依然会出现误差,经常会发生锁定困难,导致手术时间大大延长,出血量增加,感染几率明显上升,并且需要多次透视,对病人的恢复极为不利,还会增加X线对医生的辐射,每个医生遇到髓内钉锁钉困难的情况都很头疼。本发明的目的是设计一款新型的瞄准器,来解决现有技术中锁钉困难问题。The above solutions have certain limitations, and due to various reasons, the market share is low. At present, more than 90% of the market share is using ordinary interlocking intramedullary nails, although there are distal locking nail guides and The pressure rod device, but because the deformation of the intramedullary nail is not constant, sometimes errors still occur, and locking difficulties often occur, resulting in greatly prolonged operation time, increased blood loss, and significantly increased risk of infection, and requires multiple fluoroscopy. The recovery of the patient is extremely unfavorable, and it will also increase the radiation of X-rays to the doctor. Every doctor encounters difficulties in locking the intramedullary nail. It is a headache. The purpose of the present invention is to design a new type of sight to solve the difficult problem of locking nails in the prior art.
发明内容SUMMARY OF THE INVENTION
本发明要解决的技术问题是针对以上不足,提供一种长骨髓内钉三维可调锁钉导向器,可以做到精准锁钉,解决髓内钉锁钉困难问题,并能缩短手术时间,减少X线对病人和医生的辐射,减少出血,减低感染比例,有利于病人康复。The technical problem to be solved by the present invention is to aim at the above deficiencies, and to provide a three-dimensional adjustable locking nail guide for long intramedullary nails, which can achieve precise nail locking, solve the difficult problem of intramedullary nail locking, shorten the operation time, reduce the X-ray radiation to patients and doctors can reduce bleeding, reduce the proportion of infection, and help patients recover.
为解决以上技术问题,本发明采用以下技术方案:In order to solve the above technical problems, the present invention adopts the following technical solutions:
一种长骨髓内钉三维可调锁钉导向器,将长骨髓内钉远端的三维变形分解为两个互相垂直平面内的变形分步解决,髓内钉的变形即为远端锁钉孔的位移,锁钉孔在一个平面内的位移通过固定导向臂和调节导向臂的铰接转动来实现导向孔与锁钉孔的重新精确瞄准,在另一个平面内通过调整导向孔与相应锁钉孔的距离和方向来实现本平面内的精确瞄准;当两个平面内都对应好,则可以做到所有导向孔精确瞄准。A three-dimensional adjustable locking nail guide for a long intramedullary nail, which decomposes the three-dimensional deformation of the distal end of the long intramedullary nail into two deformations in two mutually perpendicular planes and solves it step by step, and the deformation of the intramedullary nail is the distal locking nail hole The displacement of the lock nail hole in one plane is achieved by the hinged rotation of the fixed guide arm and the adjustment guide arm to achieve the re-accurate re-alignment of the guide hole and the lock nail hole, and in another plane by adjusting the guide hole and the corresponding lock nail hole The distance and direction can be used to achieve accurate aiming in this plane; when the two planes are in good correspondence, all guide holes can be accurately aimed.
进一步地,所述固定导向臂通过调节臂旋钮与调节导向臂相铰接,调节导向臂以调节臂旋钮为中心转动;所述固定导向臂主体上设有一或数个调节臂固定孔,调节导向臂近端主体上设有相对应的旋钮铰接孔,调节臂固定孔和旋钮铰接孔相互配合用于对应髓内钉的弯曲点;调节臂固定孔或旋钮铰接孔的侧边可设有型号标记。Further, the fixed guide arm is hinged with the adjustment guide arm through the adjustment arm knob, and the adjustment guide arm rotates around the adjustment arm knob; the main body of the fixed guide arm is provided with one or several adjustment arm fixing holes, and the adjustment guide arm The proximal body is provided with a corresponding knob hinge hole, and the adjustment arm fixing hole and the knob hinge hole cooperate with each other to correspond to the bending point of the intramedullary nail; the side of the adjustment arm fixing hole or the knob hinge hole can be provided with a model mark.
进一步地,所述固定导向臂的近端为手把,手把的端部通过锁紧件与髓内钉进行固定连接;所述固定导向臂的远端一侧设有一个滑动凹槽,滑动凹槽的底部设有滑动臂固定孔。Further, the proximal end of the fixed guide arm is a handle, and the end of the handle is fixedly connected with the intramedullary nail through a locking member; the distal end of the fixed guide arm is provided with a sliding groove for sliding The bottom of the groove is provided with a sliding arm fixing hole.
进一步地,所述固定导向臂的远端一侧安装有用于起定位指示作用的滑动导向臂,滑动导向臂可伸缩滑动以适应不同型号长度的髓内钉;所述滑动导向臂的远端为拐臂形状,拐臂的端部一侧设有滑动臂原点标记线和滑动臂刻度线。Further, a sliding guide arm used for positioning indication is installed on the distal side of the fixed guide arm, and the sliding guide arm can be telescopically slid to accommodate intramedullary nails of different lengths; the distal end of the sliding guide arm is: In the shape of the arm, the end of the arm is provided with a marking line for the origin of the sliding arm and a scale line for the sliding arm.
进一步地,所述远端锁钉孔包括第一锁钉孔和第二锁钉孔, 第二锁钉孔位于第一锁钉孔的一侧,第二锁钉孔方向与第一锁钉孔方向不在同一平面。Further, the distal locking nail hole includes a first locking nail hole and a second locking nail hole, the second locking nail hole is located on one side of the first locking nail hole, and the direction of the second locking nail hole is the same as that of the first locking nail hole. The directions are not in the same plane.
进一步地,所述调节导向臂包括前弓臂和Z型臂,Z型臂为Z型结构,Z型臂上安装设有滑轨;所述滑轨为标准圆弧或非圆弧状,滑轨的数量为一个或数个。Further, the adjustment guide arm includes a front bow arm and a Z-shaped arm, the Z-shaped arm is a Z-shaped structure, and a sliding rail is installed on the Z-shaped arm; The number of tracks is one or several.
进一步地,所述调节导向臂上安装有可沿滑轨滑动的导向滑块,导向滑块可以根据导向孔与相应锁钉孔之间测得的变形后距离在滑轨上滑动调整恢复两者原有对应关系并锁紧固定于滑轨的相应位置。Further, a guide slider that can slide along the slide rail is installed on the adjustment guide arm, and the guide slider can slide on the slide rail to adjust and restore both according to the measured distance between the guide hole and the corresponding lock nail hole after deformation. The original corresponding relationship is locked and fixed to the corresponding position of the slide rail.
进一步地,所述导向滑块的底部开设有与滑轨相匹配的凹槽,导向滑块主体上设有第一导向孔,第一导向孔与髓内钉远端的第一锁钉孔相对应;导向滑块主体上还设有第二导向孔,第二导向孔与髓内钉远端的第二锁钉孔相对应。Further, the bottom of the guide slider is provided with a groove that matches the slide rail, and the main body of the guide slider is provided with a first guide hole, which is in line with the first locking nail hole at the distal end of the intramedullary nail. Correspondingly; the main body of the guide slider is further provided with a second guide hole, and the second guide hole corresponds to the second locking nail hole at the distal end of the intramedullary nail.
进一步地,瞄准器还包括刻度插块,刻度插块为可透X光材料构成,内嵌有数条不透光的金属线条,金属线条包括插块原点标记线、髓内钉边缘投射线和插块刻度线,插块原点标记线用于与滑动臂原点标记线和滑动臂刻度线相对应,髓内钉边缘投射线用于对齐髓内钉边缘,插块刻度线用于指示调节距离。Further, the sighting device also includes a scale insert, which is made of X-ray permeable material and embedded with several opaque metal lines. The block scale line, the insert block origin mark line is used to correspond to the sliding arm origin mark line and the sliding arm scale line, the intramedullary nail edge projection line is used to align the intramedullary nail edge, and the plug block scale line is used to indicate the adjustment distance.
进一步地,瞄准器还包括指示杆,指示杆的中心位置处设有金属条,金属条一端膨大;所述指示杆由透X光材料制成。Further, the sight further includes an indicator rod, a metal bar is arranged at the center of the indicator rod, and one end of the metal bar is enlarged; the indicator rod is made of X-ray transparent material.
本发明采用以上技术方案后,与现有技术相比,具有以下优点:After the present invention adopts the above technical scheme, compared with the prior art, it has the following advantages:
本发明提供的瞄准器将长骨髓内钉远端的三维变形分解为两个互相垂直平面内的变形分步解决,髓内钉的变形即为远端锁钉孔的位移,锁钉孔在一个平面内的位移通过固定导向臂和调节导向臂的铰接转动来实现导向孔与锁钉孔的重新精确瞄准,在另一个平面内通过调整导向孔与相应锁钉孔的距离和对应方向来实现本平面内的精确瞄准;当两个平面内都对应好,则可以做到所有导向孔精确瞄准,最后实现精准钻孔,快速锁定,解决了髓内钉远端锁钉困难的问题,缩短了手术时间,提高了手术效率;The sight provided by the invention decomposes the three-dimensional deformation of the distal end of the long intramedullary nail into two deformations in two mutually perpendicular planes. The deformation of the intramedullary nail is the displacement of the distal locking nail hole. The displacement in the plane is realized by the hinged rotation of the fixed guide arm and the adjustment guide arm to realize the re-accurate re-alignment of the guide hole and the lock nail hole. Accurate aiming in the plane; when the two planes are well matched, all the pilot holes can be accurately aimed, and finally accurate drilling and fast locking can be achieved, which solves the problem of difficulty in locking the distal end of the intramedullary nail and shortens the operation. time and improve the efficiency of surgery;
本发明可以将透视次数减少百分之八十以上,基本可以一次锁钉成功,减少病人失血降低费用,减少暴露时间及失血还可以降低感染率,减少病人痛苦及医疗纠纷。The invention can reduce the number of fluoroscopy by more than 80%, and can basically lock the nail successfully at one time, reduce the patient's blood loss, reduce the cost, reduce the exposure time and blood loss, and also reduce the infection rate, reduce the patient's pain and medical disputes.
下面结合附图和实施例对本发明进行详细说明。The present invention will be described in detail below with reference to the accompanying drawings and embodiments.
附图说明Description of drawings
图1是本发明的结构俯视图;Fig. 1 is the structure top view of the present invention;
图2是图1的主视图;Fig. 2 is the front view of Fig. 1;
图3是本发明中固定导向臂的结构示意图;Fig. 3 is the structural representation of the fixed guide arm in the present invention;
图4是本发明中调节导向臂的结构示意图;Fig. 4 is the structural representation of adjusting guide arm in the present invention;
图5是本发明中滑动导向臂与刻度插块的配合示意图;5 is a schematic diagram of the cooperation between the sliding guide arm and the scale insert in the present invention;
图6是本发明中导向滑块的结构示意图;Fig. 6 is the structural representation of the guide slider in the present invention;
图7是本发明中指示杆的结构示意图;Fig. 7 is the structural representation of the indicator rod in the present invention;
图中,1-髓内钉,101-第一锁钉孔,102-第二锁钉孔;2-锁紧件;3-固定导向臂,301-手把,302-滑动凹槽,303-调节臂固定孔,304-滑动臂固定孔 ;4-调节导向臂,401-前弓臂,402-旋钮铰接孔,403-Z型臂,404-滑轨;5-调节臂旋钮,6-导向滑块,601-凹槽,602-第一导向孔,603-插槽,604-第二导向孔;7-刻度插块,701-插块原点标记线,702-髓内钉边缘投射线,703-插块刻度线;8-滑动导向臂,801-条形孔,802-拐臂,803-滑动臂原点标记线,804-滑动臂刻度线;9-滑动臂旋钮;10-指示杆,1001-金属条;11-螺钉。In the figure, 1 - intramedullary nail, 101 - first locking nail hole, 102 - second locking nail hole; 2 - locking piece; 3 - fixed guide arm, 301 - handle, 302 - sliding groove, 303 - Adjusting arm fixing hole, 304-sliding arm fixing hole; 4-adjusting guide arm, 401-front bow arm, 402-knob hinge hole, 403-Z-arm, 404-slide rail; 5-adjusting arm knob, 6-guide Slider, 601-groove, 602-first guide hole, 603-slot, 604-second guide hole; 7-scale insert, 701- insert origin mark line, 702- intramedullary nail edge projection line, 703- insert block scale line; 8- sliding guide arm, 801- bar hole, 802- crutch arm, 803- sliding arm origin mark line, 804- sliding arm scale line; 9- sliding arm knob; 10- indicator rod, 1001-metal bars; 11-screws.
具体实施方式Detailed ways
为了对本发明的技术特征、目的和效果有更加清楚的理解,现对照附图以股骨髓内钉为例,说明本发明的具体实施方式。In order to have a clearer understanding of the technical features, purposes and effects of the present invention, the specific embodiments of the present invention will now be described with reference to the accompanying drawings, taking a femoral intramedullary nail as an example.
实施例1一种长骨髓内钉三维可调锁钉导向器Embodiment 1 A three-dimensional adjustable locking nail guide for long intramedullary nails
如图1、图2、图3和图4共同所示,本发明提供一种长骨髓内钉三维可调锁钉导向器,包括固定导向臂3,固定导向臂3通过调节臂旋钮5与调节导向臂4相铰接,调节导向臂4以调节臂旋钮5为中心转动来解决髓内钉1在矢状面内前后变形后的瞄准问题;所述固定导向臂3上设有调节臂固定孔303,调节导向臂4上设有旋钮铰接孔402,调节臂固定孔303和旋钮铰接孔402相互配合用于对应髓内钉1的弯曲点,使调节后的瞄准器与髓内钉1在矢状面变形后的形状相匹配;所述调节导向臂4上安装有可沿滑轨404滑动的导向滑块6,导向滑块6用于解决髓内钉1在冠状面内左右变形后的瞄准问题。As shown in Figure 1, Figure 2, Figure 3 and Figure 4 together, the present invention provides a three-dimensional adjustable locking nail guide for long intramedullary nails, including a
如图1所示,所述髓内钉1的远端主体上设有两个与冠状面平行的第一锁钉孔101,两个第一锁钉孔101的中间位置设有一个与冠状面呈一定角度的第二锁钉孔102,第二锁钉孔102是开口为长圆形的通孔。As shown in FIG. 1 , the distal body of the intramedullary nail 1 is provided with two first
如图3所示,所述固定导向臂3的近端为手把301,手把301的端部通过锁紧件2与髓内钉1进行固定连接;固定导向臂3的近端主体为前弓形状,与髓内钉1的前弓形状相匹配,固定导向臂3主体上设有一或数个调节臂固定孔303,调节臂固定孔303侧边可设有对应髓内钉1长度型号的标记;固定导向臂3的远端一侧设有一个滑动凹槽302,滑动凹槽302的底部设有一个滑动臂固定孔 304。As shown in FIG. 3 , the proximal end of the fixed
如图1和图5共同所示,所述固定导向臂3的远端一侧安装有用于起定位指示作用的滑动导向臂8,滑动导向臂8上开设有条形孔801,条形孔801内安装有滑动臂旋钮9,滑动臂旋钮9可锁紧于滑动臂固定孔 304内,滑动导向臂8通过滑动臂旋钮9固定于固定导向臂3的滑动凹槽302内,滑动导向臂8可伸缩滑动以适应不同型号长度的髓内钉1;所述滑动导向臂8的远端为拐臂802形状,拐臂802的端部一侧设有滑动臂原点标记线803和滑动臂刻度线804,滑动臂刻度线804均匀分布在滑动臂原点标记线803的两侧。As shown in FIG. 1 and FIG. 5 , a sliding
如图4所示,所述调节导向臂4包括近端的前弓臂401和远端的Z型臂403,前弓臂401的主体上设有旋钮铰接孔402,旋钮铰接孔402与固定导向臂3上的调节臂固定孔303相对应,旋钮铰接孔402的侧边可设有对应髓内钉1长度型号的标记;所述Z型臂403为Z型结构,Z型臂403上一端上方安装设有滑轨404,所述滑轨404为标准圆弧或非圆弧状,滑轨404的数量为一个或数个。As shown in FIG. 4 , the
如图6所示,所述导向滑块6可以根据导向孔与对应锁钉孔之间测得的变形后距离在滑轨404上进行滑动使其恢复原有的距离及对应方向并通过螺钉11锁紧固定于滑轨404的相应位置; 所述导向滑块6的底部开设有与滑轨404相匹配的凹槽601,导向滑块6主体的左右两侧分别设有一个第一导向孔602,第一导向孔602分别与髓内钉1远端的第一锁钉孔101相对应;导向滑块6主体的顶部设有第二导向孔604,第二导向孔604与髓内钉1远端的第二锁钉孔102相对应;导向滑块6主体一侧还开设有插槽603,插槽603内安装有用于测算髓内钉1变形距离的刻度插块7。As shown in FIG. 6 , the
如图5所示,所述刻度插块7为可透X光材料构成,内嵌有数条不透光的金属线条,金属线条包括插块原点标记线701、髓内钉边缘投射线702和插块刻度线703,插块原点标记线701用于与滑动臂原点标记线803和滑动臂刻度线804相对应,髓内钉髓边缘投射线702用于对齐髓内钉1边缘,插块刻度线703用于指示调节距离。As shown in FIG. 5 , the
如图7所示,瞄准器在安装过程中还用到指示杆10,指示杆10呈圆杆状,指示杆10的中心位置处设有一个金属条1001,金属条1001一端膨大,使指示作用更明显;所述指示杆10由透X光材料制成。As shown in FIG. 7 , an
本发明的具体操作过程:The specific operation process of the present invention:
以股骨骨折为例,不同骨折类型弯曲点所在区域差别较大,对应不同类型的导向器。术前根据骨折类型预估弯曲点位置选择合适导向器,根据髓内钉1的长短型号来确定调节导向臂4的旋钮铰接孔402的位置,进而确定调节导向臂4的铰接转动中心;术中在确定髓内钉1型号后,将固定导向臂3和调节导向臂4、滑动导向臂8与刻度插块7、滑轨404与导向滑块6都于原点对应处分别固定,要根据髓内钉1远端直径选择合适的刻度插块7,刻度插块7上的髓内钉边缘投射线702的距离与髓内钉1远端直径一致;将髓内钉1与固定导向臂3通过锁紧件2牢固固定在一起,髓内钉1插入体内前用测深尺测量髓内钉1与第一导向孔602之间的距离为a,髓内钉顺利插入后,进行远端锁定,首先用C型臂拍标准侧位片,先在第一导向孔602内插入指示杆10,让C型臂球管与接收板中心的连线与指示杆10平行,这样基本能够拍出较标准的侧位片,如果还不够满意,可以再调整C型臂,直至髓内钉1的第一锁钉孔101为正圆,且指示杆10内的金属条101为圆心的一个点,则为标准侧位;髓内钉1如有变形,此时有一条髓内钉边缘投射线702会远离髓内钉1的边缘,根据刻度插块7上的插块刻度线703读出偏离距离,松开调节臂旋钮5,让调节导向臂4转动一定的角度,使滑动导向臂8顶端的滑动臂原点标记线803与刻度插块7的插块原点标记线701之间的距离等于髓内钉1的偏离距离即可,锁紧调节臂旋钮5,在相应大腿外侧位置切开小口,分离皮下及肌肉达股骨,在第一导向孔602内插入套筒及钻头,钻孔穿过股骨及髓内钉1;用测深尺探测第一导向孔602到髓内钉1的距离,根据其与a的差来调整导向滑块6在滑轨404上的位置,使第一导向孔602到髓内钉1的位置最终为a,锁定导向滑块6,一一钻孔完成远端锁钉。近端常规锁钉,不赘述。Taking femoral fractures as an example, the bending points of different fracture types are quite different, corresponding to different types of guides. Preoperatively, an appropriate guide is selected according to the fracture type to estimate the position of the bending point, and the position of the knob hinge hole 402 of the
本发明的设计原理:The design principle of the present invention:
首先说明本发明总的指导思想,髓内钉的变形,不是单纯左右变形或者前后变形,而是一个立体的变形。目前所有的其他设计都是平面思维,没有引入立体概念,这是锁定不准的原因之一。把概念简化一下,研究具体一个锁钉孔,将其设为一个点,髓内钉没有变形时这个点在原点o,当髓内钉变形后,这个点的在XY坐标上位置为(a,b),我们将这个点分解为X轴距离为a的变形和Y轴距离为b的变形分别解决,或者说把髓内钉的形变分解为互相垂直的两个面内的变形,两个面的交线与长骨平行。First, the general guiding idea of the present invention is explained. The deformation of the intramedullary nail is not a simple left-right deformation or an anterior-posterior deformation, but a three-dimensional deformation. All other designs at present are flat thinking and do not introduce the concept of three-dimensional, which is one of the reasons for the inaccuracy of locking. Simplify the concept, study a specific locking nail hole and set it as a point. When the intramedullary nail is not deformed, this point is at the origin o. When the intramedullary nail is deformed, the position of this point on the XY coordinates is (a, b), we decompose this point into the deformation of the X-axis distance a and the Y-axis distance b to solve separately, or the deformation of the intramedullary nail is decomposed into the deformation in two mutually perpendicular planes, the two planes The line of intersection is parallel to the long bones.
再说明一下弯曲点的概念以及滑轨的设计依据,髓内钉插入髓腔后之所以变形,一定是因为有两个受力点使其弯曲,受力点之间弯曲的中心位置,则定义为弯曲点,股骨近端的髓内钉进钉点为一个恒定受力点,而另一个受力点则是变化的,如果骨折处在股骨峡部以远,峡部完整,因为其狭窄,容易对髓内钉形成把持,则其为另一个受力点,弯曲点大约在近端三分之一处,附图中所画旋钮固定孔和旋钮铰接孔的设置即以此种骨折为例;当峡部也有骨折的时候,则其无法对髓内钉形成把持,因为腿的重力作用等因素容易让髓内钉远端受力,则远端为另一个受力点,那么弯曲点接近髓内钉中间。即便是相同类型的骨折,髓内钉的型号越长,弯曲点也越往远端移动。当我们在矢状面内调整调节臂旋钮让调节导向臂弯曲来适应髓内钉变形的时候,调节导向臂上的导向孔与髓内钉远端的锁钉孔不是一个,而是多个,调节导向臂的弯曲位置与髓内钉弯曲点一致,导向孔与锁钉孔才都能更精确对位。理论上,不同类型骨折弯曲点所在区域不同,同类型骨折不同长度的髓内钉弯曲点的区域相同但位置也会不同,所以我们设置了多个旋钮固定孔。目前所有其他的导向器设计都没有体现出弯曲点的概念,这也是锁定不准确的原因之一。髓内钉在冠状面内的变形通过让滑块沿着滑轨做相应移动来解决,把弯曲点、锁钉孔、导向孔用线连接起来,是一个直角三角形,当髓内钉变形后,等于这个三角形以弯曲点为圆心做了一个小角度的旋转,我们只要让导向孔以弯曲点为圆心,以弯曲点到导向孔的距离为半径也做相应旋转,使这三点依然保持同样的直角三角形关系,那么导向孔与锁钉孔之间无论是距离还是方向都会恢复到未变形时的最佳对应关系,即便是与冠状面成夹角的锁钉孔,我们也能精确锁定。因此,滑轨的最佳设计方案是以弯曲点为圆心,以弯曲点到导向孔的距离为半径。Let me explain the concept of the bending point and the design basis of the slide rail. The reason why the intramedullary nail is deformed after being inserted into the medullary cavity must be because there are two stress points to make it bend, and the center of the bending between the stress points is defined. It is the bending point, the insertion point of the intramedullary nail at the proximal end of the femur is a constant force point, while the other force point is variable. If the fracture is located far from the isthmus of the femur, the isthmus is complete, because it is narrow and easy to treat. If the intramedullary nail is held, it is another point of force, and the bending point is about one third of the proximal end. When the isthmus is also fractured, it cannot hold the intramedullary nail, because the gravity of the leg and other factors can easily force the distal end of the intramedullary nail, so the distal end is another point of force, and the bending point is close to the intramedullary nail. middle. Even within the same type of fracture, the longer the intramedullary nail size, the more distal the inflection point is. When we adjust the adjustment arm knob in the sagittal plane to bend the adjustment guide arm to adapt to the deformation of the intramedullary nail, the guide hole on the adjustment guide arm and the locking nail hole at the distal end of the intramedullary nail are not one, but multiple. Adjust the bending position of the guide arm to be consistent with the bending point of the intramedullary nail, so that the guide hole and the locking nail hole can be more accurately aligned. Theoretically, the bending points of different types of fractures are located in different areas, and the bending points of intramedullary nails with different lengths of the same type of fractures have the same area but different positions, so we set up multiple knob fixing holes. All other current guide designs do not incorporate the concept of inflection points, which is one of the reasons for the inaccurate locking. The deformation of the intramedullary nail in the coronal plane is solved by moving the slider along the slide rail accordingly, connecting the bending point, the locking nail hole and the guide hole with a line, which is a right triangle. When the intramedullary nail is deformed, It is equivalent to this triangle making a small angle rotation with the bending point as the center. We only need to make the guide hole take the bending point as the center, and make the corresponding rotation with the distance from the bending point to the guide hole as the radius, so that the three points remain the same. Right-angled triangle relationship, then the distance and direction between the guide hole and the lock pin hole will return to the best corresponding relationship when they are not deformed. Even the lock pin hole that forms an angle with the coronal plane can be accurately locked. Therefore, the best design scheme of the slide rail is to take the bending point as the center of the circle and the distance from the bending point to the guide hole as the radius.
髓内钉导向器设计在长骨一侧的,一般先通过旋转调节臂调整矢状面上的前后位置,后沿滑轨在冠状面调整导向孔相对位置,如股骨髓内钉;髓内钉导向器设计在长骨前方的,则先沿冠状面通过左右旋转调节臂将导向孔对齐锁钉孔,然后沿滑轨调节矢状面上导向孔与锁钉孔的距离和对应方向,如胫骨髓内钉。The intramedullary nail guide is designed on the side of the long bone. Generally, the anterior-posterior position on the sagittal plane is adjusted by rotating the adjusting arm, and then the relative position of the guide hole is adjusted on the coronal plane along the slide rail, such as the femoral intramedullary nail; the intramedullary nail guide If the device is designed in front of the long bone, first rotate the adjusting arm left and right along the coronal plane to align the guide hole with the locking pin hole, and then adjust the distance and corresponding direction between the guide hole and the locking pin hole on the sagittal plane along the slide rail, such as in the tibia intramedullary nail.
本发明提供的瞄准器将髓内钉远端的三维变形进行分解为两个互相垂直平面内的变形,锁钉孔在一个平面内的位移通过调节固定导向臂和调节导向臂的铰接转动角度来实现导向孔与锁钉孔的精确瞄准,在一个平面内通过调整导向孔与锁钉孔的距离及对应方向来实现精确瞄准,最后实现精准钻孔,快速锁定,解决了髓内钉远端锁钉困难的问题,缩短了手术时间,提高了手术效率。The sight provided by the invention decomposes the three-dimensional deformation of the distal end of the intramedullary nail into deformations in two mutually perpendicular planes, and the displacement of the locking nail hole in one plane is determined by adjusting the fixed guide arm and the hinged rotation angle of the guide arm. Realize the accurate aiming of the guide hole and the locking nail hole. In one plane, the distance between the guide hole and the locking nail hole and the corresponding direction can be adjusted to achieve precise aiming. Finally, accurate drilling and fast locking are realized, which solves the problem of locking the distal end of the intramedullary nail. The problem of difficult nailing shortens the operation time and improves the operation efficiency.
以上所述为本发明最佳实施方式的举例,其中未详细述及的部分均为本领域普通技术人员的公知常识。本发明的保护范围以权利要求的内容为准,任何基于本发明的技术启示而进行的等效变换,也在本发明的保护范围之内。The above are examples of the best embodiments of the present invention, and the parts not described in detail are the common knowledge of those of ordinary skill in the art. The protection scope of the present invention is subject to the content of the claims, and any equivalent transformation based on the technical inspiration of the present invention is also within the protection scope of the present invention.
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Cited By (5)
Publication number | Priority date | Publication date | Assignee | Title |
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CN111759445A (en) * | 2020-07-08 | 2020-10-13 | 陈聚伍 | Visual intramedullary nail far-end aiming device |
CN113558743A (en) * | 2021-08-09 | 2021-10-29 | 北京市春立正达医疗器械股份有限公司 | Adjustable aiming arm for intramedullary nail |
CN113855157A (en) * | 2021-11-01 | 2021-12-31 | 北京力达康科技有限公司 | Drilling guider for femoral greater tuberosity fixing screw |
CN114052874A (en) * | 2020-08-07 | 2022-02-18 | 北京蒙太因医疗器械有限公司 | Intramedullary nail sight and skeletal treatment system including the same |
CN118845181A (en) * | 2024-09-25 | 2024-10-29 | 浙江德康医疗器械有限公司 | Intramedullary nail aiming system |
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2019
- 2019-10-30 CN CN201911045001.7A patent/CN110680494A/en not_active Withdrawn
Cited By (6)
Publication number | Priority date | Publication date | Assignee | Title |
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CN111759445A (en) * | 2020-07-08 | 2020-10-13 | 陈聚伍 | Visual intramedullary nail far-end aiming device |
CN114052874A (en) * | 2020-08-07 | 2022-02-18 | 北京蒙太因医疗器械有限公司 | Intramedullary nail sight and skeletal treatment system including the same |
CN113558743A (en) * | 2021-08-09 | 2021-10-29 | 北京市春立正达医疗器械股份有限公司 | Adjustable aiming arm for intramedullary nail |
CN113855157A (en) * | 2021-11-01 | 2021-12-31 | 北京力达康科技有限公司 | Drilling guider for femoral greater tuberosity fixing screw |
CN118845181A (en) * | 2024-09-25 | 2024-10-29 | 浙江德康医疗器械有限公司 | Intramedullary nail aiming system |
CN118845181B (en) * | 2024-09-25 | 2025-02-14 | 浙江德康医疗器械有限公司 | Intramedullary nail aiming system |
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