CN111991099A

CN111991099A - Lifting proportion template prop for bone surgery fracture operation and measuring method

Info

Publication number: CN111991099A
Application number: CN202011003067.2A
Authority: CN
Inventors: 赵德来
Original assignee: Individual
Current assignee: Individual
Priority date: 2020-09-22
Filing date: 2020-09-22
Publication date: 2020-11-27
Anticipated expiration: 2040-09-22
Also published as: CN111991099B

Abstract

The invention relates to the field of medical instruments for orthopedic surgery, in particular to a lifting proportion template device and a measuring method for an orthopedic surgery fracture operation of a long tubular bone of a human body. The method is characterized in that: one end of the bolt is dynamically connected with the hemisphere through threads, and the other end of the bolt is fixedly connected with the base to form a proportional template; the semispherical thread can be lifted up and down; performing proximal femur rotation-preventing intramedullary nail surgery, namely, a patient lies on a flat bed, a proportional template is placed on the flat bed to be in a horizontal state, an X-ray film is shot, an operator touches the maximum point of the greater tuberosity with hands, a horizontal ruler is used for measuring a hemisphere, the hemisphere is lifted to the position with the same height as the greater tuberosity, and a picture is taken; the invention has the positive effects that: the diameter in the X-ray sheet is measured to be 1 mm; the diameter of the medullary cavity of the bone of the part of the affected limb needing to be treated in the X-ray film is calculated to be accurate to 1 mm. Data were obtained to guide surgical success to 100%. 1. The operation time of the proximal femur anti-rotation intramedullary needle is 15-30 minutes; 2. the operation time of the intramedullary needle for femoral shaft fracture is less than or equal to 1 hour; 3. the operation time of the tibia marrow internal needle is less than or equal to 1 hour; 4. the operation time of the tibial steel plate is less than or equal to 1 hour.

Description

Lifting proportion template prop for bone surgery fracture operation and measuring method

Technical Field

The invention relates to a prop used in the bone surgery department during X-ray photographing, in particular to a lifting proportion template prop used in the bone surgery department of long tubular bones of a human body and a measuring method.

Background

For patients with long tubular bone fracture, doctors pursue preoperative accurate calculation and accurate positioning of fracture surgery, and the method is short in time, less in bleeding, low in postoperative infection rate and fast in wound healing. But the patients are cured with less pain, early recovery and less cost. Including intramedullary fixation (intramedullary nail system) and extramedullary fixation (steel plate) operations, the latter has the disadvantages of more exposure, large wound, longer time, more bleeding and the like.

The common operation method for the fracture of the long tubular bone of the human body comprises the following steps: 1. proximal femur rotation-preventing intramedullary nail operation, 2 femoral shaft fracture intramedullary nail operation, 3 tibia intramedullary nail operation, and 4 tibia steel plate operation.

At present, the traditional method of doctors in domestic hospitals for femoral and tibial dry fracture surgery is as follows: intramedullary nails are superior to steel plates, i.e., central fixation is superior to eccentric fixation. If the bone is too thin and the intramedullary nail fails to be inserted, the steel plate is used instead. In order to shorten the operation time and perform more accurate operation. Various medical instruments which are considered to be used in the preparation operation are basically prepared; the X-ray film is also shot at the fracture part of the patient, the X-ray film is provided with a centimeter (cm) level precision scale, the transverse and longitudinal distances of each bone part in the film are calculated to measure and calculate, the method can only calculate approximate numerical values, the body types of the patient are different, and the X-ray machine has the defects of uncertain projection distance, so that the error is larger, the scaling ratios of different devices are different, the calculation is more complicated, and the error rate is increased for the subsequent operation. Fig. 7 is a photograph taken with an actual X-ray film, which is given a scale of 70% and an actual 90% with too large an error. The following disadvantages result from this: 1. the proportion in the X-ray film is different from the actual proportion, which causes misjudgment to doctors before operation; 2. the diameter of the minimum femoral medullary needle is 9.5mm, and the operation in the operation can cause iatrogenic fracture of the medullary cavity due to inaccuracy of the preoperative X-ray film and excessively thin medullary cavity, so that secondary trauma is caused to a patient; 3. if the medullary cavity of the patient is less than 9.5mm, the intramedullary nail can not be inserted, the success rate is less than or equal to 96 percent, and the intramedullary nail is fixed by a steel plate. For example, the anterior-lateral longitudinal incision of the left thigh is about 25cm long with the fold end as the center, skin and subcutaneous tissues are incised, the incision is made in the gap between the rectus femoris and the lateral femoris, the medial femoral muscle is incised, hemostasis is performed along the way, the fold end is exposed, the repositor is reset, the C-shaped arm is seen through the perspective during the operation, the fracture alignment is good, and the double-steel-plate screw fixation is performed. ". The secondary wound of a patient is caused, the intraoperative hemorrhage is increased, the exposure time is long, the infection risk is increased, and the infection rate is increased from 0.5% to 2%; 4. the time of the surgery is increased to 2 hours. If a plurality of internal fixtures are disinfected simultaneously, larger surgical equipment resources are occupied, the cost is increased, and the efficiency is reduced.

Disclosure of Invention

The invention aims to provide a lifting proportion template prop for bone surgery fracture surgery and a measuring method, which have the advantages of simple structure, low cost, accurate operation and use and quickness. The purpose of the invention is realized as follows: the utility model provides a lift proportion template device that bone surgery fracture operation used, it contains hemisphere, bolt, screw thread, base, its characterized in that: one end of the bolt is dynamically connected with the hemisphere through threads, and the other end of the bolt is fixedly connected with the base to form a proportional template;

furthermore, the hemisphere can be adjusted up and down through the screw thread; the diameter of the hemisphere is 100 mm.

Further, a lifting proportion template measuring method for bone surgery fracture operation is characterized in that:

a. performing proximal femur rotation-preventing intramedullary nail operation, namely, a patient lies on a bed surface, a proportional template is placed on the bed surface to be in a horizontal state, an X-ray film is shot, an operator touches the highest point of the tuberositas with hands, and the vertical distance between the tuberositas and the bed surface is measured, so that the hemisphere rises to the same height as the level of the tuberositas; measuring the hemisphere by using a horizontal ruler, lifting the hemisphere to the position with the same height as the great tuberosity, and taking a picture;

further, after the X-ray film is obtained, the numerical value of the pulp cavity isthmus of the patient is calculated by applying a pulp cavity isthmus (D × hemisphere diameter/A formula); measuring data A and D on an X-ray film, wherein D is the measured pulp cavity isthmus diameter in the X-ray film, A is the measured hemisphere diameter in the X-ray film, and the hemisphere diameter is 100 mm; according to the formula, the value of the pulp cavity isthmus is more than 9.5mm, so that the operation can be carried out; if the medullary cavity isthmus is less than 9.5mm, the proximal femur rotation-preventing intramedullary nail operation can not be carried out, and the steel plate operation is carried out instead;

b. performing femoral shaft fracture intramedullary nail operation, namely, a patient lies on a bed surface, a proportional template is placed on the bed surface to be in a horizontal state, an X-ray film is shot, an operator touches the highest point of the tuberositas with hands, and the vertical distance between the tuberositas and the bed surface is measured, so that a hemisphere rises to the same height as the level of the tuberositas; photographing an X-ray film; after the X-ray film is obtained, the numerical value of the pulp cavity isthmus of the patient is calculated by applying a pulp cavity isthmus (D × hemisphere diameter/A formula); measuring data A and D on an X-ray film, wherein D is the measured pulp cavity isthmus diameter in the X-ray film, A is the measured hemisphere diameter in the X-ray film, and the hemisphere diameter is 100 mm; according to the formula, the value of the pulp cavity isthmus is more than 9.5mm, so that the operation can be carried out; if the medullary cavity isthmus is less than 9.5mm, the operation can not be performed, and the operation is changed into extramedullary steel plate operation;

c. the tibia intramedullary nail operation cannot be carried out when the tibia medullary cavity is smaller than 8.0 mm; the patient lies on the bed surface, the proportional template is placed on the bed surface to be in a horizontal state, an X-ray film is taken, an operator holds the tibial eminence with the hand, the vertical distance between the tibial eminence and the bed surface is measured, and the hemisphere is lifted to the same height as the tibial eminence; taking a picture of an X-ray film according to a formula D-hemisphere diameter/A of the medullary cavity isthmus; after the X-ray film is obtained, the numerical value of the pulp cavity isthmus of the patient is calculated by applying a pulp cavity isthmus (D × hemisphere diameter/A formula); measuring data A and D on an X-ray film, wherein D is the measured pulp cavity isthmus diameter in the X-ray film, A is the measured hemisphere diameter in the X-ray film, and the hemisphere diameter is 100 mm; according to the formula, the value of the pulp cavity isthmus is more than 8.0mm, so that the operation can be carried out; if the medullary cavity isthmus is less than 8.0mm, the operation cannot be performed, and the operation is changed to extramedullary steel plate operation. The invention has the positive effects that: the diameter in the X-ray sheet is measured to be 1 mm; the diameter of the medullary cavity of the bone of the part of the affected limb needing to be treated in the X-ray film is calculated to be accurate to 1 mm. Data were obtained to guide surgical success to 100%. 1. The operation time of the proximal femur anti-rotation intramedullary needle is 15-30 minutes; 2. the operation time of the intramedullary needle for femoral shaft fracture is less than or equal to 1 hour; 3. the operation time of the tibia marrow internal needle is less than or equal to 1 hour; 4. the operation time of the tibial steel plate is less than or equal to 1 hour; simple structure, low cost, accurate and quick operation and use, and reduces the pain time of patients.

Drawings

FIG. 1 is a schematic front view of the structural principle of the present invention;

FIG. 2 is a schematic side view of the structural principle of the present invention;

FIG. 3 is a schematic top view of the present invention;

FIG. 4 is a schematic top view of the structure of the scale template and the long tubular bone of the human body according to the present invention after being photographed by an X-ray machine;

FIG. 5 is a schematic front view of the structure principle of the proportional template and human tibia after being photographed by an X-ray machine;

FIG. 6 is a schematic side view of the structure principle of the proportional template and human tibia taken by an X-ray machine;

FIG. 7 is a schematic top view of the structural principle of the long tubular bone of a human body photographed by an X-ray machine;

6-acetabulum, 7-ilium, 8-femoral head, 9-femoral neck, 10-greater tuberosity, 11-greater tuberosity peak, 12-smaller tuberosity, 13-bed surface, 14-femoral shaft, 15-pear-shaped fossa, 16-medullary cavity isthmus, 17-tibia, 18-fibula, 19-tibial plateau, 20-tibial crest and 21-tibial tubercle.

Detailed Description

A lifting proportion template device for bone surgery fracture operation and a measuring method thereof comprise a hemisphere 1, a bolt 2, a thread 3 and a base 4, and are characterized in that: one end of the bolt 2 is dynamically connected with the hemisphere 1 through a thread 3, and the other end of the bolt is fixedly connected with the base 4 to form a proportional template 5; the hemisphere 1 can be lifted up and down through the thread 3; hemisphere 1 has a diameter of 100 mm.

Example 1, name: certain jun li, male, age 45, height: 1.85 m. The proximal femur rotation-proof intramedullary nail operation. The patient lies on the bed surface 13, the proportional template 5 is placed on the bed surface 13 to be in a horizontal state, an X-ray film is shot, an operator touches the maximum point 11 of the Dacron 10 with the hand, the vertical distance between the Dacron 10 and the bed surface 13 is measured to be 70mm, and the hemisphere 1 is adjusted to rise by 70mm to be at the same height as the level of the Dacron 10. The hemisphere 1 is measured with a horizontal ruler, and the hemisphere 1 is raised to the same height as the apex 11 of the greater trochanter, and photographed. The patients have fat and thin, and the adjustment range is 70mm-100 mm. After taking X-ray film, a is 82mm, D is 10mm, C is the diameter of hemisphere 1 100mm, according to the formula, the medullary canal isthmus 16 is D C/a, the medullary canal isthmus 16 is 10mm 100mm/82mm is 1000mm/82mm is 12.195mm, which is greater than 9.5mm, and the operation can be performed. If the medullary cavity isthmus 16 is less than 9.5mm, the proximal femur rotation-proof intramedullary nail operation can not be performed, but the steel plate operation is performed instead. C is the diameter of hemisphere 1 of 100mm, D is the medullary canal isthmus 16 diameter measured on an X-ray film, and A is the hemisphere 1 diameter measured on an X-ray film. 1. Performing proximal femoral anti-rotation intramedullary nail operation, enabling a patient to lie on an operating table, performing full anesthesia and effect display, then performing traction, closure and restoration, enabling the folded end position to be good when the C-shaped arm is seen through perspective, disinfecting the skin of an operation area by iodophor solution, and laying a sterile sheet for operation; 2. taking a right hip incision to cut the skin by about 3cm, cutting the skin and fascia, opening a mouth gag, resetting a folding end of a restorer, inserting a guide pin, performing fluoroscopy, inserting a main nail, performing fluoroscopy, driving the folding end at a proper position, connecting a sighting device to drive in the guide pin, performing fluoroscopy, expanding a hole, driving a spiral blade, locking, performing fluoroscopy, driving a distal end locking nail in the same method, screwing in a tail cap, performing fluoroscopy, and fixing well; 3. washing with Qingda saline, adding antibiotics, suturing wound layer by layer, and applying sterile dressing; 4. after the operation, the operation is carried out for 30 minutes. If the diameter of the pulp chamber isthmus 16 is less than 9.5mm as measured before the operation, the intramedullary fixation can not be performed, and the operation is changed into extramedullary steel plate operation.

The intraoperative modification is fixation of a proximal femur steel plate: taking a left proximal femur lateral incision, incising the skin by about 15cm, which is longer than the wound of the proximal femur anti-rotation intramedullary nail operation, incising the subcutaneous part and the fascia, stopping bleeding by a delayed electric knife, separating the muscle blunt, exposing the folding end, resetting a restorer, and fixing a steel plate screw.

Example 2, name: zhanghuangbo, male, age 55, height: 1.65 m. Intramedullary nail operation for femoral shaft fracture: the patient lies on the bed surface 13, the proportional template 5 is placed on the bed surface 13 to be in a horizontal state, an X-ray film is shot, an operator touches the maximum point 11 of the Dacron 10 with the hand, the vertical distance between the Dacron 10 and the bed surface 13 is measured to be 100mm, and the hemisphere 1 is adjusted to rise by 100mm to be at the same height as the level of the Dacron 10. The hemisphere 1 is measured with a horizontal ruler, and the hemisphere 1 is raised to the same height as the apex 11 of the greater trochanter, and photographed. And taking a picture of an X-ray film. After the X-ray film is taken, the patient's true medullary canal isthmus 16 is calculated using the medullary canal isthmus 16 (D C/a equation). When measured on an X-ray film, A is 96mm, D is 9.4mm, C is the diameter of the hemisphere 1 of 100mm, and the medullary cavity isthmus 16 is 9.4mm 100mm/100mm 940mm/96mm is 9.79mm, which is greater than 9.5mm, the intramedullary fixation operation can be performed.

1. Lying a patient on the back on an operating table, after the anesthesia has the effect, performing conventional disinfection, laying a sterile sheet, and adhering an iodophor film to an operation area; 2. the length of a longitudinal incision on the front side of a left thigh is about 10cm by taking a folding end as a center, skin and subcutaneous tissues are incised, the skin enters into a gap between a rectus femoris and a vastus lateralis muscle, the vastus intermedialis is incised, hemostasis is performed along the way, the folding end is exposed, a restorer is reset, a greater tuberosity vertex incision of a left hip is made, an opener is opened in a pear-shaped pit 15, a guide pin is inserted, a medulla needle is inserted after medulla expanding, a distal magnetic navigation positioner is connected, aiming is performed, the incision is drilled for depth measurement, a distal screw is screwed in, perspective and good fixation is realized, a proximal screw is screwed in; 3. after flushing with saline water, the electric knife can thoroughly stop bleeding, and then antibiotics are sprayed into the electric knife, and the wound is sutured layer by layer for 20 minutes after the operation is finished.

Example 3, name: somebody in korea, woman, age 48, height: 1.69 m. Tibia marrow 22 internal nail operation: the patient lies on the bed surface 13, the proportional template 5 is placed on the bed surface 13 to be in a horizontal state, an X-ray is taken, the operator holds the tibial eminence 22 with the hand, the vertical distance between the tibial eminence 22 and the bed surface 13 is measured to be 80mm, and the hemisphere 1 is adjusted to be 80mm high and has the same height as the level of the tibial eminence 22. The hemisphere 1 is measured with a horizontal ruler, and the hemisphere 1 is raised to the same height as the tibial eminence 22, and photographed. The measurement on X-ray film shows that A is 90mm, D is 7.5mm, according to the formula, the medullary cavity isthmus 16 is D C/A, C is the diameter 100mm of hemisphere 1, medullary cavity isthmus 16 is 7mm 100mm/90mm 750mm/90mm is 8.33mm, and the value is more than 8mm, the operation of intramedullary nail for tibial dry fracture can be performed.

1. The patient lies on the operating table, after the waist stiffness is fully narcotized, the left thigh is wound with a tourniquet, the skin of the operation area is sterilized by a powerful iodophor solution, and a sterile sheet is laid; 2. the affected limb is raised, the left tourniquet is inflated, the left calf is longitudinally cut by about 5cm by taking the folded end as a center, the skin and subcutaneous tissues are cut layer by layer, the broken end of the tibia is exposed, the bone fractures, the left calf is rotated, shortened and displaced, the reduction forceps are closed and reset under direct vision, the knee is bent by the stabilized folded end, an upper cut of the tibial tubercle, the skin and the subcutaneous tissues are cut layer by layer, the tibial tubercle is exposed, an opening device is opened, the marrow is enlarged, a medullary needle is inserted, the folded end is adjusted, a sighting device is connected, positioning, drilling, sounding, a screw is screwed in, a near-end screw is driven in the same way, the wound is washed by using the saline, the bleeding is thoroughly stopped, the cut is.

When the photo taking device is used for taking a photo, only one person of the applicant can see the photo, and the other person cannot see the photo. After photographing, the product is put into a bag. The invention finishes 200 cases till now, accurately measures the diameter of the medullary cavity, is applied to the internal fixation of the long tubular bone fracture cutting and resetting, greatly shortens the operation time, greatly improves the accuracy of preoperative design, saves medical resources and ensures good postoperative rehabilitation of patients.

Claims

1. The utility model provides a lift proportion stage property template device that orthopedic surgery fracture operation was used, it contains hemisphere, bolt, screw thread, base, its characterized in that: one end of the bolt is dynamically connected with the hemisphere through threads, and the other end of the bolt is fixedly connected with the base to form a proportional template; the semispherical thread can be adjusted up and down in a lifting way; the diameter of the hemisphere is 100 mm.

2. A method for measuring a lifting proportion prop template for bone surgery fracture operation is characterized in that:

a. performing proximal femur rotation-preventing intramedullary nail surgery, namely, enabling a patient to lie on a flat bed, enabling a proportional template to be placed on the flat bed to be in a horizontal state, shooting an X-ray film, enabling an operator to touch the highest point of the tuberositas with hands, and measuring the vertical distance between the tuberositas and the bed surface to enable the hemisphere to rise to the same height as the level of the tuberositas; measuring the hemisphere by using a horizontal ruler, lifting the hemisphere to the position with the same height as the great tuberosity, and taking a picture;

after the X-ray film is obtained, the numerical value of the pulp cavity isthmus of the patient is calculated by applying a pulp cavity isthmus (D × hemisphere diameter/A formula); measuring data A and D on an X-ray film, wherein D is the measured pulp cavity isthmus diameter in the X-ray film, A is the measured hemisphere diameter in the X-ray film, and the hemisphere diameter is 100 mm; according to the formula, the value of the pulp cavity isthmus is more than 9.5mm, so that the operation can be carried out; if the medullary cavity isthmus is less than 9.5mm, the proximal femur rotation-preventing intramedullary nail operation can not be carried out, and the steel plate operation is carried out instead;

b. performing femoral shaft fracture intramedullary nail operation, namely, a patient lies on a flat bed, a proportional template is placed on the flat bed to be in a horizontal state, an X-ray film is shot, an operator touches the highest point of the tuberositas with hands, the vertical distance between the tuberositas and the bed surface is measured, and the hemisphere rises to the same height as the level of the tuberositas; photographing an X-ray film; after the X-ray film is obtained, the numerical value of the pulp cavity isthmus of the patient is calculated by applying a pulp cavity isthmus (D × hemisphere diameter/A formula); measuring data A and D on an X-ray film, wherein D is the measured pulp cavity isthmus diameter in the X-ray film, A is the measured hemisphere diameter in the X-ray film, and the hemisphere diameter is 100 mm; according to the formula, the value of the pulp cavity isthmus is more than 9.5mm, so that the operation can be carried out; if the medullary cavity isthmus is less than 9.5mm, the operation can not be performed, and the operation is changed into extramedullary steel plate operation;

c. the tibia intramedullary nail operation cannot be carried out when the tibia medullary cavity is smaller than 8.0 mm; the patient lies on the flat bed, the proportional template is placed on the flat bed to be in a horizontal state, an X-ray film is taken, an operator holds the shin ridge with hands, the vertical distance between the shin ridge and the bed surface is measured, and the hemisphere is lifted to the same height as the shin ridge; taking a picture of an X-ray film according to a formula D-hemisphere diameter/A of the medullary cavity isthmus; after the X-ray film is obtained, the numerical value of the pulp cavity isthmus of the patient is calculated by applying a pulp cavity isthmus (D × hemisphere diameter/A formula); measuring data A and D on an X-ray film, wherein D is the measured pulp cavity isthmus diameter in the X-ray film, A is the measured hemisphere diameter in the X-ray film, and the hemisphere diameter is 100 mm; according to the formula, the value of the pulp cavity isthmus is more than 8.0mm, so that the operation can be carried out; if the medullary cavity isthmus is less than 8.0mm, the operation cannot be performed, and the operation is changed to extramedullary steel plate operation.