CN112315540A

CN112315540A - A kind of auxiliary guidance system for high osteotomy of proximal tibia with varus deformity of knee joint

Info

Publication number: CN112315540A
Application number: CN202011382015.0A
Authority: CN
Inventors: 刘德印; 孟羿彬; 孙亮; 马腾; 任程; 路遥; 卢代刚; 赵赞栋; 李忠; 张堃; 林华; 姚晓蓉
Original assignee: Xian Honghui Hospital
Current assignee: Xian Honghui Hospital
Priority date: 2020-12-01
Filing date: 2020-12-01
Publication date: 2021-02-05

Abstract

The invention provides an auxiliary guidance system for high-level osteotomy of the proximal tibia with knee varus deformity, including a force line guidance sub-system and an osteotomy guidance sub-system, wherein the force line guidance sub-system includes a femoral head locator and an iliac bone fixation nail , Hip end connector, transverse connecting rod, ankle fixation pin, ankle end connector and ankle connecting rod, described osteotomy guide sub-system including proximal tibia lateral positioning Kirschner wire, angle adjustment assembly and osteotomy Channel components and positioning lines. The force line guidance sub-system of the present invention is mainly used for force line reference, and the osteotomy guidance sub-system is mainly used for the guidance and positioning of the proximal tibia osteotomy line. The ingenious design can not only facilitate the force line correction, but also accurately place the osteotomy. Guided Kirschner wire, which can quickly and accurately locate the osteotomy direction, limit the osteotomy depth, simplify the measurement time of the force line, shorten the operation time and increase the orthopedic effect of the osteotomy.

Description

High-order supplementary guide system that cuts of knee joint enstrophe deformity shin bone near-end

Technical Field

The invention belongs to the field of orthopedics osteotomy correction, and particularly relates to a knee joint varus deformity tibia proximal end high osteotomy auxiliary guide system.

Background

The tibia high-position osteotomy combined with internal fixation is an operation mode for treating varus deformity caused by abrasion of the inner side gap of the knee joint, and the proximal force line of the tibia is improved by opening the inner side of the tibia to cut, so that the load and abrasion of the inner side platform are reduced, and the axial load is transferred to the outer side platform, thereby achieving the purposes of relieving pain and improving the quality of life. The literature reports that the treatment effect of the high tibial osteotomy is satisfactory.

The high tibial osteotomy adopts biplane osteotomy, which is divided into an oblique osteotomy line from inside to outside and a coronal osteotomy line for keeping continuity of a tibial tubercle and a distal end. The oblique fracture line is required to be parallel to the tibial plateau plane in the sagittal plane, to be horizontal from the upper edge of the goose foot, to point 1cm below the lateral plateau, and to be about 1/3 above the fibula capitula. In the clinical operation process, before osteotomy, 2 Kirschner wires are parallelly drilled in the oblique fracture line direction to a proper depth as a guide, the oscillating saw is obliquely and incompletely osteotomy along the Kirschner wires, and the continuity of outer part bone is kept as a hinge when the osteotomy line is expanded. A coronal section of bone thickness was then maintained behind the tibial tubercle, with a line angle of about 110 degrees. After the osteotomy is completed, the near end of the external hard force line rod is corresponding to the center of the femoral head, and the far end of the external hard force line rod is corresponding to the center of the ankle joint. The oblique osteotomy line is opened, so that the force line rod passes through the knee joint center or the fujisawa point at the knee joint position, and at the moment, the force line rod is fixed by using the internal fixing steel plate, thereby realizing the force line correction of the varus deformity of the lower limbs, improving the symptoms and improving the life quality of patients.

During surgery, there are two major problems. Firstly, the insertion of the kirschner wire guide needle needs to be suitable in height from the upper edge of a platform to an inner side needle insertion point and an outer side needle point, the needle insertion direction and the needle insertion angle are positioned under perspective by adopting a bare-handed technology at present, the needle insertion point is selected, the perspective is interrupted in the drilling process, and the proper nail insertion point, direction and depth are determined. After the first guiding Kirschner wire is successfully placed, the second guiding needle is placed by taking the first guiding Kirschner wire as a mark, and the needle feeding point and the direction are deviated due to free-hand operation, so that the needle feeding point and the direction are required to be adjusted repeatedly, the operation time is prolonged, and the number of times of perspective radiation is increased. The accuracy of bone cutting is reduced. Secondly, the hard force line rod is manually adjusted in the using process and mainly perspectives the femoral head, the knee joint and the ankle joint, the near end of the force line rod is required to pass through the center of the femoral head, the far end of the force line rod passes through the center of the ankle joint, the knee joint part is the knee joint center or fujisawa point, and after one position is adjusted satisfactorily, the deviation possibly existing in other parts is verified and needs to be adjusted. Because the force line of the lower limb can not be kept static, the patient has to be repeatedly subjected to fluoroscopy and adjustment, the operation time is prolonged, and the bleeding amount and the risk of postoperative complications are increased.

Disclosure of Invention

The invention aims to solve the technical problem of providing an auxiliary guiding system for proximal high osteotomy of knee-joint varus malformed tibia, which is skillfully designed for two subsystems of force line guiding and osteotomy guiding, particularly the force line guiding subsystem is mainly used for force line reference, and the osteotomy guiding subsystem is mainly used for guiding and positioning the proximal osteotomy line of the tibia, so that the force line correction can be facilitated, and a kirschner pin for positioning and a kirschner pin for guiding can be accurately placed, thereby being capable of quickly and accurately positioning the osteotomy direction, limiting the osteotomy depth, simplifying the force line measuring time, and increasing the orthopedic effect of osteotomy while shortening the operation time.

In order to solve the technical problems, the invention adopts the technical scheme that: a knee joint varus deformity tibia near-end high osteotomy auxiliary guiding system is characterized by comprising a force line guiding subsystem and an osteotomy guiding subsystem;

the force line guiding subsystem is used for force line reference and comprises a hip structure assembly and an ankle structure assembly, wherein the hip structure assembly comprises a femoral head positioner, two iliac fixation nails and a transverse connecting rod which is transversely connected with the two iliac fixation nails through a hip end connector, the ankle structure assembly comprises ankle fixation nails which are respectively positioned at the inner ankle and the outer ankle, and an ankle connecting rod which is transversely connected with the ankle fixation nails through an ankle end connector;

the osteotomy guiding subsystem is used for guiding and positioning a proximal tibia high-position osteotomy line and comprises a proximal tibia guiding structure component and a positioning line, and the proximal tibia guiding structure component comprises an angle adjusting component and an osteotomy channel component.

The knee joint varus deformity tibia near-end high-position osteotomy auxiliary guide system is characterized in that the ilium fixing nail is formed by integrally forming a top smooth cylindrical structure, a middle circular retaining sheet, a lower thread-shaped cylindrical structure and a bottom nail-shaped structure.

The knee joint varus deformity tibia near-end high-position osteotomy auxiliary guide system is characterized in that the upper section of the femoral head positioner is of a rod-shaped structure and the structure is connected with a transverse connecting rod between two iliac fixing nails through a middle section connecting piece, the lower section of the femoral head positioner is of a circular ring-shaped structure, and a circular ring inner hole is used for accurately positioning the center of a femoral head under a perspective condition.

The high-position osteotomy auxiliary guide system for the proximal tibia with the knee-joint varus deformity is characterized in that the ankle bone fixing nail is formed by integrally forming a top smooth cylindrical structure, a middle circular retaining sheet, a lower threaded cylindrical structure and a bottom nail-shaped structure.

The high-position osteotomy auxiliary guide system for the proximal tibia with the knee-joint varus deformity is characterized in that an ankle moving part penetrates through an ankle connecting rod between two ankle fixing nails, the ankle moving part can move back and forth along the ankle connecting rod to accurately position the center of an ankle joint under a perspective condition, and a hanging hole is formed in the ankle moving part and is connected with a circular inner hole at the lower end of a femoral head positioner through a positioning line.

The proximal high-position osteotomy auxiliary guide system for knee-joint varus deformity tibia is characterized in that the angle adjusting assembly is structurally characterized in that

And the horizontal section of the component is a solid cylinder, and the vertical section is provided with a positioning hole so that the Kirschner wire for positioning is inserted into the positioning hole.

The knee joint varus deformity tibia near-end high-position osteotomy auxiliary guide system is characterized in that the osteotomy channel assembly is formed by integrally forming a cylindrical structure located at the front section and a right trapezoid structure located at the rear section, wherein a horizontal channel is formed in the front section cylindrical structure, so that a horizontal section of the angle adjustment assembly can move in the horizontal channel, an osteotomy guide groove and a guide hole are formed in the inclined plane of the rear section right trapezoid structure in a penetrating mode along the horizontal direction, and the guide hole is used for inserting a kirschner wire for guiding, so that the osteotomy direction is determined.

The proximal high osteotomy auxiliary guide system for knee-joint varus deformity tibia is characterized in that the osteotomy guide groove is in the shape of

And the three guide holes are uniformly distributed on the same side of the osteotomy guide groove and are tangent to the osteotomy guide groove.

The invention relates to a knee joint varus deformity tibia proximal end high osteotomy auxiliary guide system, wherein the tibia proximal end high belongs to the industry known term, and refers to a tibia proximal metaphysis part.

Compared with the prior art, the invention has the following advantages:

1. the invention relates to an auxiliary guide system for proximal high osteotomy of a knee-joint varus malformed tibia. This system is through the ingenious design to two subsystems of line of force direction and osteotomy direction, and wherein the line of force direction subsystem mainly used line of force is referenced, cuts the direction and the location of bone direction subsystem mainly used shin bone near-end osteotomy line, can not only make things convenient for the line of force to correct, can also accurately put into osteotomy direction kirschner wire.

2. When the osteotomy guiding system is used, only the ideal osteotomy height and depth of the outer side of the proximal end of the tibia are positioned under perspective, the positioning kirschner wire is arranged in the vertical channel in the angle adjusting assembly, the angle adjusting assembly and the osteotomy channel piece are assembled and then rotate by taking the positioning kirschner wire as the axis, and the guiding kirschner wire can be arranged in the guiding hole after rotating to the proper position of the inner osteotomy line, so that perspective verification is carried out. Because the kirschner wire holes of the osteotomy channel component are designed to be a plurality of and are uniformly distributed on the same side of the osteotomy guide groove, two osteotomy guide kirschner wires which are parallel to each other and point to the outer side of the proximal tibia in the direction can be rapidly placed in. Compared with the prior free-hand operation, the operation is more scientific, reasonable, simple, convenient and accurate, and the operation efficiency and the operation success rate are higher.

3. At present, when the proximal tibial osteotomy orthopedic surgery is performed, a force line is measured by a handheld force line rod, the femoral head center, the ankle joint center and the knee joint center need to be repeatedly seen through, and if one position changes, other parts need to be adjusted and verified again. According to the invention, through the bold assumption, rigorous design and continuous clinical optimization, the femoral head center and the ankle joint center are fixed by setting, repeated perspective is not needed, only the relative position of the knee joint center and the force line positioning line needs to be viewed, the positioning line for guiding the force line corresponds to the ideal tibial plateau position when the inner side gap is expanded, and at the moment, the expansion gap only needs to be maintained, and a bone fracture plate and a screw are placed.

4. The components in the force line guiding subsystem and the osteotomy guiding subsystem can be connected and separated at will, and the Kirschner wire for guiding and the Kirschner wire for positioning can be common Kirschner wires without additionally modifying the existing surgical equipment, so that the force line guiding subsystem is reasonable in design, ingenious in structure and excellent in clinical effect.

The present invention will be described in further detail with reference to the accompanying drawings and examples.

Drawings

Fig. 1 is a schematic view of the general structure of the present invention.

Figure 2 is a schematic view of the hip structural assembly of the present invention.

FIG. 3 is a schematic view of the connection relationship of the iliac fixation nail, the transverse connection rod, the hip end connector and the middle connector of the present invention.

Fig. 4 is a schematic structural view of the ilium fixing nail of the invention.

Fig. 5 is a schematic view of an ankle block assembly according to the invention.

FIG. 6 is a schematic view showing the connection relationship among the ankle nails, the ankle connecting rods, the ankle connecting members and the ankle moving members according to the present invention.

Fig. 7 is a schematic structural view of an ankle bone fixation nail according to the present invention.

Figure 8 is a schematic view of the angle adjustment assembly and osteotomy passage assembly of the present invention in an assembled condition.

Fig. 9 is a front view of fig. 8.

Detailed Description

Example 1

The invention designs an auxiliary guiding system for proximal high osteotomy of knee-joint varus deformity tibia, the overall structure of the system is shown in figure 1, and the system comprises two subsystems: a force line guiding subsystem and an osteotomy guiding subsystem; the osteotomy guiding subsystem is used for guiding and positioning a proximal tibial high-position osteotomy line and comprises a proximal tibial guiding structure component III and a positioning line IV.

As shown in fig. 2, the upper section of the femoral head positioner I-1 is a rod-shaped structure and the structure is connected with a transverse connecting rod I-3 located between two iliac fixation nails I-2 through a middle connecting piece I-5, the lower section of the femoral head positioner I-1 is a circular ring-shaped structure, and a circular ring inner hole is used for accurately positioning the center of the femoral head under a perspective condition.

As shown in figures 2 and 3, in the force line guiding sub-system, the hip structural assembly I comprises a femoral head locator I-1, two iliac fixation nails I-2 and a transverse connecting rod I-3 transversely connected with the two iliac fixation nails I-2 through hip end connectors I-4.

As shown in figures 3 and 4, in the hip structure assembly I, the ilium fixing nail I-2 is formed by integrally forming four parts of a top smooth cylindrical structure, a middle circular baffle plate, a lower thread-shaped cylindrical structure and a bottom nail-shaped structure.

As shown in Figs. 5 and 6, in the force line directing subsystem, the ankle component II includes an ankle staple II-2 located respectively at the medial and lateral malleoli, and an ankle connector II-3 connected transversely to the ankle staple II-2 by an ankle end connector II-4.

As shown in fig. 5 and fig. 6, in the force line guiding subsystem, an ankle moving part II-5 penetrates through an ankle connecting rod II-3 located between two ankle nails II-2, the ankle moving part II-5 can move back and forth along the ankle connecting rod II-3 to accurately position the center of the ankle joint under the perspective condition, and a hanging ring is arranged on the ankle moving part II-5 and connected with a circular structure at the lower end of a femoral head positioner I-1 through a positioning line IV.

As shown in fig. 7, in the force line guiding subsystem, the ankle bone fixation nail II-2 is formed by integrally forming four parts of a top smooth cylindrical structure, a middle circular baffle, a lower thread-shaped cylindrical structure and a bottom nail-shaped structure.

As shown in figures 8 and 9, in the osteotomy guide subsystem, proximal tibial guide assembly III includes an angular adjustment assembly III-2 and an osteotomy channel member III-3.

As shown in fig. 8 and 9, the angle adjusting assembly III-2 has a structure

In the shape of a square,and the vertical section of the component is provided with a positioning hole III-1 so that a Kirschner wire for positioning is inserted into the positioning hole III-1.

As shown in fig. 8 and 9, the osteotomy channel assembly III-3 is formed by integrally forming a cylindrical structure at the front section and a right trapezoid structure at the rear section, wherein the cylindrical structure at the front section is provided with a horizontal channel to enable the horizontal section of the angle adjusting assembly III-2 to move in the horizontal channel, the inclined surface of the right trapezoid structure at the rear section is provided with an osteotomy guide groove III-4 and a guide hole III-5 along the horizontal direction, and the guide hole III-5 is used for inserting a kirschner pin for guiding, so as to determine the osteotomy direction.

As shown in fig. 8 and 9, the osteotomy guide groove III-4 has a shape of

And the three guide holes III-5 are uniformly distributed on the same side of the osteotomy guide groove III-4 and are tangent to the osteotomy guide groove III-4.

The connecting rods related to the invention, such as the transverse connecting rod I-3 and the ankle connecting rod II-3, have no special design requirements on shapes and materials, and can meet the connecting requirements between the parts. As for the shape, it is sufficient to use a homogeneous connecting rod of a general shape, such as a circular rod, a square rod, a hexagonal rod, an octagonal rod, etc. For the material, the material only needs to meet the material requirement in the medical field. The invention is applied to the practice of clinical application by using common square stainless steel rods.

The connecting pieces such as the hip end connecting piece I-4, the middle section connecting piece I-5, the ankle end connecting piece II-4 and the ankle moving piece II-5 related in the invention have no special design requirements on the shape and the material, and can meet the connecting requirements among the parts. For the shape, the connecting hole of the connecting piece can be a circular hole, a square hole, a hexagonal hole, an octagonal hole and the like. For the material, the material only needs to meet the material requirement in the medical field. The invention uses common stainless steel materials in clinical practice, except that the upper parts of the hip end connecting piece I-4 and the ankle end connecting piece II-4 adopt round holes for connecting the ilium fixing nail I-2 and the ankle fixing nail II-2, and the other parts all use common square holes.

With reference to fig. 1 to 9, the clinical application method of the present invention comprises the following steps:

step one, conventionally disinfecting and laying a sheet, wherein the near end of a disinfection range comprises anterior superior iliac spines at two sides, the far end of the disinfection range disinfects the whole limb at the affected side, and the perineum area is covered when the sheet is laid;

secondly, screwing the ilium fixing nails I-2 in the vertical direction of the anterior superior iliac spines at the two sides, installing the hip end connecting piece I-4, penetrating the middle connecting piece I-5 on the transverse connecting rod I-3, then penetrating the hip end connecting piece I-4, and locking the hip end connecting piece I-4; connecting a femoral head positioner I-1 with an upper middle section connecting piece I-5, positioning the femoral head under perspective, and fixing the positions of all parts after the requirements are met;

thirdly, screwing ankle fixing nails II-2 in the vertical direction of the inner and outer ankles, installing an ankle end connecting piece II-4, threading an ankle moving piece II-5 on an ankle connecting rod II-3, and then threading the ankle connecting rod II-3 through the ankle end connecting piece II-4; sliding the ankle moving part II-5, and enabling the ankle moving part II-5 to pass through the center of the ankle joint in the longitudinal direction under perspective so as to fix the positions of all parts after meeting the requirements;

and fourthly, determining an ideal external positioning point of the proximal tibia osteotomy under fluoroscopy, and screwing a positioning kirschner wire in a manner of being vertical to the coronal plane of the affected limb. Sleeving the angle adjusting assembly III-2 into the Kirschner wire through the Kirschner wire hole;

fifthly, exposing the inner side and the back bone surface of the proximal tibia through a conventional proximal tibia anterior-medial incision;

sixthly, connecting the osteotomy passage member III-3 with the angle adjusting assembly III-2 through a horizontal passage, rotating the combined osteotomy passage member III-3 and angle adjusting assembly III-2 to an ideal inner osteotomy line position by taking the positioning kirschner wire as an axis, and drilling the kirschner wire into the guide hole III-5 to verify the osteotomy direction;

seventhly, soft tissue protection is carried out on the rear side of the proximal end of the tibia by using bone stripping, the swing saw is used for cutting bones through the bone cutting guide groove III-4, and the bone cutting depth is satisfied when a saw blade of the swing saw is in contact with a proximal positioning Kirschner wire of the tibia;

eighthly, connecting the positioning line IV with the femoral head positioner I-1 and the ankle joint sliding part hanging ring, and verifying the femoral head center and the ankle joint center through fluoroscopy again; the perspective machine is corresponding to the knee joint, and the positioning line is positioned at the inner side of the center of the knee joint under the normal condition;

and step nine, using a distraction tool to perform distraction operation on the inner side of the osteotomy line, and moving the positioning line to the outer side along with the increase of the distraction gap. And stopping the stretching operation after the positioning line moves to a satisfactory position, placing the inner side bone fracture plate, drilling holes, screwing in screws for fixing, and finishing the operation.

The above description is only for the preferred embodiment of the present invention, and is not intended to limit the present invention in any way. Any simple modification, change and equivalent changes of the above embodiments according to the technical essence of the invention are still within the protection scope of the technical solution of the invention.

Claims

1. A knee joint varus deformity tibia near-end high osteotomy auxiliary guiding system is characterized by comprising a force line guiding subsystem and an osteotomy guiding subsystem;

the force line guiding subsystem is used for force line reference and comprises a hip structure component (I) and an ankle structure component (II), wherein the hip structure component (I) comprises a femoral head positioner (I-1), two ilium fixing nails (I-2) and a transverse connecting rod (I-3) which is transversely connected with the two ilium fixing nails (I-2) through a hip end connector (I-4), the ankle structure component (II) comprises an ankle fixing nail (II-2) which is respectively positioned at the medial malleolus and the lateral malleolus and an ankle connecting rod (II-3) which is transversely connected with the ankle fixing nail (II-2) through the ankle end connector (II-4);

the osteotomy guiding subsystem is used for guiding and positioning a proximal tibia high-position osteotomy line and comprises a proximal tibia guiding structure component (III) and a positioning line (IV), wherein the proximal tibia guiding structure component (III) comprises an angle adjusting component (III-2) and an osteotomy channel component (III-3).

2. The proximal high osteotomy auxiliary guiding system for knee varus deformity tibia according to claim 1, wherein said iliac fixation nail (I-2) is integrally formed by four parts of a top smooth cylindrical structure, a middle circular block piece, a lower thread-shaped cylindrical structure and a bottom nail-shaped structure.

3. The proximal high osteotomy auxiliary guiding system of knee varus deformity tibia according to claim 1, wherein an upper section of the femoral head locator (I-1) is a rod-shaped structure and is connected with a transverse connecting rod (I-3) between two iliac fixation nails (I-2) through a middle connecting piece (I-5), a lower section of the femoral head locator (I-1) is a circular ring-shaped structure, and an inner hole of the circular ring is used for accurately positioning the center of the femoral head under a perspective condition.

4. The proximal high osteotomy auxiliary guiding system of knee varus deformity tibia according to claim 1, wherein said ankle bone fixation nail (II-2) is integrally formed by four parts of a top smooth cylindrical structure, a middle circular block piece, a lower thread-shaped cylindrical structure and a bottom nail-shaped structure.

5. The proximal high osteotomy auxiliary guiding system of knee varus deformity tibia according to claim 1, wherein an ankle moving member (II-5) is provided on an ankle connecting rod (II-3) between two ankle nails (II-2), the ankle moving member (II-5) can move back and forth along the ankle connecting rod (II-3) for accurately positioning the ankle center under fluoroscopy, and the ankle moving member (II-5) is provided with a hanging hole connected with a circular ring inner hole at the lower end of the femoral head positioner (I-1) through a positioning line (IV).

6. The proximal high osteotomy auxiliary guiding system for knee varus deformity tibia according to claim 1, wherein said angle adjusting assembly (III-2) is constructed in a manner of

The horizontal section of the component is a solid cylinder, the vertical section is provided with a positioning hole (III-1),so that the positioning k-wire is inserted therein.

7. The proximal high osteotomy auxiliary guiding system of knee varus deformity tibia according to claim 6, wherein said osteotomy passage component (III-3) is formed by integrally forming a cylindrical structure at the front section and a right trapezoid structure at the rear section, wherein the cylindrical structure at the front section is provided with a horizontal passage for allowing the horizontal section of the angle adjusting component (III-2) to move in the horizontal passage, the inclined plane of the right trapezoid structure at the rear section is provided with an osteotomy guiding groove (III-4) and a guiding hole (III-5) along the horizontal direction, and the guiding hole (III-5) is used for inserting a kirschner wire for guiding, thereby determining the osteotomy direction.

8. The guiding system of claim 7, wherein the osteotomy guiding slot (III-4) is shaped like "/and the number of the guiding holes (III-5) is three, and the three guiding holes are uniformly arranged on the same side of the osteotomy guiding slot (III-4) and are tangent to the osteotomy guiding slot (III-4).