CN205054394U - Preceding way dissection template of extensive region dentata dislocation that restores to throne by oneself - Google Patents

Abstract

The utility model discloses a self-resetting anterior anatomical plate for atlantoaxial dislocation, which comprises an atlas part, an axis part and a connecting part. It is located at the back and lower part of the atlas, which matches the front structure of the axial vertebral body. There are five screw holes designed on it, four of which are located on both sides, in a symmetrical distribution, and there is an oblong sliding screw hole in the middle. The atlas part is connected with the axis part through the connecting part. The utility model plays the role of resetting the dislocation of the atlantoaxial through the sliding of the screw in the hole of the sliding screw; and fixes the atlantoaxial to achieve the purpose of resetting the atlantoaxial, and the shape is completely consistent with the anatomical shape of the atlas and the axis. Matching, more fit, beautiful appearance, good reset effect.

Description

Self-reduction anterior anatomical plate for atlantoaxial dislocation

technical field

The utility model belongs to the technical field of medical internal fixation, in particular to a self-resetting anterior anatomical plate for atlantoaxial dislocation.

Background technique

The upper cervical vertebrae of the human body are the first and second cervical vertebrae, namely the atlantoaxial vertebrae. The incidence rate of atlantoaxial dislocation is low, but because it is adjacent to the medulla oblongata, the odontoid process compresses the spinal cord after dislocation, prone to quadriplegia, and even affects the medulla oblongata respiratory center, which is life-threatening.

At present, when atlantoaxial instability causes neurological symptoms due to compression and stimulation of the upper cervical spinal cord, direct reduction and fusion fixation at the rear is usually selected according to the situation, or relaxation and decompression at the front, resection of the odontoid process, fixation or setting aside. However, the normal structure is destroyed after simple odontectomy, the instability between the atlantoaxial vertebrae increases, the range of motion increases, and the irritation to the nerves increases. Therefore, anterior or posterior fusion fixation is often used. Posterior fusion and fixation are relatively simple. For patients who are easier to reduce, one-stage posterior surgery can be used for treatment followed by screw fixation. However, posterior surgical fusion and fixation requires anatomical cutting of the starting and ending points of many posterior muscle groups, resulting in neck muscle atrophy and a high incidence of neck pain; and the rear implantation of internal fixation requires a certain width of soft tissue separation. And complications such as vertebral artery injury often occur during the process of implanting internal fixation screws. At the same time, in some cases, after atlantoaxial dislocation, a large number of fibrous or bony connections in the anterior approach appeared, and it was difficult to reset only from the posterior approach. It must be loosened from the anterior approach in one stage and then fixed by the posterior approach surgery, which increased the surgical trauma. , and need to turn over many times during the operation, which increases the risk of the operation. At the same time, in some cases, the posterior fixation structure was damaged, or there were factors such as posterior infection, which made it impossible to perform surgery from the posterior approach. The use of anterior fixation can avoid the occurrence of these disadvantages.

Anterior surgery can loosen the fibrous connection or bony connection between the atlantoaxial vertebrae through the oral cavity, and perform reduction and fixation.

The structure of the atlantoaxial spine is different from that of the lower cervical spine. There is no intervertebral disc structure, and its vertebral body is irregular, so it cannot be fixed by conventional internal fixation. At present, there is only an anterior reduction and fixation plate designed by Guangzhou Military Region General Hospital at home and abroad. However, the application of the steel plate is difficult to operate, and the reset requires an additional expansion device to achieve. The design of the steel plate is a straight steel plate on the atlas, while the front of the atlas has a certain curvature, which makes it impossible for the steel plate to fit completely, and some screws are exposed between the steel plate and the bone; the screw hole design of the axis vertebra is wider , requiring larger tissue exposure. For reduction, additional screws and spreaders are needed to achieve the reduction between the atlantoaxial vertebrae, which cannot achieve the purpose of resetting through its own structure.

To sum up, at present, no anatomical plate for anterior reduction that fully conforms to the physiological structure of the human body and realizes the reduction of atlantoaxial dislocation has not been successfully designed at home and abroad.

Utility model content

The purpose of this utility model is to overcome the disadvantages of posterior fusion surgery, and at the same time, in order to make most of the atlantoaxial dislocation can achieve the purpose of reset, fixation and fusion through the self-design of the anterior plate, aiming at the characteristics of atlantoaxial dislocation, combined with atlantoaxial Anterior vertebral anatomical structure features provide a self-resetting anterior anatomical plate for atlantoaxial dislocation.

In order to achieve the above object, the utility model adopts the following technical solutions:

The anatomical plate includes an atlas partly arc-shaped plate in contact with the front of the atlas and an axis partly arc-shaped plate in contact with the front of the axis, the lower end of the atlas partly arc-shaped plate is in contact with the axis partly arc-shaped plate The upper ends of the atlas are connected with connecting plates that are compatible with the steps between the atlantoaxial vertebrae; the two ends of the arc-shaped plates of the atlas are provided with locking screw holes, and the two ends of the arc-shaped plates of the atlas are provided with Locking screw holes, the middle part of the arc-shaped plate of the shaft part is provided with a sliding screw hole extending longitudinally, the inside of the sliding screw hole is slope-shaped, and the higher end of the slope is close to the arc of the shaft part The outer surface of the upper end (proximal end) of the shaped plate, and the lower end of the slope is close to the inner surface of the lower end (far end) of the arc-shaped plate of the pivot vertebrae.

The inner surface of the partial arc plate of the atlas is consistent with the curvature of the anterior arch of the atlas, and the locking screw holes at both ends of the partial arc plate of the atlas correspond to the positions of the lateral mass of the atlas.

The arc-shaped plate of the axial part is made of a plate that matches the shape of the front of the vertebral body of the axis. Two locking screw holes are arranged at both ends of the arc-shaped plate of the axis. The arc-shaped part of the axis The locking screw holes at both ends of the plate are symmetrically arranged and arranged in an inverted trapezoidal position on the arc-shaped plate of the pivot vertebra part. One locking screw hole corresponds to the position of the pedicle of the axis vertebrae, and the two locking screw holes located at both ends of the arc-shaped plate of the axis vertebrae and the two locking screw holes on the inner side in the arrangement of the positions and the sliding screw holes correspond to the position of the pivot vertebrae. Corresponding to the position of the vertebral body.

The partial arc-shaped plate of the axis is located at the rear and lower part of the partial arc-shaped plate of the atlas, and the anatomical plate is bent in a Z shape.

The included angle between the connecting plate and the partial arc plate of the atlas is 120°-127°, and the included angle between the connecting plate and the partial arc plate of the axis is 120°-132°.

The anatomical template is integrally formed.

The inner surface of the anatomical template is provided with a hydroxyapatite coating.

The anatomical template also includes a screw disposed in each locking screw hole and the sliding screw hole.

The screw disposed in the sliding screw hole has a bevel-shaped nail tail structure matched with the slope.

The anatomical template (including screws) is made of titanium alloy.

The beneficial effects of the utility model are reflected in:

The self-resetting anterior anatomical plate of the atlantoaxial dislocation described in the utility model is designed according to the anatomical features of the front of the atlantoaxial, so that the anatomical plate can fit well with the corresponding bone of the atlas and the axis, increasing the fixed stability. And by sliding the slope-shaped design of the screw hole itself, the extrusion effect between the slope of the screw tail and the slope of the nail hole can be used to make the pivot slide to the distal end when the screw is tightened, thereby driving the fixed pivot. The vertebral body slides downward, and the height difference between the bending part where the connecting plate is located and the atlantoaxial vertebrae matches, so that the anatomical plate serves the purpose of resetting the dislocated atlantoaxial vertebrae, and has a better reduction and fixation effect.

Furthermore, the nail holes on both sides of the arc-shaped plate of the atlas correspond to the lateral mass of the atlas, and the fixing strength is high; the nail holes on the arc-shaped plate of the axis can be equipped with a total of five screws, and the outermost two screws are fixed on the axis vertebra. Among the pedicles, the middle three are fixed to the axial vertebral body; compared with the existing anatomical plate, three screw fixation designs are added, which greatly enhances the fixation strength and reduces the chance of internal fixation falling off.

Furthermore, the surface of the anatomical template in the present invention that is in contact with the cortical bone is coated with hydroxyapatite, which can increase the probability of bone ingrowth and increase the firmness of the anatomical template.

Furthermore, multiple screws can be fixed from different angles, which increases the angle stability and reduces the risk of screw loosening and falling out.

Description of drawings

Fig. 1 is the front view of the utility model;

Fig. 2 is the rear view of the utility model;

Fig. 3 is the top view of the utility model;

Fig. 4 is the bottom view of the utility model;

Fig. 5 is a middle side sectional view of the utility model, and the sectional direction is A direction in Fig. 1;

Fig. 6 is a sectional view of the sliding screw hole described in the utility model;

Fig. 7 is a median sectional view when the screw in the sliding screw hole is not fully tightened when the utility model is applied, the screw is located at the proximal end of the screw hole, and the atlantoaxial dislocation has not been reset;

Fig. 8 is a median sectional view when the screw in the sliding screw hole is fully tightened when the utility model is applied, the screw slides to the tail end of the nail hole, and the atlantoaxial dislocation is completely reset;

In the figure: 1 is the arc plate of the atlas, 2 is the locking screw hole, 3 is the arc plate of the axis, 4 is the bending connection part, 5 is the sliding screw hole, 5A is the proximal end of the sliding screw hole , 5B is the distal end of the sliding screw hole, 5C is the inner slope of the sliding screw hole, 6 is the screw in the sliding screw hole, 7 is the longitudinal section of the atlas, and 8 is the longitudinal section of the axis.

detailed description

The utility model is described in detail below in conjunction with accompanying drawing and embodiment.

Referring to Figures 1 to 8, the self-resetting anterior anatomical plate for atlantoaxial dislocation of the present invention includes an atlas part, an axis part, a bending connection part and screws.

The atlas part is a curved plate with an opening facing the front of the atlas, which is consistent with the curvature of the anterior arch of the atlas. Symmetrical screw holes are designed on both sides of the curved plate (locking screw hole 2, which has a large outer radius and an inner radius Small holes are used to match the slope of the screw tail to achieve locking), and the position of the screw hole corresponds to the lateral mass of the atlas.

The axis part is located behind and below the atlas part, and has a lordotic and concave shape (that is, a curved plate protruding away from the atlanto-axis), and its shape is consistent with the front shape of the axis vertebral body. There are five screw holes designed, of which the four symmetrical screw holes on both sides (locking screw hole 2, which is a hole with a large outer radius and a smaller inner radius, to cooperate with the screw tail slope to achieve locking) are inverted trapezoidal, inverted In the trapezoid, the outermost two screw holes correspond to the pedicles of the axis vertebrae, the middle two screw holes correspond to the axis vertebral body, and the middlemost one is a longitudinal oblong sliding screw hole 5 . The lower part of the arc-shaped plate 1 of the atlas is connected with the upper part of the arc-shaped plate 3 of the axis, forming a zigzag bend. That is, it adapts to the height difference between the atlantoaxial vertebrae), and the width is the same as the upper half of the axial vertebral body.

The atlas partial arc plate 1 is composed of a rectangular part in the middle and semicircular parts on both sides, with a total width of 48 mm, a height of 10.9 mm, and a thickness of 2 mm. The distance between the centers of the screw holes on the arc-shaped plate 1 of the atlas is 36 mm, and the radius of the screw holes is 3.5 mm. The inner surface of the arc-shaped plate 1 of the atlas (that is, the bone contact surface with the atlantoaxial vertebrae) is coated with hydroxyapatite coating.

The thickness of the arc-shaped plate 3 of the axis part is 2 mm, and the total height is 22.5 mm. The inside diameter of the arc is 61mm. The arc-shaped plate 3 of the axis part is generally in the shape of a rhombus with blunt edges, and its shape matches the structure in front of the vertebral body of the axis. 4 connections. The inner surface of the arc-shaped plate 3 of the axis part is coated with hydroxyapatite coating.

The middlemost one on the arc-shaped plate 3 of the axis vertebrae is longitudinally oblong sliding screw nail hole, with a width of 2.7mm and a longitudinal length of 5.5mm. , the distal end (lower end) is lower, and the proximal end is about 1mm higher than the distal end. The diameter of the remaining four screw holes on the arc-shaped plate 3 of the axis is 2.7mm.

The bending connection part 4 (a strip-shaped connecting plate) is in the direction of front-up to back-down, respectively connecting the atlas part and the axis part, with a width of about 12mm, and an angle of about 120°-127° with the atlas part, and with the axis part The angle is about 120°-132°, and the specific angle is adjusted according to the actual structure. The thickness is 2mm, and the front-to-back width is 3-4mm.

When resetting: fix the atlas part on the atlas with two screws, and then fix one screw on the proximal slope of the sliding screw hole 5. By tightening the screw, use the gap between the slope of the screw tail and the inner slope of the screw hole. When the screw is tightened, the axis will slide to the distal end, so that the atlantoaxial dislocation can be reset by itself through the anatomical plate. After reduction, fix the remaining four screws on the axis part to complete the reduction and fixation.

The arc-shaped plate 1 of the atlas, the arc-shaped plate 3 of the axis, the bending connection part 4 and the screws can all be made of medical titanium alloy, and the arc-shaped plate 1 of the atlas, the arc-shaped plate 3 of the axis and the bending The bent connection part 4 can be integrally formed.

In a word, the anatomical plate proposed by the utility model can not only fit well with the anatomical structure in front of the normal human body's atlantoaxial vertebrae in appearance, but also has a narrow range of exposure, less tissue irritation, and less trauma; The slope-shaped sliding screw hole design utilizes the extrusion effect between the slope of the screw tail and the slope of the screw hole to make the axis slide distally when the screw is tightened, thereby achieving the purpose of resetting the atlantoaxial dislocation. Not only is it more beautiful in appearance, but it also integrates reset and fixation, and does not require additional reset devices, making it more practical.

Claims (10)

1. template is dissected on the front road of self-resetting atlantoaxial dislocation, it is characterized in that: this dissection template comprises the atlas part arc (1) contacted with atlas front and the dentata part arc (3) contacted with dentata front, between the lower end of described atlas part arc (1) and the upper end of described dentata part arc (3), be connected with the connecting plate that step between atlas and axis adapts; The two ends of described atlas part arc (1) are provided with lock screw nail (2), the two ends of described dentata part arc (3) are provided with lock screw nail (2), the middle part of described dentata part arc (3) is provided with the sliding screw nail (5) of longitudinal extension, be ramped shaped in described sliding screw nail (5), the outer surface of one end near described dentata part arc (3) upper end that described slope is higher, the inner surface of one end near described dentata part arc (3) lower end that described slope is lower.

2. template is dissected on the front road of a kind of self-resetting atlantoaxial dislocation according to claim 1, it is characterized in that: the inner surface of described atlas part arc (1) is consistent with anterior arch of atlas radian, the lock screw nail (2) at described atlas part arc (1) two ends is corresponding with lateral mass of atlas portion.

3. template is dissected on the front road of a kind of self-resetting atlantoaxial dislocation according to claim 1, it is characterized in that: described dentata part arc (3) is made up of the plate body mating with dentata vertebral body front form, the two ends of described dentata part arc (3) are provided with two lock screw nail (2), the lock screw nail at described dentata part arc (3) two ends is arranged symmetrically with and arranges in the upper position forming inverted trapezoidal of described dentata part arc (3), described dentata part arc (3) two ends are positioned at and two lock screw nail are in the outer part corresponding with axis arch root position in the arrangement of described position, be positioned at described dentata part arc (3) two ends in the arrangement of described position and two lock screw nail in the inner part and described sliding screw nail (5) corresponding with dentata vertebral body position.

4. template is dissected on the front road of a kind of self-resetting atlantoaxial dislocation according to claim 1, it is characterized in that: described dentata part arc (3) is positioned at the back lower place of described atlas part arc (1), and described dissection template is zigzag bending.

5. according to claim 1 or 4, template is dissected on the front road of a kind of self-resetting atlantoaxial dislocation, it is characterized in that: the angle of described connecting plate and described atlas part arc (1) is 120 ° ~ 127 °, the angle of described connecting plate and described dentata part arc (3) is 120 ° ~ 132 °.

6. template is dissected on the front road of a kind of self-resetting atlantoaxial dislocation according to claim 1, it is characterized in that: described dissection template is formed in one.

7. template is dissected on the front road of a kind of self-resetting atlantoaxial dislocation according to claim 1, it is characterized in that: the inner surface of described dissection template is provided with hydroxyapatite coating layer.

8. template is dissected on the front road of a kind of self-resetting atlantoaxial dislocation according to claim 1, it is characterized in that: described dissection template also comprises the screw be arranged in each lock screw nail (2) and described sliding screw nail (5).

9. template is dissected on the front road of a kind of self-resetting atlantoaxial dislocation according to claim 8, it is characterized in that: the screw be arranged in described sliding screw nail (5) has the inclined-plane sprig stern construction coordinated with described slope.

10. template is dissected on the front road of a kind of self-resetting atlantoaxial dislocation according to claim 8, it is characterized in that: described dissection template adopts titanium alloy to make.