CN206880715U - A kind of subpatellar fat pad device for excising - Google Patents

Abstract

The utility model patent belongs to the field of orthopedic surgical appliances, and specifically relates to the structure of an infrapatellar fat pad quantitative excision tool. An infrapatellar fat pad resection device, including a patella fixer, a positioning rod, a patellar tendon measuring rod, and a resection knife. The patella fixator includes a caliper and a patellar tendon fixing rod, which can remove excess infrapatellar fat pad to expose the surgical field , can also effectively preserve the dense vascular area of the infrapatellar fat pad, reduce the complications caused by excessive resection of the infrapatellar fat pad, and resect the dense vascular area together, which is convenient for joint surgeons to control, and is conducive to total knee replacement The operation is carried out.

Description

A device for resection of infrapatellar fat pad

technical field

The utility model patent belongs to the field of orthopedic surgical appliances, and specifically relates to the structure of an infrapatellar fat pad quantitative excision tool.

Background technique

According to statistics from the National Bureau of Statistics of China, at the end of 2013, the total population of mainland China was 1,360.72 million, of which 202.43 million were 60 years old and above, accounting for 14.9% of the total population, and 131.61 million people were 65 years old and above, accounting for 9.7% of the total population. Beginning in 2013, the number of aging population in my country will increase by 10 million, and will double to 400 million in the next 20 years. According to statistical data, 51% of the elderly over 60 years old in my country suffer from knee osteoarthritis. In the United States, more than 9 million people have been diagnosed with knee arthritis by clinical symptoms and imaging data. Coupled with traumatic arthritis, rheumatoid arthritis, etc., a large number of elderly patients suffer from knee joint diseases. The early conservative treatment methods for knee joint diseases mainly include lifestyle changes, physical therapy, weight loss, non-steroidal anti-inflammatory drugs, orthopedic shoes, crutches, closed therapy, etc. ^[2] . Knee arthroplasty is an important treatment for elderly patients with knee joint disease in the middle and advanced stages. With the continuous deepening of reform and opening up and the continuous improvement of the country's comprehensive strength, most tertiary hospitals in my country can carry out artificial total knee replacement surgery. At present, whether to preserve the infrapatellar fat pad in total knee arthroplasty is still controversial at home and abroad, and there is a lack of long-term clinical follow-up data.

The infrapatellar fat pad is located behind the patellar ligament, between the anterior intercondylar area and the lower part of the patellar surface of the femur, and has a cushioning and lubricating effect. The outer side of the infrapatellar fat pad vascular network is composed of the inferior lateral genicular artery and the descending branch of the superior lateral genicular artery, and the inner side is composed of the ascending branch of the inferior medial genicular artery, the descending branch of the superior patella branch of the descending genu artery, and the infrapatellar branch of the articular branch of the descending genicular artery. Studies by Lin Yujin and others have shown that the infrapatellar fat pad is different from fat tissue in other parts of the body. It contains a rich vascular network. This vascular network not only nourishes itself, but also supplies blood to adjacent tissue structures such as the patellar ligament and the lower pole of the patella. Studies by Nemschak et al. have shown that the rich vascular network in the infrapatellar fat pad is an important source of blood vessels for the patella. Studies by Ushiyama et al. have shown that the infrapatellar fat pad is rich in nerve and immune cells, which can produce inflammatory factors and growth factors. Excessive resection of the infrapatellar fat pad in total knee arthroplasty can cause changes in the biomechanics of the knee joint, leading to lower patellar height, shortened patellar ligament, anterior knee pain, and even avascular necrosis of the patellar ligament and patellar fracture. The reason is closely related to the damage to the blood supply of the infrapatellar fat pad. Therefore, preserving the infrapatellar fat pad during total knee arthroplasty is the main academic proposition both at home and abroad. However, there is currently no tool that can quantitatively resect the infrapatellar fat pad to completely preserve the dense vascular area.

Utility model content

The technical problem to be solved by the utility model is: aiming at the deficiencies in the prior art, the purpose of the utility model is to provide a resection device capable of quantitatively resecting the infrapatellar fat pad.

In order to realize the purpose of this utility model, adopt following technical scheme to realize:

An infrapatellar fat pad resection device includes a patella fixer, a positioning rod, a patellar tendon measuring rod and a resection knife. The patella fixator includes a caliper and a patellar tendon fixing rod. There are two clamping blocks on the top, and the patellar tendon fixing rods are respectively installed on the clamping blocks. The lifting rods are sleeved in the patellar tendon fixing rods. One side of the patellar tendon fixing rods is provided with a lifting knob, which is connected to the The inner lifting rod controls its lifting. A connecting rod is arranged on the upper part between the lifting rods. A connecting block that can move left and right is arranged in the middle of the connecting rod. Chuck, the connecting chuck is fixed on the upper surface of one side of the positioning rod, the connecting chuck passes through the positioning rod and is snapped into the connection hole, and the other end of the positioning rod can be clipped into the patellar ligament measuring rod , a balance bar is clamped on the side of the patellar ligament measuring rod, a balance hole is installed on the positioning rod, a mounting bump is provided on the balance rod to snap into the balance hole, and the balance hole is clipped into the mounting bump;

In the middle of the positioning rod, there are slots through which both sides are connected. The upper end of the cutting knife is provided with a detachable moving block. The moving block matches the slot, and the cutting knife is installed on the lower surface of the positioning rod. The direction of the knife face of the knife and the positioning bar are arranged perpendicular to each other, and the cutting knife moves back and forth along the position of the slot.

As a preferred solution: a scale line is provided on the lower side surface of the patellar tendon fixing rod.

As a preferred solution: the bottom of the patellar tendon measuring rod is provided with fixed teeth.

Compared with the prior art, the beneficial effect of the utility model is that: the redundant infrapatellar fat pad can be excised to reveal the surgical field, and the dense blood vessel area of the infrapatellar fat pad can be effectively reserved, reducing the risk of excision of the infrapatellar fat pad. If there are too many, the dense vascular area will be resected together, and the complications caused by it will be convenient for joint surgeons to control and facilitate the operation of total knee joint replacement.

Description of drawings

Fig. 1 is the structural representation of the utility model;

Fig. 2 is a schematic structural view of the patellar ligament measuring rod 3 on which the positioning rod 2 of the utility model is installed;

Fig. 3 is a structural schematic diagram of the operating position of the infrapatellar fat pad remover of the utility model.

1. Patella fixator; 2. Positioning rod; 3. Patellar ligament measuring rod; 4. Resection knife; 5. Caliper; 6. Patellar ligament fixing rod; 7. Lifting rod; , connecting rod; 11, connecting block; 12, lifting knob; 13, slot; 14, connecting hole; 15, balancing hole; 16, balancing rod; 17, mounting bump; 18, fixed tooth; 19, moving block; 20, scale line;

21. Connect the chuck.

detailed description

The specific embodiment of the utility model is described in detail below according to the accompanying drawings.

According to Fig. 1 to Fig. 3 shown, a kind of infrapatellar fat pad resection device described in the present embodiment includes patella fixer 1, positioning bar 2, patellar tendon measuring bar 3 and resection knife 4, and patella fixer 1 includes The caliper 5 and the patellar ligament fixing rod 6 are provided with two claws 8 inside the caliper 5, and two clamping blocks 9 are arranged on one side of the caliper, and the patellar ligament fixing rod 6 and the patellar ligament fixing rod 6 are installed on the clamping blocks 9 respectively. All are socketed with elevating rod 7 in the fixed rod 6, and one side of patellar ligament fixed rod 6 is provided with elevating knob 12, and elevating knob 12 connects inner elevating rod 7 and controls its elevating, and elevating rod 7 is arranged on the upper segment. There is a connecting rod 10, the middle of the connecting rod 10 is provided with a connecting block 11 which can move left and right, the middle of the connecting block 11 is provided with a connecting hole 14, and a connecting chuck 21 is installed on the connecting hole 14, and the connecting chuck 21 is fixed on On the upper surface of one side of the positioning rod 2, the connecting chuck 21 passes through the positioning rod 2 and is snapped into the connection hole 14, and the other end of the positioning rod 2 can be clamped in the described patellar ligament measuring rod 3, and the patellar tendon A balance bar 16 is clamped on the side of the ligament measuring rod 3, and a balance hole 15 is installed on the positioning rod 2. The balance bar 16 is provided with a mounting bump 17 that snaps into the balance hole 15, and the balance hole 15 is clipped on the mounting bump. within 17;

In the middle of the positioning rod 2, there are slots 13 through which both sides are connected. The upper end of the cutting knife 4 is provided with a detachable moving block 19. The moving block 19 matches the slot 13. The cutting knife 4 is installed in the positioning position. On the lower end face of the rod 2, the direction of the knife surface of the resection knife 4 is perpendicular to the positioning rod 2, and the resection knife 4 moves back and forth along the position of the slot 13, and the lower side surface of the patellar ligament fixing rod 6 is provided with a scale line 20. The bottom of the patellar tendon measuring rod 3 is provided with fixed teeth 18 .

operation method

1) Pre-set resection height for filming

The first choice is to observe the height of the dense blood vessel area in the infrapatellar fat pad according to the filming. The dense blood vessel area in the infrapatellar fat pad is located 5 mm away from the medial and lateral sides of the patella, 14 mm below the patellar tip, and 10 mm behind the patellar ligament. In the general range, observe whether there is deformation on the front side of the patella, otherwise the device cannot be used;

2) Resect part of the infrapatellar fat pad first

During the operation, the epidermis is incised and turned to one side, so that the infrapatellar fat pad is exposed to the view, and the upper infrapatellar fat pad is excised first with a knife, so that it is easier to cut the infrapatellar fat pad.

3) Install and adjust the position of the cutting tool

Clamp the outer side of the patella with the caliper 5, place the patellar ligament measuring rod 3 on the patella ligament, insert and fix it with the fixing teeth 18, install the resecting knife 4 on the positioning rod 2, and then connect one end of the positioning rod 2 to the chuck 21 Insert it into the connecting hole 14, and insert the balance hole 17 at the other end into the installation bump 18. Observe to ensure that the positioning rod 2 is placed horizontally, and the positioning rod should be placed vertically with the balance rod. If it is observed to be inclined, you can hold the caliper 5 for adjustment. Until the positioning rod 2 is vertical to the connecting rod and the balance rod, if the position is not enough, you can connect the block to make fine adjustments to move left and right;

4) Adjust cutting height

Make fine adjustments according to the actual position, rotate the lifting knob 12, adjust the height of the lifting rod 7, and ensure that the lifting height is appropriate;

5) Resection of the infrapatellar fat pad

Take off the positioning rod 2, take away the patellar ligament measuring rod 3, and put back the positioning rod 2. Since the resection knife 4 is fixed at the lower end of the positioning rod 2, it needs to be put back slowly, and the hand holds the moving block and moves back and forth for cutting. until the cutting is completed, remove the infrapatellar fat pad at the upper end after cutting with pliers.

Operating effect

The infrapatellar fat pad is rich in nerve and immune cells, which can produce inflammatory factors and growth factors. Excessive resection of the infrapatellar fat pad in total knee arthroplasty can cause changes in the biomechanics of the knee joint, leading to lower patellar height, shortened patellar ligament, anterior knee pain, and even avascular necrosis of the patellar ligament and patellar fracture. The reason is closely related to the damage to the blood supply of the infrapatellar fat pad. During total knee arthroplasty, we found that the complete preservation of the infrapatellar fat pad would affect the operation. Some patients would experience symptomatic postoperative popping. Very few patients had the popping disappear after the fat pad was removed under arthroscopy. As for the resection of the infrapatellar fat pad—whether to resect, how much to resect, and how to do it, there is still a lack of detailed information on international research in this area.

In total knee arthroplasty, the ischemic contracture of the patellar tendon caused by resection of the infrapatellar fat pad is one of the important reasons for postoperative shortening of the low patella and patellar tendon. Resection of the infrapatellar fat pad during total knee arthroplasty can result in a lower postoperative patellar height, resulting in shortening of the patellar tendon and lowering of the patella. In total knee arthroplasty, the infrapatellar fat pad should be preserved as much as possible, and the damage to the infrapatellar fat pad and its surrounding tissues can be reduced through precise operation and correct handling during the operation, and more satisfactory surgical results can be obtained.

The study found that total resection of the infrapatellar fat pad will lead to a significant reduction in the external rotation of the tibia and a significant medial shift of the patella during knee extension, and the pressure on the patella point will decrease, and the degree of reduction is greater when the knee is flexed than when the knee is extended. Therefore, they believe that the infrapatellar fat pad has biomechanical functions and can relieve the symptoms of anterior knee pain syndrome. Resection can affect the biomechanics of the patella and the kinematics of the knee joint. The infrapatellar fat pad plays an important role in maintaining the blood supply to adjacent structures, and the infrapatellar fat pad should be preserved as much as possible in the preoperative plan.

Excessive resection of the infrapatellar fat pad during TKA will lead to patellar tendon and patellar ischemia, and postoperative complications such as patellar fracture and patellar tendon shortening will increase significantly. In cadaveric angiographic studies, complete resection of the infrapatellar fat pad resulted in occlusion of the blood supply to the inferior half of the patella. One to three years after the resection of the infrapatellar fat pad in knee arthroplasty, the length of the patellar ligament was significantly shortened by 2 to 3 mm compared with preoperatively, accounting for about 5%. One of the important factors of lower pole fracture. Regarding the relationship between the anatomical structure of the infrapatellar fat pad and the clinic, the most authoritative proposal is that the infrapatellar fat pad should be preserved as much as possible during TKA to maintain the blood supply to adjacent structures. Excessive resection of the infrapatellar fat pad can cause changes in the biomechanics of the knee joint, leading to anterior knee pain, sometimes shortening of the patellar tendon, and even avascular necrosis of the patellar tendon and patellar fracture. It is considered that the infrapatellar fat pad has a direct protective effect on the patellar tendon, and the fatty liver cells in it play an important role in the repair of the patellar tendon, and have a greater impact on the occurrence of the low patella. The low patella will cause significant changes in the mechanical activity of the patellofemoral joint, resulting in abnormalities of the patellofemoral joint. The main manifestation is that the lower pole of the patella can collide with the tibia, and the downward movement of the patella will also increase the pressure on the patellofemoral joint. Studies have shown that preserving the infrapatellar fat pad is beneficial to reduce the occurrence of wound complications.

Trauma, wear, inflammation, etc. lead to edema and hyperplasia of the infrapatellar fat pad, forming pinching or impingement on the tibiofemoral joint and/or patellofemoral joint, which can cause Hoffa's disease and a series of clinical symptoms, which can involve the related synovium and tendon . When the fat pad is stimulated by certain factors to cause acute or chronic injury, aseptic inflammation can occur, resulting in pain, edema, hemorrhage, exudation, hyperplasia, hypertrophy, sclerosis, fibrous tissue degeneration and adhesion between the fat pad and patellar ligament , organization, loss of elasticity, so that the activities of knee extension are limited, and its abundant nerve endings are chemically stimulated by inflammation to cause knee pain. Studies have shown that fibrosis of the infrapatellar fat pad is significantly correlated with anterior knee pain after TKA, and fibrosis of the infrapatellar fat pad will affect the range of motion of the knee joint. Many experts believe that full exposure is more conducive to TKA surgery. Studies have shown that there is not much difference in postoperative complications between resection of the infrapatellar fat pad and preservation of the fat pad, but the probability of anterior knee pain in patients is slightly higher. It is recommended that the infrapatellar fat pad can be preserved if it does not affect the surgeon's exposure of the incision. Otherwise, it will be removed.

At present, the Insall-Salviti index is the most commonly used index in clinical evaluation of patellar tendon shortening after TKA, but the acquisition of the Insall-Salviti index requires the patient to take a lateral knee joint radiograph when the knee is flexed to 30°. The tools are used by radiographers, so the development of a specialized resection tool is a strong guarantee for accurate Insall-Salviti index.

The instrument of the utility model can roughly judge the degree of resection according to the preoperative analysis, comparison and quantification, and the resection amount can be adjusted during the operation to ensure that the dense blood vessel area of the infrapatellar fat pad is preserved, and the precise resection of the infrapatellar fat pad can be ensured. It is particularly important to avoid future complications. Individual differences are different, so the example cannot be used as a single comparison, but the recovery degree of the preserved patellar tendon is obviously better than that of the operation without quantitative work during the operation, and the probability of patellar tendon shortening is much smaller.

Claims (3)

1. An infrapatellar fat pad resection device is characterized in that: it includes a patella fixator, a positioning bar, a patellar tendon measuring bar and a resection knife, and the patella fixator includes a caliper and a patellar tendon fixation bar, and the inner side of the caliper is provided with two clips. There are two clamping blocks on one side of the caliper, the patellar ligament fixing rods are respectively installed on the clamping blocks, and the patellar ligament fixing rods are all sleeved with lifting rods, and one side of the patellar ligament fixing rods is provided with a lifting knob. Button, the lifting knob is connected to the inner lifting rod and controls its lifting. There is a connecting rod in the upper section between the lifting rods. The middle of the connecting rod is provided with a connecting block that can move left and right. A connecting clip is installed on the connecting hole, and the connecting clip is fixed on the upper surface of one side of the positioning rod. The connecting clip passes through the positioning rod and is snapped into the connecting hole. In the patellar ligament measuring rod, a balance bar is clamped on the side of the patellar ligament measuring rod, a balance hole is installed on the positioning rod, and a mounting bump for snapping into the balance hole is provided on the balance rod, and the balancing hole is clipped on the mounting bump Inside; In the middle of the positioning rod, there are slots through which both sides are connected. The upper end of the cutting knife is provided with a detachable moving block. The moving block matches the slot, and the cutting knife is installed on the lower surface of the positioning rod. The direction of the knife face of the knife and the positioning bar are arranged perpendicular to each other, and the cutting knife moves back and forth along the position of the slot. 2 . The infrapatellar fat pad resection device according to claim 1 , wherein a scale line is provided on the lower side surface of the patellar tendon fixing rod. 3 . 3. The infrapatellar fat pad resection device according to claim 1, characterized in that: the bottom of the patellar tendon measuring rod is provided with fixed teeth.