CN110623719A - Medial patella ligament surgery access positioning device and method - Google Patents
Medial patella ligament surgery access positioning device and method Download PDFInfo
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- 210000003041 ligament Anatomy 0.000 title claims description 22
- 210000000426 patellar ligament Anatomy 0.000 claims abstract description 49
- 238000013459 approach Methods 0.000 claims abstract description 46
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- 238000003780 insertion Methods 0.000 claims description 37
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
- A61B17/90—Guides therefor
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
- A61B2090/3983—Reference marker arrangements for use with image guided surgery
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Abstract
The invention discloses a medial patellar ligament surgery approach positioning device and a medial patellar ligament surgery approach positioning method, the device comprises an anatomy dead point positioning device and a Kirschner wire positioning device, the anatomy dead point positioning device is fixed according to a reference dead point determined based on an adductor tendon dead point, a sleeve for leading in a Kirschner wire is installed on the Kirschner wire positioning device, a linkage angle measuring component and a length measuring component are arranged on the anatomy dead point positioning device, the length measuring component is connected to the Kirschner wire positioning device through an elastic telescopic piece, the Kirschner wire positioning device is pulled to stretch the length measuring component to a set length, the angle measuring component is rotated to a set angle, and the sleeve is positioned on the anatomy dead point according to the surgery approach. The surgical access positioning device can customize and adapt surgical access according to individual difference of patients, accurately determine the anatomical stop point and the rotation angle to avoid human errors, and simultaneously reduce the incidence rate of postoperative complications and shorten the surgical time.
Description
Technical Field
The invention relates to the technical field of medical instruments, in particular to a medial patellar ligament surgical access positioning device and method.
Background
The knee joint is a synovial joint composed of a distal femur, a proximal tibia and a patella. The fracture of the patellofemoral ligament on the inner side of the knee, which is often caused by the fracture of the patella femoral ligament on the patient suffering from sports accidents or direct violence, can be damaged by tearing or fracture of the ligament due to sports accidents or external trauma, and the ligament reconstruction operation is required to be completed through knee arthroscopic surgery.
Common injuries to the knee include patellar dislocation. Patella dislocation is manifested by a significant lateral dislocation of the knee joint patella, often accompanied by rupture of the medial patellofemoral ligament. Over hundreds of thousands of teenagers dislocate the patella after movement/trauma every year, the injury can not be self-healed, the patellofemoral joint is unstable for a long time and is accompanied with arthralgia and limited movement, and even long-term arthritis is caused.
Arthroscopic knee surgery uses specialized surgical instruments to probe and treat the joint. The arthroscopic knee joint surgery needs at least two surgical incisions, inserts an arthroscopic metal tube with a lighting device into a joint cavity through a surgical approach, enlarges the internal structure of the joint cavity on a monitor, and observes the pathological change condition and the part in the joint cavity.
In knee joint surgery, a kirschner wire is a commonly used positioning material for orthopedics, and is used for primary positioning and temporary fixation.
However, in the operation, the accuracy of the kirschner wire implantation cannot be ensured only by performing positioning and marking on the body surface by a doctor or advancing the kirschner wire at an anatomical point by adopting an visual inspection mode, so that a great error exists in the operation access position. Complete parallelism is difficult to achieve when the K-wire is implanted without the aid of special instruments. Therefore, how to improve the accuracy of the parallel implantation of the kirschner wire, how to reduce the excessive exposure of the patient to X-rays in the operation, how to shorten the operation time, and how to improve the curative effect of the operation becomes a technical problem to be solved urgently in the current orthopedic operation.
Therefore, existing techniques for locating surgical access anatomical stops for the medial patellar ligament still remain to be improved.
Disclosure of Invention
Aiming at the technical problems, the invention provides a medial patella ligament surgery access positioning device and method which can customize and adapt to the surgical access according to individual differences of patients, accurately determine an anatomical stop point and a rotation angle so as to avoid human errors, reduce the incidence rate of postoperative complications and shorten the surgery time.
In a first aspect, the technical solution provided by the embodiments of the present invention is: the utility model provides a medial patella ligament surgery approach positioner, including dissecting dead point positioner and kirschner wire positioner, should dissect dead point positioner and fix according to the reference dead point that confirms based on adductor tendon dead point, the last sleeve that is used for introducing the kirschner wire of rotation installation of this kirschner wire positioner, set up angle survey subassembly and the length survey subassembly of linkage on this dissect dead point positioner, this length survey subassembly is connected to this kirschner wire positioner through elastic expansion piece, pull this kirschner wire positioner and make this length survey subassembly stretch to setting length, and make this angle survey subassembly rotate and set for the angle, thereby pass the location of establishing a way on dissecting the dead point according to the operation with this sleeve.
For fluoroscopic visualization, the metal dead center mark is fixed on the reference dead center.
The angle measuring component comprises a rotating wheel and a pointer, the dissection dead point positioning device further comprises a first scale plate, a reference dead point positioning hole is formed in the first scale plate, the rotating wheel is fixed on the scale plate and penetrates through the center of the reference value point positioning hole, the pointer is rotatably installed on the rotating wheel, and first angle scales are arranged on the periphery of the reference dead point positioning hole.
The pointer is provided with length scales, the elastic telescopic piece is sleeved on the pointer, and one end of the elastic telescopic piece is fixed on the rotating wheel.
Preferably, the length measuring assembly includes a pointer member, the pointer member includes a fixing portion and a collar, the fixing portion is connected to the other end of the elastic expansion member, and the collar is sleeved on the pointer.
When the Kirschner wire positioning device is specifically implemented, the Kirschner wire positioning device comprises a second scale plate, a second angle scale is arranged on the second scale plate, and a first connecting part is arranged at the center of the second angle scale.
The sleeve is provided with a second connecting portion, and the second connecting portion is matched with the first connecting portion to rotatably install the sleeve on the second scale plate.
When the perspective image is analyzed, the distance, the deviation angle and the femur rotation angle between the reference stop point and the anatomical stop point are measured based on the CT perspective head image, the Kirschner wire positioning device is pulled to enable the length measuring component to be pulled to the distance, the angle measuring component is rotated to the deviation angle, and the sleeve is rotated to the femur rotation angle so as to accurately determine the surgical approach of the anatomical stop point.
In a second aspect, the technical solution provided by the embodiment of the present invention is: the medial patellar ligament surgery access positioning method comprises the following steps:
determining adductor tendon insertion points as reference insertion points, and fixing metal insertion point marks at the reference insertion points;
determining the midpoint position of the medial edge of the patella of the patient as a reference midpoint, and fixing a metal midpoint mark at the reference midpoint;
carrying the metal dead point mark and the metal midpoint mark to obtain a perspective view combination of the affected knee through CT fluoroscopy;
determining an image correction point of an anatomical dead point according to the perspective combination, and measuring the distance, the deviation angle and the femur rotation angle of the image correction point and a reference dead point based on a measurement scale;
and determining the surgical approach of the anatomical stop point by using a medial patellar ligament surgical approach positioning device according to the distance, the deviation angle and the femur rotation angle, wherein the medial patellar ligament surgical approach positioning device comprises the anatomical stop point positioning device and a Kirschner wire positioning device.
The perspective view combination includes a first perspective view and a second perspective view. Compounding the first perspective view and the second perspective view, and the step of determining the track of the tackle and the rotation center thereof further comprises the following steps of:
the first perspective view and the second perspective view are transparent and overlapped in the same scale and the same position;
establishing a coordinate system based on the reference dead point image and the reference midpoint image;
establishing a pulley track by using the sliding surfaces in the first perspective view and the second perspective view, determining a rotation center by using the pulley track as an equal length point on a circumference, and setting the rotation center as an image correction point;
measuring the distance value between the image correction point and the reference stop point image;
measuring the deviation angle of the image correction point;
measuring the rotation angle of the femur of the affected knee according to the horizontal line and the connecting line behind the medial and lateral condyles of the femur;
the reference dead point image is connected with the image correction point to form a first connecting line, the reference midpoint image is connected with the image correction point to form a second connecting line, and the deviation angle is an included angle between the first connecting line and the second connecting line.
The beneficial effects of the embodiment of the invention are as follows: the medial patella ligament surgery approach positioning device of the embodiment determines the distance, the deviation angle and the femur rotation angle of an anatomical stop point relative to a reference stop point through a CT perspective view, and sets a linkage anatomical stop point positioning device and a Kirschner wire positioning device, a sleeve used for guiding a Kirschner wire is rotatably mounted on the Kirschner wire positioning device, the Kirschner wire positioning device is pulled to stretch a length measuring component to a predetermined distance, the angle measuring component is rotated to a predetermined deviation angle, the sleeve is rotated to a predetermined femur rotation angle to accurately guide the Kirschner wire, the Kirschner wire is accurately placed, artificial errors are avoided, treatment recovery of patella is facilitated, the incidence rate of postoperative complications is reduced, and the surgery time is shortened.
According to the medial patellar ligament surgery approach positioning method, a doctor firstly positions and preliminarily determines a reference dead point and a reference midpoint through a manipulation, fixes a metal mark at the reference dead point and the reference midpoint, obtains a first perspective view and a second perspective view of an affected knee through CT (computed tomography) fluoroscopy by carrying the metal dead point mark and the metal midpoint mark, and determines a correction dead point of the surgery approach closest to an anatomical dead point through analyzing knee joint image data in the first perspective view and the second perspective view, so that the optimal position of a surgery approach channel is found, and subsequent surgery operation can be performed smoothly. The positioning method of the embodiment is not influenced by the height and body weight index of the patient, and can analyze and calculate the adaptive surgical access point closest to the anatomical dead point according to different patients in an image radiography mode, so that the surgical success rate is improved on the basis of the minimum surgical wound, the incidence rate of postoperative complications is reduced, the surgical time is shortened, and the surgical time can be shortened by one third through empirical statistics.
In the medial patellar ligament surgery approach positioning method, a metal dead point mark and a metal midpoint mark are arranged on the body surface of a patient before fluoroscopy; after a three-dimensional reconstruction perspective view of a CT instrument, position parameters of an anatomical stop relative to a reference stop are measured on the perspective view, the distance and the angle between the anatomical stop of an operative approach and the reference stop and the rotation angle of the femur of the Kirschner wire are respectively measured, the guiding and the accurate embedding of the Kirschner wire are realized by combining an operative approach positioning device, and the minimally invasive characteristic of the operation is improved so as to facilitate the treatment and the recovery of the patella.
Drawings
One or more embodiments are illustrated by way of example in the accompanying drawings, which correspond to the figures in which like reference numerals refer to similar elements and which are not to scale unless otherwise specified.
FIG. 1 is a front view of a medial patellar ligament surgical access positioning device according to an embodiment of the present invention;
FIG. 2 is a schematic structural view of an anatomical stop location device of a medial patellar ligament surgical access location device according to an embodiment of the present invention;
FIG. 3 is a schematic structural diagram of a Kirschner wire positioning device of a medial patellar ligament surgical access positioning device according to an embodiment of the invention;
FIG. 4 is a schematic view of an anatomical stop point inference for a medial patellar ligament surgical access positioning device according to an embodiment of the present invention;
FIG. 5 is a first perspective view and a second perspective view of a medial patellar ligament surgical approach positioning method in accordance with an embodiment of the present invention;
FIG. 6 is a perspective composite image schematic view of a medial patellar ligament surgical approach positioning method according to an embodiment of the present invention;
FIG. 7 is a schematic view of the angle of rotation of the femur of the medial patellar ligament surgical approach positioning method of the present invention;
FIG. 8 is a schematic view of body surface markings of a medial patellar ligament surgical approach positioning method according to an embodiment of the present invention;
FIG. 9 is a schematic structural diagram of a pointer of the medial patellar ligament surgical approach positioning device according to the embodiment of the invention; and
fig. 10 is a flowchart of a medial patellar ligament surgical approach positioning method according to an embodiment of the present invention.
Detailed Description
The technical solutions in the embodiments of the present invention will be clearly and completely described below with reference to the drawings in the embodiments of the present invention, and it is obvious that the described embodiments are only a part of the embodiments of the present invention, and not all of the embodiments. All other embodiments, which can be derived by a person skilled in the art from the embodiments given herein without making any creative effort, shall fall within the protection scope of the present invention.
It should be noted that, if directional indications (such as up, down, left, right, front, and back … …) are involved in the embodiment of the present invention, the directional indications are only used to explain the relative positional relationship between the components, the movement situation, and the like in a specific posture (as shown in the drawing), and if the specific posture is changed, the directional indications are changed accordingly.
In addition, if there is a description of "first", "second", etc. in an embodiment of the present invention, the description of "first", "second", etc. is for descriptive purposes only and is not to be construed as indicating or implying relative importance or implicitly indicating the number of technical features indicated. Thus, a feature defined as "first" or "second" may explicitly or implicitly include at least one such feature. In addition, technical solutions between various embodiments may be combined with each other, but must be realized by a person skilled in the art, and when the technical solutions are contradictory or cannot be realized, such a combination should not be considered to exist, and is not within the protection scope of the present invention.
Referring to fig. 1 and 10, the present embodiment relates to a positioning device and a positioning method for surgical approach of anatomical insertion point of medial patellar ligament 34.
As shown in fig. 2, the knee joint is a synovial joint composed of a distal femur 10, a proximal tibia 20, and a patella 30. The medial patellofemoral ligament 34 (MPFL) is an important structure for maintaining medial stability and limiting patellar dislocation. Can provide a retarding force for preventing the patella from moving outwards, and can start the patella to enter the femoral trochlear groove smoothly.
Medial patellar ligament 34 injury or defect is a major causative factor in patellar instability following recurrent or acute patellar dislocation.
In knee joint surgery, accurate determination of the anatomical stop location of the medial patellar ligament 34 is a key factor in the success of the relational procedure and the high and low probability of postoperative complications.
The medial patella ligament surgery access positioning device of the embodiment can accurately guide the kirschner wire to complete implantation at an accurate angle on the basis of finding the position of the anatomical dead point.
The medial patellar ligament surgical approach positioning device of the embodiment determines the distance d, the deviation angle theta and the femoral rotation angle beta of the anatomical dead point relative to the reference dead point A through the CT perspective. A linkage dissecting dead point positioning device 50 and a kirschner wire positioning device 80 are provided, and a sleeve 90 for guiding the kirschner wire is rotatably arranged on the kirschner wire positioning device 80. Pulling the Kirschner wire positioning device 80 to stretch the length measuring component to a predetermined distance, rotating the angle measuring component to a predetermined deviation angle theta, and rotating the sleeve 90 to a predetermined femur rotation angle beta to accurately guide the Kirschner wire, accurately insert the Kirschner wire, and avoid human errors to facilitate the treatment and recovery of the patella.
In the medial patellar ligament surgical approach positioning method of the present embodiment, firstly, a doctor preliminarily determines a reference insertion point a and a reference midpoint B on the body surface of the patient knee by means of manual positioning, and fixes metal markers at the positions of the reference insertion point a and the reference midpoint B. Then, the patient carries two metal markers to complete CT fluoroscopy to obtain a first perspective view and a second perspective view of the affected knee. Then, the first perspective view and the second perspective view are compounded. And acquiring the position relation data of the patellar ligament on the inner side of the knee joint of the patient by analyzing the composite perspective image data. And then, determining a correction dead point D of the surgical approach closest to the anatomical dead point according to the knee joint position relation data, and determining the anatomical dead point based on the correction dead point D. Finally, the Kirschner wire is accurately guided and placed into the affected knee with the surgical access positioning device of this embodiment.
The positioning method of the embodiment is not influenced by the height and body mass index of the patient, and can analyze and calculate the adaptive surgical access point closest to the anatomical stop point according to different patients in an image radiography mode, so that the surgical success rate is improved on the basis of the least hand wound, the incidence rate of postoperative complications is reduced, and the surgical time is shortened.
Example 1
As shown in fig. 1, the present embodiment relates to a medial patellar ligament surgical access positioning device. The surgical access positioning device is used for guiding the Kirschner wire during operation. Before the Kirschner wire is used, the position relation data of the patellar ligament on the inner side of the knee joint, such as the distance d of the anatomical dead point relative to the reference dead point A, the deviation angle theta, the femoral rotation angle beta and the like, are analyzed and measured based on the CT perspective combination acquired by the patient in advance. And then using the operation access positioning device based on the position relation data of the patellar ligament on the inner side of the knee joint.
The medial patellar ligament surgical access positioning device comprises an anatomical stop positioning device 50 and a k-wire positioning device 80.
The dissection dead center positioning device 50 is fixed according to a reference dead center a determined based on adductor tendon dead centers. For fluoroscopic visualization, the metal stop mark is fixed on the reference stop a.
As shown in fig. 2, the dissection dead point positioning device 50 is provided with an angle measuring unit and a length measuring unit which are linked with each other. The length measurement assembly is connected to the K-wire positioning device 80 by a resilient telescoping member 64.
The dissection dead point positioning device 50 further comprises a first scale plate, and a reference dead point positioning hole is formed in the first scale plate. When the metal stop mark is used, the reference stop positioning hole is aligned to the reference stop A, and the metal stop mark is exposed. The angle measuring assembly includes a wheel 53 and a pointer 60. The rotating wheel 53 is fixed on the scale plate and passes through the center of the reference point positioning hole, one end of the pointer 60 is rotatably mounted on the rotating wheel 53, and the first angle scale 56 is arranged on the peripheral scale plate of the reference point positioning hole.
The pointer 60 of the angle measuring assembly is also used as a scale carrier of the length measuring assembly, the pointer 60 is provided with length scales, the elastic expansion piece 64 is sleeved on the pointer 60, and one end of the elastic expansion piece is fixed on the rotating wheel 53.
Referring to fig. 9, the length measuring assembly includes an indicator 62, and the indicator 62 includes a fixing portion 621 and a collar 622. In one embodiment, the fixed portion is connected to the other end of the elastic expansion member, and the sleeve ring is sleeved on the pointer 60. In another embodiment, the other end of the elastic expansion piece 64 is connected to the lower connecting block 83 of the kirschner wire positioning device 80, and the fixing part is arranged at the expansion center of the elastic expansion piece 64.
As shown in FIG. 3, the K-wire positioning device 80 is rotatably mounted with a sleeve 90 for introducing the K-wire, the center line of the sleeve 90 serving as an angularly directed pointer. The kirschner wire positioning device 80 comprises a second scale plate, a second angle scale 84 is arranged on the second scale plate, and a first connecting part 81 is arranged at the center of the second angle scale 84. The sleeve 90 is provided with a second connecting portion 92, and the second connecting portion 92 cooperates with the first connecting portion 81 to rotatably mount the sleeve 90 on the second scale plate.
In order to determine the positional relationship data of the patellar ligament inside the knee joint in the present embodiment, the distance d between the reference dead point a and the anatomical dead point, the deviation angle θ and the femoral rotation angle β need to be measured based on the CT fluoroscopy head image. Before the kirschner wire is placed in the operation, the kirschner wire positioning device 80 is pulled to stretch the length measuring component to the distance measured in advance, the angle measuring component is rotated to the deviation angle measured in advance, and the sleeve 90 is rotated to the femur rotation angle beta by referring to the second angle scale 84, so that the kirschner wire is guided from the anatomical dead point to be placed in the affected knee according to the operation access positioning requirement.
Example 2
Referring to fig. 6, 7 and 10, the medial patellar ligament surgical approach positioning method of the present embodiment mainly includes the following steps:
step 101: determining adductor tendon insertion points as reference insertion points A, and fixing metal insertion point marks at the reference insertion points A; determining a reference dead point A by adopting a manual positioning mode, and fixing a metal dead point mark at the reference dead point A;
step 102: determining the midpoint position of the inner side edge of the patella of the patient as a reference midpoint B by adopting a manual positioning mode, and fixing a metal midpoint mark at the reference midpoint B;
step 103: carrying the metal dead point mark and the metal midpoint mark to obtain a perspective view combination of the affected knee through CT fluoroscopy; the perspective view combination comprises a first perspective view and a second perspective view, and the first perspective view and the second perspective view of the affected knee are obtained by CT perspective with the metal dead point mark and the metal midpoint mark;
step 104: determining an image correction point of an anatomical dead point according to the perspective combination, and measuring the distance d, the deviation angle theta and the femur rotation angle beta of the image correction point and a reference dead point A based on a measurement scale; in specific implementation, compounding the first perspective view and the second perspective view, determining a pulley track C and a rotation center thereof, and setting the rotation center as an image correction point; as shown in fig. 6, the distance d and the deviation angle θ of the image correction point from the reference dead point a image and the reference midpoint B image are measured based on the measurement scale; as shown in fig. 7, the rotation angle β of the femur of the affected knee is measured according to the horizontal line and the line connecting the posterior of the medial and lateral condyles of the femur;
step 105: and determining the surgical approach of the anatomical stop by using the medial patellar ligament surgical approach positioning device according to the distance d, the deviation angle theta and the femoral rotation angle beta.
The medial patellar ligament surgery approach positioning device comprises an anatomy dead point positioning device 50 and a kirschner wire positioning device 80.
After determining the position relation data of the patellar ligament on the inner side of the knee joint, the doctor refers the reference dead point A mark on the surface of the affected knee joint as a correction dead point D of the surgical access point according to the distance and the deviation angle theta.
As shown in FIG. 5, the first perspective view in this embodiment is a three-dimensional reconstruction of the affected knee, and the second perspective view is a CT view.
Referring to fig. 4, using arthroscopy to explore the revision insertion point D and the points of equal length around the revision insertion point D, the femoral side anatomical insertion point of the medial patellofemoral ligament is determined.
The medial patellar ligament surgery approach positioning method is described in detail as follows:
firstly, in-vitro manual initial positioning of the medial patellofemoral ligament:
the physician places his or her finger along the patient's body surface at the adductor tendon insertion point of the adductor muscle, and identifies the reference insertion point a at a first set distance from the femoral side below the adductor tendon insertion point.
Anatomically, the femoral side insertion point of the medial patellofemoral ligament is typically located about 3 mm below the femoral adductor insertion point, and most patients have the adductor tendon insertion point in the body surface.
The metal dead point mark is a first steel ball mark, the first set distance is 3 mm, the manipulation positioning mode is that fingers touch adductor tendon dead points of adductor muscles along the body surface, the position 3 mm below the adductor tendon dead points is marked as the reference dead point A, and the first steel ball mark is fixed on the femur side of a patient by using transparent adhesive tape. In practice, the physician orders the patient to squat at 30 ° with the most prominent adductor tendon in the thigh. The physician touches down the adductor muscle with his finger at the insertion point of the adductor muscle, marks the position of the adductor muscle approximately 3 mm below the insertion point on the body surface, and fixes the first steel ball mark on the femur side of the patient with scotch tape.
The metal midpoint mark is a second steel ball mark, the manual positioning mode is that fingers touch the inner edge of the patella 30 along the body surface, the midpoint position of the inner edge of the patella 30 is set as the reference midpoint B, and the second steel ball mark is fixed at the reference midpoint B by using a transparent adhesive tape. In actual operation, a doctor touches the inner edge of the patella 30 with fingers, marks the midpoint position of the inner edge of the patella 30, and fixes the second steel ball mark at the reference midpoint B by using a transparent adhesive tape.
(II) CT fluoroscopy and three-dimensional reconstruction:
the metal dead point mark and the metal midpoint mark are carried to obtain a first perspective view and a second perspective view of the affected knee through CT fluoroscopy. Wherein, the first perspective view is a three-dimensional reconstruction image of the affected knee, and the second perspective view is a CT image.
Wherein, the patient is instructed to stand upright at the tiptoe and relax the affected limb by means of fluoroscopy under CT. The CT image of the standard lateral position of the affected knee is obtained, and the CT image of the lateral position of the affected knee passing through the sliding surface is picked out, as shown in the right image of figure 5. A standard medial three-dimensional reconstructed image is reconstructed based on several CT images, as shown in the left image of fig. 5.
(III) accurate measurement and evaluation of medial patellofemoral ligament femoral side insertion points:
referring to fig. 4 and 6, the first perspective view and the second perspective view are combined to determine a pulley track C and a rotation center thereof, and the rotation center is set as an image correction point. And measuring the distance between the image correction point and the reference dead point A image and the reference midpoint B image and the deviation angle theta value based on the measurement scale.
The principle of determining the pulley trajectory C is as follows: when the knee is flexed, the patella 30 makes circular motions of approximately equal length with the medial patellofemoral ligament as the axis and the lateral femoral dead center as the center of rotation, so we can deduce the approximate center of rotation in a reversible way through the pulley trajectory C in the composite perspective view. The isometric center of rotation of the pulley trajectory C in the composite perspective view can be approximated as the femoral anatomical stop position, i.e., the presumed center of rotation is closest to the anatomical stop position.
Referring to fig. 4 again, in the image analysis processing stage, the reference stop point a image is connected to the image correction point to form a first connection line, and the reference middle point B image is connected to the image correction point to form a second connection line; and measuring a distance value d between the image correction point and the reference dead point A image based on a measuring scale, and measuring an included angle value theta between the first connecting line and the second connecting line.
The step of compounding the three-dimensional reconstruction image and the CT image and determining the pulley track C and the rotation center thereof further comprises the following steps:
the first perspective view and the second perspective view are transparent and overlapped in the same scale and the same position;
establishing a coordinate system based on the reference dead point A image and the reference midpoint B image;
establishing a pulley track C by using the sliding surfaces in the first perspective view and the second perspective view, determining a rotation center by using the pulley track C as an isometric point on a circumference, and setting the rotation center as an image correction point;
measuring the distance value d between the image correction point and the image of the reference stop point A;
the deviation angle θ of the image correction point is measured.
The reference dead point A image is connected with the image correction point to form a first connecting line, the reference midpoint B image is connected with the image correction point to form a second connecting line, and the deviation angle theta is an included angle theta between the first connecting line and the second connecting line.
For example, in one embodiment, the distance d between the image correction point and the image of the reference dead point a is measured to be 13.04 mm, and the angle θ between the first connecting line and the second connecting line is measured to be 78 °. As shown in fig. 7, the angle between the horizontal line and the line connecting the medial and lateral condyles of the femur is measured as the rotation angle β of the femur of the affected knee, which is 24 °.
(IV) body surface marking:
according to the distance D and the deviation angle theta, a correction dead point D which is used as an operation access point is marked on the surface of the affected knee by referring to the reference dead point A. As shown in fig. 8. And finding a first steel ball mark and a second steel ball mark of the affected knee, namely the position A and the position B according to the measured distance d between the image correction point and the image of the reference stop point A and the included angle theta between the first connecting line and the second connecting line. And moving downwards by a distance Td relative to the first steel ball mark and rotating by a deviation angle T theta relative to the second steel ball mark, and marking the correction dead point D on the body surface of the patient. The modified stop D serves as a minimally invasive access point for the patient during surgery.
(V): determining anatomical stop
Referring to fig. 4 again, to determine the anatomical insertion point, the revision insertion point D and the isometric points around the revision insertion point D are detected by arthroscopy within the detection range F, and the femoral anatomical insertion point of the medial patellofemoral ligament is determined. For example, the detection range F is detected under an arthroscope, and the femoral side anatomical insertion point of the medial patellofemoral ligament can be quickly found by finely adjusting the arthroscope.
(VI): inserting kirschner wire
The surgical access positioning device of this embodiment is used prior to placing the k-wire in the surgery. Firstly, aligning a reference dead center positioning hole with the reference dead center A to expose a metal dead center mark. Pulling the K-wire positioner 80 to stretch the length measuring assembly to a predetermined distance, rotating the angle measuring assembly to a predetermined offset angle θ, and rotating the sleeve 90 to a femoral rotation angle β with reference to the second angular scale 84, thereby guiding the K-wire from the anatomical stop to the affected knee in accordance with the surgical access positioning requirements.
The medial patella ligament surgery approach positioning device of the embodiment determines the distance d, the deviation angle theta and the femur rotation angle beta of an anatomical stop point relative to a reference stop point A through a CT perspective view, and is provided with the linked anatomical stop point positioning device 50 and a Kirschner wire positioning device 80, a sleeve 90 for guiding a Kirschner wire is rotatably mounted on the Kirschner wire positioning device 80, the Kirschner wire positioning device 80 is pulled to stretch a length measuring component to a predetermined distance, the angle measuring component is rotated to a predetermined deviation angle theta, the sleeve 90 is rotated to a predetermined femur rotation angle beta to accurately guide the Kirschner wire, the Kirschner wire is accurately placed, artificial errors are avoided, treatment and recovery of the patella are facilitated, and meanwhile, the incidence rate of postoperative complications is reduced and the surgery time is shortened.
The medial patellar ligament surgery approach positioning method of the embodiment includes that a doctor initially determines a reference dead point A and a reference midpoint B through manual positioning, metal marks are fixed at the positions of the reference dead point A and the reference midpoint B, a first perspective view and a second perspective view of an affected knee are obtained through CT (computed tomography) fluoroscopy by carrying the metal dead point marks and the metal midpoint marks, and a correction dead point D, which is closest to an anatomical dead point, of surgical approach is determined through analyzing knee joint image data in the first perspective view and the second perspective view, so that the optimal position of a surgical approach channel is found, and subsequent surgical operation can be performed smoothly. The positioning method of the embodiment is not influenced by the height and body weight index of the patient, and can analyze and calculate the adaptive surgical access point closest to the anatomical dead point according to different patients in an image radiography mode, so that the surgical success rate is improved on the basis of the minimum surgical wound, the incidence rate of postoperative complications is reduced, and the surgical time is shortened.
Meanwhile, according to the medial patellar ligament surgical approach positioning method, data of a correction dead point D of the reference dead point A are calculated through image analysis, the incision position of the surgical approach channel is determined at the position closest to the dissection dead point, surgery can be completed through the minimum incision, surgical scars are reduced, and the surgical scars are basically invisible under ideal conditions. The medial patella ligament surgery access positioning device of the embodiment can eliminate the continuous use of a CB machine in the surgery and eliminate the radiation influence on a patient caused by repeated fluoroscopy in the surgery. The medial patellar ligament surgery access positioning device of the embodiment has strong operability.
Finally, it should be noted that: the above examples are only intended to illustrate the technical solution of the present invention, but not to limit it; within the idea of the invention, also technical features in the above embodiments or in different embodiments may be combined, steps may be implemented in any order, and there are many other variations of the different aspects of the invention as described above, which are not provided in detail for the sake of brevity; although the present invention has been described in detail with reference to the foregoing embodiments, it will be understood by those of ordinary skill in the art that: the technical solutions described in the foregoing embodiments may still be modified, or some technical features may be equivalently replaced; and the modifications or the substitutions do not make the essence of the corresponding technical solutions depart from the scope of the technical solutions of the embodiments of the present invention.
Claims (10)
1. The utility model provides a medial patella ligament surgery approach positioner, its characterized in that, is including dissecting dead point positioner and kirschner wire positioner, dissect dead point positioner and fix according to the reference dead point based on adduction tendon dead point is confirmed, the sleeve that the installation is used for introducing the kirschner wire rotates on the kirschner wire positioner, dissect the angle survey subassembly and the length survey subassembly that sets up the linkage on the dead point positioner, the length survey subassembly is connected to through elastic expansion piece the kirschner wire positioner, the pulling the kirschner wire positioner makes the length survey subassembly is tensile to setting length, and makes the angle survey subassembly rotates the angle of settlement, thereby will the sleeve is according to the surgery approach location on dissecting the dead point.
2. The medial patellar ligament surgical access positioning device of claim 1, wherein the reference insertion point is a fixed metal insertion point marker.
3. The medial patellar ligament surgical approach positioning device according to claim 1, wherein the angle measurement component comprises a rotating wheel and a pointer, the dissection dead point positioning device further comprises a first scale plate, a reference dead point positioning hole is formed in the first scale plate, the rotating wheel is fixed on the scale plate and penetrates through the center of the reference dead point positioning hole, the pointer is rotatably mounted on the rotating wheel, and a first angle scale is arranged on the periphery of the reference dead point positioning hole.
4. The medial patellar ligament surgical approach positioning device according to claim 3, wherein the pointer is provided with length scales, the elastic expansion piece is sleeved on the pointer, and one end of the elastic expansion piece is fixed on the rotating wheel.
5. The medial patellar ligament surgical approach positioning device according to claim 4, wherein the length measurement component comprises an index member, the index member comprises a fixing portion and a collar, the fixing portion is connected to the other end of the elastic expansion member, and the collar is sleeved on the pointer.
6. The medial patellar ligament surgical access positioning device according to claim 1, wherein the k-wire positioning device comprises a second scale plate, a second angle scale is arranged on the second scale plate, and a first connecting portion is arranged at the center of the second angle scale.
7. The medial patellar ligament surgical access positioning device of claim 6, wherein the sleeve is provided with a second connection portion, the second connection portion cooperating with the first connection portion to rotatably mount the sleeve on the second scale plate.
8. The medial patellar ligament surgical access positioning device according to any of claims 1-7, wherein a distance, an offset angle, and a femoral rotation angle of the reference insertion point and an anatomical insertion point are measured based on a CT fluoroscopy head image, pulling the k-wire positioning device stretches the length measuring component to the distance, rotates the angle measuring component by the offset angle, and rotates the sleeve onto the femoral rotation angle to accurately determine the surgical access of the anatomical insertion point.
9. A medial patellar ligament surgery approach positioning method is characterized by comprising the following steps:
determining adductor tendon insertion points as reference insertion points, and fixing metal insertion point marks at the reference insertion points;
determining the midpoint position of the medial edge of the patella of the patient as a reference midpoint, and fixing a metal midpoint mark at the reference midpoint;
carrying the metal dead point mark and the metal midpoint mark to obtain a perspective view combination of the affected knee through CT fluoroscopy;
determining an image correction point of an anatomical dead point according to the perspective combination, and measuring the distance, the deviation angle and the femur rotation angle of the image correction point and a reference dead point based on a measurement scale;
and determining the surgical approach of the anatomical stop point by using a medial patellar ligament surgical approach positioning device according to the distance, the deviation angle and the femur rotation angle, wherein the medial patellar ligament surgical approach positioning device comprises the anatomical stop point positioning device and a Kirschner wire positioning device.
10. The medial patellar ligament surgical access positioning method of claim 9, wherein the perspective view combination comprises a first perspective view and a second perspective view, the first and second perspective views being compounded, the step of determining the trochlear trajectory and its center of rotation further comprising:
the first perspective view and the second perspective view are transparentized and overlapped in the same scale and the same position;
establishing a coordinate system based on the reference dead point image and the reference midpoint image;
establishing a pulley track by using the sliding surfaces in the first perspective view and the second perspective view, determining a rotation center by using the pulley track as an equal length point on a circumference, and setting the rotation center as an image correction point;
measuring the distance value between the image correction point and the reference stop point image;
measuring the deviation angle of the image correction point;
measuring the rotation angle of the femur of the affected knee according to the horizontal line and a connecting line behind the medial condyle and the lateral condyle of the femur;
the reference dead point image is connected with the image correction point to form a first connecting line, the reference midpoint image is connected with the image correction point to form a second connecting line, and the deviation angle is an included angle between the first connecting line and the second connecting line.
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