CN111772771A - First-collimation type femoral neck surgery central axis minimally invasive mechanical navigation system - Google Patents
First-collimation type femoral neck surgery central axis minimally invasive mechanical navigation system Download PDFInfo
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- CN111772771A CN111772771A CN202010809393.6A CN202010809393A CN111772771A CN 111772771 A CN111772771 A CN 111772771A CN 202010809393 A CN202010809393 A CN 202010809393A CN 111772771 A CN111772771 A CN 111772771A
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- 210000002436 femur neck Anatomy 0.000 title claims abstract description 80
- 238000001356 surgical procedure Methods 0.000 title claims abstract description 20
- 239000000725 suspension Substances 0.000 claims description 13
- 230000000087 stabilizing effect Effects 0.000 claims description 9
- 230000000712 assembly Effects 0.000 claims description 8
- 238000000429 assembly Methods 0.000 claims description 8
- 230000000694 effects Effects 0.000 claims description 8
- 238000005259 measurement Methods 0.000 claims description 7
- 239000000523 sample Substances 0.000 claims description 7
- 238000013461 design Methods 0.000 claims description 6
- 230000000399 orthopedic effect Effects 0.000 abstract description 3
- 238000004659 sterilization and disinfection Methods 0.000 abstract description 2
- 230000001954 sterilising effect Effects 0.000 abstract 1
- 210000001694 thigh bone Anatomy 0.000 description 7
- 238000000034 method Methods 0.000 description 6
- 230000000642 iatrogenic effect Effects 0.000 description 5
- 238000005516 engineering process Methods 0.000 description 4
- 210000000689 upper leg Anatomy 0.000 description 4
- 208000020089 femoral neck fracture Diseases 0.000 description 3
- 230000009286 beneficial effect Effects 0.000 description 2
- 210000000988 bone and bone Anatomy 0.000 description 2
- 210000000845 cartilage Anatomy 0.000 description 2
- 238000010276 construction Methods 0.000 description 2
- 230000001054 cortical effect Effects 0.000 description 2
- 238000005034 decoration Methods 0.000 description 2
- 238000010586 diagram Methods 0.000 description 2
- 238000012986 modification Methods 0.000 description 2
- 230000004048 modification Effects 0.000 description 2
- 238000011160 research Methods 0.000 description 2
- 230000008093 supporting effect Effects 0.000 description 2
- 208000010392 Bone Fractures Diseases 0.000 description 1
- 206010017076 Fracture Diseases 0.000 description 1
- 229910000831 Steel Inorganic materials 0.000 description 1
- 208000027418 Wounds and injury Diseases 0.000 description 1
- 210000000588 acetabulum Anatomy 0.000 description 1
- 210000003484 anatomy Anatomy 0.000 description 1
- 230000033228 biological regulation Effects 0.000 description 1
- 239000002131 composite material Substances 0.000 description 1
- 230000006378 damage Effects 0.000 description 1
- 230000007547 defect Effects 0.000 description 1
- 238000005553 drilling Methods 0.000 description 1
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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
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/74—Devices for the head or neck or trochanter of the femur
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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
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/84—Fasteners therefor or fasteners being internal fixation devices
- A61B17/846—Nails or pins, i.e. anchors without movable parts, holding by friction only, with or without structured surface
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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
- A61B17/8897—Guide wires or guide pins
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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
- 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
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- A—HUMAN NECESSITIES
- 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
- A61B2090/3904—Markers, e.g. radio-opaque or breast lesions markers specially adapted for marking specified tissue
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- A—HUMAN NECESSITIES
- 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
- A61B2090/3937—Visible markers
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Abstract
The invention belongs to the technical field of orthopedic surgery equipment, and relates to a head-on femoral neck surgery central axis minimally invasive mechanical navigation system which comprises a femoral neck positioning hook connecting component, an adapter, a porous positioning guide plate, a positioning guide, a slide bar right-angle adapter and a central axis positioning guide component, wherein the femoral neck positioning hook connecting component is connected with the adapter through a vertical connecting rod, the porous positioning guide plate is arranged on the adapter, the slide bar right-angle adapter is respectively connected with the porous positioning guide plate and the positioning guide, and the central axis positioning guide component is arranged on the positioning guide. The invention can objectively and accurately completely match the shaft angle, the anteversion angle and the anterior torsion angle, passes through the center of the femoral neck, ensures the accuracy of the central axis of the femoral neck surgery, realizes the first-level nail placement, has high accuracy, adopts a disassembly structure, is convenient for sterilization and reuse after the surgery, and has simple structure and multiple functions.
Description
Technical Field
The invention belongs to the technical field of orthopedic surgery equipment, relates to femoral neck fracture treatment auxiliary equipment, and particularly relates to an initial femoral neck surgery central axis minimally invasive mechanical navigation system.
Background
In the hip protection treatment of femoral neck fracture, the hollow nail fixing operation is still the preferred scheme, the hollow nail guide needle is embedded into the hollow nail guide needle, the core technology and the operation difficulty are difficult, no matter in the open reduction direct-vision hollow nail fixing or steel plate internal fixation operation or minimally invasive percutaneous hollow nail fixing operation, the hollow nail guide needle is safe, accurate and reasonable in spatial configuration, radiation is avoided or reduced, and the hollow nail guide needle is successfully embedded into the hollow nail guide needle once, and the hollow nail guide needle is always a research hotspot and continuous pursuit of orthopedics doctors.
At present, the mainstream technology in clinical practice is still based on visual inspection and estimation to drill 1 guide pin at the proximal end of femur, then repeatedly see through the right side position of femoral neck by a C-arm X-ray machine, and by using the position of the guide pin in the femoral neck as a reference, the nail feeding point, direction and length of the guide pin are estimated to drill 3-5 guide pins, and the position, direction and length of each guide pin are repeatedly seen through and adjusted until the 3 guide pins reach the proper position under the see-through, the 3 guide pins are respectively screwed in 1 hollow nail along the 3 guide pins, and the whole operation process is operated by the hand feeling of a master surgeon and the bare hand under the repeated see-through monitoring of the C-arm X-ray machine, so that the precision of the nail feeding point, direction and position of each hollow nail is poor, the spatial distribution of the 3 hollow nails cannot be accurately controlled, the length and the bone-cortex holding force of the screws have no objective standard, and the proximal end quality and the cartilage of the femur and the acetabulum cartilage are easily damaged, Iatrogenic fracture and other side injuries. During operation, once the guide needle cannot be successfully placed in one time (firstly, accurately, or just for short), the original needle path is easy to enter during adjustment, and the adjustment difficulty is greatly increased; repeated adjustment can greatly reduce the holding force of the hollow nail, and cause complications such as loosening, withdrawing, breaking and the like of the screw. In the face of a large number of cases of nail placing failure, the first-level nail placing needs to be solved urgently.
Currently, the mainstream academic view suggests that the ideal fixation is the orientation of the plurality of cannulated nails parallel to the central axis of the femoral neck. Therefore, the accurate finding of the femoral neck surgical central axis in the operation is the premise of ideal fixation; however, because the proximal femur has a complicated anatomical structure and an extremely irregular shape, and has individualized differences in the angle of the shaft of the neck, the angle of the anteversion and the angle of the anterior torsion, there is still a great challenge to find the central axis line in the operation, which is a straight line parallel to the three angles and located in the center of the narrow part of the femur neck.
Various guide positioning devices designed by scholars at home and abroad try to accurately place hollow nails by means of matching specific anatomical marks, cervical shaft angles, anteverted angles and the like at the proximal ends of thighbones, but due to individual anatomical differences, insufficient understanding of anterior torsion angles, limitation of precision of angle reference positioning and the like, placement errors of hollow nail guide needles are still large, and the hollow nail guide needles cannot meet surgical requirements and cannot be popularized. The infrared navigation technology combined with the C-shaped arm X-ray machine improves the accuracy of nail placement, but due to the reasons of error, high price, excessive dependence on rays, long operation time and the like of a navigation system, the popularization and the use of the infrared navigation technology in China are limited. In addition, in clinical surgery, the navigation technique cannot accurately measure the distance from the center of the guide pin or the thread of the hollow nail to the cortical bone, nor can it be determined whether the guide pin reaches the subchondral bone. The use of navigation in anatomical studies is also limited.
In summary, the current research on the central axis of the first-class femoral neck surgery is not easy and crucial, but lacks both ideas and technical equipment.
Disclosure of Invention
The invention aims to overcome the defects of the prior art and provides a head-on femoral neck surgery central axis minimally invasive mechanical navigation system which can be used for searching a nail feeding point N through a nail feeding point positioning guide, completely matching a shaft neck angle, an anteversion angle and an anterior torsion angle of a femoral neck, searching a middle point (front) P of the upper and lower diameters of a femoral neck isthmus as a mark point, using one half of the front and rear diameters of the femoral neck isthmus as an offset distance and successfully determining the femoral neck surgery central axis at one time by using a fixed point vertical offset distance method.
The technical scheme adopted by the invention is as follows:
a first-level femoral neck surgical central axis minimally invasive mechanical navigation system comprises a femoral neck positioning hook connecting component, an adapter, a porous positioning guide plate, a positioning guider, a slide bar right-angle adapter and a central axis positioning guide component;
the femoral neck positioning hook connecting component comprises a positioning block, a horizontal transverse positioning groove and a vertical connecting hole which penetrate through the positioning block and are staggered with each other are arranged on the positioning block, a positioning hook is movably arranged in the positioning groove, a locking component for locking the positioning hook is arranged on the positioning groove, the positioning hook can be locked and fixed by the locking component after moving left and right in the positioning groove to a proper position, the positioning hook comprises a connecting section and a functional section, the connecting section is movably arranged in the positioning groove, a right-angle hook is arranged at the front end of the functional section, a plurality of vertical guide pin holes are arranged at the position close to the front end, and a plurality of vertical calibration holes are arranged at the position close to the connecting section; the vertical connecting rod is movably arranged in the vertical connecting hole, a locking assembly used for locking the vertical connecting rod is arranged on the vertical connecting hole, and the vertical connecting rod can be locked and fixed by the locking assembly after the vertical connecting rod moves up and down in place in the vertical connecting hole; the positioning block is provided with a positioning measuring hole in the same direction as the positioning groove, the positioning measuring hole is positioned below the positioning groove, the positioning measuring hole is movably provided with a probe, and the positioning hook and the probe can be used for multi-point measurement, so that whether the hooking position of the positioning hook is accurate or not is finally determined, the upper and lower diameters of the femoral neck isthmus can be measured, and the middle point of the upper and lower diameters of the front cortex of the femoral neck isthmus is found;
the universal joint is characterized in that a horizontal transverse mounting hole and a vertical connecting hole which penetrate through the adapter and are staggered with each other are formed in the adapter, a vertical connecting rod on the femoral neck positioning hook connecting component penetrates through the vertical connecting hole in the adapter, so that the adapter is positioned above the femoral neck positioning hook connecting component, the transverse mounting hole in the adapter is in the same direction as and above a positioning groove on a positioning block of the femoral neck positioning hook connecting component, a porous positioning guide plate is movably arranged in the transverse mounting hole, and locking assemblies are arranged on the transverse mounting hole and the vertical mounting hole and are respectively used for locking the porous positioning guide plate and the vertical connecting rod;
the multi-hole positioning guide plate is composed of a connecting section and a functional section, the connecting section is movably arranged in a transverse mounting hole of the adapter, the front end of the functional section is provided with a connecting port vertical to the functional section, a plurality of vertical guide pin holes are arranged at a position close to the front end, a plurality of vertical calibration holes are arranged at a position close to the connecting section, the vertical guide pin holes and the vertical calibration holes on the multi-hole positioning guide plate are respectively in one-to-one correspondence with the vertical guide pin holes and the calibration holes on the positioning hook of the femoral neck positioning hook connecting component, the distance between any vertical guide pin hole and any vertical calibration hole on the multi-hole positioning guide plate is equal to the distance between the corresponding vertical guide pin hole and the corresponding vertical calibration hole on the positioning hook, a calibration pin is movably arranged on the vertical calibration holes, the position of the connecting section in the transverse mounting hole of the adapter is adjusted, so that the calibration pin on the vertical calibration hole is vertically downward and inserted, therefore, the vertical guide pin holes on the porous positioning guide plate are positioned right above the corresponding vertical guide pin holes on the positioning hooks of the femoral neck positioning hook connecting component (the more the number of the calibration holes is, the higher the alignment accuracy of the porous positioning guide plate and the positioning hooks is, the more accurate the upper and lower vertical guide pin holes are in correspondence), and the locking assembly is arranged on the connecting port;
the positioning guider comprises a positioning head, a plurality of horizontal guide pin holes are formed in the positioning head, the direction of the horizontal guide pin holes is vertical to the direction of a positioning hook on a femoral neck positioning hook connecting component (the extension lines of the horizontal projection of the horizontal guide pin holes and the positioning hook are perpendicular to each other), a position-adjustable vertical rod is arranged on the positioning head, the position adjusting direction is the same as the direction of the positioning hook (namely the direction perpendicular to the horizontal guide pin holes), generally speaking, the position adjusting mode in the mechanical industry is various, for example, a sliding groove is formed in the positioning head, a clamping block matched with the sliding groove is arranged at the lower part of the vertical rod, and the vertical rod is locked and fixed by a locking assembly after being moved to the right position; a slide bar right-angle adapter is arranged on the vertical rod;
the slide bar right-angle adapter is composed of a vertical connector and a fixed rod perpendicular to the connector, a moving port and a locking assembly are arranged on the connector, the moving port of the connector is sleeved on the vertical rod of the positioning guider, the fixed rod extends outwards (the extending direction is consistent with the direction of a horizontal guide pin hole on the positioning guider) and is sleeved in a connecting port at the front end of the functional section of the porous positioning guide plate, the connector is vertically moved in place on the vertical rod of the positioning guider, then the slide bar right-angle adapter is locked and fixed by the locking assembly, and meanwhile, the fixed rod is locked and fixed by the locking assembly on the connecting port;
the axis location direction component is including being the slide bar of "L" type of falling, the slide bar comprises vertical end and horizontal end, wherein vertical end sets up on the location director, the activity is provided with porous accent to slider and anteverted angle auxiliary measurement slider on the horizontal end, anteverted angle auxiliary measurement slider is located the one side that is close to vertical end, the direction of horizontal end is the same with the dead lever direction of slide bar right angle adapter, it all sets up a plurality of vertical guide pin holes to adjust to the slider and anteverted angle auxiliary measurement slider in porous, the distribution mode that porous accent was unanimous to the vertical guide pin hole that sets up on the vertical guide pin hole that sets up and the porous location deflector that sets up on the slider, when porous accent was adjusted directly over the porous location deflector promptly to the slider, each vertical guide pin hole that porous accent was adjusted on the slider all is located the vertical guide pin hole that corresponds directly over. The forward rake angle auxiliary measuring slide block is moved, and after the forward rake angle auxiliary measuring slide block is in place, the device can be objectively and accurately matched with the forward rake angle and the forward torsion angle by using the guide pin.
A further technical scheme is, the design of location hook is composite structure, including right angle hook and the porous locating plate that is down "L" shape, right angle hook and porous locating plate constitute by linkage segment and functional section, wherein vertical guide pin hole, vertical calibration hole all sets up on the functional section of porous locating plate, all set up the screw hole that the position corresponds on right angle hook and the porous locating plate (the position that sets up of screw hole generally all is on the linkage segment), be provided with fixing bolt on the screw hole, the screw hole on screwing in right angle hook and the porous locating plate with fixing bolt can make right angle hook and porous locating plate fix side by side and make up into the location hook together.
The further technical scheme is that the positioning hooks, the porous positioning guide plate and the vertical guide pin holes in the porous direction-adjusting slider are linearly arranged, and the rows are arranged in a staggered manner from left to right or from right to left. Because the vertical guide pin hole has certain aperture, can't correspond a certain specific size accurately, only be with vertical guide pin hole be the linear range, and arrange with arranging from left to right or from right to left dislocation set between the row, just can make a certain vertical guide pin hole correspond a certain size as far as possible within the scope that the error allows.
The further technical scheme is that the locking assembly is a bolt fixing assembly, if the locking assembly is arranged on the adapter, the locking assembly comprises a locking bolt and a bolt hole which is arranged in any direction of the adapter, communicated with the transverse mounting hole or the vertical connecting hole and vertical to the transverse mounting hole or the vertical connecting hole, and the locking bolt penetrates through the bolt hole to abut against a porous positioning guide plate or a vertical connecting rod which is tightly pressed in the transverse mounting hole or the vertical connecting hole, so that the porous positioning guide plate or the vertical connecting rod is prevented from shifting, and the locking fixing effect is achieved.
The technical scheme is that fastening fixture blocks are arranged on two sides of the porous direction-adjusting sliding block, the fastening fixture blocks are movably arranged at the horizontal end of the sliding rod and can slide along the horizontal end, locking assemblies are arranged on the fastening fixture blocks, and when the porous direction-adjusting sliding block moves in place on the horizontal end of the sliding rod, the fastening fixture blocks are moved from two sides and clamp the porous direction-adjusting sliding block and are locked and fixed by the locking assemblies, so that the effect of fixing the porous direction-adjusting sliding block is achieved.
The invention also comprises an adjusting and stabilizing support for adjusting and stabilizing the height and the direction of the head-on femoral neck surgery central axis minimally invasive mechanical navigation system, the adjusting and stabilizing support comprises an adjusting base, detachable suspension rods are arranged on the adjusting base at intervals side by side (the spacing distance of the suspension rods is set by the transverse distance between a femoral neck positioning hook connecting component and a positioning guider in the system as the minimum spacing distance), the left suspension rod is connected with a steering connector and a switching connecting rod, the left suspension rod can be connected with a vertical connecting rod by using the steering connector and the switching connecting rod, and similarly, the right suspension rod is connected with the steering connector and the switching connecting rod, and the right suspension rod can be connected with a fixed rod of a slide rod right-angle adapter and/or a vertical rod on the positioning guider by using the steering connector and the switching connecting rod, so as to achieve multiple connecting points, The effect of multi-azimuth suspension support and fixation. The steering connecting head is provided with vertical holes and horizontal holes which are vertical to each other and staggered with each other, locking assemblies are arranged on the vertical holes and the horizontal holes, different switching connecting rods are sleeved into the vertical holes and the horizontal holes and are used for locking the locking assemblies, and therefore the suspension height of the vertical adjusting system and the position of the horizontal (horizontal) adjusting system can be adjusted.
In the invention, in order to ensure the precision of the device and the smooth connection between the components, the shapes of various connecting rod pieces are matched with the shapes of corresponding grooves and holes, and the sizes of the connecting rod pieces are slightly smaller than the sizes of the corresponding grooves and holes.
The invention has the beneficial effects that:
1. the invention makes the porous positioning guide plate positioned below the porous direction-adjusting slide block and the guide pin hole on the positioning hook positioned at the lowest part correspond by adjusting the guide pin of the porous direction-adjusting slide block, makes the guide pin and the positioning hook completely match with the shaft angle, the anteversion angle and the anterior torsion angle of the femoral neck, then uses the positioning hook in the femoral neck positioning hook connecting component and the guide pin inserted into the positioning measuring hole of the positioning block to measure the upper and lower diameters of the isthmus of the femoral neck, then searches the upper and lower diameter midpoint P in front of the cortex of the femoral neck isthmus as a mark point to determine the accurate offset direction, determines the anteroposterior diameter midpoint M of the femoral neck as the coordinate origin by using the fixed point vertical offset method, then uses the positioning guide to search the nail feeding point N, determines the medial axis of the femoral neck surgery by connecting the M point and the N point, finally drills a hollow nail from the proper position of the proximal end of the femoral neck along the medial axis, the screw channel opener is combined to be used, the nail is successfully placed at one time, iatrogenic accidents caused by the fact that the nail is placed for many times in the operation are avoided, the iatrogenic accident rate is reduced, and the operation success rate is effectively improved.
2. Through the regulation stabilizing support of design, adjust the position and the height of whole device, have support and stabilizing effect, be convenient for use in the operation, design a plurality of parts simultaneously and connect convenient to detach, the disinfection used repeatedly after being convenient for operate, simple structure, the function is various.
3. The forward rake angle is used for assisting in measuring the sliding block, and the forward rake angle and the forward torsion angle can be objectively and accurately matched by a mechanical navigation system.
4. The use of the positioning guide can ensure the accuracy of the upper and lower positions and the front and back positions of the nail feeding point at the proximal end of the femur. The connection line of the nail feeding point and the middle point of the upper and lower diameters of the narrow part of the femoral neck ensures the accuracy of the angle of the shaft neck.
5. The virtual offset points are the middle points of the upper and lower diameters and the front and rear diameters of the narrow part of the femoral neck, and the connecting line of the virtual offset points and the nail feeding point completely matches the shaft angle, the anteversion angle and the anterior torsion angle and passes through the center of the femoral neck, so that the accuracy of the surgical central axis of the femoral neck is ensured.
Drawings
FIG. 1 is a schematic front perspective view of the present invention;
FIG. 2 is a schematic side view of the present invention;
FIG. 3 is an exploded view of the femoral neck positioning hook attachment member of the present invention;
FIG. 4 is an exploded schematic view of the positioning hook of the present invention;
figure 5 is a schematic structural view of an adapter of the present invention;
FIG. 6 is a schematic view of the construction of the multi-hole positioning guide plate of the present invention;
FIG. 7 is a schematic view of the positioning guide of the present invention;
FIG. 8 is a schematic structural view of the slider right angle adapter of the present invention;
FIG. 9 is a schematic view of the construction of the central axis positioning guide member of the present invention;
FIG. 10 is a schematic diagram of the arrangement of vertical guide pin holes of the present invention;
FIG. 11 is a schematic structural view of the tuning stabilization stand of the present invention;
fig. 12 is a usage state effect diagram of the present invention.
In the figure: 1. a femoral neck positioning hook connecting component; 2. a vertical connecting rod; 3. an adapter; 4. calibrating the needle; 5. a porous positioning guide plate; 6. a central axis positioning guide member; 7. a slide bar right angle adapter; 8. a positioning guide; 9. a probe; 10. a positioning hook; 11. calibrating the hole; 12. a vertical guide pin hole; 13. fixing the bolt; 14. positioning blocks; 15. a vertical connecting hole; 16. positioning a groove; 17. positioning the measuring hole; 18. locking the bolt; 19. a right-angle hook; 20. a porous positioning plate; 21. a screw hole; 22. a transverse mounting hole; 23. a connecting port; 24. positioning the head; 25. a horizontal guide pin hole; 26. a vertical rod; 27. a vertical connector; 28. moving the port; 29. fixing the rod; 30. a horizontal end; 31. a porous direction-adjusting slide block; 32. fastening the fixture block; 33. a forward rake angle auxiliary measuring slide block; 34. a vertical through groove; 35. a vertical end; 36. adjusting the stable seat; 37. a connecting seat; 38. a suspension rod; 39. a steering connector; 40. the connecting rod is connected in a switching way; 41. a vertical guide pin; 42. and (4) horizontally guiding the needle.
Detailed Description
The invention will now be further described, by way of example only, and not by way of limitation, with reference to the accompanying drawings.
In the structure shown in fig. 1 and 2, the first-level femoral neck surgery central axis minimally invasive mechanical navigation system designed by the invention comprises a femoral neck positioning hook connecting component 1, an adapter 3, a porous positioning guide plate 5, a positioning guide 8, a slide bar right-angle adapter 7 and a central axis positioning guide component 9; femoral neck location hook connecting elements 1 is connected with adapter 3 through vertical connecting rod 2, and porous location deflector 5 sets up on adapter 3, and slide bar right angle adapter 7 is connected with porous location deflector 5, location director 8 respectively, and axis location guide elements 9 sets up on location director 8.
The femoral neck positioning hook connecting component 1 comprises a positioning block 14, wherein the positioning block 14 is designed to be of a cuboid or cubic structure and is convenient to disassemble and assemble, a horizontal transverse positioning groove 16 and a vertical connecting hole 15 which penetrate through the positioning block and are staggered with each other are arranged on the positioning block, and the cross section of the positioning block is of a rectangular structure; the positioning hook 10 is movably arranged in the positioning groove 16, the positioning hook 10 is composed of a connecting section and a functional section, the connecting section is movably arranged in the positioning groove 16, a bolt hole which is communicated with the positioning groove and is vertical to the positioning groove is formed above the positioning block, a locking bolt 18 is arranged on the bolt hole, and the positioning hook 10 can be locked and fixed by screwing the locking bolt 18 after the connecting section of the positioning hook 10 moves in place in the positioning groove 16. Location hook 7 designs to modular structure, including being right angle hook 19 and the porous locating plate 20 of "L" shape of falling, right angle hook 19 and porous locating plate 20 constitute by linkage segment (all designing into the rectangle structure) and functional segment, the position that the functional segment of porous locating plate 20 is close to the front end sets up a plurality of guide pin holes 12, the position that is close to the linkage segment sets up a plurality of calibration holes 11, all set up the screw hole 21 that the position corresponds on the linkage segment of right angle hook 19 and porous locating plate 20, be provided with on the screw hole and can fix right angle hook and porous locating plate 13 together side by side, its appearance size slightly is less than the corresponding size of constant head tank 13 after the linkage segment of right angle hook 19 and porous locating plate 20 is fixed together side by side. The vertical connecting rod 2 is movably arranged in the vertical connecting hole 15, the vertical connecting rod 2 is designed to be of a rectangular structure, the appearance is matched with the shape of the vertical connecting hole 15, the corresponding size is slightly smaller than that of the vertical connecting hole 15, bolt holes which are communicated with the vertical connecting hole 15 and are perpendicular to the vertical connecting hole are formed in the side face of the positioning block 14, locking bolts 18 are arranged on the bolt holes, and the vertical connecting rod 2 can be locked and fixed by screwing the locking bolts 18 after the vertical connecting rod 2 is moved in place in the vertical connecting hole 15. The positioning block 14 is provided with a positioning measuring hole 17 in the same direction as the positioning groove, the positioning measuring hole 17 is positioned below the positioning groove 16, and the positioning measuring hole is movably provided with a probe 9. Utilize location hook and probe not only can the multiple spot position measure to whether the hook position of final location hook is accurate, can also measure the upper and lower footpath of thighbone neck isthmus, thereby find out the upper and lower footpath mid point in thighbone neck isthmus cortex lycii ahead.
The adapter 3 designed by the invention is designed into a square right-angle structure as shown in fig. 5, a horizontal transverse mounting hole 22 penetrating through the adapter is arranged on one right-angle side, a vertical connecting hole corresponding to the vertical connecting hole 12 on the positioning block 11 of the femoral neck positioning hook connecting component 1 is arranged on the other right-angle side, the transverse mounting hole 22 and the vertical connecting hole on the adapter 3 are staggered with each other, and the cross section of the horizontal mounting hole and the vertical connecting hole are both rectangular structures; vertical connecting rod 2 on the thighbone neck location hook connecting component runs through the vertical connecting hole on the adapter, make the adapter be located the top of thighbone neck location hook connecting component, horizontal mounting hole 22 on the adapter just is located its top with the constant head tank 16 syntropy on the locating piece of thighbone neck location hook connecting component, horizontal mounting hole 22 internalization sets up porous location deflector, all set up on horizontal mounting hole and vertical mounting hole with the thighbone neck location hook connecting component on locking Assembly similar locking Assembly (bolt fastening subassembly, all utilize locking bolt 18 to screw and support and compress tightly, thereby reach the fixed effect of locking, work as vertical connecting rod 2, porous location deflector removes to target in place after can with locking Assembly with the two locking.
The multi-hole positioning guide plate 5 designed by the invention is composed of a connecting section and a functional section, as shown in figure 6, the connecting section is in a rectangular structure and is movably arranged in a transverse mounting hole 22 of an adapter (the connecting section adopts the rectangular structure and is not only matched with the transverse mounting hole 22 but also beneficial to locking and fixing), the front end of the functional section is provided with a rectangular connecting port 23 vertical to the functional section, the part close to the front end is provided with a plurality of vertical guide pin holes 12, the part close to the connecting section is provided with a plurality of vertical calibration holes 11, the vertical guide pin holes and the vertical calibration holes on the multi-hole positioning guide plate 5 are all in one-to-one correspondence with the vertical guide pin holes and the calibration holes on the positioning hook 10 of the femoral neck positioning hook connecting component 1, the distance between any vertical guide pin hole on the multi-hole positioning guide plate and any vertical calibration hole is equal to the distance between the corresponding vertical guide pin, a calibration needle 4 is movably arranged on the vertical calibration hole, the position of the connecting section in the transverse mounting hole 22 of the adapter is adjusted, the calibration needle on the vertical calibration hole is vertically downward and inserted into the corresponding vertical calibration hole on the positioning hook of the femoral neck positioning hook connecting component, so that the vertical guide pin hole on the porous positioning guide plate is positioned right above the corresponding vertical guide pin hole on the positioning hook of the femoral neck positioning hook connecting component (the more the number of the calibration holes is, the higher the alignment accuracy of the porous positioning guide plate and the positioning hook is, the more accurate the upper and lower vertical guide pin holes are in correspondence), and a locking assembly is arranged on the connecting port 23;
the positioning guide 8 designed by the invention comprises a positioning head 24, as shown in fig. 7, a plurality of horizontal guide pin holes 25 are horizontally arranged on the positioning head, the direction of the horizontal guide pin holes is vertical to the direction of a positioning hook on a femoral neck positioning hook connecting component (the extension lines of the horizontal projection of the horizontal guide pin holes and the positioning hook are vertical to each other), a position-adjustable vertical rod 26 is arranged on the positioning head, the position adjusting direction is the same as the direction of the positioning hook (namely, the direction vertical to the horizontal guide pin holes), and the section of the vertical rod 26 is of a rectangular structure; a slide bar right angle adapter is provided on the vertical bar 26.
The slide bar right angle adapter 7 designed by the invention is composed of a vertical connector 27 and a fixed rod 29 (the section is rectangular) which is vertical to the connector, as shown in figure 8, a rectangular moving port 28 and a locking component are arranged on the connector 27, the moving port 28 of the connector is sleeved on a vertical rod 26 of a positioning guider, the fixed rod 29 extends outwards, the extending direction is consistent with the direction of a horizontal guide pin hole on the positioning guider and is sleeved in a connecting port 23 at the front end of a functional section of a porous positioning guide plate, after the fixed rod 29 horizontally moves in place in the connecting port 23, the connecting port is locked and fixed by the locking component after the connector 27 vertically moves in place on the vertical rod 27 of the positioning guider, and meanwhile, the fixed rod is locked and fixed by the locking component on the connecting port.
The designed central axis positioning guide member 6 comprises an inverted L-shaped sliding rod, as shown in FIG. 9, the sliding rod is composed of a vertical end 35 and a horizontal end 30, wherein the vertical end 35 is arranged on the positioning guide 8, the horizontal end is movably provided with a porous direction adjusting sliding block 31 and a forward inclination angle auxiliary measuring sliding block 33, two sides of the porous direction adjusting sliding block 31 are provided with fastening clamping blocks 32, the fastening clamping blocks 32 are provided with bolt fixing components, and the forward inclination angle auxiliary measuring sliding block is positioned on one side close to the vertical end; the horizontal end 30 is designed into a square rod-shaped structure, a vertical through groove 34 is formed in the middle of the horizontal end, and the direction of the horizontal end is the same as that of a fixing rod of the slide rod right-angle adapter; the multi-hole direction-adjusting slider 31, the forward inclination angle auxiliary measuring slider 33 and the fastening fixture block 32 are all provided with a through hole in a shape like a Chinese character 'hui', so that the multi-hole direction-adjusting slider, the forward inclination angle auxiliary measuring slider and the fastening fixture block 32 can be sleeved on the horizontal end 30 and can slide back and forth, when the multi-hole direction-adjusting slider 31 moves to the right on the horizontal end 30, the fastening fixture block 32 moves from two sides of the multi-hole direction-adjusting slider and clamps the multi-hole direction-adjusting slider and is locked and fixed by a locking assembly, thereby the multi-hole direction-adjusting slider is fixed, a plurality of vertical guide pin holes are arranged at the middle part of the forward inclination angle auxiliary measuring slider, a plurality of vertical guide pin holes are arranged at the left, middle and right parts of the multi-hole direction-adjusting slider, the vertical guide pin holes arranged on the multi-hole direction-adjusting slider are consistent with the distribution mode of the vertical guide pin holes arranged on the multi-hole positioning guide plate, namely, when . The forward rake angle auxiliary measuring slide block 33 is moved, and after the forward rake angle auxiliary measuring slide block is in place, the device can be objectively and accurately matched with the forward rake angle and the forward torsion angle by using the guide pin.
In the implementation of the present invention, since the vertical needle guiding holes 12 have a certain aperture, they cannot correspond to a specific size accurately, and in order to make a certain needle guiding hole correspond to a certain size as much as possible within the error tolerance, the vertical needle guiding holes disposed on the positioning hook, the multi-hole positioning guide plate, and the multi-hole direction-adjusting slider are linearly arranged, and are disposed in a staggered manner from left to right or from right to left between rows, as shown in fig. 10.
When the device is used, all parts in the whole device need to be gradually installed and suspended for fixing, and a support is adopted to support and fix the whole device from multiple connecting points in multiple directions, so that the stability of the whole system is ensured. Generally, either a conventional stent or a dedicated stent may be used. The invention also designs an adjusting and stabilizing bracket special for adjusting and stabilizing the height and the direction of the minimally invasive mechanical navigation system of the central axis in the first-level femoral neck surgery, as shown in fig. 11. The adjusting and stabilizing support comprises an adjusting base 36, the structural form of the adjusting base 36 can be various, as long as the stability of the adjusting base can be ensured, and the stability of a suspended system is ensured, and the adjusting base meets the requirements of the invention, connecting seats 37 are arranged on the adjusting base side by side at intervals (the interval distance is set by the transverse distance between a femoral neck positioning hook connecting component and a positioning guider in the system as the minimum interval distance), through holes and locking components are arranged on the connecting seats 37, a detachable hanging rod 38 is sleeved in the through hole of the connecting seats 37 and is fixed by the locking components, a left hanging rod 38 is connected with a steering connector 39 and a switching connecting rod 40, the left hanging rod 38 can be connected with the vertical connecting rod 2 by the steering connector 30 and the switching connecting rod 40, and similarly, the right hanging rod is connected with the steering connector 39 and the switching connecting rod 40, and the right hanging rod 38 can be connected with a fixing rod of a right-angle adapter of a sliding The vertical pole connect, can also utilize universal clamp, switching connecting rod etc. to connect to reach many tie points, diversified effect of hanging support, fixing. The steering connector 39 designed by the invention is the same as the adapter 3 in principle, and is provided with vertical holes and horizontal transverse holes which are vertical to each other and staggered with each other, and locking components are arranged on the vertical holes and the horizontal transverse holes, the shapes of the vertical holes and the horizontal transverse holes are set according to the cross section shapes of the switching connecting rods 40, if the switching connecting rods 40 adopt round rods, the shapes of the vertical holes and the horizontal transverse holes are round holes, and different switching connecting rods are sleeved into the vertical holes and the horizontal transverse holes and are locked and fixed by the locking components, so that the suspension height of a vertical adjusting system and the orientation of the horizontal (horizontal) adjusting system can be adjusted, and the purpose of supporting and fixing the whole system is achieved.
The working principle of the invention is as follows:
when the hollow nail guide needle for femoral neck fracture is put into operation, the whole device is installed firstly, as shown in figure 12.
Hooking the inner lower part and the functional section of the femoral neck at the front end of a positioning hook 10 to be tightly attached to the front cortex of the femoral neck, firstly, correspondingly matching the positions of the shaft angle, the anteversion angle and the front torsion angle of the femoral neck by using a plurality of vertical guide pins 40 through adjusting a vertical guide pin 41 inserted on a porous direction-adjusting slider 31, then measuring the upper and lower diameters of the isthmus of the femoral neck by using the positioning hook 10 in a femoral neck positioning hook connecting component 1 and a probe 9 on a positioning measuring hole 17 of a positioning block 14, then searching the upper and lower diameter midpoint P in front of the cortical bone of the isthmus of the femoral neck as a mark point to determine the accurate offset direction, determining the front and rear diameter midpoint M of the femoral neck as the origin of coordinates by using a fixed-point vertical offset method, then searching a nail feeding point N (which can also be determined by using the existing femoral neck nail feeding point positioner) by using a horizontal guide pin 42 through a horizontal guide pin hole 25 by using a positioning guider 8, and determining the surgical, finally, the hollow nail is drilled into the position, which is suitable for the proximal end of the femoral neck, of the femoral neck along the direction parallel to the central axis MN of the femoral neck surgery, the drilling process can be adjusted by means of perspective and combined with the use of a limiting pressure limiting channel screw channel opener, the nail is successfully placed at one time, iatrogenic accidents caused by the fact that the nail is placed for many times in the surgery are avoided, the iatrogenic accident occurrence rate is reduced, and the surgery success rate is effectively improved.
The foregoing is only a preferred embodiment of the present invention, and it should be noted that, for those skilled in the art, various modifications and decorations can be made without departing from the technical principle of the present invention, and these modifications and decorations should also be regarded as the protection scope of the present invention.
Claims (6)
1. The utility model provides a first accurate formula femoral neck surgery axis wicresoft mechanical navigation which characterized in that: the femoral neck positioning device comprises a femoral neck positioning hook connecting component, an adapter, a porous positioning guide plate, a positioning guider, a slide bar right-angle adapter and a central axis positioning guide component;
the femoral neck positioning hook connecting component comprises a positioning block, a horizontal transverse positioning groove and a vertical connecting hole which penetrate through the positioning block and are staggered with each other are arranged on the positioning block, a positioning hook is movably arranged in the positioning groove, and a locking assembly for locking the positioning hook is arranged on the positioning groove; the positioning hook is composed of a connecting section and a functional section, the connecting section is movably arranged in the positioning groove, the front end of the functional section is provided with a right-angle hook, the part close to the front end is provided with a plurality of vertical guide pin holes, and the part close to the connecting section is provided with a plurality of vertical calibration holes; the vertical connecting holes are internally and movably provided with vertical connecting rods, and the vertical connecting holes are provided with locking assemblies for locking the vertical connecting rods; a positioning measuring hole in the same direction as the positioning groove is formed in the positioning block, the positioning measuring hole is located below the positioning groove, and a probe is movably arranged on the positioning measuring hole;
the universal joint is provided with a horizontal transverse mounting hole and a vertical connecting hole which penetrate through the adapter and are staggered with each other, a vertical connecting rod on the femoral neck positioning hook connecting component penetrates through the vertical connecting hole on the adapter, the transverse mounting hole on the adapter is in the same direction as and above the positioning groove on the positioning block of the femoral neck positioning hook connecting component, a multi-hole positioning guide plate is movably arranged in the transverse mounting hole, and locking assemblies are arranged on the transverse mounting hole and the vertical mounting hole;
the multi-hole positioning guide plate is composed of a connecting section and a functional section, the connecting section is movably arranged in a transverse mounting hole of the adapter, the front end of the functional section is provided with a connecting port perpendicular to the functional section, a plurality of vertical guide pin holes are arranged at a position close to the front end, a plurality of vertical calibration holes are arranged at a position close to the connecting section, vertical guide pin holes and vertical calibration holes on the multi-hole positioning guide plate are respectively in one-to-one correspondence with vertical guide pin holes and calibration holes on a positioning hook of a femoral neck positioning hook connecting component, the distance between any vertical guide pin hole and any vertical calibration hole on the multi-hole positioning guide plate is equal to the distance between the corresponding vertical guide pin hole and the corresponding vertical calibration hole on the positioning hook, a calibration pin is movably arranged on the vertical calibration hole, and a locking assembly is;
the positioning guider comprises a positioning head, a plurality of horizontal guide pin holes are formed in the positioning head, the direction of the horizontal guide pin holes is perpendicular to the direction of a positioning hook on the femoral neck positioning hook connecting component, a position-adjustable vertical rod is arranged on the positioning head, and the position adjusting direction is the same as the direction of the positioning hook; a slide bar right-angle adapter is arranged on the vertical rod;
the slide bar right-angle adapter comprises a vertical connector and a fixed rod perpendicular to the connector, a moving port and a locking assembly are arranged on the connector, the moving port of the connector is sleeved on the vertical rod of the positioning guider, and the fixed rod extends outwards and is sleeved in a connecting port at the front end of the functional section of the porous positioning guide plate;
the axis location direction component is including being the slide bar of "L" type, the slide bar comprises vertical end and horizontal end, wherein vertical end setting is on the location director, the activity is provided with porous accent to slider and anteversion angle auxiliary measurement slider on the horizontal end, anteversion angle auxiliary measurement slider is located the one side that is close to vertical end, the direction of horizontal end is the same with the dead lever direction of slide bar right angle adapter, it all sets up a plurality of vertical guide pin holes to adjust to slider and anteversion angle auxiliary measurement slider in porous, the vertical guide pin hole that sets up on the slider and the vertical guide pin hole's that sets up on the porous location deflector distribution mode unanimous to porous accent.
2. The central axis minimally invasive mechanical navigation system for surgical operation of the femoral neck as claimed in claim 1, wherein: the location hook design is modular structure, including being right angle hook and the porous locating plate of "L" shape of falling, right angle hook and porous locating plate constitute by linkage segment and functional section, and wherein vertical guide pin hole, vertical calibration hole all set up on the functional section of porous locating plate, all set up the screw hole that the position corresponds on right angle hook and the porous locating plate, are provided with fixing bolt on the screw hole.
3. The central axis minimally invasive mechanical navigation system for surgical operation of the femoral neck as claimed in claim 1, wherein: the positioning hooks, the porous positioning guide plate and the vertical guide pin holes in the porous direction-adjusting slider are linearly arranged, and the rows are arranged from left to right or from right to left in a staggered manner.
4. The central axis minimally invasive mechanical navigation system for surgical operation of the femoral neck as claimed in claim 1, wherein: the locking assembly is a bolt fixing assembly.
5. The central axis minimally invasive mechanical navigation system for surgical operation of the femoral neck as claimed in claim 1, wherein: fastening fixture blocks are arranged on two sides of the porous direction-adjusting sliding block, the fastening fixture blocks are movably arranged at the horizontal end of the sliding rod, and locking assemblies are arranged on the fastening fixture blocks.
6. The central axis minimally invasive mechanical navigation system for surgical operation of the femoral neck as claimed in claim 1, wherein: the adjusting and stabilizing support comprises an adjusting base, detachable suspension rods are arranged on the adjusting base side by side at intervals, a left suspension rod is connected with a steering connector and a switching connecting rod, and a right suspension rod is connected with a steering connector and a switching connecting rod; the steering connecting head is provided with a vertical hole and a horizontal hole which are vertical to each other and staggered with each other, and the vertical hole and the horizontal hole are provided with locking components.
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| CN113693702A (en) * | 2021-09-03 | 2021-11-26 | 邓迎生 | Head-on femoral neck hollow nail placing system based on individualized safety boundary |
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