CN113317875A

CN113317875A - Collimation guide system

Info

Publication number: CN113317875A
Application number: CN202110571846.0A
Authority: CN
Inventors: 陈新治; 石磊; 芦明; 司赟; 戴炜建; 马艳丽; 陈雄权; 严肖锋; 贾水兰
Original assignee: Individual
Current assignee: Individual
Priority date: 2021-05-25
Filing date: 2021-05-25
Publication date: 2021-08-31
Also published as: CN115054368B; CN115054368A

Abstract

The present application relates to a collimation guide system. At present, the traditional stereotaxic apparatus can be accurately positioned, but is complex to use, and increases the pain of the upper head frame of a conscious patient, and the patient with unconsciousness is difficult to cooperate. The existing nerve navigation can realize accurate positioning and accurate guiding in operation, but is expensive and complex in use method. The collimation guiding system provided by the application has the advantages of simple structure principle, accurate positioning, convenience in carrying, easiness in learning and usability, and is suitable for any medical unit with CT. The application provides a collimation guiding system, which comprises a guide instrument, a positioning patch and a headstock; the guide instrument comprises a support and a collimating device, the support is used for guiding the needle-shaped instrument, the support is semicircular, one end of the support is provided with a positioning part, and the support is also provided with a sliding rail; the collimating device comprises a sliding block and at least one clamping assembly, the positioning patch at least comprises a first marking line and a second marking line, the headstock at least comprises three stand columns, and silica gel pads are mounted on the stand columns.

Description

Collimation guide system

Technical Field

The application belongs to the technical field of collimation guides, and particularly relates to a collimation guide system.

Background

Cerebral hemorrhage (cerebral hemorrhage) refers to hemorrhage caused by vascular rupture in non-traumatic brain parenchyma, and accounts for 20% -30% of all cerebral apoplexy, and the death rate in acute stage is 30% -40%. The cause of the disease is mainly related to the pathological changes of the cerebral vessels, namely closely related to hyperlipidemia, diabetes, hypertension, vascular aging, smoking and the like. Patients with cerebral hemorrhage often suffer from sudden onset of diseases due to emotional agitation and strenuous exertion, the early mortality rate is very high, and most survivors have different degrees of sequelae such as dyskinesia, cognitive impairment, speech dysphagia and the like.

Cerebral hemorrhage is common hemorrhagic stroke, has high disability rate and mortality, is particularly most dangerous for cerebral hemorrhage, accounts for about 10 percent of clinical cerebral hemorrhage cases, has low morbidity, but has acute onset of cerebral hemorrhage, serious illness and poorer prognosis, and is the disease with the highest fatality rate and the worst prognosis in all cerebral apoplexy. The cerebral hemorrhage accounts for 5.0-13.4% of cerebral hemorrhage, and is usually caused by rupture of the artery passing through the basilar artery supplying the cerebral bridge. The death rate of patients with 10ml of cerebral hemorrhage is 100%; in the past, brainstem hemorrhage is not suitable for surgery, but with the development of minimally invasive technology, particularly the application of stereotactic accurate positioning in clinic, the surgery has obviously benefited patients with brainstem hemorrhage, the survival rate is obviously improved, and even a part of patients are conscious. Hemorrhage puncture drainage and intracerebral lesion (brain tumor, inflammation, infarction and the like) disease detection of important structures such as brainstem and the like: according to the concept of precise neurosurgery, the damage to the surrounding brain tissue is minimized, intracerebral hematoma such as brainstem and the like is led out to the maximum extent, and intracerebral lesion tissues are taken out accurately for definite diagnosis, so that the method has important significance for improving the curative effect of operations on important functional areas of the brain, reducing complications and maintaining the life quality of patients.

Because the tumor in the brain is not directly visible, the three-dimensional stereotaxic apparatus is usually adopted for directional treatment, and the domestic three-dimensional stereotaxic apparatus is mainly used in provincial and municipal major hospitals and cannot be widely popularized in local hospitals at present due to the fact that the price is high and the three-dimensional stereotaxic apparatus is mainly imported. Moreover, such three-dimensional orientation instruments are complex to operate.

Although the traditional stereotaxic apparatus and the neuronavigation system can realize intracranial accurate positioning, the following characteristics are not easy to popularize:

1) the traditional stereotactic needs a plurality of people to cooperate to install a head frame before an operation and adjust coordinates in the operation, and the operation is complex and tedious;

2) the preoperative installation of the head frame is finished under the general anesthesia of the tracheal cannula, otherwise, the patient is not matched or the pain of the patient is increased;

3) the exposure of the operative field is influenced by the blockage of the head frame in the operation, and particularly the operation of the posterior fossa cerebellum and the brain stem part is easily blocked;

4) the coordinate parameter processing is complex, the manual measurement and calculation steps are complicated, and computer software processing is often needed;

5) the price is relatively expensive (over 50 ten thousand of the localization);

the above reasons affect the popularization of the medicine in the vast primary medical units, and the medicine is not easy to be applied in emergency treatment.

Although a nerve navigation system (a frameless stereotactic system) does not need to install a head frame before an operation, the cost is high, generally more than 200 ten thousand yuan, complicated processes such as preoperative registration and the like are needed, and the nerve navigation system is not suitable for popularization and application in primary hospitals.

Therefore, there is a need for a collimation guide system that is simple to operate.

Disclosure of Invention

Technical problem to be solved

Based on but accurate positioning of present traditional three-dimensional stereotaxic apparatus, accurate direction in the neural navigation can art, but the price is expensive, uses loaded down with trivial details problem, this application provides a collimation guide system.

Technical scheme

In order to achieve the above object, the present application provides a collimation guiding system, which includes a guide instrument, a site, and a headstock;

the guide instrument comprises a bracket and an alignment device, the bracket is used for guiding the needle-shaped instrument, the bracket is semicircular, one end of the bracket is provided with a positioning part, the positioning part comprises a positioning screw rod and a screw hole arranged on the bracket, the screw rod is aligned with the circle center of the bracket, and the bracket is also provided with a slide rail;

the collimating device comprises a sliding block and at least one clamping assembly, the sliding block is arranged in the sliding rail, the clamping assembly is arranged on the sliding block, the clamping assembly comprises a rotating sleeve, a fixed body, a nut and a clamping jaw, and the fixed body is fixed on the sliding block;

the fixing body is provided with a clamping jaw hole inclined to the axis of the fixing body, the clamping jaw obliquely moves back and forth by taking the clamping jaw hole as a guide to clamp or loosen the needle-shaped instrument, the nut is provided with a conical threaded hole and is in threaded connection with an external thread of the inclined clamping jaw, and a circle of steel balls are arranged around the fixing body behind the nut; the rotating sleeve is sleeved outside the nut and drives the nut to rotate; the clamping jaw clamps the needle-shaped instrument and aligns to the circle center of the bracket;

the positioning patch comprises at least two groups of marks, each mark comprises 3 mutually parallel first marking lines and a plurality of second marking lines arranged between the first marking lines, the distance between the first marking lines is 2cm, the first marking lines and the second marking lines are 45 degrees, no second marking line exists between the first line and the second line of the first marking lines, 1 second marking line is arranged between the second line and the third line of the first marking lines, 2 second marking lines are arranged between the third line of the first marking lines and the first line of the next group of first marking lines, and the first marking lines and the second marking lines are made of materials capable of developing on CT scanning;

the headstock at least comprises three upright posts, and the upright posts are provided with silica gel pads.

Further, the collimating device has two clamping assemblies, the rotating sleeves of which are connected to each other.

Furthermore, the device also comprises a base, a movable arm is arranged on the base, a bracket is arranged on the movable arm, and the head frame is connected with the base.

Furthermore, the bracket is provided with scale marks.

The clamping assembly on the alignment device may determine a line passing through the location point. Therefore, when it is necessary to perform a directional treatment (e.g., a directional operation) on a specific point or a specific area inside a regular or irregular object, the alignment guide system can be used to guide the relevant instruments (e.g., puncture needles (tubes)) as follows:

(1) performing tomography on the object;

(2) and determining front and back reference points (puncture points and navigation mark points) on the object according to the tomography scanning result so that the specific point or specific area is positioned on the center of the semicircular bracket.

(3) And adjusting the collimation device to determine the puncture point position.

(4) The relevant instruments are guided into the object from the point clamped by the clamping assembly, and the guiding depth is set according to the tomography until reaching the specific point or the specific area.

Through the guide instrument of this application, can eliminate the difficult problem of confirming of object inside position, especially the problem that shelters from of brain treatment position can not pinpoint can accurately judge cerebral hemorrhage (pathological change) position and carry out accurate treatment, alleviate patient's misery greatly.

Preferably, the bracket may be a telescopic bracket to adjust a distance between the first positioning portion and the second positioning portion. The structure of such a telescopic support is referred to a number of prior art techniques, such as the telescopic structure of a headset, etc.

It is another object of the present application to provide a collimation guidance system wherein the first and second indicator lines of the site are metal for use with tomography.

The alignment guide system has simple positioning method and convenient and quick operation, can carry out operation in any CT hospital in emergency treatment, and can complete positioning scanning, operation planning (determination of puncture points, navigation mark points and hematoma target points at the center of a sphere) and operation within 90 minutes if CT examination and operation anesthesia are connected; the positioning and guiding system has low price (less than 5 ten thousand yuan); can be popularized and applied in vast primary hospitals.

Drawings

FIG. 1 is a schematic view of a director structure of a collimating guidance system of the present application;

FIG. 2 is a schematic view of a site configuration of an alignment guidance system of the present application;

FIG. 3 is a schematic view of a collimating device of a collimating guide system of the present application;

FIG. 4 is a schematic view of an installation structure of a guide rail, a slide block and a collimating device of a collimating guide system of the present application;

FIG. 5 is a head frame configuration schematic of a collimation guide system of the present application;

FIG. 6 is a CT tomoscan;

FIG. 7 is a schematic view of a collimation guidance system positioning principle of the present application;

FIG. 8 is a schematic view of a screw, needle like instrument of an alignment guide system of the present application in alignment;

FIG. 9 is a schematic view of a collimator having two collimating devices of a collimating guide system of the present application

FIG. 10 is a primary CT scan of a first embodiment of a collimation guidance system of the present application;

FIG. 11 is a primary positioning diagram of a first embodiment of a collimation guide system of the present application;

FIG. 12 is a patch application view of a first embodiment of a collimation guide system of the present application;

FIG. 13 is a CT rescanning view of a first embodiment of a collimation guidance system of the present application;

FIGS. 14-16 are CT puncture point, landmark point measurements of a first embodiment of a collimation guidance system of the present application;

FIGS. 17-19 are puncture point, landmark point location views of a first embodiment of a collimation guidance system of the present application;

FIG. 20 is a diagram of a site conversion of a first embodiment of a collimation guidance system of the present application;

FIG. 21 is a schematic diagram of a puncture point, a beacon point, and a target point of a second embodiment of a collimation guiding system of the present application

FIG. 22 is a schematic view of a first positioning of a second embodiment of a collimation guide system of the present application;

FIG. 23 is a schematic view of a first penetration of a second embodiment of a collimation guide system of the present application;

FIG. 24 is a schematic view of a second positioning of a second embodiment of a collimation guidance system of the present application;

FIGS. 25-27 are schematic illustrations of a second penetration of a second embodiment of a collimation guide system of the present application;

in the figure: 1-bracket, 2-positioning patch, 2-1-first marking line, 2-2-second marking line, 3-headstock, 3-1-upright post, 3-2-silica gel pad, 4-slide block, 5-screw rod, 6-screw hole, 7-needle-shaped instrument, 8-collimation device, 81-rotating sleeve, 82-fixing body, 83-nut, 84-clamping jaw and 85-steel ball.

Detailed Description

Hereinafter, specific embodiments of the present application will be described in detail with reference to the accompanying drawings, and it will be apparent to those skilled in the art from this detailed description that the present application can be practiced. Features from different embodiments may be combined to yield new embodiments, or certain features may be substituted for certain embodiments to yield yet further preferred embodiments, without departing from the principles of the present application.

Referring to fig. 1-5, the present application provides a collimation guide system for guiding a needle-like instrument 8, comprising:

a collimation guiding system comprises a guide instrument, a positioning patch and a headstock;

as shown in fig. 3-4, the collimating device comprises a sliding block and at least one clamping assembly, the sliding block is installed in the sliding rail, the clamping assembly is installed on the sliding block, the clamping assembly comprises a rotating sleeve, a fixing body, a nut and a clamping jaw, and the fixing body is fixed on the sliding block;

as shown in fig. 2, the site includes two sets of first and second marking lines made of metal, the first marking line has a distance of 2cm, the first marking line has 3 lines as a set, the first and second marking lines are 45 degrees, the second marking line is vertically arranged with 2 lines as a set, there is no second marking line between the first and second lines of the first marking line, there are 1 second marking line between the second and third lines of the first marking line, and there are 2 second marking lines between the third line of the first marking line and the first line of the next set of first marking line; the first marking line and the second marking line are made of materials which can be developed on CT scanning;

as shown in fig. 5, the head frame at least comprises three upright posts, and the upright posts are provided with silica gel pads.

Furthermore, the bracket is provided with scale marks for marking the sliding angle of the collimation device on the nail.

Further, as shown in fig. 9, the alignment guide system has 2 sets of alignment devices, one set of alignment device is used for positioning and the other set of alignment device is slid on the support for puncturing when performing single-hole multi-target surgery.

In the using process, the position of the sliding block is generally adjusted to enable the needle-shaped instrument to be in a straight line with the screw rod, the specific point or specific area to be processed in the object is placed on the straight line, then the screw rod of the positioning part is adjusted to enable the specific point or specific area to be processed in the object to be placed at the center of the circle of the support, the sliding block is moved, and the needle-shaped instrument can pass through the specific point or specific area to be processed certainly, so that accurate positioning is achieved. The specific process is as follows:

(1) as shown in fig. 6, the object is subjected to tomographic scanning;

(2) as shown in fig. 7, two reference points (a puncture point and a navigation mark point) are determined on the object according to the tomography result, so that the specific point or the specific area is located on the straight line where the needle-shaped instrument and the screw rod are located.

(3) And adjusting the screw of the positioning part to enable the specific point or specific area to be processed in the object to be arranged at the center of the circle of the bracket.

(4) As shown in fig. 8, the introduction depth is set up to the above-described specific point or specific region according to the tomographic scanning.

Example one

As shown in fig. 10-20, single-well single-target puncture was performed by the following steps:

1. patients who need intracerebral hematoma puncture drainage or need taking pathological biopsy are shaved;

2. determining a puncture point:

1) as shown in fig. 10, according to the craniocerebral CT film, puncture points, navigation mark points and puncture paths are roughly planned: selecting a hematoma maximum layer, avoiding an important neurovascular structure, puncturing the hematoma at a position closest to the body surface or along the longitudinal axis direction of the hematoma (the direction of the longitudinal axis of the hematoma is adopted in the embodiment), wherein a small circle is a puncture point, a lower circle is a navigation mark point, and a '+' character at the center of the hematoma is a target point; .

) As shown in fig. 11, a positioning scale (perpendicular to the scanning plane) is respectively attached to the positions passing through two points (puncture point and navigation mark point), the range of the puncture point is circled, and a body surface marking straight line is drawn; and drawing a marked straight line at the navigation mark point position of the body surface of the opposite side by the same method.

) As shown in fig. 12, after a positioning scale is pasted, positioning and scanning are performed; the method comprises the following steps: the scanning plane is vertical to the positioning scale; the skin of the position pasted with the positioning scale is not wrinkled under stress; the marking straight line is similar to the length of the positioning scale axis metal wire, and the marking straight line and the positioning scale axis metal wire are overlapped and stuck.

) As shown in fig. 13-14, after scanning, a puncture path is determined according to the positioning image, and a puncture point and a navigation mark point are further determined; determining a puncture point, a navigation mark point and a puncture path; the puncture path selects the largest layer of hematoma, avoids important blood vessels, is closest to the body surface or is along the longitudinal axis direction of the hematoma.

) As shown in fig. 15, it can be seen that the number of the longitudinal wires is 2, the distance from the oblique wires is 1.94cm (as the bottom square), and is also equal to the height of the longitudinal square (the longitudinal coordinate value);

6) as shown in FIG. 16, the puncture point is seen to be about 1.04cm from the longitudinal axis (abscissa values); the puncture point A can be determined on the body surface according to the coordinate values;

7) referring to FIG. 17, a is the length of the perpendicular side of 1.94cm and is also the length of the unit longitudinal metal shadow (ordinate);

8) as shown in FIG. 18, the small horizontal line b is equal to 1.04cm, i.e., the distance (abscissa value) between the puncture point and the body surface mark line; the body surface puncture point A can be determined;

3. determining a navigation mark point B according to the method in the step 2;

4. puncture under the guide of the guide instrument:

1) so that the screw rod on the positioning part is aligned with the navigation mark point, the needle-shaped instrument is aligned with the puncture point (figure 19), and the telescopic length of the screw rod is rotationally adjusted, so that the center of the hematoma is positioned at the center of the circle of the bracket. Cutting skin, drilling holes and cutting dura mater at the puncture point;

2) the collimation guiding device is arranged in the puncture needle (tube) and is aligned with the puncture point, and the screw rod is aligned with the navigation mark point; the needle is slowly inserted to generate the hematoma center (the puncture needle (tube) punctures to the bottom, so that the needle point reaches the center O1).

The support is combined with a CT fault to determine a puncture point, a hematoma (focus) center and a navigation mark point. Three points are required to be in a line. (in addition, the puncture point is relatively nearest to the center of the hematoma, and the puncture path avoids important vascular nerve structures).

In the embodiment, the puncture needle inserting depth can be determined according to the CT before the operation and the distance from the puncture point to the hematoma center without adjusting the circle center position of the bracket.

In this embodiment, it is common knowledge in the art that the reading and analysis of CT slices requires a judgment in combination with adjacent slices.

Example two

As shown in fig. 9, 21-27, single well multi-target puncture was performed as follows:

according to the CT scanning picture for the first time, setting target points (two to multiple target points can be set when hematoma is large and irregular), preliminarily planning puncture points, guide points and puncture paths: selecting a hematoma maximum layer in principle, avoiding important vascular nerves, and puncturing the layer close to the body surface or along the longitudinal axis of the hematoma;

fixing the positioning patch, and determining a target point and a puncture path after CT positioning scanning:

as shown in fig. 21, two puncture paths are determined, the first puncture path is composed of a puncture point a1, a navigation mark point B1 and a target point 01, the second puncture path is composed of a puncture point a2, a navigation mark point B2 and a target point 02, the guide instrument is in a semi-arc shape, the diameter (outer diameter) is 20cm, the length of the puncture needle (tube) is 20cm, and the puncture needle (tube) is exactly the center of a circle (focus and hematoma center).

) Puncture first target point O1: the screw rod on the positioning part is aligned with the navigation mark point B1, the needle-shaped instrument is aligned with the puncture point A1, and the telescopic length of the screw rod is rotationally adjusted, so that the center of the hematoma is positioned at the circle center O1 of the bracket. Cutting skin, drilling holes and cutting dura mater at the puncture point; the collimation guiding device is arranged in the puncture needle (tube) and is aligned with the puncture point A1, and the screw rod is aligned with the navigation mark point B1; the needle is slowly inserted to the center of hematoma (the puncture needle (tube) is punctured to the bottom, so that the needle point reaches the center O1). In this case, a collimating guide is positioned with the screw.

) Puncturing a second target point O2: the screw rod on the positioning part is aligned with the navigation mark point B2, the needle-shaped instrument is aligned with the puncture point A2, and the telescopic length of the screw rod is rotationally adjusted, so that the center of the hematoma is positioned at the circle center O2 of the bracket. Another alignment guide slides on the carriage so that the puncture needle (tube) is aligned with puncture point a1 and the screw is aligned with navigation point B2; the needle is slowly inserted to generate the hematoma center (the puncture needle (tube) punctures to the bottom, so that the needle point reaches the center O2).

Therefore, the puncture of the needle is realized through the puncture point A1 for two times, and the needle is respectively aligned to the target points O1 and O2, so that the wound of a patient is reduced, the speed of the operation is increased, and the rescue time is saved.

Although the present application has been described above with reference to specific embodiments, those skilled in the art will recognize that many changes may be made in the configuration and details of the present application within the principles and scope of the present application. The scope of protection of the present application is determined by the appended claims, and all changes that come within the meaning and range of equivalency of the claims are intended to be embraced therein.

Claims

1. A collimation guiding system comprises a guide instrument, a positioning patch and a headstock;

the guide instrument comprises a bracket and a collimating device and is used for guiding the needle-shaped instrument, and the guide instrument is characterized in that the bracket is semicircular, one end of the bracket is provided with a positioning part, the positioning part comprises a positioning screw rod and a screw hole arranged on the bracket, the screw rod is aligned with the circle center of the bracket, and the bracket is also provided with a slide rail;

the collimating device comprises a sliding block and at least one clamping assembly, the sliding block is arranged in the sliding rail, the clamping assembly is arranged on the sliding block, the clamping assembly comprises a rotating sleeve, a fixing body, a nut and a clamping jaw, and the fixing body is fixed on the sliding block;

the fixing body is provided with a clamping jaw hole inclined to the axis of the fixing body, the clamping jaw obliquely moves back and forth to clamp or loosen the needle-shaped instrument by taking the clamping jaw hole as a guide, the nut is provided with a conical threaded hole and is in threaded connection with an external thread of the inclined clamping jaw, and a circle of steel balls are arranged around the fixing body pad behind the nut; the rotating sleeve is sleeved on the outer side of the nut and drives the nut to rotate; the clamping jaw clamps the needle-shaped instrument and aligns to the circle center of the bracket;

the positioning patch comprises at least two groups of marks, each mark comprises 3 mutually parallel first marking lines and a plurality of second marking lines arranged between the first marking lines, the distance between the first marking lines is 2cm, the first marking lines and the second marking lines are 45 degrees, no second marking line exists between the first marking lines and the second marking lines, 1 second marking line exists between the second marking lines and the third marking lines of the first marking lines, 2 second marking lines exist between the third marking lines of the first marking lines and the first marking lines of the next group of first marking lines, and the first marking lines and the second marking lines are made of materials capable of developing on CT scanning;

the headstock at least comprises three upright posts, and silica gel pads are arranged on the upright posts.

2. The alignment guide system of claim 1 wherein the alignment device has two clamp assemblies, the rotating sleeves of the two clamp assemblies being interconnected.

3. The collimation guide system of claim 1, further comprising a base having a moveable arm mounted thereon, the support being mounted on the moveable arm, the head frame being connected to the base.

4. The alignment guide system of claim 1 wherein the frame has graduations.

5. The collimation guide system of claim 1, having 2 sets of collimation devices.