Visualized intramedullary nail distal aiming instrument

Abstract

The present invention discloses a visualized intramedullary nail distal aiming instrument, including a horizontal adjustment mechanism and a vertical axis, the outer side of the vertical axis is sleeved with a vertical axial steering constraint kit, the axial steering constraint kit is fixed to the adjustment output end of the horizontal adjustment mechanism, the upper end of the vertical axis is vertically fixed with a horizontal axis, the horizontal axis is sleeved with a vertical sliding sleeve and a locking pin is arranged; the front end of the vertical sliding sleeve is directly and movably sleeved with the aiming instrument component, the present invention mainly solves the problem of difficulty in locking the distal end of the intramedullary nail, no matter whether the intramedullary nail is bent or deformed arbitrarily after entering the medullary cavity, it can be quickly and accurately locked by the aiming instrument of the present invention, simplifying the operation steps and saving precious time for the operation. The present invention is in vitro positioning, that is, in vitro aiming. It ensures success at one time, improves the speed of surgery, reduces the occurrence of complications, greatly reduces the number of fluoroscopy times, and reduces the impact of radiation.

Description

Technical Field

[0001] The invention belongs to the technical field of distal aiming of a locking screw of a femoral intramedullary nail, and in particular relates to a visualized distal aiming instrument for an intramedullary nail. Background Art

[0002] At present, femoral intramedullary nails are used clinically for femoral fractures, which is a minimally invasive treatment method for femoral fractures. Since the intramedullary nail will deform to a certain extent after being implanted into the bone, it is often difficult to lock the nail at the distal end. In order to reduce the difficulty of locking the nail at the distal end, a mechanical aiming device is generally used to improve the success rate of locking the nail. However, the basic principle of the mechanical aiming device currently used is to adjust the offset of the aimer through a positioning rod. The success rate of the first locking nail in actual clinical application is not high, and multiple drillings are required to succeed. The offset of the aimer is adjusted by the positioning rod, which cannot be adjusted after being fixed. However, after the positioning rod is adjusted, there is still offset when drilling, which will inevitably cause difficulty in locking the nail during drilling.

[0003] During the operation, the skin at the fracture site must be cut open. In order to reduce the trauma area and achieve the purpose of minimally invasive surgery, a smaller incision is usually made in the skin, the required femoral end is inserted into the intramedullary nail, and then the distal end of the intramedullary nail is fixed with a locking screw. Because the femoral bone curvature is large and the bone plate is located below the surface of the skin, it is impossible to visually observe, so the position of the corresponding locking screw hole cannot be accurately found. Since intramedullary nailing has high technical requirements for the treatment of femoral fractures, it has not been fully carried out. One of the difficulties is the difficulty in locking the distal end. There are currently a variety of aiming devices (hand-held aiming, mechanical aiming, magnetic navigation), but there are still many shortcomings.

[0004] Among the various existing intramedullary nail distal aiming instruments, most of them are fixedly connected to the proximal end (exposed end) of the intramedullary nail to constrain the aiming instrument at the proximal end of the intramedullary nail to ensure that the position and direction of the positioning hole of the aiming instrument and the distal end of the intramedullary nail (located in the medullary cavity) correspond to each other, such as the interlocking intramedullary nail distal locking nail aiming device with publication number CN109223150 A and the A translucent intramedullary nail distal locking nail sight is designed to make the position and direction of the distal fixing hole of the intramedullary nail correspond to the positioning hole on the sight. When the intramedullary nail penetrates into the medullary cavity, it is drilled and fixed on the outside using the corresponding positioning hole on the sight. Before the intramedullary nail enters the medullary cavity, the distal fixing hole and the sight positioning hole are completely corresponding to each other. However, the intramedullary nail is slender, and after entering the medullary cavity, the distal end of the intramedullary nail may be deformed due to the compression of the two ends of the fracture. Especially for femoral intramedullary nails, the distal end will cause the sight positioning hole to deviate from the distal fixing hole of the intramedullary nail due to moderate bending deformation, so it will cause the drilling deviation problem, affecting the smooth progress of the operation. This type of sight cannot be adjusted arbitrarily under fluoroscopic conditions, resulting in difficulty in locking. It can only be applied to intramedullary nails that are not deformed under fluoroscopic conditions, and the scope of application is limited. Summary of the invention

[0005] In view of the problem that the existing intramedullary nail aiming instruments are difficult to aim at the far end or difficult to adjust, the present invention provides a device that can perform arbitrary lateral movement and angle adjustment on the aiming device mounting sleeve, and use the external lateral aiming device and the vertical aiming device as references under perspective conditions, and the overlap with the projection of the far end fixing hole of the intramedullary nail is used as the adjustment purpose, so as to realize the accurate visualization of the far end aiming operation of the intramedullary nail.

[0006] The technical solution adopted to achieve the above-mentioned purpose is as follows: a visualized intramedullary nail distal aiming instrument, including a horizontal adjustment mechanism and a vertical axis, the outer side of the vertical axis is sleeved with a vertical axial steering constraint kit, the axial steering constraint kit is fixed to the adjustment output end of the horizontal adjustment mechanism, the upper end of the vertical axis is vertically fixed with a horizontal axis, or the upper end of the vertical axis is sleeved or fixed with a horizontal axis through a vertical fixing sleeve, when sleeved, the vertical fixing sleeve is matched with a horizontal axis and a locking pin is set, and the horizontal axis is sleeved with a vertical sliding sleeve and a locking pin is set; the front end of the vertical sliding sleeve is directly and movably sleeved with a sight assembly, or the vertical sliding sleeve is matched with a sight mounting sleeve, and the front end of the sight mounting sleeve is movably sleeved with the sight assembly. An aimer assembly, an axial constraint structure is arranged between the vertical sliding sleeve and the horizontal axis so that the vertical sliding sleeve can only slide axially on the horizontal axis but cannot rotate, and an axial constraint structure is arranged between the aimer mounting sleeve and the vertical sliding sleeve so that the aimer mounting sleeve can only slide axially in the vertical sliding sleeve but cannot rotate; the aimer assembly includes a lateral aimer and a vertical aimer, the lateral aimer includes a connecting seat, an axial auxiliary needle is axially fixed at the front end of the connecting seat, a lateral projection needle is vertically arranged at the front end of the axial auxiliary needle, and a lateral projection cross mark is arranged at the end of the lateral projection needle, and the vertical aimer includes a connecting seat, a vertical projection needle is axially fixed at the front end of the connecting seat, and a vertical projection cross mark is arranged at the end of the vertical projection needle.

[0007] There are multiple implementation methods of the axial steering restraint kit. Implementation method 1: the axial steering restraint kit includes a sliding lock sleeve and a steering lock sleeve. The inner diameter of the sliding lock sleeve includes a thin diameter section and a thick diameter section. There is an inner step at the intersection of the two. A radial perforation or groove or key is arranged on the thin diameter section of the sliding lock sleeve. A sliding pin is installed in the perforation or groove. The sliding pin or key is installed in cooperation with the axial sliding groove or axial sliding edge arranged on the side of the vertical shaft to ensure that the vertical shaft only moves axially along the sliding sleeve; the steering lock sleeve is matched and sleeved in the thick diameter section, and the vertical shaft is matched and sleeved in the thin diameter section and the steering lock sleeve. A sliding lock wire is radially installed on the thin neck section to prevent the vertical shaft from axially sliding, and a steering lock wire is radially installed on the thick diameter section of the sliding lock sleeve to prevent the sliding lock sleeve from rotating.

[0008] Implementation method two: The axial steering constraint kit includes a cylindrical outer sleeve and a cylindrical inner sleeve which are mounted together. A steering lock wire is vertically installed on the side wall of the cylindrical outer sleeve to prevent the cylindrical inner sleeve from rotating. An anti-axial sliding baffle is arranged between the end of the cylindrical inner sleeve and the end of the cylindrical outer sleeve. The axis of the cylindrical inner sleeve is a prismatic hole, and the vertical axis is a prism. The vertical axis is matched and mounted in the prismatic hole of the cylindrical inner sleeve, and a sliding lock wire is vertically installed on the side wall of the cylindrical inner sleeve to prevent the vertical axis from axial sliding.

[0009] Implementation method three: The axial steering constraint kit includes a prism outer sleeve and a prism inner sleeve which are mounted together. A sliding lock wire is vertically installed on the side wall of the prism outer sleeve to prevent the prism inner sleeve from axial sliding. The axis of the prism inner sleeve is a cylindrical hole. The vertical axis is a cylinder. The vertical axis is matched and mounted in the cylindrical hole of the prism inner sleeve. An anti-axial sliding baffle is arranged between the vertical axis and the end of the prism inner sleeve. A steering lock wire is vertically installed on the side wall of the prism inner sleeve to prevent the vertical axis from rotating.

[0010] Furthermore, on the basis of the above, a horizontal adjustment reference mechanism is provided on the axial steering constraint kit or on the vertical fixing sleeve to ensure that the vertical axis is in a vertical state, and a fixing seat is installed at the proximal end of the intramedullary nail, and a horizontal reference mechanism is installed on the fixing seat to ensure that the distal locking hole of the intramedullary nail is axially horizontal.

[0011] Specifically, the horizontal adjustment reference mechanism involved is that a positive vertical reference line and a side vertical reference line are respectively arranged axially on the front and side of the vertical steering lock sleeve, and a suspension line is fixed to the upper end of the positive vertical reference line and the side vertical reference line, and a plumb line is fixed to the bottom of each suspension line. By adjusting the horizontal rod and the vertical adjustment shaft, the front suspension line and the side suspension line are respectively overlapped with the positive vertical reference line and the side vertical reference line to ensure that the vertical steering lock sleeve and the vertical axis inside it are in a vertical state.

[0012] Alternatively, the horizontal adjustment reference mechanism is to set an upper plane or a slot on the upper end of the vertical fixing sleeve or the vertical axis or the horizontal rotating tube, ensure that the surface of the upper plane or the slot is perpendicular to the vertical axis, and install a remote level on the upper plane or the slot.

[0013] In order to achieve the purpose of quantitative adjustment, an angle disc jack is further provided on the vertical steering lock sleeve and an angle disc is installed horizontally, and the end of the horizontal shift fork corresponds to the scale on the surface of the horizontally installed angle disc.

[0014] In order to achieve the purpose of quantitative adjustment, a vertical plate parallel to the horizontal axis can be provided on the vertical fixing sleeve as a correction plate, and the vertical projection of one side of the correction plate coincides with the axis center of the horizontal axis. A corner plate is mounted in the transverse axial locking sleeve. When the surface of the corner plate overlaps with the surface of the correction plate, the working longitudinal tube located on the horizontal axis is in a horizontal state.

[0015] The above-mentioned quantitative adjustment mainly utilizes C-arm machine to respectively perform lateral perspective and superior perspective of the intramedullary nail. The host of the C-arm machine contains a distance and angle measurement program, which can display the moving distance or swing angle of the perspective line. However, this measurement function of the C-arm machine is rarely used in practical applications. The present invention can make use of the original distance and angle measurement software of the C-arm machine. On the basis of the above mechanical navigation scheme of the femoral neck guide needle, the numerical distance of each guide needle is given by means of the C-arm machine to realize the digital aiming function.

[0016] The above-mentioned horizontal reference mechanism located at the proximal end of the intramedullary nail can also be realized in a variety of ways. For example, the first way is to install a fixing seat at the proximal end of the intramedullary nail, and install a proximal level on the fixing seat. The second way is to vertically connect a vertical axis to the fixing seat, and the front and side surfaces of the vertical axis are respectively engraved with reference lines along the axial direction, and the upper ends of each reference line are respectively connected to a plumb line through a vertical line. The third way is to include a top plate and a bottom plate in the fixing seat, and a plumb line is connected to the middle part below the top plate through a vertical line, and a reference point is set in the middle of the bottom plate, and the plumb line is directly opposite to the reference point when it is vertical.

[0017] Regarding the axial constraint structure designed between the horizontal axis and the vertical movable sleeve, and between the vertical movable sleeve and the sight mounting sleeve, the cylindrical cavity of the outer sleeve is matched with the cylindrical inner sleeve, and a key and a keyway of a matching set are set between the two, so as to ensure that the two can only slide axially but not rotate. Alternatively, the axial constraint structure is to design the outer sleeve and the inner sleeve as prismatic structures respectively, and the two are matched. For example, the relationship between the horizontal axis and the vertical movable sleeve is: the cylindrical cavity of the vertical sleeve is matched with the cylindrical horizontal axis, and a key and a keyway of a matching set are set between the two, so as to ensure that the two can only slide axially but not rotate; or the axial constraint structure is to design the vertical sleeve and the horizontal axis as prismatic structures respectively, and the two are matched. For example, the relationship between the vertical movable sleeve and the sight mounting sleeve is: the cylindrical cavity of the vertical movable sleeve is matched with the horizontal axis of the sight mounting sleeve, and a matching key and keyway are set between the two, so as to ensure that the two can only slide axially but not rotate; or, the axial constraint structure is to design the vertical movable sleeve and the sight mounting sleeve as prismatic structures respectively, and the two are matched.

[0018] Furthermore, an axial constraint structure is provided between the vertical fixing sleeve and the horizontal axis so that the horizontal axis can only slide axially but cannot rotate in the vertical fixing sleeve. The purpose of such a design is to enable the vertical fixing sleeve to slide and lock on the horizontal axis. This sliding only requires translational sliding and does not require rotation. There are many ways to achieve this. For example, implementation method one: the axial constraint structure is to match the cylindrical cavity of the vertical fixing sleeve with the cylindrical horizontal axis, and to set a matching key and keyway between the two, thereby ensuring that the two can only slide axially but cannot rotate. Implementation method two: the axial constraint structure is to set the vertical fixing sleeve and the horizontal axis as prismatic structures respectively, and the two are matched and fitted.

[0019] The horizontal adjustment mechanism used to adjust the instrument of the present invention is used to achieve the above-mentioned horizontal adjustment, that is, to adjust the horizontal swing angle, lateral movement and lifting adjustment. The vertical fixed sleeve and the horizontal axis include a support rod fixed on the bracket, and a horizontal rotating sleeve and an axis hole are arranged at the top of the support rod, which are used to match the horizontal rod. The horizontal rod can rotate in the horizontal rotating sleeve and can be locked by the horizontal locking wire. A horizontal rotating tube is vertically fixed at the end of the horizontal rod, and a vertical adjustment shaft is arranged inside the horizontal rotating tube. The vertical adjustment shaft can rotate in the horizontal rotating tube and can be locked by the vertical locking wire. The vertical adjustment shaft is fixed to the vertical axial steering constraint kit as the adjustment output end of the horizontal adjustment mechanism. Specifically, it is fixed to the vertical steering lock sleeve, or to the vertical cylindrical outer sleeve, or to the vertical cylindrical inner sleeve. The upper end of the vertical axis is specifically fixed to the vertical fixed sleeve, or to the horizontal cylindrical outer sleeve, or to the horizontal cylindrical inner sleeve.

[0020] A vertical steering lock sleeve can also be vertically fixed at the end of the vertical adjustment shaft, a vertical sliding lock sleeve is sleeved on the outer side of the upper end of the vertical steering lock sleeve, a vertical shaft is matched and sleeved on the inner side of the vertical steering lock sleeve, the lower end of the vertical sliding lock sleeve is sleeved on the end of the vertical steering lock sleeve and is installed with a vertical rotation locking pin, the upper end is sleeved on the vertical shaft and is installed with a vertical movement locking pin, the vertical shaft is provided with an axial vertical groove parallel to the axis, a fork mounting hole is provided on the upper side of the vertical sliding lock sleeve, a vertical fork is installed in the fork mounting hole, and the vertical fork is matched and sleeved in the axial vertical groove.

[0021] The present invention mainly solves the problem of difficulty in locking the distal end of the intramedullary nail. No matter whether the intramedullary nail is bent or deformed after entering the medullary cavity, it can be quickly and accurately locked by the aiming device of the present invention, simplifying the operation steps and saving precious time for surgery. The present invention is in vitro positioning, that is, in vitro aiming. It ensures success at one time, improves the speed of surgery, reduces the occurrence of complications, greatly reduces the number of fluoroscopy times, and reduces the impact of radiation.

[0022] The present invention uses a lateral aimer and a vertical aimer to accurately lock the distal hole of the intramedullary nail under C-arm fluoroscopy conditions, thereby ensuring that the position and direction of the aimer mounting sleeve and the locking hole are consistent, with a simplified structure, high precision, good effect and strong practicality.

[0023] The present invention can also display the moving distance or swing angle of the perspective line by means of the distance and angle measurement program contained in the mainframe of the C-arm machine, and provide the numerical distance of each guide needle by means of the C-arm machine to realize the digital aiming function.

[0024] The present invention introduces a plumb bob or a level for adjusting the vertical axis to be vertical or the horizontal axis to be horizontal. Its purpose is to adjust the aiming part to a horizontal state according to the sight before fluoroscopy. Since the lateral perspective light of the C-arm is in a horizontal direction and the vertical perspective light is in a vertical direction, after the sight is adjusted to be horizontal, it only needs to be raised, lowered or translated under the lateral perspective condition to achieve the purpose of making the lateral aimer and the intramedullary nail perpendicular. The vertical aimer and the intramedullary nail are in a vertical direction, and only horizontal translation adjustment is required under the vertical perspective condition, thereby reducing the number and difficulty of adjustments under the vertical perspective condition, and further reducing the amount of radiation exposure during vertical perspective. BRIEF DESCRIPTION OF THE DRAWINGS

[0025] Figure 1 It is one of the three-dimensional structural schematic diagrams of the present invention.

[0026] Figure 2 yes Figure 1 Schematic diagram of the front structure.

[0027] Figure 3 yes Figure 1 Schematic diagram of the side structure.

[0028] Figure 4 yes Figure 2 Schematic diagram of the partially enlarged structure.

[0029] Figure 5 yes Figure 1 Schematic diagram of the top view structure.

[0030] Figure 6 It is a structural diagram of the support rod.

[0031] Figure 7 It is a schematic diagram of the horizontal rod and horizontal rotating tube structure.

[0032] Figure 8 It is a schematic diagram of the structure of a vertical adjustment shaft and a vertical steering lock sleeve.

[0033] Fig. 9 yes Figure 8 Stereoscopic diagram.

[0034] Fig.10 yes Figure 8 End view of .

[0035] Fig.11 It is a structural diagram of the horizontal adjustment mechanism.

[0036] Fig.12 It is a schematic diagram of the sliding and rotating lock sleeve structure.

[0037] Fig.13 yes Fig.12 Schematic diagram of the sliding lock sleeve structure.

[0038] Fig.14 It is a schematic diagram of the side structure of the calibration board.

[0039] Fig.15 yes Fig.14 Schematic diagram of the three-dimensional structure.

[0040] Fig.16 It is a schematic diagram of the corner plate structure.

[0041] Fig.17 It is a schematic diagram of another structure of an axial steering restraint kit.

[0042] Fig.18 It is a schematic diagram of the structure of another axial steering restraint kit.

[0043] Fig.19 It's a side sight.

[0044] Fig. 20 It is a vertical sight.

[0045] Fig.21 It is the sight mounting sleeve.

[0046] Fig. 22 It is a vertical fixed sleeve.

[0047] Fig.23 It is a vertical sliding sleeve.

[0048] Fig.24 It is a spare guide tube.

[0049] Fig.25 It is the inner sleeve guide tube.

[0050] Fig.26 This is the second schematic diagram of the three-dimensional structure of the present invention.

[0051] Fig. 27 It is the third schematic diagram of the three-dimensional structure of the present invention.

[0052] Fig.28 yes Fig. 27 Schematic diagram of the structure of the mid-angle disk.

[0053] Fig.29 It is a schematic diagram of another horizontal reference mechanism structure at the end of the intramedullary nail.

[0054] Fig.30 yes Fig.29 Schematic diagram of the enlarged structure of part A in the middle.

[0055] Numbers in the figure: 100 is a support rod, 101 is a horizontal swivel sleeve, 200 is a horizontal rod, 201 is a horizontal hand wheel fixed end, 202 is a horizontal swivel tube, 203 is a horizontal lock hole, 204 is a horizontal adjustment hand wheel, 205 is a horizontal lock wire, 300 is a vertical adjustment shaft, 301 is a vertical hand wheel fixed end, 302 is a vertical steering lock sleeve, 303 is an angle plate jack, 304 is a positive vertical reference line, 305 is a side vertical reference line, 306 is a positive hanging line fixing hole, 307 is a side hanging line fixing hole, 308 is a vertical adjustment hand wheel, 309 is a vertical lock wire, 310 is a vertical Ring card groove, 400 is the thick diameter section of the sliding lock sleeve, 401 is the thin diameter section of the sliding lock sleeve, 402 is the rotation locking hole, 403 is the vertical movement locking hole, 404 is the fork mounting hole, 405 is the vertical fork, 406 is the hanging line, 407 is the plumb line, 408 is the vertical rotation locking pin, 409 is the vertical movement locking pin, 500 is the vertical axis, 501 is the axial vertical groove, 502 is the vertical fixing sleeve, 5021 is the horizontal square sleeve, 5022 is the horizontal column sleeve, 5023 is the horizontal prism cavity, 5024 is the cylindrical cavity, 5025 is the keyway, 5026 is the fixed sleeve locking pin, 503 is the slide rod locking pin, 503 701 is the vertical scale, 600 is the horizontal axis, 601 is the horizontal key, 700 is the vertical sliding sleeve, 7001 is the longitudinal square sleeve, 7002 is the sleeve head, 7003 is the longitudinal prism cavity, 7004 is the sleeve head prism cavity, 701 is the sighting device mounting sleeve, 7011 is the cylindrical tube cavity, 7012 is the square head slot, 702 is the guide sleeve, 703 is the spare guide tube, 704 is the drill rod, 705 is the sliding sleeve locking pin, 706 is the sleeve head locking pin, 707 is the longitudinal key, 801 is the lateral sighting device, 8011 is the connecting square seat, 8012 is the axial auxiliary needle, 8013 is the lateral projection needle, 8014 is the side 802 is a vertical projection cross mark, 8021 is a connecting square seat, 8022 is a vertical projection needle, 8023 is a vertical projection cross mark, 900 is an angle plate, 901 is an arc-shaped clearance groove, 902 is a plate plug, 903 is a clamp, 904 is a calibration plate, 905 is a clamp plug, 906 is a corner plate, 907 is a fork, 908 is a fixed or adjusted seat, 10 is a distal level, 11 is an intramedullary nail, 12 is a distal hole, 13 is a fixed seat, 14 is a proximal level, 15 is a vertical rod, 16 is a vertical line, 17 is a plumb line, 18 is a reference line, and 19 is a stop. A1 is a cylindrical outer sleeve, A2 is a cylindrical inner sleeve, B1 is a prism outer sleeve, and B2 is a prism inner sleeve. DETAILED DESCRIPTION

[0056] After the intramedullary nail penetrates into the medullary cavity along the end of the fractured femur, it penetrates the proximal end and the distal end of the fracture. The proximal end and the distal end of the intramedullary nail are respectively provided with fixing holes, and the proximal end and the distal end of the intramedullary nail are respectively fixed at the two ends of the fracture site by using locking wires. The intramedullary nail is thin and long and has rigid materials. It is a common phenomenon that the intramedullary nail is bent and deformed after penetrating into the medullary cavity. It is very easy to lock the proximal hole of the intramedullary nail, but it is more troublesome to lock the distal fixing hole of the intramedullary nail. Because the distal hole 12 of the intramedullary nail 11 swings in different directions due to the uncertain bending direction of the intramedullary nail, it is difficult to lock the hole. Therefore, the locking of the distal hole of the intramedullary nail is not as easy as the locking of the proximal hole (the proximal hole of the intramedullary nail can be connected to the aiming mechanism based on the proximal connecting seat of the intramedullary nail as the basis), and the distal aiming of the intramedullary nail can no longer be based on the connecting seat at the end of the intramedullary nail as the basis, and an independent adjustment aiming instrument is required to achieve it.

[0057] Embodiment 1: adopt a kind of Figure 1 The visualized distal intramedullary nail aiming device shown in the figure is used to aim the distal end of the intramedullary nail at the locking hole. Although the distal hole of the intramedullary nail is located in the medullary cavity and cannot be directly observed, the aiming device mounting sleeve can be adjusted synchronously by adjusting the lateral aiming device and the vertical aiming device under the C-arm fluoroscopic condition, and finally the axis of the aiming device mounting sleeve corresponds to the axis of the distal hole of the intramedullary nail. Since the lateral aiming device and the vertical aiming device are respectively located outside and can be directly viewed, after the aiming device is adjusted horizontally, the target position that needs to be adjusted can be quickly and accurately determined through the lateral projection and the vertical projection. When the C-arm machine is used for distance and angle measurement, the C-arm machine can be used to display the distance and angle values, and the corresponding angle disk can be used as the basis and reference for adjustment to achieve precise adjustment.

[0058] Specifically, the visual intramedullary nail distal aiming device of this embodiment first requires a horizontal adjustment mechanism to ensure that the vertical axis is in a vertical state, that is, the horizontal axis is in a horizontal state, such as Figure 1 , Figure 6-Figure 11 As shown, the support rod 100 is fixed to the corresponding bracket by a fixing member (the bracket and the fixing member are not shown in the figure), and the bracket can be a bed frame or an equipment rack, etc. In this embodiment, the corresponding adjustment is achieved on the basis of the support rod 100 being fixed. Figure 6 After the support rod 100 is fixed in a nearly vertical direction, the horizontal rod 200 and the vertical adjustment shaft 300 need to be adjusted, as shown in FIG. Figure 6-Figure 11 As shown, with the horizontal reference instrument (a plumb line is used in this embodiment) as a reference, the vertical axis 500 is finally adjusted to be in an absolutely vertical state before the aiming operation can be further adjusted.

[0059] For the specific structure of the horizontal adjustment mechanism, see Fig.11: When the support rod 100 is fixed, the top of the support rod 100 has a horizontal sleeve 101, and the horizontal sleeve 101 has a transverse shaft hole, which is used to match the set. Figure 5 The horizontal rod 200 shown can rotate in the horizontal rotating sleeve 101 and can be locked by a horizontal locking wire 205 (installed in a horizontal locking hole 203). Fig.11 In the embodiment, a horizontal rotating tube 202 is vertically fixed to one end of the horizontal rod 200, and a horizontal adjustment hand wheel 204 is fixed to the other end (i.e., the horizontal hand wheel fixing end 201). A vertical adjustment shaft 300 is sleeved inside the horizontal rotating tube 202, and the vertical adjustment shaft 300 can rotate in the horizontal rotating tube 202 and can be locked by a vertical locking wire 309. A vertical steering lock sleeve 302 is vertically fixed to one end of the vertical adjustment shaft 300, and a vertical adjustment hand wheel 308 is fixed to the other end (i.e., the vertical hand wheel fixing end 301).

[0060] The collimator of this embodiment is adjusted for the purpose of adjusting the vertical axis to be vertical. A vertical axial steering constraint kit is mounted on the outer side of the vertical axis and fixed to the adjustment output end of the horizontal adjustment mechanism. The axial steering constraint kit in this embodiment is as follows: Figure 1 , Fig.12 and Fig.13 As shown, it includes a sliding lock sleeve and a steering lock sleeve. A vertical ring groove 310 is provided at the upper end of the vertical steering lock sleeve 302, a vertical sliding lock sleeve is sleeved on the outer side of the upper end of the vertical steering lock sleeve 302, and a vertical shaft 500 is matched and sleeved on the inner side of the vertical steering lock sleeve 302. Fig.12 and Fig.13 As shown, the vertical sliding lock sleeve includes a sliding lock sleeve thick diameter section 400 and a sliding lock sleeve thin diameter section 401, and there is an inner step at the intersection of the two. The sliding lock sleeve thin diameter section is provided with a radial perforation or groove, and a sliding pin is installed in the perforation or groove. The sliding pin is installed in cooperation with the axial sliding groove or axial sliding edge provided on the side of the vertical shaft, which can ensure that the vertical shaft only moves axially along the sliding sleeve. The steering lock sleeve is matched and fitted in the thick diameter section, and the vertical shaft is matched and fitted in the thin diameter section and the steering lock sleeve. A sliding lock wire is radially installed in the thin neck section to prevent the vertical shaft from sliding axially, and a steering lock wire is radially installed in the thick diameter section of the sliding lock sleeve to prevent the sliding lock sleeve from rotating. The vertical steering lock sleeve 302 is driven by the above-mentioned horizontal adjustment mechanism to swing horizontally and longitudinally, that is, it can be adjusted to swing arbitrarily, and finally can be adjusted to be vertical, so that the vertical axis of the vertical steering lock sleeve 302 is also in a vertical state.

[0061] Line-plumb horizontal reference instrument: When adjusting the vertical steering lock sleeve 302 to a vertical state, a horizontal reference instrument is needed as a reference. Figure 1 Specifically, a positive vertical reference line 304 and a side vertical reference line 305 are respectively arranged along the axial direction on the front and side of the vertical steering lock sleeve 302 (such as Figure 8and Fig. 9 As shown), the upper ends of the positive vertical reference line 304 and the side vertical reference line 305 are respectively fixed with hanging wires (the positive hanging wire fixing hole 306 and the side hanging wire fixing hole 307 and the corresponding screws are installed respectively), and the arc between the positive vertical reference line 304 and the side vertical reference line 305 is 90 degrees. A plumb bob 407 is fixed below each hanging wire, and the plumb bob is a cone, which can ensure that the hanging wire is in a stretched state. In the initial state, the front hanging wire and the side hanging wire are likely to not coincide with the corresponding reference lines, so it is necessary to adjust the horizontal rod 200 and the vertical adjustment shaft 300 respectively, so that the front hanging wire and the side hanging wire overlap with the positive vertical reference line 304 and the side vertical reference line 305 respectively, and then fix and lock them accordingly to ensure that the vertical steering lock sleeve 302 and the vertical axis 500 inside it are in a vertical state, thereby ensuring that the vertical fixing sleeve 502 is in a horizontal state. It can be seen that by adjusting the horizontal adjustment hand wheel and the vertical adjustment hand wheel in coordination and with the aid of the adjustment instrument as a reference, the vertical axis 500 can be placed in an absolutely vertical state.

[0062] It can be seen that after the vertical axis is adjusted to a vertical state, the vertical axis horizontal rotation adjustment and vertical translation, as well as locking can be achieved by means of the vertical axial steering constraint kit. Fig. 27 , Fig.12 and Fig.13 As shown, the vertical shaft 500 is provided with an axial vertical groove 501 parallel to the axis, and the axial vertical groove 501 is a through groove penetrating the axis or a blind groove recessed in the radial direction. At the same time, a fork mounting hole 404 is provided on the upper side of the vertical sliding lock sleeve, and a vertical fork 405 (or a clamping pin) is installed in the fork mounting hole 404, and the vertical fork 405 is matched and fitted in the axial vertical groove 501. It can be seen that when the vertical shaft 500 is rotated and adjusted, the vertical sliding lock sleeve is integrated with the vertical shaft 500, rotates relative to the vertical steering lock sleeve 302, and the vertical sliding lock sleeve can be locked together with the vertical steering lock sleeve 302 by using the vertical rotation locking pin, that is, the vertical shaft 500 and the vertical steering lock sleeve 302 are locked together by using the vertical rotation locking pin. In addition, the vertical shaft 500 and the vertical sliding lock sleeve of the vertical rotation locking pin can slide relative to each other, that is, the vertical shaft 500 can slide axially along the vertical sliding lock sleeve. The vertical axis 500 can be locked with the vertical sliding lock sleeve by using the vertical movable locking pin, and the vertical axis 500 can be lifted and moved after unlocking. It can be seen that under the action of the vertical sliding lock sleeve and the vertical rotating tube, the vertical axis 500 can be rotated and locked, and can also be lifted and locked.

[0063] This embodiment can also be Fig. 27 For example, the vertical steering lock sleeve 302 is provided with Fig.28 The angle disc 900 shown, the angle disc socket 303 ( Figure 8 The angle plate jack 303 is included and is installed horizontally as shown in Fig.19 The angle disc 900 shown in the figure has an arc-shaped clearance groove in the middle of the angle disc 900, and a disc plug is provided at the center of the arc-shaped clearance groove. The disc plug is inserted into the angle disc socket 303 of the vertical steering lock sleeve 302, as shown in FIG. Figure 4 The angle disc 900 is symmetrically distributed with angle scales, and the end of the vertical shift fork 405 corresponds to the scale on the surface of the horizontally installed angle disc 900. The angle disc 900 can be used as a reference value for the rotation angle of the vertical axis 500.

[0064] The vertical axis can be directly fixed to the horizontal axis vertically, for example, the vertical axis can be welded vertically to the horizontal axis at the upper end, or the vertical axis and the horizontal axis can be directly designed as T-shaped castings, which is simple and feasible. The following is a detailed description of the method in which the vertical axis and the horizontal axis are fixed to each other through a vertical fixing sleeve. The upper end of the vertical axis is vertically fixed or vertically sleeved with a vertical fixing sleeve. This embodiment adopts the following method: Figure 1 As shown, a vertical fixing sleeve 502 is installed on the upper end of the vertical axis, but it is locked by a locking wire so that the vertical fixing sleeve 502 and the vertical axis are in a vertical fixed relationship. As long as the vertical axis 500 is kept vertical, the vertical fixing sleeve 502 can be kept horizontal (the previous text has described the content of adjusting the vertical axis by a horizontal adjustment mechanism, which will not be described in detail). In addition, when the vertical fixing sleeve is vertically installed on the upper end of the vertical axis, it is necessary to satisfy the axial constraint structure between the vertical fixing sleeve and the horizontal axis so that the horizontal axis can only slide axially but not rotate in the vertical fixing sleeve, and to set a corresponding locking wire. For example, implementation method one: the axial constraint structure is to match the cylindrical cavity of the vertical fixing sleeve with the cylindrical horizontal axis, and to set a matching key and keyway between the two, so as to ensure that the two can only slide axially but not rotate. Implementation method two: the axial constraint structure is to set the vertical fixing sleeve and the horizontal axis as prismatic structures respectively, and the two are matched. It can be adopted as follows Fig. 22 The square column tube structure shown is provided with corresponding locking wires.

[0065] like Figure 1 As shown, a vertical sliding sleeve is sleeved on the horizontal axis and a locking pin is provided. Different from the vertical fixed sleeve mentioned above, the vertical fixed sleeve can be directly integrated with the vertical axis or the horizontal axis, but the vertical sliding sleeve must satisfy the function of being able to slide in parallel but not rotate. Considering the diversity of connection methods, the structural relationship between the vertical sliding sleeve and the horizontal axis can also adopt a cylindrical tube sleeve connection relationship, but an axial constraint structure needs to be set. For example, the cylindrical cavity of the vertical movable sleeve is matched with the cylindrical horizontal axis, and a matching key and keyway are set between the two to ensure that the two can only slide axially but not rotate. Alternatively, the axial constraint structure is to design the vertical movable sleeve and the horizontal axis as prismatic structures respectively, and the two are matched and fitted. The simplest way can be adopted as follows Fig.23 The square tube structure shown, that is, the vertical sliding sleeve contains longitudinal ridge holes, which just match the horizontal axis shape of the square tube. After the two are assembled, they cannot rotate but can slide axially, and corresponding locking wires are set.

[0066] If the front end of the vertical sliding sleeve is long enough, it can directly flexibly sleeve the sight assembly. However, usually a sight mounting sleeve is matched and sleeved in the vertical sliding sleeve, and an axial constraint structure is set between the sight mounting sleeve and the vertical sliding sleeve so that the sight mounting sleeve can only slide axially in the vertical sliding sleeve but cannot rotate, and the front end of the sight mounting sleeve is flexibly sleeved with the sight assembly. The axial constraint structure between the sight mounting sleeve and the vertical sliding sleeve, for example, matches and sleeves the cylindrical cavity of the vertical movable sleeve with the horizontal axis of the sight mounting sleeve, and sets a matching key and keyway between the two, so as to ensure that the two can only slide axially but cannot rotate. Alternatively, the axial constraint structure is to design the vertical movable sleeve and the sight mounting sleeve as prismatic structures respectively, and the two are matched and sleeved.

[0067] like Fig.19 and Fig. 20 In the invention, the aimer assembly includes a lateral aimer and a vertical aimer. The lateral aimer includes a connecting seat, an axial auxiliary needle is axially fixed at the front end of the connecting seat, a lateral projection needle is vertically arranged at the front end of the axial auxiliary needle, and a lateral projection cross mark is arranged at the end of the lateral projection needle. The vertical aimer includes a connecting seat, a vertical projection needle is axially fixed at the front end of the connecting seat, and a vertical projection cross mark is arranged at the end of the vertical projection needle.

[0068] When in use, first use the proximal level 14 on the proximal connection seat of the intramedullary nail as a reference, rotate the intramedullary nail, and adjust the axis of the distal hole of the intramedullary nail to be horizontal. Although the intramedullary nail will bend and deform moderately in the medullary cavity, it will not be twisted, so the proximal level 14 and the axis of the distal hole are set in advance to be in the same horizontal plane. When the proximal level 14 is adjusted to be in a horizontal state, it can be determined that the axis of the distal hole of the intramedullary nail is in a horizontal state.

[0069] Then, adjust the horizontal axis of the sight to be horizontal (i.e., adjust the vertical axis to be vertical). For the method of adjusting the horizontality in this embodiment, refer to the method of adjusting the plumb line described above.

[0070] Then install the lateral aimer or the vertical aimer in sequence. Take the vertical aimer as an example, install the vertical aimer in the aimer installation sleeve, and make the vertical aimer directly above the intramedullary nail. The adjustment projection view is as follows: Figure 2-Figure 5 As shown, the vertical projection needle is located at the axis of the distal hole of the intramedullary nail (when the distal hole of the intramedullary nail is vertically perspective, there are two concave arcs on both sides of the hole as shown in the figure). Figure 5As shown in the figure, the vertical projection needle is located at the center of the two concave arcs. Since the horizontal axis is horizontal, the sighting device mounting sleeve and the vertical projection needle are both horizontal. The adjustment of the vertical projection needle involves horizontal swing angle adjustment and lateral translation adjustment. The horizontal swing angle adjustment is achieved by rotating and locking the steering lock sleeve on the vertical axis. When the vertical projection needle is adjusted to the right position, the direction and horizontal position of the sighting device mounting sleeve are adjusted to the right position. The second projection is horizontal projection from the side. Before projection, replace the lateral sighting device. Figure 4 It can be seen that in the lateral aimer, the center of the lateral projection crosshair has a height difference of △h from the axial auxiliary pin, so it is necessary to first translate the horizontal axis carrying the aimer installation sleeve and the lateral aimer downward by a height of △h (the purpose of the downward movement is to avoid the lateral projection ray of the C-arm and prevent the aimer body from blocking the ray), and then determine the height of the aimer installation sleeve based on the coincidence of the center of the lateral projection crosshair of the lateral aimer and the center of the distal hole of the intramedullary nail. Since the horizontal axis and the aimer installation sleeve are both in a horizontal state, there is no need to consider the pitch angle of the lateral aimer, and the adjustment is simple and quick, reducing the workload in the radiation environment. After the lateral aimer is adjusted to the right position, the fixed value △h is used as the standard, and then the horizontal axis and the aimer installation sleeve are translated upward by △h (returned) to achieve the final adjustment purpose (through the axial sliding and locking of the sliding lock sleeve on the vertical axis). At this time, the axis of the aimer installation sleeve completely coincides with the axis of the distal hole of the intramedullary nail.

[0071] Embodiment 2: Based on Embodiment 1, the horizontal adjustment reference mechanism adopts the following Fig.26 The structure shown in the figure constitutes a new visual distal aiming device for intramedullary nails. Fig.26 It can be seen that an upper plane or a slot is provided at the upper end of the vertical fixing sleeve 502 to ensure that the surface of the upper plane or the slot is perpendicular to the vertical axis 500, and a remote level 1010 is installed on the upper plane or the slot. Fig.11 The horizontal rod 200 and the vertical adjustment shaft 300 shown are adjusted to when the bubble in the remote level 1010 is located at its center position, indicating that the upper plane or the slot is in a horizontal state, thereby determining that the vertical axis 500 is in a vertical state and the vertical fixing sleeve 502 is in a horizontal state.

[0072] When in use, first fix the support rod 100 by means of a fixing component to ensure that the support rod 100 is in an approximately vertical position when observed with the naked eye. Then adjust the horizontal adjustment hand wheel and the vertical adjustment hand wheel respectively to achieve vertical adjustment of the vertical rotating tube. The adjustment process uses the horizontal adjustment reference mechanism as a reference to finally achieve vertical adjustment of the vertical rotating tube, that is, to achieve vertical adjustment of the vertical axis 500. From the analysis of Example 1 above, it can be determined that the vertical axis 500 can move up and down and be locked together with the vertical fixed sleeve 502, and can rotate and be locked in the horizontal plane, and the horizontal axis 600 can move horizontally and be locked together with the vertical movable sleeve 700. The instrument is located below the C-arm to ensure that the X-ray can be viewed vertically (vertically) and from the side. Vertical perspective such as Figure 5 As shown, under perspective conditions, the projection of the vertical aimer at the distal hole of the intramedullary nail can be determined. Regardless of whether the projection position is accurate, the vertical aimer can be adjusted and locked by horizontally moving the vertical axis 500. The position of the lateral aimer can be moved horizontally and locked by adjusting the horizontal axis 600 to translate, and finally the following is achieved: Figure 5 The projection of the guide pin is placed in the best position where the femoral neck will be fixed. Then operate the C-arm to make the X-ray from the side, as shown Figure 3 As shown. Regardless of whether the projection of the lateral aimer is appropriate, it can be adjusted to achieve the best projection position. By adjusting the horizontal axis lifting method, the height of the lateral aimer can be lifted and locked, and finally the lateral aimer is projected at the best position of the femoral neck.

[0073] Embodiment 3: Based on Embodiment 1, compared with Embodiment 1 which uses a C-arm machine to provide specific numerical functions of translation and angle, and uses a dial to quantify the adjustment, this embodiment adopts the following method: Figure 1 , Fig.14 , Fig.15 and Fig.16 The structure shown in the figure is used for quantitative adjustment of the angle adjustment. The bracket on the vertical fixing sleeve has a vertical plate parallel to the horizontal axis as a calibration plate, such as Fig.14 and Fig.15 As shown, the vertical projection of one side of the calibration plate coincides with the axis of the horizontal axis, and a corner plate is clamped in the transverse axial locking sleeve. When the surface of the corner plate overlaps with the surface of the correction plate, the working longitudinal tube located on the horizontal axis is in a horizontal state.

[0074] Embodiment 4: Based on Embodiment 1 or 2, only the corresponding axial steering constraint kit is modified, see Fig.17As shown, the axial steering constraint kit adopted in this embodiment includes a cylindrical outer sleeve A1 and a cylindrical inner sleeve A2 which are sleeved together, a steering lock wire is vertically installed on the side wall of the cylindrical outer sleeve A1 to prevent the cylindrical inner sleeve A2 from rotating, an anti-axial sliding stopper 19 is arranged between the end of the cylindrical inner sleeve A2 and the end of the cylindrical outer sleeve A1, the axis of the cylindrical inner sleeve A2 is a prism hole, the vertical axis is a prism, the vertical axis is matched and sleeved in the prism hole of the cylindrical inner sleeve A2, and a sliding lock wire is vertically installed on the side wall of the cylindrical inner sleeve A2 to prevent the vertical axis from axial sliding.

[0075] Embodiment 5: Based on Embodiment 1 or 2, only the corresponding axial steering constraint kit is modified, see Fig.18 As shown, the axial steering restraint kit adopted in this embodiment includes a prism outer sleeve B1 and a prism inner sleeve B2 which are sleeved together, and a sliding lock wire is vertically installed on the side wall of the prism outer sleeve B1 to prevent the prism inner sleeve B2 from axial sliding, the axis of the prism inner sleeve B2 is a cylindrical hole, and the vertical axis is a cylinder, and the vertical axis is matched and sleeved in the cylindrical hole of the prism inner sleeve B2, and an anti-axial sliding stopper 19 is arranged between the vertical axis and the end of the prism inner sleeve B2, and a steering lock wire is vertically installed on the side wall of the prism inner sleeve B2 to prevent the vertical axis from rotating.

[0076] Embodiment 6: Based on Embodiment 1, the horizontal reference mechanism in Embodiment 1 adopts a fixing seat 13 installed at the proximal end of the intramedullary nail, and a proximal level 14 is installed on the fixing seat 13. In this embodiment, a vertical rod 15 is vertically connected to the fixing seat 13, and reference lines 18 are engraved on the front and side surfaces of the vertical rod along the axial direction, and the upper ends of the reference lines are connected to plumb lines 17 through vertical lines 16.

[0077] Embodiment 7: Based on Embodiment 1, the horizontal reference mechanism in Embodiment 1 adopts a fixing seat 13 installed at the proximal end of the intramedullary nail, and a proximal level 14 is installed on the fixing seat 13. In this embodiment, the fixing seat includes a top plate and a bottom plate, a plumb line is connected to the middle of the bottom of the top plate through a vertical line, and a reference point is set in the middle of the bottom plate, and the plumb line is opposite to the reference point when it is vertical.

[0078] Embodiment 8: According to the solution in Embodiment 1, after the sighting device installation sleeve is installed in the vertical sliding sleeve so that it can only slide axially and be locked, the lateral sighting device and the vertical sighting device are alternately installed at the front end of the guide sleeve. Based on this solution, when the sighting device installation sleeve is adjusted in place and drilling is performed, the lateral sighting device and the vertical sighting device need to be removed, and then the guide sleeve is installed, and the drill rod is constrained by the guide sleeve. Alternatively, a spare guide tube is used, that is, when drilling is performed after the sighting device installation sleeve is adjusted in place, the vertical sighting device is directly removed, and the spare guide tube is matched and installed in the vertical sliding sleeve.

[0079] The above embodiments are based on the horizontal axis being fixed vertically to the upper end of the vertical axis. Although the horizontal axis can be installed on the upper end of the vertical axis through a vertical fixing sleeve, it is still fixedly connected when in use. The vertical sliding sleeve can slide and lock on the horizontal axis. A square tube sleeve connection is preferred, but a round tube sleeve connection is not excluded. After the round tube sleeve connection, a key and a key slot are used to ensure that only axial sliding but not rotation occurs. However, in the design and production process, the vertical sliding sleeve and the horizontal axis are connected by a round tube sleeve, but no key and key slot are provided, that is, the vertical sliding sleeve can slide and rotate on the horizontal axis of the cylinder, but when in use, it is locked by a locking component to prevent rotation, which still falls within the scope of protection of the present invention.

Claims

1. A visual intramedullary nail distal aiming instrument, comprising a horizontal adjustment mechanism, characterized in that: It also includes a vertical shaft, a vertical axial steering constraint kit is sleeved on the outer side of the vertical shaft, and the axial steering constraint kit is fixed to the adjustment output end of the horizontal adjustment mechanism. A horizontal shaft is vertically fixed to the upper end of the vertical shaft, or the upper end of the vertical shaft is sleeved or fixed with the horizontal shaft through a vertical fixing sleeve, and a vertical sliding sleeve is sleeved on the horizontal shaft and a locking pin is arranged; the front end of the vertical sliding sleeve is directly and movably sleeved with the sight assembly, or a sight installation sleeve is matched and sleeved inside the vertical sliding sleeve, and the front end of the sight installation sleeve is movably sleeved with the sight assembly, an axial constraint structure is arranged between the vertical sliding sleeve and the horizontal shaft so that the vertical sliding sleeve can only slide axially on the horizontal shaft but cannot rotate, and an axial constraint structure is arranged between the sight installation sleeve and the vertical sliding sleeve so that the sight installation sleeve can only slide axially in the vertical sliding sleeve but cannot rotate; the sight assembly includes a lateral sight and a vertical sight, the lateral sight includes a connecting seat, an axial auxiliary needle is axially fixed at the front end of the connecting seat, and a lateral projection needle is vertically arranged at the front end of the axial auxiliary needle, and the vertical sight includes a connecting seat, and a vertical projection needle is axially fixed at the front end of the connecting seat; The axial steering constraint kit includes a sliding lock sleeve and a steering lock sleeve, the inner diameter of the sliding lock sleeve includes a thin diameter section and a thick diameter section, and an inner step is provided at the intersection of the two. A radial perforation or groove or key is provided on the thin diameter section of the sliding lock sleeve, and a sliding pin is installed in the perforation or groove. The sliding pin or key is installed in cooperation with an axial sliding groove or axial sliding edge provided on the side of the vertical shaft, which can ensure that the vertical shaft only moves axially along the sliding sleeve; the steering lock sleeve is matched and sleeved in the thick diameter section, and the vertical shaft is matched and sleeved in the thin diameter section and the steering lock sleeve, a sliding lock wire is radially installed in the thin neck section to prevent the vertical shaft from axially sliding, and a steering lock wire is radially installed in the thick diameter section of the sliding lock sleeve to prevent the sliding lock sleeve from rotating; or, the axial steering constraint kit includes a cylindrical outer sleeve and a cylindrical inner sleeve that are sleeved together, and the side wall of the cylindrical outer sleeve is vertical A steering lock wire is installed to prevent the cylindrical inner sleeve from rotating, an anti-axial sliding block is arranged between the end of the cylindrical inner sleeve and the end of the cylindrical outer sleeve, the axis of the cylindrical inner sleeve is a prism hole, the vertical axis is a prism, the vertical axis is matched and sleeved in the prism hole of the cylindrical inner sleeve, and a sliding lock wire is vertically installed on the side wall of the cylindrical inner sleeve to prevent the vertical axis from axial sliding; or, the axial steering constraint kit includes a prism outer sleeve and a prism inner sleeve that are sleeved together, a sliding lock wire is vertically installed on the side wall of the prism outer sleeve to prevent the axial sliding of the prism inner sleeve, the axis of the prism inner sleeve is a cylindrical hole, the vertical axis is a cylinder, the vertical axis is matched and sleeved in the cylindrical hole of the prism inner sleeve, an anti-axial sliding block is arranged between the vertical axis and the end of the prism inner sleeve, and a steering lock wire is vertically installed on the side wall of the prism inner sleeve to prevent the vertical axis from rotating; A horizontal adjustment reference mechanism is arranged on the axial steering constraint kit or on the vertical fixing sleeve to ensure that the vertical axis is in a vertical state, and a fixing seat is installed at the proximal end of the intramedullary nail, and a horizontal reference mechanism is installed on the fixing seat to ensure that the distal locking hole of the intramedullary nail is axially horizontal; the horizontal adjustment reference mechanism is that a positive vertical reference line and a side vertical reference line are axially arranged on the front and side of the vertical steering lock sleeve respectively, and the upper ends of the positive vertical reference line and the side vertical reference line are respectively fixed with hanging lines, and the bottom of each hanging line is respectively fixed with a plumb line; or the horizontal adjustment reference mechanism is that an upper plane or a slot is arranged on the upper end of the vertical fixing sleeve or the vertical axis or the horizontal rotating tube to ensure that the surface of the upper plane or the slot is perpendicular to the vertical axis, and a distal level is installed on the upper plane or the slot; An angle plate jack is provided on the vertical steering lock sleeve and an angle plate is installed horizontally, and the end of the horizontal shift fork corresponds to the scale on the surface of the horizontally installed angle plate; or, a vertical plate parallel to the horizontal axis is provided on the seat of the vertical fixed sleeve as a correction plate, and the vertical projection of one side of the correction plate coincides with the axis of the horizontal axis, and a corner plate is clamped in the horizontal axial lock sleeve, and when the surface of the corner plate overlaps with the surface of the correction plate, the working longitudinal tube located on the horizontal axis is in a horizontal state; The horizontal adjustment mechanism includes a support rod fixed on a bracket, a horizontal rotating sleeve and an axial hole are arranged at the top end of the support rod, which are used to match the horizontal rod, the horizontal rod can rotate in the horizontal rotating sleeve and can be locked by a horizontal locking wire, a horizontal rotating tube is vertically fixed to the end of the horizontal rod, a vertical adjustment shaft is arranged inside the horizontal rotating tube, the vertical adjustment shaft can rotate in the horizontal rotating tube and can be locked by a vertical locking wire, and the vertical adjustment shaft is fixed to the vertical axial steering constraint kit as the adjustment output end of the horizontal adjustment mechanism; the end of the vertical adjustment shaft A vertical steering lock sleeve is vertically fixed, a vertical sliding lock sleeve is sleeved on the outer side of the upper end of the vertical steering lock sleeve, a vertical shaft is matched and sleeved on the inner side of the vertical steering lock sleeve, the lower end of the vertical sliding lock sleeve is sleeved on the end of the vertical steering lock sleeve and is installed with a vertical rotation locking pin, the upper end is sleeved on the vertical shaft and is installed with a vertical movement locking pin, an axial vertical groove parallel to the axis is provided on the vertical shaft, a fork mounting hole is provided on the upper side of the vertical sliding lock sleeve, a vertical fork is installed in the fork mounting hole, and the vertical fork is matched and sleeved in the axial vertical groove.

2. The visualized intramedullary nail distal aiming instrument according to claim 1, characterized in that: The horizontal reference mechanism is a fixing seat installed at the proximal end of the intramedullary nail, and a proximal level is installed on the fixing seat; or a vertical rod is vertically connected to the fixing seat, and reference lines are engraved on the front and side of the vertical rod along the axial direction, and the upper ends of each reference line are connected to a plumb line through a vertical line; or the fixing seat includes a top plate and a bottom plate, a plumb line is connected to the middle below the top plate through a vertical line, and a reference point is set in the middle of the bottom plate, and the plumb line is opposite to the reference point when vertical.

3. The visualized intramedullary nail distal aiming instrument according to claim 1, characterized in that: An axial restraint structure is provided between the vertical fixing sleeve and the horizontal shaft so that the horizontal shaft can only slide axially but cannot rotate in the vertical fixing sleeve.

4. The visualized intramedullary nail distal aiming instrument according to claim 1 or 3, characterized in that: The axial constraint structure is to match the cylindrical cavity of the outer sleeve with the cylindrical inner sleeve, and set a matching key and keyway between the two, so as to ensure that the two can only slide axially but not rotate; or, the axial constraint structure is to design the outer sleeve and the inner sleeve as prismatic structures respectively, and the two are matched and fitted.

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