Combined dual-node misalignment-minimally invasive retrograde acetabular posterior column screw positioning aimer

Abstract

The present invention discloses a combined double-node offset-minimally invasive retrograde acetabular posterior column screw positioning aimer, comprising a T-shaped bracket, a offset adjustment device is provided below the bracket, a sleeve guide device is provided on the offset adjustment device, at least two positioning devices each including a vertical guide positioning combination are provided from top to bottom on the vertical rod of the bracket, the offset adjustment device is vertically movably connected to the vertical rod, and the sleeve guide device includes a sleeve perpendicular to the positioning combination. The present invention utilizes the positioning device, the offset adjustment device, and the sleeve guide device on the T-shaped bracket to determine the position of the ischial tuberosity needle insertion point, the needle insertion direction, and the screw position, with a low surgical risk, greatly reducing the risks and complications of nerve damage, pelvic organ damage, poor fixation, loose fixation, and broken screws, and ensuring a one-time successful placement of the acetabular posterior column screw.

Description

Technical Field

[0001] The present invention belongs to the field of medical devices and relates to a minimally invasive orthopedic treatment device, and specifically relates to a combined double-node misalignment-minimally invasive retrograde acetabular posterior column screw positioning aimer for fractures of the acetabular posterior column with no displacement or small displacement and requiring retrograde lag screw fixation. Background Art

[0002] The hip bone is a bone in the human pelvis. It consists of two parts, the ilium, the ischium and the pubis. There is a large and deep socket on the outer side called the acetabulum. The acetabulum is located at the top of an arched structure. This arched structure is composed of two bone columns, called the anterior column and the posterior column. The two columns meet in a thick and strong bone belt-like area, which is located in front and below the sacroiliac joint surface.

[0003] At present, there are more and more acetabular posterior column fractures caused by trauma. The vital signs of such patients are often unstable. Surgical treatment is now advocated. The traditional method is open reduction and plate internal fixation. The advantages of this method are that it can achieve anatomical reduction, early activity, reduce bed rest time and accelerate fracture healing time. However, due to the deep anatomical position of the acetabulum and the complex adjacent anatomical relationship, the surgical incision is long, the normal tissue in the surgical area is severely damaged, there is a lot of bleeding (blood transfusion is usually required), sciatic nerve damage during surgery, heterotopic ossification after surgery, femoral head necrosis, infection and many other surgical risks and complications, which seriously affect the joint function of the affected limb.

[0004] In recent years, with the rapid development of modern medical technology, the concept of minimally invasive surgery has been deeply rooted in people's hearts. More and more orthopedic surgeons and patients will choose minimally invasive surgery with percutaneous retrograde lag screw fixation as the first choice. The operation of this treatment method is generally to make a small incision on the ischial tuberosity of the affected side. The surgeon, based on his own experience and the assistance of C-arm X-ray fluoroscopy, inserts the screw from the ischial tuberosity and drills the Kirschner wire into the center of the posterior column of the acetabulum (to avoid entering the acetabulum to damage the articular cartilage and to prevent drilling outside the bone from losing the fixation effect). After repeated multi-angle fluoroscopy combined with the surgeon's feeling, it is determined whether the Kirschner wire is suitable, and then a hollow screw of appropriate diameter and length is screwed in along the direction of the Kirschner wire. For cases with good alignment of the posterior column of the acetabulum fracture or good alignment after reduction by traction, lifting and other methods, there is no need to expose the fracture end in a large area for reduction. Only internal fixation such as screws is needed to maintain fracture reduction and provide a good mechanical environment for fracture healing. At this time, choosing percutaneous minimally invasive lag screw fixation not only avoids all complications of traditional hip joint posterior surgery, but also greatly reduces medical expenses and greatly shortens the patient's recovery time. However, due to technical limitations such as the needle insertion point and direction, the risks of this type of surgery are significantly increased. There are reports of cases of death due to screw damage to large pelvic blood vessels. There are also risks and complications such as nerve damage, pelvic organ damage, poor fixation position, loose fixation, and broken screws.

[0005] At present, some scholars have designed a guide device for the screw, with the center of the ischial tuberosity as the screw entry point and the midpoint of the line connecting the bony protrusions of the anterior superior iliac spine and the posterior superior iliac spine as the aiming direction. The device can roughly guide the drilling of the Kirschner wire, but there are some disadvantages: 1. Since the ischial tuberosity, the bony protrusions of the anterior superior iliac spine and the posterior superior iliac spine are all in one area, and there are individual differences in anatomical structure, the device is relatively rough in determining the direction of the Kirschner wire in the coronal plane. 2. The device can only roughly determine the direction of the Kirschner wire in the coronal plane, and lacks guiding parameters in the sagittal plane, so there is a large error, and it is very easy to penetrate the bone from the front or back, damage the acetabular articular cartilage, and lose the effective fixation effect. 3. In the process of drilling the Kirschner wire, it is completely dependent on the operator's experience, feeling and the assistance of C-arm X-ray machine fluoroscopy, and it is difficult to ensure that the Kirschner wire and screw are successfully placed in the ideal position, direction and length at one time.

[0006] In conclusion, minimally invasive percutaneous retrograde acetabular posterior column lag screw placement lacks objective standards in determining the needle insertion point, needle insertion direction, screw position and length, and it is impossible to ensure success at one time. It is technically very difficult and challenging. Summary of the invention

[0007] The main purpose of the present invention is to overcome the shortcomings of the prior art and provide a combined double-node misalignment-minimally invasive retrograde acetabular posterior column screw positioning aimer, which uses a positioning device, a double-node misalignment adjustment device, and a sleeve guide device to determine the position of the ischial tuberosity needle insertion point, the needle insertion direction and the screw position. The surgical risk is relatively small, and the risks and complications of nerve damage, pelvic organ damage, poor fixation position, loose fixation and broken screws are reduced.

[0008] In order to achieve the above object, the present invention adopts the following technical solutions:

[0009] A combined double-node misalignment-minimally invasive retrograde acetabular posterior column screw positioning aimer comprises a T-shaped bracket, a misalignment adjustment device is provided below the bracket, a sleeve guide device is provided on the misalignment adjustment device, at least two positioning devices each comprising a vertical guide positioning combination are provided from top to bottom on the vertical rod of the bracket, two determined positioning points are positioned by the vertical guide positioning combination, thereby accurately determining the introduction direction of the Kirschner wire in the coronal plane (medial and lateral deviation angle), the misalignment adjustment device is vertically movably connected to the vertical rod, and can be vertically moved up and down along the vertical rod, and is used to adjust the distance between the Kirschner wire and the bottom of the positioning combination, maintain the appropriate front-back angle of the Kirschner wire on the sagittal plane, and avoid the Kirschner wire from deviating in the front-back direction (i.e., the sagittal plane) when drilling into the bone due to the unevenness of the bone surface of the positioning point, and the sleeve guide device comprises a sleeve perpendicular to the positioning combination, so that when the Kirschner wire is inserted into the bone from the sleeve, it is perpendicular to the positioning combination and is located directly below the positioning combination, and is accurately inserted into the ideal position, thereby determining the direction and position of the screw entry point.

[0010] A further technical solution is that fixing devices are respectively provided on the horizontal rods on both sides of the vertical rod of the T-shaped bracket, which can be fixed to the ilium to play a role in fixing and supporting the bracket. The fixing device includes a fixing block, a vertical circular fixing guide hole and a threaded nail. The fixing block is movably arranged on the horizontal rod so that the fixing block can move left and right along the horizontal rod. The threaded nail passes through the fixing guide circular hole and is arranged on the fixing block. It is fixed to the ilium through the threaded nail to fix and maintain the stability of the positioning bracket.

[0011] A further technical solution is that the positioning device includes a positioning block and a positioning circular guide hole that cooperates with the positioning combination. The positioning block is movably arranged on the vertical rod, and the positioning circular guide hole is arranged in the positioning block. The positioning combination is used to accurately locate the point on the acetabulum, and the principle of determining a straight line by two points is used to enable the Kirschner wire to be accurately inserted in the coronal plane (i.e., the inner and outer directions).

[0012] A further technical solution is that the positioning combination includes a circular guide rod and a threaded puncture needle. The threaded puncture needle is detachably arranged in the circular guide rod. Its length is greater than that of the circular guide rod. The circular guide rod is used to locate a point on the skin. The threaded puncture needle penetrates into the guide rod and vertically punctures into the hip bone along the point to locate the hip bone, thereby determining the introduction direction of the Kirschner wire and then the insertion direction of the screw. The tip of the circular guide rod is located on the bone surface of the posterior column of the acetabulum.

[0013] A further technical solution is that the distance adjustment device includes a longitudinal adjustment rod and a transverse adjustment rod. The longitudinal adjustment rod is connected to the vertical rod through a connecting block. One side of the connecting block is connected to the vertical rod. A guide hole is arranged on the connecting block. The longitudinal adjustment rod passes through the connecting block through the guide hole so that the connecting block can move back and forth on the longitudinal adjustment rod. A slide groove is arranged on one side of the transverse adjustment rod. A sleeve guide device is movably arranged in the slide groove so that the sleeve guide device can move along the slide groove. The transverse adjustment rod is parallel to the horizontal rod. The vertical distance between the transverse adjustment rod and the threaded puncture needle can be adjusted by moving the longitudinal adjustment rod, thereby adjusting the vertical distance between the sleeve guide device and the threaded puncture needle, thereby avoiding the Kirschner wire penetrating the bone or being offset due to the height inconsistency of acetabulum in different positions, thereby ensuring that the Kirschner wire is always located in the bone of the posterior column of the acetabulum.

[0014] A further technical solution is that the sleeve guide device also includes a sleeve block and a sleeve guide hole perpendicular to the positioning combination, the sleeve block is slidably arranged on the offset adjustment unit, and the sleeve and the sleeve guide hole are arranged therein in cooperation, so as to adjust the lateral horizontal distance between the Kirschner wire in the sleeve and the threaded puncture needle, so that the Kirschner wire is located directly below the threaded puncture needle when inserted into the acetabulum, thereby improving the accuracy of insertion.

[0015] A further technical solution is that the positioning block, fixing block, connecting block and sleeve block are respectively fixed to the horizontal rod, vertical rod, longitudinal adjustment rod and transverse adjustment rod by adjusting locking bolts, which is convenient for adjusting to the position required by different patients and adjusting existing errors, thereby improving the accuracy of the nail insertion point and nail insertion direction.

[0016] A further technical solution is that the horizontal rod, the vertical rod, the transverse adjustment rod and the longitudinal adjustment rod are all provided with scale lines, so that the distance thereon can be adjusted according to the determined parameters, which is intuitive and accurate.

[0017] Compared with the prior art, the present invention has the following beneficial effects:

[0018] 1. The positioning device of the present invention has a simple structure, is easy to use, safe and reliable, and can accurately position the needle and screws, so that the Kirschner wire is not easy to penetrate the bone from the front or back and lose its fixing effect, thereby preventing the Kirschner wire from entering the acetabulum and damaging the articular cartilage, and preventing the screws from damaging the large blood vessels in the pelvis.

[0019] 2. Use the coordination of the longitudinal adjustment rod, the transverse adjustment rod and the sliding sleeve guide device to adjust the vertical and horizontal offset between the Kirschner wire and the positioning thread puncture needle, so that it can be inserted vertically and horizontally with the positioning thread puncture needle toward the straight line determined by the fixed point, accurately determine the position of the needle insertion point, and prevent the Kirschner wire from breaking through the bone cortex.

[0020] 3. Effectively avoid damage to surrounding tissues and improve the accuracy of implantation.

[0021] 4. The surgical risk is relatively low, reducing the risks and complications of nerve damage, pelvic organ damage, poor fixation, loose fixation and broken nails.

[0022] 5. 1-3 screws can be successfully and accurately inserted at one time to increase the fixation strength. BRIEF DESCRIPTION OF THE DRAWINGS

[0023] Figure 1 It is a structural schematic diagram of the present invention;

[0024] Figure 2 It is a schematic structural diagram of the threaded puncture needle, the round guide rod and the threaded nail of the present invention;

[0025] Figure 3 It is a schematic diagram of the structure of the present invention in use state.

[0026] Among them: 1. horizontal rod; 2. fixing block; 3. adjusting locking bolt; 4. horizontal adjustment connecting block; 5. circular fixing guide hole; 6. positioning block; 7. circular positioning guide hole; 8. circular guide rod; 9. threaded puncture needle; 10. vertical rod; 11. longitudinal adjustment connecting block; 12. longitudinal adjustment rod; 13 sleeve block; 14. sleeve; 15. transverse adjustment rod; 16. threaded nail. DETAILED DESCRIPTION

[0027] In order to explain in detail the technical content and structural features of the combined dual-node misalignment-minimally invasive retrograde acetabular posterior column screw positioning aiming device of the present invention, further description will be given below in conjunction with the implementation methods and the accompanying drawings.

[0028] like Figures 1 to 3 As shown, the combined dual-node misalignment-minimally invasive retrograde acetabular posterior column screw positioning aiming device provided by the present invention includes a T-shaped bracket, a misalignment adjustment device, and a sleeve guide device, and the specific structure is as follows:

[0029] The horizontal rod 1 is connected to the vertical rod 12 through the horizontal adjustment connecting block 4 to form a T-shaped bracket. The vertical rod 10 can move horizontally left and right relative to the horizontal rod 1. Scale lines are provided on the horizontal rod 1 and the vertical rod 10. The vertical rod 10 is detachably connected to the horizontal adjustment connecting block 4 (fixed with the connecting block by bolts). An adjustment locking device is provided on one side of the horizontal adjustment connecting block 4, preferably an adjustment locking bolt 3, which is fixed to the horizontal rod 1 by adjusting the locking bolt 3. Two fixing blocks located on both sides of the vertical rod 10 are respectively provided on the horizontal rod 1 of the T-shaped bracket. 2, the fixing block 2 can move horizontally left and right relative to the horizontal rod 1, and an adjusting locking bolt 3 is provided on one side of the fixing block 2. The movement state of the fixing block 2 is controlled by adjusting the locking bolt 3. Vertical circular fixing guide holes 5 are respectively provided through the fixing block 2, and the two circular guide holes 5 are respectively located on both sides of the horizontal rod 1, that is, one guide circular hole is on the left side of the fixing block 2, and the other is on the right side of the fixing block 2. A threaded nail 16 matching with the threaded nail 16 is inserted downward through the circular fixing guide hole 5, that is, the threaded nail 16 is inserted into the ilium to stabilize the bracket; in the vertical direction of the T-shaped bracket, the fixing block 2 is provided with a vertical guide hole 5, and ... Two positioning blocks 6 are arranged on the rod 10 from top to bottom, and the positioning blocks 6 can move on the vertical rod 10. An adjusting locking bolt 3 is arranged on one side thereof to adjust the position of the positioning block 6 on the vertical rod 10, that is, to adjust the distance between the two positioning blocks 6 to adapt to different fixed point positions. A circular positioning guide hole 7 is vertically passed through the positioning block 6, and a detachable circular guide rod 8 with a slightly smaller diameter that matches the circular positioning guide hole 7 is also arranged therein. The upper part of the circular guide rod 8 is a circular guide rod slightly smaller than the circular positioning guide hole 7, and the lower part is a circular guide rod slightly larger than the diameter of the Kirschner wire. A scale is provided on the upper part of the guide rod 8, and the upper part of the circular guide rod 8 is higher than the thickness of the positioning block 6. A channel is axially provided on the circular guide rod 8, and a thread is provided on the inner wall. A threaded puncture needle 9 matching with the thread is provided through the channel passing through the circular guide rod 8. The length of the threaded puncture needle 9 is greater than the length of the circular guide rod 8, that is, the threaded puncture needle 9 is screwed into the circular guide rod 8 and fixed in the positioning block 6 to perform a fixed point function on it. An adjusting locking bolt is provided on one side of the circular positioning guide hole 7. The up and down movement of the circular guide rod 8 is adjusted by adjusting the locking bolt, which is suitable for positioning points at different heights and positions.

[0030] The staggered distance adjustment device is located below the T-shaped bracket, and includes an L-shaped longitudinal adjustment rod 12 and a transverse adjustment rod 15. Both the longitudinal adjustment rod 12 and the transverse adjustment rod 15 are provided with scale lines. The longitudinal adjustment rod 12 is vertically connected to the vertical rod 10 through the longitudinal adjustment connecting block 11, and the transverse adjustment rod 15 is parallel to the horizontal rod 1, that is, the longitudinal adjustment rod 12 is vertically connected to the longitudinal adjustment connecting block 11, and the vertical rod 10 is horizontally connected to the longitudinal adjustment connecting block 11. An adjusting locking bolt is provided on the longitudinal adjustment connecting block 11 to control the up and down movement of the longitudinal adjustment rod 12, that is, to adjust the vertical distance between the transverse adjustment rod 15 and the threaded puncture needle 9, and a slide groove is provided on the outer side of the transverse adjustment rod 15.

[0031] The sleeve guide device is movably connected to the staggered distance adjustment device and is arranged thereon, including a sleeve block 13, a sleeve 14 and a sleeve guide hole perpendicular to the threaded puncture needle 9. The thickness of the sleeve block 13 is consistent with the thickness of the transverse adjustment rod 15. A protrusion that cooperates with the slide groove of the transverse adjustment rod 15 is provided on the side facing the transverse adjustment rod 15, so that it can slide horizontally left and right on the transverse adjustment rod 15. The sleeve 14 is detachably placed in the sleeve guide hole, that is, the sleeve 14 is perpendicular to the threaded puncture needle 9 and is located directly below the threaded puncture needle 9. The Kirschner wire can pass through the sleeve 14 and is perpendicular to the threaded puncture needle 9 and is located directly below the threaded puncture needle 9. When there is a deviation between the positions of the Kirschner wire and the threaded puncture needle 9, the longitudinal adjustment rod 12 is moved up and down and the sleeve block 13 is slid horizontally left and right to adjust it to an accurate position, thereby accurately determining the needle insertion direction and needle insertion point, thereby improving the accuracy of screw insertion.

[0032] The use process of the present invention is:

[0033] 1. Let the patient lie in the chest-knee position and ensure that the pelvis is parallel to the ground. There are coordinate points on the grid. Through the grid, the patient's affected hip is viewed in the anteroposterior position. Find the teardrop level in the acetabulum B, the midpoint of the line connecting the inner edge of the teardrop and the lowest point of the posterior wall of the acetabulum B in the same plane, determine the coordinate point of the point on the grid, mark it on the skin with reference to the coordinate point on the grid, and determine it as point C. Find the coordinate point on the grid at the level of the upper edge of the greater sciatic foramen (to avoid damaging the sciatic nerve), the middle and inner 1 / 3 of the line connecting the lateral edge of the greater sciatic notch and the outer edge of the acetabulum B, and mark it on the skin according to the steps to determine point C, and determine it as point D.

[0034] 2. Place the bottoms of the two circular guide rods 8 vertically at the positions of points C and D determined on the skin, then screw the threaded puncture needles 9 into the circular guide rods 8 respectively, and puncture vertically from points C and D perpendicular to the horizontal plane until the posterior wall / column of acetabulum B. The points on the bone surface of the posterior wall / column of acetabulum B are C′ and D′.

[0035] 4. After the two threaded puncture needles 9 are screwed into the circular guide rod 8 and punctured into the acetabulum B, the distance between the two positioning blocks 6 in the adjustment device is adjusted so that the circular positioning guide hole 7 on the circular guide rod 8 corresponds to the circular guide rod 8, and then the circular guide rod 8 is sleeved on the circular guide rod 8, and the circular guide rod 8 is fixed to the positioning block 6 by the adjusting locking bolt 3 thereon. The threaded puncture needle 9 is inserted into the bone for stability, and the tip of the circular guide rod 8 is close to the posterior wall / column bone surface of the acetabulum B.

[0036] 5. Touch the ischial tuberosity A on the buttocks (the bony protrusion under the buttocks when sitting), make an incision of 1-2 cm, and peel under the periosteum.

[0037] 6. Make the sleeve block 13 be located at the front and back of the ischial tuberosity A. Adjust the locking bolt 3 according to the position of the operation to control the up and down movement distance of the longitudinal adjustment rod 12, so as to adjust the vertical distance between the sleeve 14 and the bottom of the threaded puncture needle 9. Then adjust the sleeve block 13 horizontally to the left and right so that the sleeve 14 is located directly below the threaded puncture needle 9. Correspondingly, the sleeve 14 can be located directly below the threaded puncture needle 9 by fine-tuning the threaded puncture needle 9 left and right and slightly adjusting the camber angle.

[0038] 7. The assistant temporarily maintains the stent, and the surgeon screws the threaded screws 16 through the guide holes of the fixing block 2 on the horizontal rod 1 according to the position determined before the operation. The threaded screws 16 pass into the iliac crest, and a fixing block 2 is connected to the vertical rod 10 above the horizontal adjustment connecting block 4. The threaded screws 16 are screwed in from the fixing block 2, and the stability of the stent is maintained by three points.

[0039] 8. Insert a 3 mm Kirschner wire into the sleeve so that the needle tip is located at the center of the front and back of the ischial tuberosity A, and drill the 3 mm Kirschner wire along the direction of the sleeve 14.

[0040] 9. Then adjust the circuit opener individually by limiting pressure in the direction of the Kirschner wire and screw in a hollow screw of appropriate diameter and length.

[0041] Although the present invention has been described using the above preferred embodiments, it is not intended to limit the scope of protection of the present invention. Any person skilled in the art who makes various changes and modifications to the above embodiments without departing from the spirit and scope of the present invention still fall within the scope of protection of the present invention.

[0042] The protection scope of the present invention shall be based on the definition of the claims.

Claims

1. Combined dual-node misalignment-minimally invasive retrograde acetabular posterior column screw positioning aimer, characterized by: It comprises a T-shaped bracket, a staggered distance adjustment device is provided below the bracket, a sleeve guide device is provided on the staggered distance adjustment device, at least two positioning devices each comprising a vertical guiding positioning assembly are provided from top to bottom on the vertical rod of the bracket, the staggered distance adjustment device is vertically movably connected to the vertical rod, and the sleeve guide device comprises a sleeve perpendicular to the positioning assembly; The horizontal bars on both sides of the vertical bar of the T-shaped bracket are respectively provided with fixing devices, including a fixing block, a vertical circular fixing guide hole and a screw thread, the fixing block is movably arranged on the horizontal bar, and the screw thread passes through the fixing guide circular hole and is arranged on the fixing block; The positioning device also includes a positioning block and a positioning circular guide hole matched with the positioning assembly, the positioning block is movably arranged on the vertical rod, and the positioning circular guide hole is arranged in the positioning block; The offset adjustment device includes a longitudinal adjustment rod and a transverse adjustment rod. The longitudinal adjustment rod is connected to the vertical rod through a connecting block. The longitudinal adjustment rod vertically penetrates the connecting block and is movably connected to the connecting block. A sliding groove is provided on one side of the transverse adjustment rod, and a sleeve guide device is movably arranged on the sliding groove.

2. The combined dual-node misalignment-minimally invasive retrograde acetabular posterior column screw positioning aimer according to claim 1, characterized in that: The positioning assembly comprises a circular guide rod and a threaded puncture needle, wherein the threaded puncture needle is detachably arranged in the circular guide rod.

3. The combined dual-node misalignment-minimally invasive retrograde acetabular posterior column screw positioning aimer according to claim 1, characterized in that: The sleeve guide device also includes a sleeve block and a sleeve guide hole perpendicular to the positioning assembly. The sleeve block is movably arranged on the offset adjustment device, and the sleeve is matched with the sleeve guide hole and arranged therein.

4. The combined dual-node misalignment-minimally invasive retrograde acetabular posterior column screw positioning aimer according to claim 3, characterized in that: The positioning block, the fixing block, the connecting block and the sleeve block are respectively fixed on the horizontal rod, the vertical rod, the longitudinal adjustment rod and the transverse adjustment rod through adjusting locking bolts.

5. The combined dual-node misalignment-minimally invasive retrograde acetabular posterior column screw positioning aimer according to claim 4, characterized in that: The horizontal rod, the vertical rod, the transverse adjustment rod and the longitudinal adjustment rod are all provided with scale lines.

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