Irregular surface multi-node misalignment-antegrade acetabular posterior column screw positioning aiming device

Abstract

The present invention discloses an irregular surface multi-node staggered-anterograde acetabular posterior column screw positioning aimer, comprising: a positioning guide module and a sliding guide module, the positioning guide module comprising a positioning support rod and a fixed support rod that are in the same horizontal plane and vertically connected, and a sliding rod that is vertically perpendicular to the fixed support rod, the positioning support rod is provided with a plurality of positioning screw holes, the sliding guide module comprises a sliding seat, a sleeve and a guide pin, the sliding seat is provided with a vertical sliding groove for inserting the sliding rod, the sliding seat is provided with a guide hole for inserting the sleeve, and the vertical sliding groove is designed to be vertical; a locking mechanism for fixing the sliding rod and the sleeve on the sliding seat is provided on the sliding seat; a guide pin channel is provided in the sleeve, and the present invention can avoid damage to the patient caused by multiple screw placements, and effectively ensure the accurate position of the guide pin in the bone.

Description

Technical Field

[0001] The present invention relates to the field of orthopedic medical devices, in particular to orthopedic surgical equipment for minimally invasive treatment, and in particular to an irregular surface multi-node misalignment-antegrade acetabular posterior column screw positioning aimer for complex acetabular fractures such as anterior column + posterior column. Background Art

[0002] In traditional open reduction and internal fixation surgery, for anterior column fractures of the acetabulum, the ilioinguinal region must be incised from the front to expose the fracture ends; and for posterior column fractures of the acetabulum, the gluteal muscles must be incised from the back to expose them; therefore, for cases with combined anterior and posterior column fractures of the acetabulum, both the anterior and posterior approaches must be incised at the same time, and the surgery is extremely traumatic (both require large amounts of blood transfusions), has many complications, and the patient's joint function and general condition recover slowly.

[0003] In order to reduce surgical trauma, in recent years, with the popularization of minimally invasive surgical concepts and surgical techniques, for patients with combined anterior and posterior acetabular column fractures, more and more surgeons will choose to insert screws from the inner plate of the iliac bone (which can be exposed during anterior acetabular surgery) and drill hollow screws toward the ischial tuberosity to stabilize the posterior column of the acetabulum, based on the anterior fixation of the anterior column of the acetabulum. This is the so-called "antegrade acetabular posterior column channel screw". This procedure not only avoids the great damage to muscles, blood vessels and nerves caused by posterior open reduction and fixation and all the complications it brings, but also greatly reduces medical expenses and greatly shortens the patient's recovery time.

[0004] However, the current surgical procedure for antegrade acetabular posterior column channel screws is that the surgeon selects the entry point from the inner plate of the iliac bone based on his or her own experience and the assistance of C-arm X-ray fluoroscopy, and attempts to drill the guide wire through the center of the posterior column of the acetabulum toward the ischial tuberosity (to avoid entering the acetabulum and damaging 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, the surgeon determines whether the guide wire is satisfactory and makes corresponding adjustments in a timely manner, and then screws in 1-2 hollow screws of appropriate diameter and length along the satisfactory guide wire direction. However, since it is impossible to drill the posterior column screw under direct vision in the surgical field incised from the anterior approach, there are certain surgical blind spots. In addition, the square area of ​​the acetabulum is a concave irregular surface. It is difficult to make a timely and accurate judgment during the operation whether the running trajectory of the guide needle is completely within the bone. Generally, multiple adjustments are required to insert the guide needle with the right direction, but multiple adjustments will inevitably cause bone damage and a decrease in the holding force of the screw. In addition, there is currently a lack of objective standards for technical issues such as the selection of the insertion point and the selection of the insertion direction, and the risk of such surgery is significantly increased. The anatomical structure around this area is complex and important, with pelvic organs and "crown of death" blood vessels on its inner side (in the pelvis) and the acetabulum, sciatic nerve, superior gluteal blood vessels on its outer side. Once the screw penetrates the bone, it will not only cause complications such as loose fixation, broken screws, and fracture re-displacement, but also greatly increase the risk of surgery.

[0005] The current antegrade acetabular posterior column screw insertion technology lacks objective standards and relevant guiding devices in determining the screw entry point, the direction of travel in the coronal and sagittal planes, and the screw length. It is impossible to ensure success at one time, and it is even more impossible to accurately position the guide needle and screw, which can easily break through the bone and cause iatrogenic damage to the surrounding tissues. Summary of the invention

[0006] In view of the above-mentioned prior art, the purpose of the present invention is to overcome the shortcomings of the prior art and provide an irregular surface multi-node dislocation-antegrade acetabular posterior column screw positioning aiming device which uses the anterior bone ridge of the greater sciatic notch (i.e., the junction of the posterior wall of the acetabulum and the quadrilateral) as a reference, within 25 mm in front of the bone ridge, uses multiple positioning screws to make graphic corrections to the irregular quadrilateral and point the direction of the guide needle, selects the most concave part of the quadrilateral, determines the entry point of the guide needle in the pubic comb, the direction of the guide needle and the length of the screw, successfully places the screw at one time, and effectively avoids damage to the surrounding structures.

[0007] An irregular surface multi-node misalignment-antegrade acetabular posterior column screw positioning aiming device, comprising:

[0008] A positioning and guiding module; the positioning and guiding module comprises a positioning support rod and a fixed support rod which are in the same horizontal plane and vertically connected, and a sliding rod which is vertically perpendicular to the fixed support rod, and a plurality of positioning screw holes are arranged on the positioning support rod; a plurality of positioning screws are passed through the positioning screw holes, and the needle tips of the positioning screws are aligned with the bone cortex at the most depressed part of the quadrilateral, and the connecting line of the plurality of positioning screws on the positioning support rod can be used to guide the insertion direction of the posterior column screw guide pin, and the other screws are adjusted to be applied to the surface bone of the quadrilateral and consistent with the longitudinal direction of the expected guide pin movement, and the edge of the positioning support rod is tightly attached to the pubic comb, and the longitudinal direction of the positioning support rod is parallel to the inner surface of the quadrilateral; so as to facilitate the measurement and design of the bone depth of the acetabular posterior column screw guide pin.

[0009] Sliding guide module; the sliding guide module includes a sliding seat, a sleeve and a guide needle, the sliding seat is provided with a vertical sliding groove for inserting the sliding rod, the sliding seat is provided with a guide hole for inserting the sleeve, and the vertical sliding groove is designed to be vertical; the sliding seat is provided with a locking mechanism for fixing the sliding rod and the sleeve on the sliding seat; a guide needle channel is provided in the sleeve for placing the guide needle.

[0010] A further technical solution is: a digital scale is set on the sliding rod, the scale is set to better determine the position of the sliding guide module, and the scale is set to more conveniently adjust the distance between the guide needle and the positioning screw, which is the so-called "offset distance".

[0011] A further technical solution is: the locking mechanism includes a plurality of locking screw holes arranged on the sliding seat, and the locking screw holes are used to lock the sleeve and the sliding guide module to prevent shaking from affecting surgery and positioning.

[0012] A further technical solution is: the guide hole is designed to be an arc-shaped structure that matches the sleeve, and the arc-shaped structure matches the sleeve structure for better placement of the sleeve.

[0013] A further technical solution is: the irregular surface multi-node offset-antegrade acetabular posterior column screw positioning aimer also includes a limiting directional hook, which is vertically arranged at the front end of the positioning support rod, and the limiting directional hook is used to hook the ischial spine or the lower part of the ischial tuberosity.

[0014] A further technical solution is: a through hole is opened on the limiting directional hook, and the through hole is used to prevent the guide needle from passing through the through hole. When positioning the guide needle, it is used to prevent the guide needle from being inserted too deeply and damaging the surrounding tissue. When the guide needle presses against the through hole, it is known that it has reached the farthest point.

[0015] A further technical solution is: the number of the positioning screw holes is 3 to 5, three are sufficient, one of which is used to align with the bone cortex at the most depressed point of the quadrilateral. Since the quadrilateral is irregular, the other positioning screws are adjusted to fit the bone on the surface of the quadrilateral and be consistent with the longitudinal direction of the expected guide wire movement. The edge of the positioning support rod is close to the pubic comb, and the longitudinal direction of the positioning support rod is parallel to the inner surface of the quadrilateral.

[0016] A further technical solution is that the positioning guide module, the sliding guide module and the limiting directional hook are all made of medical stainless steel, which is beneficial to environmental protection and hygiene.

[0017] A further technical solution is: a transverse groove is arranged on the guide hole, the guide hole is connected to the transverse groove, the height of the transverse groove is smaller than the diameter of the guide hole and larger than the diameter of the guide pin. Since the operating space for pelvic acetabulum surgery is small, when the device is fully inserted into the pelvis and needs to be assembled or disassembled, since the height of the transverse groove is smaller than the diameter of the guide hole, it will not fall off when the sleeve is inserted. The sleeve is removed first, and since the height of the transverse groove is larger than the diameter of the guide pin, the entire positioning device can be assembled and disassembled very conveniently, and the guide pin or screw is fixed inside, which is convenient for disassembly and assembly of the sleeve and the positioning device.

[0018] The beneficial effects of the present invention are:

[0019] Within 25 mm in front of the bone ridge, the irregular quadrilateral is corrected graphically by multiple positioning screws, the guide needle direction is indicated, and the fixed-point staggered distance method at the most concave part of the quadrilateral is selected to determine the entry point of the guide needle on the pubic comb, the guide needle running direction and the screw length. According to the selected entry point, guide needle running direction and screw length, 1-3 screws are successfully placed at one time to avoid harm to the patient caused by multiple screw placements, effectively avoid damage to surrounding structures, and ensure the accurate position of the guide needle in the pelvis. BRIEF DESCRIPTION OF THE DRAWINGS

[0020] Figure 1 It is a structural schematic diagram of embodiment 1 of the present invention;

[0021] Figure 2 This is a schematic diagram of the structure of Embodiment 2 of the present invention;

[0022] Figure 3 This is a schematic diagram of the structure of the positioning and guiding module in Example 1 of the present invention;

[0023] Figure 4 It is a structural schematic diagram of the sliding guide module of the present invention;

[0024] Figure 5 It is a schematic diagram of the structure of the sleeve and the guide needle of the present invention;

[0025] Figure 6 This is a schematic diagram of the structure of the positioning and guiding module in Example 2 of the present invention;

[0026] Figure 7 This is a usage status diagram of Example 1 of the present invention;

[0027] Figure 8 This is a usage status diagram of Embodiment 2 of the present invention;

[0028] Fig. 9 It is a schematic diagram of the pelvic structure of the present invention.

[0029] In the figure: 1 positioning support rod, 2 fixing support rod, 3 guide hole, 4 locking screw hole, 5 sliding seat, 6 sliding rod, 7 digital scale, 8 sliding groove, 9 transverse groove, 10 sleeve, 11 guide needle, 12 positioning screw hole, 13 limiting directional hook, 14 through hole, 15 guide needle channel, 16 pubic slit, 17 quadrilateral, 18 ischial tuberosity, 19 ischial spine, 20 greater sciatic foramen, 21 iliac fossa. DETAILED DESCRIPTION

[0030] In order to explain the technical content and structural features of the present invention in detail, further description will be given below in combination with the embodiments and the accompanying drawings.

[0031] Example 1

[0032] See also Figure 1 , Figure 3 , Figure 4 , Figure 5 , Figure 7 and Fig. 9, an irregular surface multi-node misalignment-antegrade acetabular posterior column screw positioning aimer, first install the positioning guide module, place the positioning support rod 1 and the fixed support rod 2 in the same horizontal plane and weld them vertically together, the sliding rod 6 is vertically welded to the fixed support rod 2, a digital scale 7 is set on the sliding rod 6, three positioning screw holes 12 are set in the middle of the positioning support rod 1, three positioning screws are passed through the positioning screw holes 12, the needle tip of the positioning screw is aligned with the bone cortex at the most concave part of the quadrilateral 17, a limiting directional hook 13 is vertically welded at the front end of the positioning support rod 1, and a through hole 14 is set on the limiting directional hook 13; the through hole 14 is smaller than the guide pin 11 to prevent the guide pin 11 from penetrating too deep , and then install the sliding guide module, which includes a sliding seat 5, a sleeve 10 and a guide pin 11. The vertical slide groove 8 on the sliding seat 5 is inserted into the sliding rod 6, and the sliding seat 5 is locked by inserting a screw into the locking screw hole 4. The sleeve 10 is placed in the guide hole 3 on the sliding seat 5, and a transverse groove 9 is arranged on the guide hole 3. The transverse groove 9 is smaller than the guide hole 3 and larger than the guide pin 11. The vertical slide groove 8 is designed to be vertical. The locking screw hole 4 is inserted into the sleeve 10 to lock the guide pin 11. A guide pin channel 15 is arranged in the sleeve 10, and the guide pin channel 15 is used to place the guide pin 11. The positioning guide module, the sliding guide module and the limiting directional hook 13 are all made of medical stainless steel.

[0033] The operation steps of this embodiment 1 are as follows:

[0034] Step 1. Before starting the operation, the pelvis is cut open to expose the iliac fossa, quadrilateral body 17 (quadrilateral body 17 is also called quadrilateral area, also called square area, which is the name of the anatomical profession, expressing a part of the pelvis) and the bones below the ischial spine 19 or the inner wall of the ischial tuberosity 18, and then the tissue below the ischial spine 19 or the ischial tuberosity 18 is loosened with medical equipment (the hook of the nerve stripper), and the positioning guide module is installed, the positioning support rod 1 and the fixed support rod 2 are in the same horizontal plane and are vertically connected, and the sliding rod 6 is vertically perpendicular to the fixed support rod 2, and the sliding rod 6 is provided with a digital scale 7 for reading the value, and the limiting directional hook 13 is installed, and the limiting directional hook 13 is vertically arranged on the positioning At the front end of the support rod 1, a through hole 14 is set on the limiting directional hook 13, and the limiting directional hook 13 is used to hook the ischial spine 19 or the lower part of the ischial tuberosity 18. A plurality of positioning screw holes 12 are set on the positioning support rod 1. The positioning screw hole 12 is designed in the middle, and the number of the positioning screw holes 12 is set to 3. The positioning screw hole 12 passes through the positioning screw hole 12, and the needle tip of the positioning screw is aligned with the cortex at the most depressed part of the quadrilateral 17. The other positioning screws are adjusted to fit the surface bone of the quadrilateral 17 and are consistent with the longitudinal direction of the expected guide needle movement. The plane of the positioning support rod 1 is close to the inner surface of the quadrilateral 17 (the edge of the pubic slit 16, that is, the boundary edge of the pubic slit 16 and the quadrilateral 17) and the longitudinal direction of the positioning support rod is parallel to the inner surface of the quadrilateral 17.

[0035] Step 2. Set the offset: When the needle tip of the positioning screw on the positioning screw hole 12 is in close contact with the bone cortex at the most depressed part of the quadrilateral 17, the center offset of the guide needle 11 is set to be 4mm-6mm away from the needle tip (i.e., the distance from the central axis of the guide needle 11 to the needle tip of the positioning screw); when the base surface of the limiting directional hook 13 is in close contact with the bone cortex on the inner surface of the quadrilateral 17 (the junction of the ischial spine 19 and the quadrilateral 17), the center offset of the guide needle 11 should be set to be 9-10mm away from the base surface (i.e., the distance from the guide needle 11 to the base surface of the limiting directional hook 13).

[0036] Step 3. Install the sliding guide module, align the vertical slide groove 8 of the sliding seat 5 with the sliding rod 6 and insert it, then use the screw to penetrate the locking screw hole 4 to lock the sliding seat 5, place the sleeve 10 into the guide hole 3 of the sliding seat 5, place the guide needle 11 in the guide needle channel of the sleeve 10, enter from the above-selected nail entry point, and drill an appropriate length along the direction determined by the positioning support rod 1 and the fixed support rod 2.

[0037] Step 4. Replace the guide pin 11 with a screw opener, and slowly rotate and advance the screw opener until it reaches the contralateral cortical bone, wherein the screw opener belongs to the prior art, and read the screw length.

[0038] Step 5. Screw in a hollow screw of appropriate length in the above direction.

[0039] Example 2

[0040] The difference between this embodiment 2 and embodiment 1 is that, see Figure 2 , Figures 4 to 6 as well as Figure 8 A positioning aimer for irregular surface multi-node misalignment-antegrade acetabular posterior column screws. First, the positioning guide module is installed, and the positioning support rod 1 and the fixed support rod 2 are in the same horizontal plane and welded vertically together. The sliding rod 6 is vertically welded to the fixed support rod 2. A digital scale 7 is set on the sliding rod 6. Three positioning screw holes 12 are set at the front end of the positioning support rod 1. Three positioning screws are passed through the positioning screw holes 12, and the needle tip of the positioning screw is aligned with the bone cortex at the most depressed part of the quadrilateral 17. Then install the sliding guide module, which includes a sliding seat 5, a sleeve 10 and a guide needle 11. The vertical sliding groove 8 on the sliding seat 5 is inserted into the sliding rod 6, and the screw is inserted into the locking screw hole 4 to lock it. The sleeve 10 is placed in the transverse groove 9 on the sliding seat 5, and the screw is inserted into the locking screw hole 4 to lock it. A guide hole 3 for placing the sleeve 10 is set on the sliding seat 5; a guide needle channel 15 is set in the sleeve 10 for placing the guide needle 11. The positioning guide module and the sliding guide module are both made of medical stainless steel.

[0041] The operation steps of this embodiment 2 are as follows:

[0042] Step 1. First, the pelvis is cut open to expose the iliac fossa 21 and the upper part of the quadrilateral body 17 (about 3 cm deep). It is not necessary to expose the deep part of the quadrilateral body 17, the ischial spine 19 and the ischial tuberosity 18.

[0043] Step 2. Install the positioning guide module so that the front end of the positioning support rod 1 is parallel to the greater sciatic notch (the front part of the positioning support rod 1 in the positioning guide module enters about 30 mm below the plane of the pubic notch 16, not too deep), 10 mm away from the edge of the greater sciatic notch, and the rear part of the positioning support rod 1 is close to the inner surface of the quadrilateral 17 (the edge of the pubic notch 16, i.e., the junction of the pubic notch 16 and the quadrilateral 17).

[0044] Step 3. The positioning screw hole 12 is designed at the front part of the positioning support rod 1. The number of the positioning screw holes 12 is set to 3. 2-3 positioning screws are screwed into the 3 positioning screw holes 12 of the positioning support rod 1. The positioning guide module is placed on the inner surface of the quadrilateral 17, so that the positioning screws on the positioning screw holes 12 are perpendicular to the quadrilateral 17, and the tip of one of them is at the most depressed point on the bone surface of the quadrilateral 17. The other positioning screws are used to assist in selecting the direction of the guide needle 11, so that the positioning support rod 1 of the positioning guide module is parallel to the greater sciatic notch, the distance is 10-20mm, and it is applied to the bone ridges of the quadrilateral 17 and the pubic bone 16.

[0045] Step 4. The center offset of the guide pin 11 should be set to 4-6 mm from the tip of the positioning screw (the most concave point of the quadrilateral 17).

[0046] Step 5. Install the sliding guide module, align the sliding groove 8 of the sliding seat 5 with the sliding rod 6 and insert it, then use the screw to penetrate the locking screw hole 4 to lock the sliding seat 5, fix the sliding seat 5 on the sliding rod 6, insert the sleeve 10 into the guide hole 3 of the sliding seat 5, penetrate the screw to penetrate the locking screw hole 4 to lock it, ensure that the sleeve 10 is fixed to avoid affecting the guide pin 11, and then insert the guide pin 11 into the guide pin channel of the sleeve 10, drill from the selected nail entry point, and drill an appropriate length along the direction determined by the positioning guide module.

[0047] Step 6. Replace the guide pin 11 with a screw opener, and slowly rotate and advance the screw opener until it reaches the contralateral cortical bone, wherein the screw opener belongs to the prior art, and read the screw length.

[0048] Step 7. Screw in a hollow screw of appropriate length in the above direction.

[0049] The above disclosure is only the preferred embodiment of the present invention, which certainly cannot be used to limit the scope of the present invention. Therefore, equivalent changes made according to the claims of the present invention still fall within the scope covered by the present invention.

Claims

1. An irregular surface multi-node misalignment-antegrade acetabular posterior column screw positioning aimer, characterized in that: include: The cam is an angular channel that is configured to move the guide rails of the vehicle body in a direction of rotation and to move the guide rails in a direction of rotation. The cam is configured to move the guide rails in a direction of rotation and to move the guide rails in a direction of rotation. The cams are configured to move the guide rails in a direction of rotation and to move the guide rails in a direction of rotation.

2. The irregular surface multi-node offset-antegrade acetabular posterior column screw positioning aimer according to claim 1, characterized in that: A digital scale is arranged on the sliding rod.

3. The irregular surface multi-node staggered-antegrade acetabular posterior column screw positioning aimer according to claim 1, characterized in that: The locking mechanism comprises a plurality of locking screw holes arranged on the sliding seat.

4. The irregular surface multi-node offset-antegrade acetabular posterior column screw positioning aiming device according to claim 1, characterized in that: The guide hole is designed to be an arc-shaped structure matching the sleeve.

5. The irregular surface multi-node staggered-antegrade acetabular posterior column screw positioning aiming device according to claim 1, characterized in that: The number of the positioning screw holes is 3 to 5.

6. The irregular surface multi-node staggered-antegrade acetabular posterior column screw positioning aiming device according to claim 1, characterized in that: The positioning guide module, the sliding guide module and the limiting directional hook are all made of medical stainless steel.

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