Three-dimensional guiding device for pedicle channel screw

Abstract

The present invention discloses a three-dimensional guiding device for pedicle channel screws, which includes a base, a three-dimensional distance adjusting member disposed on the base, and an angle adjusting member disposed at the other end of the three-dimensional distance adjusting member. The structure of the present invention is simple and easy to operate. The screw insertion direction is adjusted through the angle adjusting member, and then the angle adjusting member is aligned with the screw insertion point through the three-dimensional distance adjusting member, so that the screw insertion direction can be accurately determined at one time, effectively avoiding the situation that the osteotome penetrates the pedicle cortical bone due to the inaccurate determination of the screw insertion direction by the surgeon in chief, or the decrease of the holding force of the pedicle screw caused by repeatedly adjusting the direction of the osteotome, ensuring the success of the spinal pedicle screw internal fixation surgery, facilitating the operation of the surgeon in chief, having strong practicability, and having accurate positioning. It is applicable to patients with normal vertebral morphology, especially applicable to patients with vertebral deformities, such as those with non-linear lower edges of spinous processes, spinous process fusion, etc., who cannot use the lower edge of the spinous process as a reference benchmark.

Description

Technical Field

[0001] The present invention belongs to the field of orthopedic surgical instruments, and particularly relates to a three-dimensional guide for pedicle channel screws. Background Art

[0002] The internal fixation surgery of spinal pedicle channel screws is a basic technique in modern spinal surgery. Based on the anatomical characteristics of the pedicle, the pedicle channel screw is passed through the narrow pedicle channel of the pedicle to fix the spine. The vertebral body is an irregular bone with extremely complex anatomy. The pedicle channel not only has an external inclination angle relative to the sagittal plane of the human body, but also has a pitch inclination angle relative to the transverse plane of the human body. Moreover, the inner and outer diameters and the upper and lower diameters of the pedicle are very narrow. Especially in the cervical vertebrae and upper thoracic vertebrae, the narrowest part of the pedicle channel is less than 5 mm. If there is a slight deviation in the external inclination angle and the pitch inclination angle, the osteotome will break through the cortical bone of the pedicle, which not only fails to meet the accuracy requirements of scientific research (accurate screw positioning and successful placement at one time), but also makes it extremely difficult to adjust during the operation, resulting in screw placement failure and damage to nerves, blood vessels, etc., and even endangering life. Therefore, the internal fixation surgery of spinal pedicle channel screws has extremely high requirements for the screw insertion direction. During the operation, on the premise of accurately positioning the screw insertion point, whether the screw insertion direction of the pedicle channel screw can be accurately determined has become one of the key factors determining the success or failure of the operation. To determine the screw insertion direction, it is necessary to first determine the central axis of the pedicle channel on the vertebra through the pitch inclination angle (the angle between the central axis of the pedicle channel and the central transverse plane of the vertebral body on the CT sagittal plane or the lateral X-ray) and the internal inclination angle (the angle between the central axis of the pedicle channel and the central axis of the vertebral body on the CT cross-section, which cannot be measured on the X-ray), and then determine the screw insertion direction.

[0003] At present, when determining the insertion direction of spinal pedicle channel screws during surgery, after determining the position of the insertion point, the surgeon generally uses the ground plane as a reference, and then estimates the direction of the osteotome after adjusting the angles in two planes based on the pitch angle and the medial inclination angle measured from the preoperative data, and uses this angle as the insertion direction. However, since there are two variables, the pitch angle and the medial inclination angle, that control the insertion direction, the determination of both depends on the subjective judgment of the surgeon in charge and the insertion direction cannot be accurately determined. During the surgery for patients with spinal fusion deformity, the pitch angle cannot be eliminated by using the angle between the perpendicular line of the pedicle axis and the lower edge of the spinous process. Although a probe can be inserted after drilling the channel and measured, judged, and adjusted through the lateral X-ray fluoroscopy of the spine, it cannot ensure success in one attempt. Once there is a deviation, it is difficult to adjust. Moreover, the lateral inclination angle cannot be measured by X-ray fluoroscopy and can only be judged by the surgeon's hand feeling and experience. At the same time, the upper and lower diameters and the inner and outer diameters of the pedicle channel are very narrow (the inner and outer diameters are even smaller). Especially in the cervical vertebrae and the upper thoracic vertebrae, the narrowest part of the pedicle channel is less than 5 mm. Therefore, even if the insertion point is accurate, the pedicle channel screw may penetrate the cortical bone from any position such as the upper and lower walls, the medial wall, and the lateral wall of the pedicle, and then damage the surrounding important tissues. Currently, there is a lack of a device that can accurately determine the lateral inclination angle and the pitch angle of the central axis of the pedicle channel on the vertebra in cases such as spinal fusion deformity to solve the above problems. Summary of the Invention

[0004] The purpose of the present invention is to provide a three-dimensional guide for pedicle channel screws. After determining the position of the insertion point, when it is impossible to use a protractor with the angle between the perpendicular line of the pedicle channel central axis and the lower edge of the spinous process to find the vertical plane of the pedicle channel central axis to compensate for the pitch angle, the lateral inclination angle is adjusted by the lateral inclination angle adjusting member, the pitch angle is preset according to the preoperative measurement, and then the three-dimensional distance adjusting member is used to align the guide needle inserted into the guide block with the insertion point. The pitch angle is adjusted to the optimal position through the lateral X-ray fluoroscopy of the spine, so as to achieve the purpose of accurately positioning the insertion direction in extreme cases such as spinal fusion deformity without reference marks, and solve the problem that the insertion direction of the pedicle screw is inaccurate and penetrates the cortical bone to damage the surrounding important tissues.

[0005] The technical solution adopted by the present invention is as follows:

[0006] A three-dimensional guide for pedicle channel screws, characterized in that it comprises a base, a three-dimensional distance adjusting member provided on the base, and an angle adjusting member provided at the other end of the three-dimensional distance adjusting member;

[0007] The base includes a portal plate and a sagittal sleeve provided at the other end of the portal plate. The portal plate can be clamped and fixed on the spinous process. The sagittal sleeve is used for sliding connection with the three-dimensional distance adjusting member. A reference needle is longitudinally provided at the top of the portal plate to provide a reference for adjusting the insertion direction;

[0008] The three-dimensional distance adjustment member includes a sagittal slide bar disposed within a sagittal sleeve, a transverse slide bar disposed above the sagittal slide bar, a transverse sleeve sleeved on the transverse slide bar, a longitudinal slide bar disposed on the transverse sleeve, and a longitudinal sleeve sleeved on the longitudinal slide bar. Positioning members are provided on the sagittal sleeve, the transverse sleeve, and the longitudinal sleeve. The position of the angle adjustment member is adjusted by sliding the sagittal slide bar, the transverse slide bar, and the longitudinal slide bar within the sagittal sleeve, the transverse sleeve, and the longitudinal sleeve respectively, and its position is fixed by the positioning members so that the angle adjustment member is aligned with the nail insertion point. A transverse arc-shaped sleeve is provided below the longitudinal sleeve, and the transverse arc-shaped sleeve is used for sliding connection with the three-dimensional distance adjustment member;

[0009] The angle adjustment member includes a transverse arc-shaped scale bar disposed within the transverse arc-shaped sleeve, a longitudinal arc-shaped sleeve disposed at one end of the transverse arc-shaped scale bar, a longitudinal arc-shaped scale bar disposed within the longitudinal arc-shaped sleeve, and a guide block disposed at one end of the longitudinal arc-shaped scale bar. The transverse arc-shaped scale bar slides in and out within the transverse arc-shaped sleeve to adjust the magnitude of the medial inclination angle, and the longitudinal arc-shaped scale bar slides up and down within the longitudinal arc-shaped sleeve to adjust the magnitude of the pitch inclination angle, thereby achieving the purpose of accurately controlling the nail insertion direction. Locking members are provided on the transverse arc-shaped sleeve and the longitudinal arc-shaped sleeve, and a guide hole is penetrated through the guide block, and the guide hole is used for passing through the osteotome.

[0010] Further, a card slot is opened at the top end of the gantry plate, a T-shaped block is disposed within the card slot, a reference hole is opened on the T-shaped block, the reference pin is disposed within the reference hole, a concave groove is opened on the inner side wall of the top of the gantry plate, a convex plate is disposed between the concave grooves, a pin slot for the reference pin to pass through is opened on the convex plate, and half of the reference pin is inserted into the spinous process. In order to use the reference pin as a reference to facilitate determining the nail insertion direction, the rear end of the reference pin passes through the pin slot of the convex plate and is inserted into the reference hole of the T-shaped block, which is convenient for installing or removing the base on the spinous process (because the spinous processes have differences in length, T-shaped blocks with different thicknesses can be selected).

[0011] Further, a fixing hole is opened on the bottom side wall of the gantry plate, a fixing pin is disposed within the fixing hole, and the fixing pin passes through the fixing hole to nail the base on the spinous process, preventing the base from moving during the operation.

[0012] Further, the positioning member includes positioning chutes opened on the sagittal sleeve, the transverse sleeve, and the longitudinal sleeve, and positioning bolts passing through the positioning chutes and threadedly connected to the sagittal slide bar, the transverse slide bar, and the longitudinal slide bar.

[0013] Further, a connecting rod perpendicular to the middle of the transverse slide bar is vertically disposed at the top end of the sagittal slide bar, and rectangular chutes through which the connecting rod can pass are opened on both the transverse sleeve and the vertical sleeve, effectively increasing the adjustment range of the position of the angle adjustment member.

[0014] Further, a guiding sleeve is arranged in the guiding hole, aiming to increase the guiding distance and make the guiding more accurate. A locking member is arranged on the guiding block for locking the guiding sleeve in the guiding hole.

[0015] Further, the locking member includes a locking threaded hole and a locking stud arranged in the threaded hole.

[0016] Advantages of the present invention:

[0017] 1. The structure of the present invention is simple and easy to operate;

[0018] 2. The present invention adjusts the nail insertion direction through the angle adjusting member, and then makes the angle adjusting member align with the nail insertion point through the three-dimensional distance adjusting member, which can accurately determine the nail insertion direction at one time, effectively avoiding the situation that the osteotome pierces through the cortical bone of the pedicle due to the inaccurate determination of the nail insertion direction by the surgeon, or the decrease of the holding force of the pedicle screw caused by repeatedly adjusting the direction of the osteotome, ensuring the success of the spinal pedicle screw internal fixation surgery;

[0019] 3. In the present invention, the angle adjusting member slides in and out of the transverse arc-shaped sleeve through the transverse arc-shaped scale rod to adjust the size of the inner inclination angle, and slides up and down in the longitudinal arc-shaped sleeve through the longitudinal arc-shaped scale rod to adjust the size of the pitch inclination angle, so as to achieve the purpose of accurately controlling the nail insertion direction;

[0020] 4. In the present invention, the three-dimensional distance adjusting member slides the sagittal slide bar, the transverse slide bar and the longitudinal slide bar in the sagittal sleeve, the transverse sleeve and the longitudinal sleeve respectively to adjust the vertical, transverse and longitudinal positions of the angle adjusting member, which is convenient for the surgeon to operate, has strong practicability and accurate positioning;

[0021] 5. In the present invention, a reference needle is inserted on the spinous process. Taking the reference needle as a reference, it is convenient to determine the nail insertion direction through the pitch inclination angle and the inner inclination angle, and even if the patient's body position changes, it will not affect the operation.

[0022] 6. The present invention is applicable to patients with normal vertebral morphology; especially applicable to patients with vertebral deformities, such as patients who cannot use the lower edge of the spinous process as a reference benchmark due to the non-linear lower edge of the spinous process, spinous process fusion, etc. Description of the Drawings

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

[0024] Figure 2 is a schematic structural diagram of the base of the present invention;

[0025] Figure 3 is an exploded structural diagram of the base of the present invention;

[0026] Figure 4Structural schematic diagram of the three-dimensional distance adjustment member of the present invention;

[0027] Figure 5 Structural schematic diagram of the angle adjustment member of the present invention;

[0028] Figure 6 Schematic diagram of the usage state of the present invention.

[0029] In the figure: 1, base; 2, gantry plate; 3, sagittal slide bar; 4, three-dimensional distance adjustment member; 5, transverse slide bar; 6, transverse sleeve; 7, longitudinal slide bar; 8, longitudinal sleeve; 9, transverse arc-shaped sleeve; 10, angle adjustment member; 11, transverse arc-shaped scale bar; 12, longitudinal arc-shaped sleeve; 13, longitudinal arc-shaped scale bar; 14, guide block; 15, guide sleeve; 16, convex plate; 17, T-shaped clamping block; 18, sagittal sleeve; 19, fixing needle; 20, needle groove; 21, reference hole; 22, reference needle; 23, clamping groove; 24, concave groove; 25, opener; 26, transverse process; 27, superior articular process; 28, vertebral body; 29, vertebral foramen; 30, pedicle; 31, spinous process. Detailed implementation manners

[0030] It should be noted that, without conflict, the embodiments in the present application and the features in the embodiments can be combined with each other. The present invention will be described in detail below with reference to the drawings and in combination with the embodiments.

[0031] As Figure 1 , 2 , 3, 4, 5 show, a three-dimensional guiding device for pedicle channel screws provided by the present invention includes a base 1, a three-dimensional distance adjustment member 4 arranged on the base 1, and an angle adjustment member 10 arranged at the other end of the three-dimensional distance adjustment member 4;

[0032] The base 1 includes a portal plate 2 and a sagittal sleeve 18 provided at the other end of the portal plate 2. The portal plate 2 can be clamped and fixed on the spinous process. The sagittal sleeve 18 is used for sliding connection with the three-dimensional distance adjustment member 4. A clamping groove is provided at the top end of the portal plate 2. A T-shaped clamping block 17 is arranged in the clamping groove. A reference hole 21 is provided on the T-shaped clamping block 17. A reference pin 22 is arranged in the reference hole 21. The diameter of the reference pin 22 is 2 mm. A concave groove 24 is provided on the inner top wall of the portal plate 2. A convex plate 16 is arranged between the concave grooves 24. The convex surface length of the convex plate 16 has multiple specifications. A needle groove 20 for the reference pin 22 to pass through is provided on the convex plate 16. Half of the reference pin 22 is inserted into the spinous process. In order to use the reference pin 22 as a reference to facilitate determining the nail insertion direction, the rear end of the reference pin 22 passes through the needle groove of the convex plate 16 and is inserted into the reference hole 21 of the T-shaped clamping block 17, which is convenient for installing or removing the base 1 on the spinous process. A fixing hole is provided on the bottom side wall of the portal plate 2. A fixing pin 19 is arranged in the fixing hole. The fixing pin 19 passes through the fixing hole to nail the base 2 to the spinous process, preventing the base 1 from moving during the operation;

[0033] The three-dimensional positioning member 4 includes a sagittal slide bar 3 arranged in the sagittal sleeve 18, a transverse slide bar 5 arranged above the sagittal slide bar 3, a transverse sleeve 6 sleeved on the transverse slide bar 5, a longitudinal slide bar 7 arranged on the transverse sleeve 6, and a longitudinal sleeve 8 sleeved on the longitudinal slide bar 7. Positioning members are arranged on the sagittal sleeve 18, the transverse sleeve 6, and the longitudinal sleeve 8. The positioning members include positioning sliding grooves opened on the sagittal sleeve 18, the transverse sleeve 6, and the longitudinal sleeve 8, and positioning bolts passing through the positioning sliding grooves and connected to the sagittal slide bar 3, the transverse slide bar 5, and the longitudinal slide bar 7. By sliding the sagittal slide bar 3, the transverse slide bar 5, and the longitudinal slide bar 7 in the sagittal sleeve 18, the transverse sleeve 6, and the longitudinal sleeve 8 respectively to adjust the position of the angle adjustment member 10, and fixing its position through the positioning members, so that the angle adjustment member 10 is aligned with the nail insertion point. A connecting rod perpendicular to the middle of the transverse slide bar 5 is vertically arranged at the top end of the sagittal slide bar 3. Rectangular sliding grooves through which the connecting rod can pass are opened on both the transverse sleeve 6 and the sagittal sleeve 18, effectively increasing the position adjustment range of the angle adjustment member 10. A transverse arc-shaped sleeve 9 is arranged below the longitudinal sleeve 8. The transverse arc-shaped sleeve 9 is used for sliding connection with the three-dimensional distance adjustment member 4;

[0034] The angle adjustment member 10 includes a transverse arc scale rod 11 disposed within a transverse arc sleeve 9, a longitudinal arc sleeve 12 disposed at one end of the transverse arc scale rod 11, a longitudinal arc scale rod 13 disposed within the longitudinal arc sleeve 12, and a guide block 14 disposed at one end of the longitudinal arc scale rod 13. The transverse arc scale rod 11 slides in and out within the transverse arc sleeve 9 to adjust the magnitude of the inner inclination angle, and the longitudinal arc scale rod 13 slides up and down within the longitudinal arc sleeve 12 to adjust the magnitude of the pitching inclination angle, thereby achieving the purpose of precisely controlling the nail insertion direction. Locking members are provided on the transverse arc sleeve 9 and the longitudinal arc sleeve 12. The locking members include locking threaded holes and locking studs disposed within the threaded holes. A guide hole is penetrated through the guide block 14, and a guide sleeve 15 is disposed within the guide hole, aiming to increase the guide distance to make the guiding more precise. A locking member is provided on the guide block 14 for locking the guide sleeve 15 within the guide hole.

[0035] Such as Figure 6As shown in the figure, the vertebra consists of a transverse process 26, a superior articular process 27, a vertebral body 28, a vertebral foramen 29, a pedicle 30 and a spinous process 31. When the vertebra is damaged or suffers from spinal cord diseases, pedicle screws need to be implanted into several adjacent vertebrae to fix the upper and lower vertebrae. Before use, mark the position of the screw insertion point on the lamina. During use, drill the front end of the reference pin 22 forward within the sagittal plane of the spinous process 31. According to the preoperative CT measurement, determine the inner inclination angle between the reference pin 22 and the central axis of the pedicle channel. Insert the rear end of the reference pin 22 through the pin slot of the convex plate 16 and into the reference hole 21 of the T-shaped block 17. Adjust the base 1 to be parallel to the reference pin 22, and insert the fixing pin 19 through the fixing hole of the portal plate 2 and fix it on the spinous process 31. Preset a pitch angle by adjusting the longitudinal arc scale rod 13 within the longitudinal arc sleeve 12 according to the pitch angle measured by preoperative CT, and tighten the locking stud to fix the longitudinal arc scale rod 13. Then, adjust the transverse arc scale rod 11 within the transverse arc sleeve 9 according to the inner inclination angle between the reference pin 22 and the central axis of the pedicle channel, and tighten the locking stud to fix the transverse arc scale rod 11, so as to obtain a screw insertion direction with an undetermined pitch angle and an accurate outer inclination angle (the direction of the guide hole of the guide block is the preset screw insertion direction). Slide the sagittal slide bar 3, the transverse slide bar 5 and the longitudinal slide bar 7 respectively within the sagittal sleeve 19, the transverse sleeve 6 and the longitudinal sleeve 8 to adjust the vertical, transverse and longitudinal positions of the angle adjustment member 10, and fix the sagittal sleeve 18, the transverse sleeve 6 and the longitudinal sleeve 8 with positioning bolts. Finally, pass the guide sleeve 15 through the guide hole of the guide block 14 and fix it therein with a locking stud, so that the tip of the guide pin within the guide hole is aligned with the screw insertion point. Perform a lateral X-ray fluoroscopy of the spine to understand the angle between the guide pin within the guide hole and the central axis of the pedicle channel. Adjust the pitch angle until the angle is 0° - that is, when the guide pin is completely aligned with the central axis of the pedicle channel, remove the guide pin, pass the reamer 25 through the guide sleeve 15 and ream along the screw insertion direction from the screw insertion point to obtain a pedicle screw channel. After the pedicle screw channel is completed, remove the reamer from the guide sleeve 15, pull out the fixing pin 19 on the spinous process 31, withdraw the base 1 along the end of the reference pin 23, and pull out the reference pin 23 on the spinous process 31. Finally, disinfect the removed components for future use.

[0036] The above-disclosed are only the preferred embodiments of the present invention. Of course, the scope of the rights of the present invention cannot be limited thereby. Therefore, equivalent changes made according to the claims of the present invention still fall within the scope covered by the present invention.

Claims

1. A three-dimensional guiding device for pedicle channel screws, characterized in that: It includes a base, a three-dimensional distance adjustment member provided on the base, and an angle adjustment member provided at the other end of the three-dimensional distance adjustment member; The base includes a portal plate and a sagittal sleeve provided at one end of the portal plate. A reference pin is longitudinally provided on the top of the portal plate. A card slot is provided at the top end of the portal plate. A T-shaped card block is provided in the card slot. A reference hole is provided on the T-shaped card block. The reference pin is provided in the reference hole. A concave groove is provided on the inner top wall of the portal plate. A convex plate is provided between the concave grooves. A needle slot for the reference pin to pass through is provided on the convex plate; The three-dimensional distance adjustment member includes a sagittal slide rod provided in the sagittal sleeve, a transverse slide rod provided above the sagittal slide rod, a transverse sleeve sleeved on the transverse slide rod, a longitudinal slide rod provided on the transverse sleeve, and a longitudinal sleeve sleeved on the longitudinal slide rod. Positioning members are provided on the sagittal sleeve, the transverse sleeve and the longitudinal sleeve. A transverse arc-shaped sleeve is provided below the longitudinal sleeve; A connecting rod perpendicular to the middle of the transverse slide rod is vertically provided at the top end of the sagittal slide rod. Rectangular sliding grooves through which the connecting rod can pass are provided on both the transverse sleeve and the sagittal sleeve; The positioning member includes positioning sliding grooves provided on the sagittal sleeve, the transverse sleeve and the longitudinal sleeve, and positioning bolts passing through the positioning sliding grooves and threadedly connected to the sagittal slide rod, the transverse slide rod and the longitudinal slide rod; The angle adjustment member includes a transverse arc-shaped scale rod provided in the transverse arc-shaped sleeve, a longitudinal arc-shaped sleeve provided at one end of the transverse arc-shaped scale rod, a longitudinal arc-shaped scale rod provided in the longitudinal arc-shaped sleeve, and a guide block provided at one end of the longitudinal arc-shaped scale rod. Locking members are provided on the transverse arc-shaped sleeve and the longitudinal arc-shaped sleeve. A guide hole is provided through the guide block; A guide sleeve is provided in the guide hole of the guide block. A locking member is provided on the guide block.

2. The three-dimensional guiding device for pedicle channel screws according to claim 1, wherein: A fixing hole is provided on the bottom side wall of the portal plate, and a fixing pin is provided in the fixing hole.

3. The three-dimensional guiding device for pedicle channel screws according to claim 1, wherein: The locking member includes a locking threaded hole and a locking stud provided in the threaded hole.

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