Square and round stereotactic puncture frame

Abstract

Fangyuan stereotactic puncture frame. Applied in the field of neurosurgery. The patent of this invention is a brain puncture navigation tool. This auxiliary tool simplifies and accurately punctures the brain. It can solve the problem of hesitation or giving up due to uncertainty about the accuracy of the puncture, or the problem of aggravated brain damage due to inaccurate puncture, and guide us to correctly reach the ideal puncture target. It can save the lives of some patients and improve the quality of life of patients. First, CT is used to determine the projection position of the puncture target on the temporal plane. Secondly, the designed stereotactic puncture frame is used to simulate the puncture direction and depth of the positioning target. After fixing the puncture direction and recording the puncture depth, the stereotactic puncture frame is introduced into the drainage tube to complete the puncture operation. It is mainly used for minimally invasive puncture and drainage of cerebral hemorrhage, biopsy and diagnosis of brain tumors, and ventricular puncture and drainage.

Description

Technical Field

[0001] A medical device for brain-assisted puncture navigation, suitable for the puncture and drainage of cerebral hemorrhage and the stereotactic puncture frame for tumor puncture to clarify pathological diagnosis. Background Art

[0002] With the improvement of people's living standards, changes in lifestyle, increased life pressure, changes in eating habits, etc., there are more and more patients with hypertension, hyperlipidemia, and hyperglycemia, and the number of patients with hypertension is getting younger and younger. my country has entered an aging society. As age increases, blood pressure increases, and there are more and more elderly patients with hypertension. The incidence of cerebral hemorrhage caused by hypertension is also increasing. Stroke is the leading cause of death and disability in human diseases, among which hemorrhagic stroke (cerebral hemorrhage) accounts for 15%-20% of all stroke patients. How to save patients' lives, reduce the degree of disability, and improve the quality of life is an important issue facing neurologists.

[0003] Surgical treatment is an effective treatment method to save the lives of patients with cerebral hemorrhage and improve their quality of life. At present, the surgical methods include craniectomy decompression hematoma removal, micro-bone window craniotomy hematoma removal (microscopic hematoma removal and endoscopic hematoma removal), minimally invasive stereotactic hematoma puncture and cube-shaped directional puncture. Among them, minimally invasive puncture is an effective method for treating hypertensive cerebral hemorrhage. The surgery for hypertensive cerebral hemorrhage has gradually developed towards minimally invasive treatment. The reason is that neurosurgeons have gradually realized in the clinical medical process that cerebral hemorrhage caused by hypertension is different from cerebral hemorrhage caused by brain trauma: cerebral hemorrhage caused by trauma is due to diffuse brain swelling and hemorrhagic space occupation, and the intracranial pressure increases beyond the limit that the brain can bear, and craniectomy decompression surgery is required. If the hematoma caused by hypertension can be removed surgically in time, the edema of the brain tissue around the hematoma will be very slight, and the intracranial pressure will be within the range that the brain tissue can bear. There is no need for craniectomy decompression surgery, and minimally invasive puncture surgery can solve the problem of increased intracranial pressure. Currently, doctors in most hospitals can only roughly locate the hematoma puncture site and puncture direction based on specific CT bone markers and the position of the external auditory canal, resulting in a "blind puncture" phenomenon.

[0004] There are two characteristics of cerebral hemorrhage: 1. All patients are in acute condition and need emergency treatment. Neurologists point out that time is brain, and sometimes every second counts. Timely treatment determines a patient's life and quality of life, as well as a patient's medical costs. 2. It is not easy to transport patients with cerebral hemorrhage over long distances. The bumps during the transportation process may aggravate the patient's bleeding and condition. Patients need on-site sedation, surgery and other emergency treatments. However, many grassroots hospitals do not have the conditions for surgical rescue.

[0005] At present, imported or domestically produced brain stereotactic instruments are used for puncture and drainage of cerebral hemorrhage, stereotactic brain biopsy, epilepsy and other surgical treatments. Combined with CT and MRI fusion technology, puncture operations can be performed accurately. However, it is expensive, most of which require hundreds of thousands to more than one million yuan, not to mention the more expensive frameless stereotactic robot system, which is not conducive to comprehensive promotion. Medical units that use stereotactic instruments for surgical treatment are mostly provincial and municipal medical units. In addition, the operation process of the stereotactic instrument is relatively cumbersome (after local anesthesia, the head frame is installed on the head, CT is scanned in the CT room, the data is input on the disc to make the surgical plan, and then the puncture treatment is performed. Critically ill patients may have their condition aggravated and are not suitable for application). For surgical puncture of the posterior cranial fossa (cerebellum and brainstem), due to the obstruction of the frame, the installed frame must be low enough, and obese patients with thick and short necks have certain difficulties in installing the frame. At present, there are some domestic auxiliary positioning tools, which need to be punctured by visually observing the puncture direction through the head line. The puncture direction and depth are not easy to master, and are prone to deviations or even errors. It requires doctors to have a certain amount of surgical experience to complete it smoothly. Summary of the invention

[0006] Common ones abroad include Leksell orientation devices, CRW / RRW orientation systems, Fischer Z-D orientation devices, etc., and domestic XZ-V orientation devices, PJ-4 orientation devices, BH-1 type orientation devices, etc., which have similar structures and are all invasive operations that require the frame to be fixed to the head under local anesthesia before surgery. These operations increase the pain of the patient and have the risk of aggravating the patient's condition, and are not suitable for critically ill neurosurgery patients. Neurosurgeons in many domestic hospitals use specific landmarks on the head for puncture, which results in a "blind puncture" phenomenon. In order to overcome the above shortcomings, the present invention uses the Cartesian three-dimensional coordinate principle combined with the normal development of the brain tissue structure with left-right symmetry and midline centering to design a stereotactic puncture frame, such as Figure 1 As shown, a relatively simple and accurate brain puncture guide tool is provided for physicians at all levels.

[0007] The structure and connection operation of the Fangyuan stereotactic puncture frame are as follows Figure 1 , Figure 2 , Figure 3 , Figure 4 , Figure 5 , Figure 6 , Figure 7:Rod 1 and rod 5 are designed the same, and rod 2 and rod 4 are designed the same. Rod 1 and rod 5 are inserted into the square holes of rod 2 and rod 4 respectively, and fixed with the fourth screw (15) and the fifth screw (16). Rod 2 and rod 4 are inserted into the seventh slot (27) and the eighth slot (28) of rod 3 respectively. The gear (17) at the center of rod 3 meshes with the toothed parts in rod 2 and rod 4, so that rod 2 and rod 4 can be extended and retracted at the same time. No matter how rod 2 and rod 4 are extended and retracted, the center of rod 3, that is, the center of the gear, always remains the center of the horizontal frame. Different people have different head widths. The frame is placed on the patient's head, and the horizontal length is adjusted. After determining the extension length, it is fixed with the second screw (10), and the horizontal length composed of the lengths of rod 2, rod 3, and rod 4 no longer changes. The second guide wire (9) inserted through this center corresponds to the midsagittal plane of the brain to ensure that the puncture target does not deviate inward or outward. The third screw (14) fixes the gear (17) to prevent it from shifting up and down. Use the fourth screw (15) and the fifth screw (16) to fix the rod 1 and the rod 5 respectively to ensure that the height of the frame is the same, so that the centers of the circular holes at the distal ends of the rods 1 and 5 are at the same level. Figure 6 , the length of rod 1 and rod 5 is marked with scales, and the circular hole part is used to insert the first guide plug (11) and the second guide plug (12). The third guide wire (13) is inserted into the first guide plug (11) and the second guide plug (12). The midpoint of the third guide wire (13) is marked with 0 scale and scales are marked in mm on both sides, respectively 5 cm long, the distal end of the second guide wire (9) coincides with the 0 scale of the third guide wire (13), and the midpoint position of the third guide wire (13), that is, the origin position, is determined, and is marked as "☆". According to the distance X between the target point and the origin measured on the CT, the target point position "○" on the third guide wire (13) is determined. The first groove (21), the second groove (22), the fifth groove (25), and the sixth groove (26) of the slotted part of rod 1, rod 3, and rod 5 have a longitudinal cross-section such as an inverted "convex" shape, which can be inserted into the guide pulley device (7). According to the target point position "○", the first guide wire (8) is inserted into the guide pulley device (7) and the puncture direction is adjusted. The first screw (6) can fix the frame of the guide pulley device (7) through the third groove (23), the fourth groove (24), the ninth groove (29), and the tenth groove (30), so that the guide pulley device (7) does not shift left and right. The sixth screw (18) fixes the pulley in the guide pulley device (7) so that it does not rotate, thereby determining the puncture direction and recording the puncture depth. Pull out the first guide plug (11), the second guide plug (12) and the third guide wire (13), as shown in FIG. Figure 7 Insert the first rotating plug (19) and the second rotating plug (20), place the tips of the two rotating plugs on the projection point of the target point on the temporal side, and rotate with the line passing through the projection points on the temporal side of both sides as the axis. Figure 7 The framework is used to select appropriate puncture sites and directions in the forehead, temporal, parietal, and occipital regions for puncture.

[0008] The beneficial effects of the present invention are: its operation is simple and accurate. Wide application scope: With the popularization of CT equipment, from grassroots township health centers to national hospitals, as long as there are medical units with CT equipment, only simple training is needed to set the target point at the temporal projection position, and then the puncture can be performed accurately and safely, solving the problem that many doctors dare not puncture patients with small amount of bleeding and deep part, such as thalamic hemorrhage, brainstem hemorrhage, etc., and effectively saving the lives of some patients. For the selection of surgical intervention for cerebral hemorrhage, usually supratentorial bleeding of more than 30ml is selected for surgical treatment, thalamic hemorrhage is selected for more than 15ml, infratentorial cerebellar hemorrhage is selected for more than 10ml, and brainstem hemorrhage is selected for more than 5ml (the determination of the amount of hematoma can be measured by Tada's formula or CT room measurement). For patients with bleeding volume of 20ml-30ml and important neurological deficits, stereotactic treatment can be performed to improve neurological deficits and improve quality of life, given that stereotactic treatment can avoid important functional areas and select appropriate puncture paths with minimal puncture damage; for patients with larger bleeding volume, multi-target and multi-directional puncture methods can be used to timely remove part of the hematoma and effectively reduce intracranial pressure. Urokinase can be used to dissolve and drain residual bleeding after surgery, which can also achieve good results. With the accumulation of experience, stereotactic biopsy and other surgeries can also be gradually carried out. BRIEF DESCRIPTION OF THE DRAWINGS

[0009] Figure 1 This is a front view, with the names and connections of each component.

[0010] Figure 2 It is a top view, the gear (17) at the top is meshed with the toothed parts of the rods 2 and 4, and the rods 2 and 4 are extended and retracted at the same time, ensuring that the midpoint of the horizontal part composed of the rods 2, 3 and 4 does not deviate. The cross-sectional view of the first groove (21), the second groove (22), the fifth groove (25) and the sixth groove (26) is an inverted "convex" shape, and the wide groove part is inserted into the directional pulley device (7). The first screw (6) fixes the frame of the directional pulley device (7) through the third groove (23), the fourth groove (24), the ninth groove (29) and the tenth groove (30), and the sixth screw (18) fixes the rotation of the pulley of the directional pulley device (7), and the round hole of the pulley is used for the insertion of the second guide wire (9) and the puncture catheter.

[0011] Figure 3 It is a left side view, the puncture target is located on the left side of the brain, and the temporal puncture directional pulley device (7) is placed in the fifth groove (25).

[0012] Figure 4 It is a right side view, the puncture target is located on the right side of the brain, and the temporal puncture directional pulley device (7) is placed in the sixth groove (26).

[0013] Figure 5It is a rear view, and the eighth slot (28) is the position where the rod 4 is inserted into the rod 3.

[0014] Figure 6 In order to simulate the puncture view, simulate the puncture direction and depth, the second guide wire (9) is located in the midline, that is, in the midsagittal plane of the patient. According to the distance X from the origin to the target, the appropriate puncture site and direction of the forehead, temporal, parietal and occipital are selected and inserted into the directional pulley device (7). The first guide wire (8) is inserted, and the direction and depth of the guide wire are determined. The first screw (6) and the sixth screw (18) are used to fix the directional pulley device (7), the puncture direction is determined, and the puncture depth is recorded.

[0015] Figure 7 For the puncture view, insert the first rotating plug (19) and the second rotating plug (20), place the tips of the two rotating plugs on the temporal projection point of the target point, and rotate with the line passing through the temporal projection points on both sides as the axis. Figure 7 Frame, insert the puncture catheter for puncture.

[0016] Figure 8 The target level is marked according to the layer distance Y and the frame is placed on the target level. The target projection point on the temporal side is marked according to the frontal distance Z.

[0017] Fig. 9 It is an enlarged schematic diagram of the directional pulley device (7).

[0018] The parts names in the figure are marked as follows:

[0019] Rod 1 (1); Rod 2 (2); Rod 3 (3); Rod 4 (4); Rod 5 (5); First screw (6); Directional pulley device (7); First guide wire (8); Second guide wire (9); Second screw (10); First guide plug (11); Second guide plug (12); Third guide wire (13); Third screw (14); Fourth screw (15); Fifth screw (16); Gear (17); Sixth screw (18); First rotating plug (19); Second rotating plug (20).

[0020] A first groove (21), a second groove (22), a third groove (23), a fourth groove (24), a fifth groove (25), a sixth groove (26), a seventh groove (27), an eighth groove (28), a ninth groove (29), and a tenth groove (30). DETAILED DESCRIPTION

[0021] 1. Locate the projection point of the puncture target on the temporal side based on CT and measure and record relevant data: Use an infusion patch to fix the nose bridge strip on the mask (the thin adhesive strip on the mask) on the bilateral OM lines and on the mid-frontal sagittal line (this can more accurately measure the forehead distance or chord length, and the nose bridge strip appears white on CT), perform a head CT scan (try to scan the CT baseline on the OM line. If it does not coincide with the OM line, the baseline can be adjusted using CT scan computer post-processing technology) to determine the scanning baseline. Based on the CT plain film, determine the maximum level of the hematoma, the puncture target, and the vertical line through the target and the sagittal plane. The intersection with the mid-frontal sagittal plane is the origin, and the intersection with the temporal side is the projection point of the target. Measure the distance X between the target and the origin, the distance Z between the origin and the forehead, the distance Y between the OM baseline layer and the target layer, and the length L of the chord formed by the midpoint of the forehead at the target layer and the projection point on the target layer of the computer or CT film.

[0022] 2. Mark the temporal projection point of the patient's head origin: mark the target point on the patient's head according to the Y value. There are two ways to mark the position of the temporal projection point based on the measurement data: ①: Chord length method, based on the chord length L, the vernier caliper is measured on the head and the temporal projection point is marked; ② Based on the distance Z from the origin to the forehead, the frame is used Figure 8 , based on the Z value within the target plane, mark the temporal projection point of the target.

[0023] 3. If Figure 6 Select appropriate puncture sites in the forehead, temporal, parietal and occipital regions. Changes in the horizontal length of the puncture frames in the forehead, parietal and occipital regions do not cause changes in the puncture positions. Therefore, the horizontal length of the frame does not need to be determined for simulated puncture. The horizontal length of the frame part needs to be determined in advance for temporal puncture in order to determine the puncture position. The frame is used to simulate the puncture direction and depth. The distal end of the first guide wire (8) is X length away from the midline. The first screw (6) and the sixth screw (18) fix the directional pulley device (7) so that it no longer rotates or shifts. The puncture direction is fixed and the puncture depth is recorded.

[0024] 4. Surgical operation: Figure 7 Insert the first rotating plug (19) and the second rotating plug (20), place the tips of the two rotating plugs on the projection point of the patient's target point on the temporal side, and after fixing the frame width, rotate with the line passing through the temporal projection points on both sides as the axis. Figure 7 No matter how the frame rotates, the position of the puncture point remains unchanged. According to the recorded puncture depth, the puncture drainage catheter is inserted to complete the operation.

[0025] The above is only a description of the preferred implementation mode of the present invention, and does not limit the scope of the present invention. Without departing from the design spirit of the present invention, various modifications and improvements made to the technical solution of the present invention by those skilled in the art should fall within the protection scope determined by the claims of the present invention.

Claims

1. A medical device for brain-assisted puncture navigation, characterized in that: The invention comprises a rod 1 (1); a rod 2 (2); a rod 3 (3); a rod 4 (4); a rod 5 (5); a first screw (6); a directional pulley device (7); a first guide wire (8); a second guide wire (9); a second screw (10); a first guide plug (11); a second guide plug (12); a third guide wire (13); a third screw (14); a fourth screw (15); a fifth screw (16); a gear (17); a sixth screw (18); a first rotating plug (19); and a second rotating plug (20); Rod 1 (1) and rod 5 (5) are of the same design, and rod 2 (2) and rod 4 (4) are of the same design; Square holes are respectively provided on the rod 2 (2) and the rod 4 (4), and the rod 1 (1) and the rod 5 (5) are respectively inserted into the square holes of the rod 2 (2) and the rod 4 (4), and fixed with a fourth screw (15) and a fifth screw (16); The side of the rod 3 (3) is provided with a seventh trapezoidal groove (27) and an eighth trapezoidal groove (28) which are small on the outside and large on the inside, and the rod 2 (2) and the rod 4 (4) are respectively inserted into the seventh groove (27) and the eighth groove (28) of the rod 3 (3); A circular hole is opened in the middle of the top of the rod 3 (3), into which a gear (17) is placed, and the gear (17) meshes with the toothed parts of the rod 2 (2) and the rod 4 (4); A second guide wire (9) passes through the center of the rod 3 (3); The gear (17) is fixed by a third screw (14); The rod 1 (1) and the rod 5 (5) are marked with scales in the length direction, and circular holes are provided at the bottom for inserting the first guide plug (11) and the second guide plug (12); The two ends of the third guide wire (13) are respectively inserted into the first guide plug (11) and the second guide plug (12); The midpoint of the third guide wire (13) is marked with a scale of 0 and scales are marked in mm on both sides, and the distal end of the second guide wire (9) coincides with the scale of 0 of the third guide wire (13); The rod 1 (1) and the rod 5 (5) are respectively provided with a fifth groove (25) and a sixth groove (26) on the left and right sides; The top of the rod 3 (3) is provided with a first groove (21) and a second groove (22); The first groove (21), the second groove (22), the fifth groove (25), and the sixth groove (26) have a longitudinal cross-section in the shape of an inverted "convex" shape and are used to insert the directional pulley device (7); The first guide wire (8) is inserted through the directional pulley device (7); A third groove (23) and a fourth groove (24) are provided on the front of the rod 3 (3); A ninth groove (29) and a tenth groove (30) are respectively formed on the front of the rod 1 (1) and the rod 5 (5); The first screw (6) fixes the frame of the directional pulley device (7) through the third groove (23), the fourth groove (24), the ninth groove (29), and the tenth groove (30); The pulley in the directional pulley device (7) rotates in the frame of the directional pulley device (7), and the sixth screw (18) fixes the pulley in the directional pulley device (7); After determining the puncture direction and recording the puncture depth, the first guide plug (11), the second guide plug (12) and the third guide wire (13) are pulled out, and the bottom round holes of rod 1 (1) and rod 5 (5) are respectively inserted into the first rotating plug (19) and the second rotating plug (20), and the tips of the first rotating plug (19) and the second rotating plug (20) are respectively placed on the projection points of the target point on the temporal side.

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