Minimally invasive screw setting guide device and method for treating pelvic acetabular anterior column fracture

Abstract

The invention discloses a minimally invasive screw setting guide device for treating pelvic acetabular anterior column fracture, which is characterized by comprising a positioning sleeve and a screw guide mechanism arranged in the positioning sleeve, compared with the prior art, by means of the positioning sleeve, in the screw placement process of the front column screw, after preliminary positioning is conducted, the positioning sleeve is firstly driven into the body of a patient, then secondary positioning of the guiding piece is conducted in the positioning guide pipe through the screw guiding mechanism in the movable positioning sleeve, and after positioning is completed, the positioning sleeve is driven into the body of the patient. The position of the guiding piece is locked at the moment, the pelvic acetabulum channel is further guided, a needle inserting point and a needle inserting direction do not need to be confirmed through repeated fluoroscopy while bone substances do not need to be thoroughly exposed in a large range, and minimal trauma, trace rays, precise guiding, safe screw placement and stable fixing of complex pelvic fractures are achieved.

Description

Technical Field

[0001] The invention relates to the field of surgical instrument processing, in particular to a minimally invasive screw placement guide device for treating pelvic acetabular anterior column fractures. Background Art

[0002] Anterior column fracture of the pelvis and acetabulum is caused by high-energy injury. The fracture line runs from the anterior column of the ilium, through the bottom of the acetabulum, downward to the middle of the inferior pubic ramus. Fracture here can lead to central dislocation of the femoral head and displacement of the fracture to the pelvic cavity. Due to the special shape of the acetabulum and the important nerves and blood vessels passing around it, combined injuries are very likely to occur. Pelvic acetabulum fractures account for 3% of all fracture incidence, and the mortality rate is as high as 13.4%. Treatment after injury has always been the focus of orthopedic surgeons.

[0003] Traditional internal fixation of pelvic acetabular fractures requires a large incision with extensive exposure. The biggest problem with a large incision is the need to expand the exposure of the incision, and the stripping and damage to the soft tissue are too great, which may cause some complications, such as massive blood loss during surgery, long postoperative recovery time, infection, wound healing, vascular and nerve damage, and heterotopic ossification.

[0004] In order to reduce the complications of traditional conventional surgical treatment of pelvic acetabular injuries, minimally invasive technology has been increasingly used in trauma orthopedics in recent years. It has many advantages: small surgical trauma, low complication rate and high patient acceptance. The minimally invasive technology of percutaneous channel screws in the treatment of pelvic acetabular injuries has been gradually promoted.

[0005] In recent years, minimally invasive treatment techniques for the pelvis and acetabulum have the advantages of small surgical incisions, less intraoperative bleeding, and low incidence of incision-related complications. In particular, anterior column screw fixation for the treatment of pelvic acetabular fractures was first used in clinical practice in the 1990s. This screw placement technique has high requirements for the surgeon's surgical operation. Deviation of the screw path during the screw placement process can cause vascular and nerve damage, and misplacement into the acetabulum can cause hip joint dysfunction. In recent years, with the assistance of navigation technology and robotic technology, the accuracy and safety of screw placement have been improved, greatly reducing the surgical trauma and intraoperative and postoperative complications caused by open reduction and internal fixation. Due to the high cost of computer navigation equipment, this technology is currently difficult to be widely used in grassroots hospitals. Summary of the invention

[0006] To solve the above problems, the present invention provides the following technical solutions:

[0007] A minimally invasive screw placement guide device for treating pelvic acetabular anterior column fractures, characterized by comprising:

[0008] A positioning sleeve, one end of which is an entry end that can enter the patient's body and contact the pelvis, and the other end is a control end located outside the patient's body, and a positioning channel is provided inside for the anterior column screw guide needle to pass through the control end to the entry end and then enter the patient's body;

[0009] A screw guide mechanism includes a guide member arranged inside a positioning channel of a positioning sleeve, and a universal locking mechanism capable of fixing the position of the guide member inside the positioning channel. The guide member can move inside the positioning channel, and a guide channel is provided inside the guide member for the movement of anterior column screw guide needle and anterior column screw. The anterior column screw guide needle and anterior column screw outside the positioning sleeve can be driven into the patient's pelvis through the guide member, and the guide member is fixed to the patient's pelvis.

[0010] Based on the above technical solution, the present invention can also be improved as follows.

[0011] Furthermore, the guide member is a tubular structure as a whole, and the overall length of the guide member is greater than or equal to the overall length of the positioning sleeve, and the diameter of the guide member is smaller than the inner diameter of the positioning channel inside the positioning sleeve.

[0012] Furthermore, a universal ball head is provided on the surface of the guide member near the entry end, and a concave lock hole structure adapted to the universal ball head is provided inside the positioning sleeve, which forms a riveted structure with the universal ball head and the guide member.

[0013] Furthermore, a fixed channel connecting the entry end and the control end is provided inside the positioning sleeve, and the fixed channel is not connected to the positioning channel. The interior of the fixed channel can allow the Kirschner wire to enter the patient's body.

[0014] Furthermore, the universal locking mechanism is located on the surface of the positioning sleeve close to the control end.

[0015] Furthermore, a hand-held handle is provided on the surface of the positioning catheter.

[0016] Furthermore, the surface of the entry end of the positioning sleeve surface is provided with an inclined surface that fits the shape of the slope surface of the posterior superior edge of the acetabulum.

[0017] Furthermore, a plurality of saw teeth are evenly arranged on the inclined surface of the entry end of the positioning sleeve surface.

[0018] Furthermore, the number of the universal locking mechanisms is at least two, and the universal locking mechanism includes a locking member located inside the positioning sleeve and in contact with the guide member, and a control member provided outside the positioning sleeve to control the position of the locking member inside the positioning sleeve.

[0019] A minimally invasive screw placement guide device for treating pelvic acetabular anterior column fractures is characterized by comprising the following steps:

[0020] S1. Use X-ray equipment to assess the fracture type and displacement direction and determine the location, direction, and length of the screws.

[0021] S2. Insert the positioning sleeve into the patient's body, and fit the entry end of the positioning sleeve surface with the slope surface of the posterior superior edge of the acetabulum;

[0022] S3. Insert the Kirschner wire into the patient's body through the fixed channel in the positioning sleeve, and rivet the positioning sleeve to the posterior superior slope of the acetabulum;

[0023] S4. Adjust the position of the guide member in the positioning sleeve, confirm that the guide member is aligned with the preselected insertion point of the anterior column screw guide needle through the X-ray device, and then fix the position of the guide member through the universal locking mechanism;

[0024] S5. Insert the anterior column screw guide wire into the guide and then drive the anterior column screw into the fracture.

[0025] Beneficial Effects

[0026] Compared with the prior art, the present invention can, through the positioning sleeve, perform preliminary positioning during the process of anterior column screw placement, and then insert the positioning sleeve into the patient's body. Then, the screw guide mechanism inside the movable positioning sleeve is used to perform secondary positioning of the guide member in the positioning catheter. After the positioning is completed, the position of the guide member is locked to further guide the pelvic acetabulum channel. Without the need to thoroughly expose the bone over a large area, there is no need for repeated fluoroscopy to confirm the insertion point and direction of the needle, thereby achieving minimal trauma, trace radiation, precise guidance, safe screw placement and stable fixation for complex pelvic fractures.

[0027] At the same time, the present invention can directly fix the positioning sleeve to the pelvic acetabulum through the toothed bevel provided at the entry end of the positioning sleeve and the fixing channel allowing the Kirschner wire to enter. The entire device can be regarded as an extension of a part of the pelvis outside the body. Taking it as a reference point, the position of the anterior column channel of the pelvic acetabulum can be accurately determined, and the guide pin and the guide piece can be used to reduce the change of orientation when penetrating the bone and the interference of the skin, soft tissue, etc., to further achieve precise guidance. At the same time, it can also effectively avoid the situation where the guide pin is easily displaced during the initial percutaneous minimally invasive manual screw placement because the insertion point of the antegrade anterior column screw is located at the upper edge of the acetabulum, which is a hard oblique ridge of bone. BRIEF DESCRIPTION OF THE DRAWINGS

[0028] In order to more clearly illustrate the technical solutions of the embodiments of the present invention, the accompanying drawings required for describing the embodiments will be briefly introduced below. Obviously, the accompanying drawings described below are only some embodiments of the present invention. For ordinary technicians in this field, other accompanying drawings can be obtained based on these accompanying drawings without paying creative work.

[0029] Figure 1 It is a schematic diagram of the cross-sectional structure of the invention;

[0030] Figure 2 It is a schematic diagram of the side section structure of the invention;

[0031] Figure 3 It is a schematic diagram of the top-sectional structure of the invention;

[0032] Figure 4 It is a schematic diagram of the cross-sectional structure of the invention;

[0033] Figure 5 for Figure 4 Enlarged structural diagram at A in the middle.

[0034] In the accompanying drawings, the components represented by the reference numerals are listed as follows:

[0035] 1. Positioning sleeve; 2. Screw guide mechanism; 21. Guide member; 22. Universal locking mechanism; 221. Locking member; 222. Control member; 23. Universal ball head; 24. Hand grip; 25. Fixed channel; 26. Concave lock hole structure. DETAILED DESCRIPTION

[0036] In order to facilitate the understanding of the present invention, the present invention will be described more fully below with reference to the relevant drawings. Several embodiments of the present invention are given in the drawings. However, the present invention can be implemented in many different forms and is not limited to the embodiments described herein. On the contrary, the purpose of providing these embodiments is to make the disclosure of the present invention more thorough and comprehensive.

[0037] It should be noted that when an element is referred to as being "fixed to" another element, it may be directly on the other element or there may be a central element. When an element is considered to be "connected to" another element, it may be directly connected to the other element or there may be a central element at the same time. The terms "vertical", "horizontal", "left", "right" and similar expressions used herein are for illustrative purposes only.

[0038] Unless otherwise defined, all technical and scientific terms used herein have the same meaning as those commonly understood by those skilled in the art of the present invention. The terms used herein in the specification of the present invention are only for the purpose of describing specific embodiments and are not intended to limit the present invention. The term "and / or" used herein includes any and all combinations of one or more related listed items.

[0039] It should be noted that similar reference numerals and letters denote similar items in the following drawings, and therefore, once an item is defined in one drawing, further definition and explanation thereof is not required in subsequent drawings.

[0040] It should be noted that the terms "center", "up", "down", "left", "right", "vertical", "horizontal", "inside", "outside", etc. indicate directions or positional relationships based on the directions or positional relationships shown in the accompanying drawings, or are directions or positional relationships in which the technical products are usually placed when in use. They are only for the convenience of describing the present technology and simplifying the description, and do not indicate or imply that the device or element referred to must have a specific direction, be constructed and operated in a specific direction, and therefore should not be understood as a limitation on the present technology.

[0041] Embodiment 1:

[0042] See also Figure 1 This embodiment discloses a minimally invasive screw placement guide device for treating pelvic acetabular anterior column fractures, including a positioning sleeve 1 and a screw guide mechanism 2 arranged inside the positioning sleeve 1.

[0043] Among them, the positioning sleeve 1 is a straight tubular structure as a whole, one end of which is an entry end that can enter the patient's body and contact the pelvis, and the other end is a control end located outside the patient's body. A positioning channel is provided inside for the anterior column screw guide needle to pass through the control end to the entry end and then enter the patient's body.

[0044] The screw guide mechanism 2 includes a guide member 21 arranged inside the positioning channel of the positioning sleeve 1, and a universal locking mechanism 22 capable of fixing the position of the guide member 21 inside the positioning channel, wherein the guide member 21 is a tubular structure as a whole, and the overall length of the guide member 21 is greater than or equal to the overall length of the positioning sleeve 1, and the diameter of the guide member 21 is smaller than the inner diameter of the positioning channel inside the positioning sleeve 1.

[0045] The guide member 21 can move inside the positioning channel, and a guide channel is provided inside the guide member 21 for the movement of the anterior column screw guide needle and the anterior column screw. The anterior column screw guide needle and the anterior column screw outside the positioning sleeve 1 can be driven into the patient's pelvis through the guide member 21, and the guide member 21 is fixed to the patient's pelvis.

[0046] Before the popularization of intelligent and remote robotic surgery, manual nail placement technology is still a basic skill that the majority of grassroots orthopedic trauma surgeons should master. Compared with manual nail placement, this embodiment can first insert the positioning sleeve 1 into the patient's body after rough positioning and make the entry end contact the pelvis, and then use the movable guide member 21 inside the positioning sleeve 1 to perform secondary positioning of the nail entry point, and then insert the anterior column screw guide needle through the guide member 21, and insert the anterior column channel screw. While there is no need to thoroughly expose the bone over a large area, there is no need for repeated fluoroscopy to confirm the insertion point and direction of the needle, thereby achieving minimal trauma, trace radiation, precise guidance, safe nail placement and stable fixation for complex pelvic fractures.

[0047] Embodiment 2:

[0048] The difference from Example 1 is that please refer to Figure 3 A universal ball head 23 is provided on the surface of the guide member 21 near the entry end, and a concave lock hole structure 26 adapted to the universal ball head 23 is provided inside the positioning sleeve 1, which forms a riveted structure with the universal ball head 23 and the guide member 21. The concave lock hole structure 26 can limit the position of the guide member 21 in the positioning sleeve 1, and can be a plate-like structure with a spherical concave hole inside, or a block-like structure with a spherical hollow groove inside that wraps the guide member 21 and the universal ball head 23 inside, which plays a certain limiting role and facilitates the adjustment of the position of the guide member 21 at the entry end at the control end.

[0049] Embodiment 3:

[0050] The difference from Example 2 is that please refer to Figure 2 In this embodiment, a fixing channel 25 connecting the entry end and the control end is provided inside the positioning sleeve 1. The fixing channel 25 is not connected to the positioning channel. The fixing channel can be a tubular structure or a cavity provided in the positioning sleeve 1. The interior of the fixing channel can allow the Kirschner wire to enter the patient's body, so as to increase the stability of the fixing sleeve riveted to the posterior upper edge slope of the acetabulum during surgery.

[0051] Embodiment 4:

[0052] Different from Example 3, please refer to Figure 2-3In order to facilitate the operation of the user, a hand-held handle 24 is provided on the surface of the positioning catheter. The universal locking mechanism 22 is located on the surface of the positioning sleeve 1 near the control end, and the number of the universal locking mechanisms 22 is at least two. Considering the production cost and the convenience of operation, the number is preferably two, and the two universal locking mechanisms 22 are relatively arranged on the surface of the positioning sleeve 1, wherein the universal locking mechanism 22 includes a locking member 221 located inside the positioning sleeve 1 and in contact with the guide member 21, and a locking member 221 located outside the positioning sleeve 1 for locking The control member 222 controls the position of the guide member 221 in the positioning sleeve 1. The locking member 221 can be a hemispherical structure, and the control member 222 can be a bolt-shaped structure. The locking member 221 is located at the end of the control member 222, and the control head of the control member 222 is located outside the positioning sleeve 1. A threaded tube compatible with the control member 222 is provided on the surface of the positioning sleeve 1. The user can lock and adjust the position of the tail end of the guide member 21 through the control member 222 according to the intraoperative fluoroscopy situation, thereby controlling the position of the guide member 21 in the patient's body.

[0053] Embodiment 5:

[0054] Different from Example 4, please refer to Figure 1-5 , considering that the most critical step in the process of anterior column screw placement is the control of the entry point, since the entry point of the antegrade anterior column screw is usually located at the upper posterior edge of the acetabulum, which is a hard oblique ridge of bone, the guide needle is easily displaced during the initial percutaneous minimally invasive freehand screw placement. In this embodiment, the surface of the entry end of the positioning sleeve 1 is provided with an inclined surface that fits the shape of the slope surface of the posterior upper edge of the acetabulum. The surface of the inclined surface of the entry end of the positioning sleeve 1 is evenly provided with a plurality of saw teeth, which can fit the surface of the posterior upper wall of the acetabulum to increase its friction, cooperate with the Kirschner wire introduced into the fixing channel, and further increase the stability of the fixing sleeve riveted to the posterior upper edge slope of the acetabulum during the operation.

[0055] To explain Embodiments 1 to 5 in more detail, based on Embodiments 1 to 5, a minimally invasive screw placement guide method for treating anterior column fracture of the pelvis and acetabulum is now disclosed, comprising the following steps:

[0056] S1. Use X-ray equipment to evaluate the type of fracture and displacement direction and determine the location, direction, and length of screw insertion.

[0057] S2. Insert the positioning sleeve 1 into the patient's body, and fit the entry end of the positioning sleeve 1 with a toothed slope on its surface to the slope surface of the posterior superior edge of the acetabulum.

[0058] S3. Insert the Kirschner wire into the patient's body through the fixed channel in the positioning sleeve 1, and rivet the positioning sleeve 1 to the posterior superior slope of the acetabulum.

[0059] S4. Adjust the position of the guide member 21 in the positioning sleeve 1, and after confirming through the X-ray equipment that the guide member 21 is aligned with the pre-selected insertion point of the anterior column screw guide needle, fix the position of the guide member 21 through the universal locking mechanism 22.

[0060] S5. Insert the anterior column screw guide needle into the guide member 21, and then drive the anterior column screw into the fracture site.

[0061] In addition, the terms "horizontal", "vertical", "overhanging" and the like do not mean that the components are required to be absolutely horizontal or overhanging, but can be slightly tilted. For example, "horizontal" only means that its direction is more horizontal than "vertical", and does not mean that the structure must be completely horizontal, but can be slightly tilted.

[0062] In the description of this technology, it is also necessary to explain that, unless otherwise clearly specified and limited, the terms "set", "install", "connect", and "connect" should be understood in a broad sense, for example, it can be a fixed connection, a detachable connection, or an integral connection; it can be a mechanical connection or an electrical connection; it can be a direct connection, or it can be indirectly connected through an intermediate medium, or it can be the internal communication of two components. For ordinary technicians in this field, the specific meanings of the above terms in this technology can be understood according to specific circumstances.

[0063] The above description is only a preferred specific implementation manner of the present invention, but the protection scope of the present invention is not limited thereto. Any technician familiar with the technical field can make equivalent replacements or changes according to the technical scheme and inventive concept of the present invention within the technical scope disclosed by the present invention, which should be covered by the protection scope of the present invention.

Claims

1. A minimally invasive screw placement guide device for treating pelvic acetabular anterior column fractures, characterized in that: include: A positioning sleeve (1) having one end as an entry end capable of entering into the patient's body and contacting the pelvis, and the other end as a control end located outside the patient's body, and having an internal positioning channel for an anterior column screw guide needle to pass through the control end to the entry end and then enter the patient's body; The screw guide mechanism (2) comprises a guide member (21) arranged inside a positioning channel of a positioning sleeve (1), and a universal locking mechanism (22) capable of fixing the position of the guide member (21) inside the positioning channel, wherein the guide member (21) is movable inside the positioning channel, and a guide channel for the movement of an anterior column screw guide needle and an anterior column screw is provided inside the guide member (21), and the anterior column screw guide needle and anterior column screw outside the positioning sleeve (1) can be driven into the patient's pelvis through the guide member (21), thereby fixing the guide member (21) on the patient's pelvis.

2. A minimally invasive screw placement guide device for treating pelvic acetabular anterior column fractures according to claim 1, characterized in that: The guide member (21) is a tubular structure as a whole, and the overall length of the guide member (21) is greater than or equal to the overall length of the positioning sleeve (1), and the diameter of the guide member (21) is smaller than the inner diameter of the positioning channel inside the positioning sleeve (1).

3. A minimally invasive screw placement guide device for treating pelvic acetabular anterior column fractures according to claim 2, characterized in that: A universal ball head (23) is provided on the surface of the guide member (21) near the entry end, and a concave lock hole structure (26) adapted to the universal ball head (23) is provided inside the positioning sleeve (1), which forms a riveted structure with the universal ball head (23) and the guide member (21).

4. A minimally invasive screw placement guide device for treating pelvic acetabular anterior column fractures according to claim 3, characterized in that: The interior of the positioning sleeve (1) is provided with a fixed channel (25) connecting the entry end and the control end. The fixed channel (25) is not connected to the positioning channel. The interior of the fixed channel (25) can allow the Kirschner wire to enter the patient's body.

5. A minimally invasive screw placement guide device for treating pelvic acetabular anterior column fractures according to claim 4, characterized in that: The universal locking mechanism (22) is located on the surface of the positioning sleeve (1) at a position close to the control end.

6. A minimally invasive screw placement guide device for treating pelvic acetabular anterior column fractures according to claim 5, characterized in that: A hand-held handle (24) is provided on the surface of the positioning catheter.

7. A minimally invasive screw placement guide device for treating pelvic acetabular anterior column fractures according to claim 6, characterized in that: The surface of the entry end of the positioning sleeve (1) is provided with an inclined surface which fits the shape of the slope surface of the posterior upper edge of the acetabulum.

8. A minimally invasive screw placement guide device for treating pelvic acetabular anterior column fractures according to claim 7, characterized in that: A plurality of saw teeth are evenly arranged on the surface of the inclined surface at the entry end of the positioning sleeve (1).

9. A minimally invasive screw placement guide device for treating pelvic acetabular anterior column fractures according to claim 8, characterized in that: The number of the universal locking mechanisms (22) is at least two, and the universal locking mechanisms (22) include a locking member (221) located inside the positioning sleeve (1) and in contact with the guide member (21), and a control member (222) located outside the positioning sleeve (1) and controlling the position of the locking member (221) inside the positioning sleeve (1).

10. A minimally invasive screw placement guiding method for treating pelvic acetabular anterior column fractures, comprising the minimally invasive screw placement guiding device for treating pelvic acetabular anterior column fractures according to any one of claims 1 to 9, characterized in that: The steps include: S1. Use X-ray equipment to assess the fracture type and displacement direction and determine the location, direction, and length of the screws. S2. The positioning sleeve (1) is inserted into the patient's body, and the surface of the positioning sleeve (1) is fitted with the slope surface of the posterior superior edge of the acetabulum; S3. Insert the Kirschner wire into the patient's body through the fixed channel in the positioning sleeve (1), and rivet the positioning sleeve (1) to the posterior superior slope of the acetabulum; S4. The position of the guide member (21) is adjusted in the positioning sleeve (1). After the guide member (21) is aligned with the preselected insertion point of the anterior column screw guide needle through the X-ray device, the position of the guide member (21) is fixed through the universal locking mechanism (22); S5. Insert the anterior column screw guide pin into the guide member (21), and then drive the anterior column screw into the fracture site.

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