Cerebral ventricle precise puncture orientation device and positioning method

Abstract

A ventricle precise puncture orientation instrument belongs to the technical field of medical instruments and comprises a fixing arm, a positioning arm, a fixing arm positioning mechanism, a positioning arm positioning mechanism and an orientation tube mechanism, and the fixing arm and the positioning arm are of an integrally nested arch structure; a fixed arm positioning mechanism and a directional pipe mechanism are arranged at the upper part of the fixed arm; a positioning arm positioning mechanism is arranged at the top end of the positioning arm; the fixing arm positioning mechanism comprises a fixing fork and fixing arm head nails, the fixing fork is movably connected to the upper portion of the fixing arm, the fixing fork is divided into two side arms, and the fixing arm head nails are arranged on the side arms respectively; the positioning arm positioning mechanism comprises a positioning arm head nail, and the positioning arm head nail and two fixed arm head nails are fixed to the head of a patient. According to the puncture orientation device, the orientation device can be directly fixed to the scalp and skull surface through a stable structure formed by the fixing arm positioning mechanism and the positioning arm positioning mechanism, so that accurate positioning is achieved, and the puncture orientation device has the advantages of being high in operability and accurate in puncture.

Description

TECHNICAL FIELD

[0001] The present application relates to the field of neurosurgical medical instruments, in particular to a ventricle precise puncture orientation instrument. BACKGROUND

[0002] Hydrocephalus is a common disease in neurosurgery, and ventriculo-peritoneal shunt is generally used to treat hydrocephalus. When ventricle puncture is performed, the approach used by neurosurgeons is divided into transoccipital angle ventricle and transfrontal angle puncture. Transfrontal angle puncture is rarely used due to its difficulty and high risk, while the transoccipital angle ventricle puncture has a long shunt ventricle end running distance. Since the operator cannot directly see the puncture direction and can only imagine, the accuracy is difficult to grasp, and deviation is easy to occur, resulting in inaccurate drainage tube position, injury or bleeding and other complications. Therefore, a ventricle puncture auxiliary device is often used to point to the positioning point. For example, patent number 201420184331.0 introduces a lateral ventricle puncture straight line positioner, which includes a crossbeam, a forehead positioning rod and a back pillow positioning rod, so that the positioning device on the forehead positioning rod and the positioning hook and hook on the back pillow positioning rod are in the same straight line, ensuring that the needle direction is along the straight line direction of the front and rear positioning points, which can realize straight line positioning of puncture, facilitate operation and reduce surgical trauma. Patent number 202120162576.3 introduces a new ventricle and hematoma directional puncture auxiliary device, which includes a support frame and three bracket devices, and has the characteristics of simple operation and precise puncture. Patent number 201621358018.X introduces a ventricle occipital angle puncture positioner, which includes a support frame, a first bracket, a second bracket and a handle, and can accurately and safely guide puncture. However, the above positioning devices need to be operated by hand and cannot be fixed to the scalp or skull. During the operation process, displacement is easy to occur, which deviates from the predetermined direction, causing the operation to fail and causing serious harm to the patient. SUMMARY

[0003] The technical problem to be solved by the present application is to overcome the defects of the prior art and provide a ventricle precise puncture orientation instrument. The stable structure formed by the fixing arm positioning mechanism and the positioning arm positioning mechanism can directly fix the orientation instrument to the scalp and skull surface, thereby realizing accurate positioning, and has the characteristics of strong operability and precise puncture.

[0004] The technical problem of the present application is solved by the following technical scheme: The application discloses a ventricle precise puncture orientation instrument, which comprises a fixing arm, a positioning arm, a fixing arm positioning mechanism, a positioning arm positioning mechanism and a directional tube mechanism, the fixing arm and the positioning arm are in an integrated arc structure, the upper part of the fixing arm is provided with the fixing arm positioning mechanism and the directional tube mechanism, and the top end of the positioning arm is provided with the positioning arm positioning mechanism, the fixing arm positioning mechanism comprises a fixing fork and a fixing arm head nail, the fixing fork is movably connected to the upper part of the fixing arm, the fixing fork is divided into two side arms, and the fixing arm head nail is arranged on each side arm, the positioning arm positioning mechanism comprises a positioning arm head nail, and the positioning arm head nail and the two fixing arm head nails are fixed on the head of a patient.

[0005] The fixing arm positioning mechanism further comprises a flange seat, the fixing fork comprises a connecting column, a supporting part and a vertical part, the supporting part is in a V-shaped structure, the bottom end of the supporting part is provided with the connecting column, the connecting column is sleeved on the flange seat, the supporting part is inclined to the direction of the positioning arm, the top end of the supporting part is provided with the vertical part, the vertical part is perpendicular to the horizontal direction, the fixing arm head nail is arranged on the inner side of the vertical part, and the distance between the two fixing arm head nails is 80mm.

[0006] The positioning arm positioning mechanism further comprises a knob, the knob is in threaded connection with the positioning arm, and the front end of the knob is provided with the positioning arm head nail.

[0007] The directional tube mechanism comprises a fixing piece, a directional tube and a first screw, the fixing piece is fixed to the top end of the fixing arm, and the directional tube is sleeved on the upper part of the fixing piece, the directional tube is in a hollow tubular structure, the directional tube is located between the two fixing arm head nails, and the axis of the directional tube is coaxial with the positioning arm head nail.

[0008] The angle between the supporting part of the fixing fork and the vertical direction is 30 degrees, and the height sum of the vertical direction of the supporting part and the vertical part is 100mm.

[0009] The directional tube is in a two-half-pipe structure which is cut along the axis of the pipe.

[0010] The fixing arm and the positioning arm are both in an L-shaped structure comprising a horizontal end and a vertical end, the horizontal end of the positioning arm is nested in the horizontal end of the fixing arm and can be telescopically moved in the horizontal end of the fixing arm, the horizontal end of the positioning arm is provided with a rack, and the horizontal end of the fixing arm is provided with a locking structure corresponding to the rack.

[0011] A positioning method of the ventricle precise puncture orientation instrument comprises the following steps. a. Perform CT or MRI of the patient's head to measure the entry point and exit point of the puncture target point, and make body surface marking, the imaginary line of the entry point and the exit point is the puncture path, and the distance from the entry point to the puncture target point is the puncture depth of the drainage tube; b. Place the directional instrument at the puncture site, place the positioning arm head nail at the exit point, and extend the directional tube end to the position of the entry point; rotate the fixed fork to make the fixed arm head nail fit on both sides of the entry point, and clamp the position of the fixed fork; adjust the fixing strength of the directional instrument by the knob, and the puncture direction is the axis of the directional tube to the positioning arm head nail; c. Loosen the first screw, remove the directional tube from the outside of the fixed arm, make a skin incision, and drill a hole in the skull; d. Install the directional tube and tighten the first screw, insert the drainage tube from the head end outside the directional tube into the directional tube and introduce it from the incision, and stop puncturing when the drainage tube reaches the predetermined puncture depth; remove the directional tube and the directional instrument, and complete the puncture operation.

[0012] The positioning method of the above-mentioned ventricle precise puncture directional instrument, after stopping puncturing in step d, the directional tube moves out of the directional instrument along the puncture direction, separates the directional tube along the radial direction and removes it, and the directional instrument is removed.

[0013] In the fixed arm positioning mechanism of the present application, the fixed fork is a V-shaped structure inclined inward, the two fixed arm head nails on the fixed fork correspond to the positioning arm head nail of the positioning arm positioning mechanism, the three head nail tips form a stable triangular structure and jointly point to the center position of the simulation ball, which can directly fix the directional instrument on the scalp and skull surface, form a stable structure and balanced moment, avoid the displacement and poor operability of the linear structure commonly used in the existing auxiliary device, and accurately reach the predetermined puncture target, realize accurate positioning and precise puncture.

[0014] The line between the directional tube and the positioning arm head nail of the directional tube mechanism of the present application is the puncture path, which can effectively realize linear positioning of puncture after being positioned on the skull surface, avoid human error displacement in handheld operation, ensure the puncture direction stable, improve the success rate of puncture tube placement, and reduce patient injury. The directional instrument of the present application has simple structure, strong operability and easy to master, which is not only suitable for ventricle puncture, but also can realize precise puncture of brain abscess and intracranial hematoma, and has wide application range. BRIEF DESCRIPTION OF DRAWINGS

[0015] Figure 1 is a structural schematic diagram of the present application; Figure 2 is a perspective view of the present application; Figure 3 is a top view of the present application; Figure 4 is a structural exploded view of the present application.

[0016] List of reference numerals in the figure: 1, fixed arm, 2, positioning arm, 3, flange seat, 4, fixed arm head nail, 5, simulation ball, 6, fixed part, 7, knob, 8, first screw, 9, directional tube, 10, fixed fork, 101, connecting column, 102, support part, 103, vertical part, 11, pin, 12, second bolt, 13, positioning arm head nail, 14, locking switch. DETAILED DESCRIPTION

[0017] The application will be further described in detail below with reference to the accompanying drawings.

[0018] As shown in Figure 1 , Figure 2 , Figure 4 The application includes a fixed arm 1, a positioning arm 2, a fixed arm positioning mechanism, a positioning arm positioning mechanism and a directional tube mechanism, the fixed arm and the positioning arm are both "L" shaped structures containing horizontal ends and vertical ends, the horizontal end of the positioning arm 2 is nested in the horizontal end of the fixed arm 1 and can move in and out of the horizontal end of the fixed arm; the fixed arm and the positioning arm nested together form an arcuate structure, the height of the arcuate structure is 225mm, and the length of the arcuate structure after stretching out is in the range of 420-450mm. The vertical end of the fixed arm 1 is provided with the fixed arm positioning mechanism and the directional tube mechanism, and the vertical end of the positioning arm 2 is provided with the positioning arm positioning mechanism; wherein the triangular structure formed by the fixed arm positioning mechanism and the positioning arm positioning mechanism can clamp the patient's head and fix the directional instrument on the head.

[0019] The distance between the fixed arm 1 and the positioning arm 2 can be adjusted, the bottom of the horizontal end of the positioning arm is provided with a rack, and the bottom of the horizontal end of the fixed arm is provided with a locking switch 14; when retracted, directly press the positioning arm to make it press into the fixed arm and fix the position by the locking switch, when stretched, pull the locking switch to make the positioning arm stretch out of the fixed arm to adjust the distance between the two, for adapting to the head size of different patients.

[0020] The fixed arm positioning mechanism comprises a flange seat 3, a fixed fork 10 and a fixed arm head nail 4. The flange seat 3 is arranged on the inner side of the upper part of the vertical end of the fixed arm. A cylindrical through slot is formed on the flange seat. A pin 11 is arranged on the side wall of the flange seat. The through slot is communicated with the pin hole. The fixed fork 10 comprises a connecting column 101, a support part 102 and a vertical part 103. The support part 102 is in V-shaped structure. The connecting column 101 is arranged at the bottom end of the support part. The connecting column is matched with the through slot of the flange seat and is nested in the through slot. The support part can rotate in the through slot. The support part is inclined to the positioning arm. The included angle between the support part and the vertical direction is 30 degrees. The sum of the vertical direction heights of the support part and the vertical part is 100 mm. The top ends of the two side arms of the support part are respectively provided with the vertical part 103. The vertical part is perpendicular to the horizontal direction. The two fixed arm head nails 4 are arranged on the inner sides of the two vertical parts. The distance between the tip ends of the two fixed arm head nails is 80 mm. The fixed fork is inclined to the positioning arm to leave space for operation. The fixed fork and the two fixed arm head nails thereon can rotate in the plane of the through slot to adapt to the different radii of the skull surface at different puncture sites and can make the fixed arm head nail directly abut against the skull surface to make the positioning stable. After the position of the fixed fork is determined, the pin 11 on the side wall of the flange seat abuts against the connecting column 101 to lock the fixed fork.

[0021] As shown in Figure 3 , Figure 4 , the top part of the vertical end of the positioning arm is provided with a sleeve. The inner wall of the sleeve is in internal thread structure. The positioning arm positioning mechanism is arranged in the sleeve. The positioning arm positioning mechanism comprises a knob 7 and a positioning arm head nail 13. The outer wall of the knob 7 is provided with external thread corresponding to the internal thread. The knob is movably connected to the top end of the positioning arm through the thread. The knob can be rotated into or out of the positioning arm by rotating the knob 7 to adjust the tightness of the directional instrument fixed on the skull surface. The positioning arm head nail 13 is arranged at the front end of the knob 7. The positioning arm head nail 13 and the two fixed arm head nails 4 form a triangular stable structure in the same plane. The simulation ball is arranged between the directional arm and the fixed arm. The simulation ball 5 is an imaginary ball for fixing the directional instrument. The diameter of the simulation ball is 20 mm, which is the head diameter of an adult. When the fixed fork is in the forward position, the two fixed arm head nails abut against the simulation ball. The axes of the fixed arm head nail and the positioning arm head nail jointly point to the central part of the simulation ball to form the moment balance of the ball. In actual application, the directional instrument can be firmly fixed on the skull surface to avoid displacement. The pressure sensor is arranged on the knob 7. The pressure applied by the knob to the skull is displayed on the sensor to provide intuitive operation basis for the doctor.

[0022] The directional tube mechanism comprises a fixing member 6, a directional tube 9, a second bolt 12 and a first screw 8. The fixing member 6 is long strip-shaped, the lower part of the fixing member is fixed to the top end of the fixed arm 1 by the second bolt 12, a through hole is formed in the upper part of the fixing member, and the directional tube 9 is inserted into the through hole. The first screw 8 is arranged on the top of the fixing member and is used for fixing the directional tube 9. The first screw is tightened or loosened to fix or loosen the directional tube. A star-shaped head is arranged on the first screw and is used for hand screwing. The directional tube 9 is hollow and tubular, the length of the directional tube is 80-120 mm, and the inner diameter of the directional tube is matched with the drainage tube. In order to reduce the weight of the directional tube, the outer diameter of the directional tube is gradually reduced while the inner diameter is kept unchanged. The directional tube can be a complete tubular structure or two half-tube structures which are cut along the axial direction of the tube, and is more convenient to use. The directional tube 9 is located at the middle position of the two fixed arm head nails and is on the same horizontal plane with the two fixed arm head nails. The directional tube is coaxial with the positioning arm head nail 13, the axis is the extension line of the two sides of the actual puncture direction of the directional instrument, and the direction of the axis is not affected by the rotation direction of the fixed fork. In use, the directional tube is selected according to the diameter of the drainage tube, the directional tube is inserted into the through hole of the fixing member, the drainage tube is pulled out of the directional tube during puncture and the direction of the drainage tube is fixed, so that the drainage tube is located on the axis of the directional tube and the positioning arm head nail. In order to adapt to drainage tubes with different diameters, several directional tubes with the same outer diameter and different inner diameters need to be provided. The directional instrument is made of stainless steel or titanium alloy, which ensures the strength of the instrument and is convenient for cleaning and disinfection.

[0023] The working process of the present application is further described as follows: Before performing craniopuncture, the intracranial point and the extracranial point of the puncture target are determined according to the head CT or MRI, and the body surface marks are made. At this time, the imaginary line connecting the intracranial point and the extracranial point is the puncture path, and the distance from the intracranial point to the puncture target is the puncture depth of the drainage tube. Electrode pieces can also be attached to the prepared body surface mark points, and then head CT scanning is performed to observe and adjust the position of the puncture path and the puncture target, so as to improve the accuracy of puncture. The positioning tube is selected according to the size of the drainage tube, and the positioning tube is placed in the through hole of the fixing member.

[0024] During puncture, the patient lies flat and turns his head to one side to expose the puncture site. The directional instrument is placed at the puncture site, and the distance between the fixed arm and the positioning arm is adjusted according to the size of the patient's head and is fixed. The positioning arm head nail 13 is placed at the extracranial point, the directional tube is extended, and the top end of the directional tube is placed at the intracranial point. The fixed fork is rotated, the fixed arm head nail 4 is fitted on both sides of the skin incision at the intracranial point, and the position of the fixed fork is clamped by the pin 11. After the positions of the fixed arm head nail and the directional tube are determined, the fixing strength of the directional instrument is adjusted by the knob to clamp the directional instrument. At this time, the puncture direction of the drainage tube has been fixed, that is, the axis of the directional tube 9 to the positioning arm head nail 13.

[0025] Loosen the first screw 8, and remove the directional tube from the outside of the fixed arm. After making a skin incision and drilling a hole in the skull, install the directional tube and tighten the first screw, insert the drainage tube into the directional tube from the outside of the directional tube, and introduce the drainage tube from the incision. Stop the puncture when the drainage tube reaches the predetermined puncture depth, move the directional tube out of the directional device parallel to the puncture direction, and remove the directional tube from the rear of the drainage tube. When the directional tube with the structure of two half tubes is used to move the directional tube out of the directional device, the directional tube is moved out of the directional device, and the directional tube is separated from the drainage tube in the radial direction, which reduces the contact with the drainage tube during the removal of the directional tube, and ensures that the punctured drainage tube does not move; then remove the directional device, and complete the puncture operation.

Claims

1. A ventricle puncture accurate orientation instrument, characterized in that, It includes fixed arm (1), positioning arm (2), fixed arm positioning mechanism, positioning arm positioning mechanism and directional tube mechanism, the fixed arm and the positioning arm are nested into an integral arch structure; The upper part of the fixed arm (1) is provided with a fixed arm positioning mechanism and a directional tube mechanism, and the top end of the positioning arm (2) is provided with a positioning arm positioning mechanism; The fixed arm positioning mechanism comprises a fixed fork (10) and a fixed arm head nail (4), the fixed fork (10) is movably connected to the upper part of the fixed arm, the fixed fork is divided into two side arms, and the fixed arm head nail (4) is arranged on each side arm respectively; The positioning arm positioning mechanism comprises a positioning arm head nail (13), and the positioning arm head nail is fixed on the head of the patient together with the two fixed arm head nails.

2. The ventricular precise puncture orientation apparatus according to claim 1, wherein, The fixed arm positioning mechanism further comprises a flange seat (3); The fixed fork (10) comprises a connecting column (101), a support part (102) and a vertical part (103), the support part (102) is a V-shaped structure, the bottom end of the support part is provided with the connecting column (101), the connecting column is sleeved on the flange seat, the support part is inclined to the positioning arm, the top end of the support part is respectively provided with the vertical part (103), the vertical part is perpendicular to the horizontal direction, the fixed arm head nail (4) is arranged on the inner side of the vertical part, and the distance between the two fixed arm head nail tips is 80mm.

3. The ventricular precise puncture orientation apparatus according to claim 2, wherein, The positioning arm positioning mechanism further comprises a knob (7), and the knob is threadedly connected with the positioning arm; The front end of the knob (7) is provided with a positioning arm head nail (13).

4. The ventricular precise puncture orientation apparatus according to claim 3, wherein, The directional tube mechanism comprises a fixing piece (6), a directional tube (9) and a first screw (8), the fixing piece (6) is fixed to the top end of the fixed arm (1), and the directional tube (9) is sleeved on the upper part of the fixing piece; The directional tube (9) is a hollow tubular structure, the directional tube is located between the two fixed arm head nails, and the axis of the directional tube is coaxial with the positioning arm head nail (13).

5. The ventricular precise puncture orientation apparatus according to claim 4, wherein, The angle between the support part (102) of the fixed fork and the vertical direction is 30 degrees, and the height sum of the support part (102) and the vertical part (103) in the vertical direction is 100mm.

6. The ventricular precise puncture orientation apparatus according to claim 5, wherein, The directional tube is a two-half-tube structure cut along the axis of the tube.

7. The ventricular precision puncture pointer of claim 6, wherein, The fixed arm and the positioning arm are both "L" shaped structures comprising a horizontal end and a vertical end, the horizontal end of the positioning arm (2) is nested in the horizontal end of the fixed arm (1) and can move in and out of the horizontal end of the fixed arm; The horizontal end of the positioning arm is provided with a rack, and the horizontal end of the fixed arm is provided with a locking structure corresponding to the rack.

8. The positioning method of the ventricle puncture directional instrument according to claim 7, characterized in that, The method comprises the following steps: a. Perform CT or MRI of the patient's head, measure and determine the intracranial point and the extracranial point of the puncture target point, and make good surface marking, the imaginary line connecting the intracranial point and the extracranial point is the puncture path, and the distance from the intracranial point to the puncture target point is the puncture depth of the drainage tube; b. Place the directional instrument at the puncture site, place the positioning arm head nail (13) at the extracranial point, and extend the end of the directional tube to the position of the intracranial point; Rotate the fixed fork so that the fixed arm head nails fit on both sides of the intracranial point, and clamp the position of the fixed fork; Adjust the fixing strength of the directional instrument by the knob, and the puncture direction is the axis of the directional tube to the positioning arm head nail; c. Loosen the first screw, remove the directional tube from the outside of the fixed arm, make a skin incision, and drill a hole in the skull; d. Install the directional tube and tighten the first screw, insert the drainage tube into the directional tube from the head end outside the directional tube and introduce it by the incision, stop the puncture when the drainage tube reaches the predetermined puncture depth; remove the directional tube and the directional instrument, complete the puncture operation.

9. The positioning method of the ventricle precision puncture direction instrument of claim 8, wherein, Step d, after stopping the puncture, the directional tube is moved out of the directional instrument along the puncture direction, the directional tube is separated along the radial direction and removed, and the directional instrument is removed.

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