Positioning structure for assisting in screw feeding of lumbar pedicle screw

Abstract

The utility model relates to the technical field of spine surgical operations, in particular to a positioning structure for assisting in screw entering of a lumbar pedicle screw, and aims to solve the problem that in the process of implanting the lumbar pedicle screw, a screw entering point is difficult to determine due to special conditions. In order to achieve the purpose, the positioning structure for assisting in nailing of the lumbar pedicle screw comprises a main body part, the main body part is provided with a first end and a second end which are opposite to each other, the first end is provided with a limiting piece, and the limiting piece is used for being attached to the side surface of the transverse process when the first end abuts against the outer side edge of the zygopophysis, so that the transverse process is clamped in the second end; therefore, the displacement of the main body part is limited. When the lumbar pedicle screw placement device is used for placing the lumbar pedicle screw, an operator can determine the position of the transverse process by touching and sensing attachment of the limiting piece and the side surface of the transverse process, then the screw entering point is determined, muscle of a surgical site of a patient does not need to be stripped in a large range, and the requirement of a minimally invasive surgery is met; and the working efficiency and the accuracy of determining the position of the nail feeding point are higher.

Description

Technical Field

[0001] The present application relates to the technical field of spinal surgery, and specifically provides a positioning structure for assisting the insertion of lumbar pedicle screws. Background Art

[0002] Lumbar pedicle screw placement is widely used to treat most spinal surgery-related diseases and is the basic step in most lumbar surgeries in spinal surgery. As for the method of inserting lumbar pedicle screws, the industry mostly uses the "herringbone ridge" method to locate the lumbar transverse process and insert the screw. However, in some special cases, for example, some patients have severe lumbar degeneration, osteophyte hyperplasia, or spinal deformity, scoliosis, etc., or the original anatomical landmarks are destroyed during revision surgery, which will make it difficult to identify and locate the midpoint of the lumbar transverse process, making it difficult to determine the insertion point. Utility Model Content

[0003] The present application aims to solve the above-mentioned technical problem, that is, to solve the problem that it is difficult to determine the screw insertion point due to special circumstances during the insertion of lumbar pedicle screws.

[0004] In a first aspect, the present application provides a positioning structure for assisting lumbar pedicle screw insertion, comprising:

[0005] The main body has a first end and a second end opposite to each other. The first end is provided with a limiting member, which is used to fit with the side surface of the transverse process when the first end abuts against the outer edge of the articular process, thereby limiting the displacement of the main body.

[0006] When the above technical solution is adopted, during the operation, after the first end of the main body abuts the outer edge of the articular process, the operator determines the position of the transverse process by tactile sensation of the fit between the limiter and the side surface of the transverse process, and then determines the nail entry point. There is no need to peel off the muscles of the patient's surgical site on a large scale, which meets the requirements of minimally invasive surgery. In addition, compared with the method of determining the position of the transverse process by "blind tactile detection", the operation efficiency is higher and the accuracy of determining the nail entry point is also higher.

[0007] In a technical solution of the above positioning structure, the limiting member includes a first clamping pin arranged on the first side of the first end, and the first clamping pin limits the movement of the main body in a direction away from the first side when it is in contact with the side surface of the transverse process of the lumbar vertebra; and / or

[0008] The limiting member includes a second clamping pin disposed on the second side of the first end, and when the second clamping pin is in contact with the side surface of the transverse process of the lumbar vertebra, it limits the movement of the main body toward a direction away from the second side.

[0009] When the above technical solution is adopted, the position of the transverse process is determined by the first clamping needle and / or the second clamping needle fitting the outer edge of the transverse process, and the structural design and operation are relatively simple.

[0010] In a technical solution of the above positioning structure, a recessed area is provided on the main body, and the recessed area forms an accommodating space for the screw to enter.

[0011] When the above technical solution is adopted, an accommodating space for the screw to enter is formed in front of the recessed area, thereby providing sufficient operating space for the screw placement process, making the screw placement more convenient.

[0012] In a technical solution of the above positioning structure, the main body is a plate-like structure with an arc-shaped cross-section, and the concave side of the plate-like structure forms the recessed area.

[0013] When the above technical solution is adopted, the space occupied by the incision site of the patient can be reduced to the maximum extent, thereby reducing the pulling of the main body on the muscles around the incision of the patient.

[0014] In a technical solution of the above positioning structure, a scale mark is provided on the main body, and an extension direction of the scale mark is perpendicular to an extension direction of the main body.

[0015] When the above technical solution is adopted, combined with the width of the transverse process measured before surgery, when the limiter is in contact with the transverse process, the reading is started from one end of the scale mark, and the scale position where half of the width of the transverse process is located is the midpoint of the transverse process.

[0016] In a technical solution of the above positioning structure, the scale mark is located away from the second end.

[0017] When the above technical solution is adopted, it is helpful to expose the scale markings to the operator's field of vision.

[0018] In a technical solution of the above positioning structure, the second end is connected to a hand-held portion, and an extension direction of the hand-held portion is arranged at an angle with an extension direction of the main body portion.

[0019] When the above technical solution is adopted, the operation of the positioning structure is more convenient.

[0020] In a technical solution of the above positioning structure, the scale mark is arranged at the connection between the main body and the hand-held part.

[0021] When the above technical solution is adopted, it can be ensured that the scale markings are fully exposed to the operator's field of vision.

[0022] In a technical solution of the above positioning structure, the first end is provided with an arcuate surface adapted to the outer edge of the articular process of the lumbar vertebra.

[0023] When the above technical solution is adopted, the arcuate surface can increase the contact area between the first end of the main body and the outer edge of the articular process, making the main body more stable when abutting against the articular process, which is more conducive to the subsequent determination of the nail entry point and nail placement.

[0024] In a technical solution of the above positioning structure, the limiting member is configured so that when the arcuate surface is in contact with the articular process, the angle between the extending direction of the main body and the sagittal plane of the lumbar vertebral body is 10°-30°.

[0025] When the above technical solution is adopted, the main body can provide sufficient space for the screw to tilt during the screw placement process and play a certain reference role in the inclination angle of the screw. BRIEF DESCRIPTION OF THE DRAWINGS

[0026] The preferred embodiments of the present application are described below in conjunction with the accompanying drawings, in which:

[0027] Figure 1 It is a schematic diagram of the bone outline of the human lumbar spine;

[0028] Figure 2 is a schematic diagram of a positioning structure for assisting lumbar pedicle screw insertion according to an embodiment of the present application;

[0029] Figure 3 This is a schematic diagram of a positioning structure according to an embodiment of the present application being applied during surgery.

[0030] The reference numerals are as follows:

[0031] 100, superior articular process; 200, inferior articular process; 300, transverse process;

[0032] 1. Main body; 11. Arc surface; 12. Recessed area; 2. Hand-held part; 31. First card pin; 32. Second card pin. DETAILED DESCRIPTION

[0033] The preferred embodiments of the present application are described below with reference to the accompanying drawings. It should be understood by those skilled in the art that these embodiments are only used to explain the technical principles of the present application and are not used to limit the scope of protection of the present application. Those skilled in the art can make adjustments to them as needed to adapt to specific application scenarios.

[0034] It should be noted that in the description of this application, the terms "upper", "lower", "left", "right", "inner", "outer", etc., which indicate directions or positional relationships, are based on the directions or positional relationships shown in the drawings. This is only for the convenience of description, and does not indicate or imply that the relevant devices or components must have a specific orientation, be constructed and operated in a specific orientation. Therefore, it cannot be understood as a limitation on this application. In addition, the ordinal numbers "first", "second", etc. are only used for descriptive purposes and cannot be understood as indicating or implying relative importance.

[0035] In addition, it should be noted that in the description of this application, unless otherwise clearly specified and limited, the terms "installation" and "connection" 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 an indirect connection through an intermediate medium. For those skilled in the art, the specific meanings of the above terms in this application can be understood according to specific circumstances.

[0036] Reference Figure 1 , is a schematic diagram of the skeleton outline of the human lumbar spine, in which the transverse process 300 is located between the superior articular process 100 and the inferior articular process 200. For the lumbar pedicle screw placement surgery, it is necessary to find the midpoint of the width direction of the transverse process 300 and insert the screw based on the midpoint of the transverse process 300. In the prior art, the "herringbone ridge screw insertion method" is generally used to achieve the above purpose, that is, the vertex of the intersection of the accessory ridge and the isthmus ridge at the posterior and lateral side of the root of the superior articular process is used as the screw insertion point.

[0037] However, in some special cases, the above-mentioned mimic crest structure is difficult to identify. For example, some elderly patients have degeneration or hyperplasia of the lumbar spine, which will block the mimic crest, or some patients have spinal deformities, scoliosis, etc., which will also make the mimic crest structure difficult to identify. In addition, in some surgical scenarios, when the transverse process is subjected to secondary revision surgery, the original anatomical landmarks may be destroyed, making it impossible to identify the mimic crest. Therefore, it is difficult to find the entry point through the "mimic crest entry method" in the above situation. For some minimally invasive surgeries, such as mis-TLIF (minimally invasive lumbar interbody fixation and fusion), a large range of muscle stripping should be avoided as much as possible during the operation. In this case, due to the small surgical incision, the area of ​​the transverse process exposed to the surgeon's field of view is very limited. Therefore, how to determine the position of the lumbar transverse process and find the entry point under the above premise has become an urgent problem to be solved in this field.

[0038] In some related technologies, in order to avoid the generation of a large range of muscle glass, a long rod-shaped device is used to blindly probe the position of the transverse process to roughly determine the entry point. Specifically, the long rod-shaped device is a rigid component. The operator holds the rod of the long rod-shaped device against the patient's lumbar spine. When the rod touches the hard part around the patient's pedicle, it indicates that the position may be the transverse process. Further, when moving along the transverse process toward the upper articular process and the lower articular process, when the soft part is touched and sensed, it indicates that the position may be the muscle at the upper and lower edges of the transverse process, and then the approximate position and width of the transverse process are determined, and then the entry point is found based on this. However, using this method, on the one hand, due to the uncertainty of the tactile "blind exploration", it is a "tentative" method, and the efficiency of determining the entry point is low. On the other hand, it is affected by human operation factors and bone differences between different patients, and the accuracy of determining the entry point is also difficult to guarantee.

[0039] Reference Figure 2 , is a positioning structure for assisting lumbar pedicle screw insertion disclosed in one embodiment of the present application, comprising a main body 1, the main body 1 having a first end and a second end opposite to each other, the first end of the main body 1 being provided with an arcuate surface 11 adapted to the outer edge of the articular process of the lumbar vertebra. In order to facilitate the operation, in one embodiment of the present application, a hand-held portion 2 is further connected to the end of the main body 1 away from the arcuate surface 11, the extension direction of the hand-held portion 2 is arranged at an angle with the extension direction of the main body 1, the specific value of the angle can be set according to actual needs, and the general principle is to facilitate screw insertion.

[0040] The first end of the main body 1 is connected to a limiting member, which may be a rod-shaped or plate-shaped member, and the present application does not impose any restrictions on this. In the process of determining the nail insertion point, the first end of the main body 1 is first inserted into the incision of the patient's surgical site. When the first end abuts against the outer edge of the articular process (the outer edge of the articular process is an arc-shaped surface, which can be observed by the surgeon with the naked eye), the main body 1 is moved, and combined with the surgeon's tactile feedback, when the limiting member is sensed to fit the side surface of the transverse process, it indicates that the position of one side edge in the width direction of the transverse process is determined. At this time, according to the location of the main body 1 and the width of the transverse process measured before the operation, the midpoint of the transverse process can be determined as the nail insertion point with the main body 1 as a reference.

[0041] Reference Figure 3 Combined with the bone shape of the human lumbar spine, at the intersection of the transverse process and the upper and lower articular processes, the outer edge contour of the articular process is an approximate arc surface. Therefore, the present application sets the end of the main body 1 as an arc surface 11, which can increase the contact area between the first end of the main body 1 and the outer edge of the articular process. The main body 1 is more stable when abutting against the articular process, which is more conducive to the subsequent determination of the nail entry point and nail placement.

[0042] The present application provides a limit piece at the first end of the main body 1. After the first end of the main body 1 abuts against the outer edge of the articular process, the operator determines the position of the transverse process by tactile sensation of the fit between the limit piece and the side surface of the transverse process, and then determines the nail entry point. There is no need to peel off the muscles of the patient's surgical site on a large scale, which meets the requirements of minimally invasive surgery. In addition, compared with the method of determining the position of the transverse process by "blind tactile detection", the operation efficiency is higher and the accuracy of determining the position of the nail entry point is also higher.

[0043] Reference Figure 2 In one embodiment of the present application, the stopper includes a first card pin 31 and a second card pin 32 connected to the first end of the main body 1. For the convenience of description, one side of the first end of the main body 1 is referred to as the first side, and the other side opposite to the first side is referred to as the second side. The first card pin 31 is located on the first side of the first end of the main body 1, and the second card pin 32 is located on the second side of the first end of the main body 1. When the first end of the main body 1 abuts against the outer edge of the articular process, the first card pin 31 and the second card pin 32 are respectively located on different sides of the transverse process, so that when the first card pin 31 abuts against the side surface of the transverse process, the main body 1 can be limited to move in the direction away from the first side, and when the second card pin 32 abuts against the side surface of the transverse process, the main body 1 can be limited to move in the direction away from the second side.

[0044] It should be noted that, due to the differences in the sizes of the transverse processes of different patients, it is difficult to achieve that the first clamping needle 31 and the second clamping needle 32 are in contact with the transverse process at the same time in actual operation. Therefore, generally speaking, in the process of determining the position of the transverse process, the position of one side edge of the transverse process can be determined only by the first clamping needle 31, or the position of the other side edge of the transverse process can be determined only by the second clamping needle 32. Both methods can achieve the positioning of the transverse process.

[0045] In addition, it should be noted that the relative position relationship between the first clamping pin 31 and the second clamping pin 32 can be determined according to actual application requirements. For example, the first clamping pin 31 and the second clamping pin 32 can form a certain angle, so that the combination of the first clamping pin 31 and the second clamping pin 32 is a trumpet-shaped opening, so as to ensure that the main body 1 can be clamped at the transverse process through the opening. Or in other implementation forms, the first clamping pin 31 and the second clamping pin 32 are movably connected to the main body 1 and can be fixed by a locking structure. In this way, when the main body 1 is inserted into the incision of the surgical site of the patient, the position of the first clamping pin 31 and the second clamping pin 32 can be adjusted to prevent them from hindering the process of determining the transverse process. When the arc surface 11 is in contact with the outer edge of the articular process, the first clamping pin 31 and the second clamping pin 32 can be adjusted again so that they clamp the transverse process and fix the main body 1.

[0046] It should be noted that, although in the above-mentioned embodiment of the present application, the position-limiting member includes the first clamping pin 31 and the second clamping pin 32 as an example for illustrative description, this does not constitute a limitation to the present application. In some other implementations, only the first clamping pin 31 or the second clamping pin 32 may be provided. For example, when only the first clamping pin 31 is provided, after the arc-shaped surface 11 is fitted with the articular process, the operator applies a force in the direction away from the first side to the main body 1, so that the first clamping pin 31 is pressed against the transverse process. At this time, the position of the transverse process is determined, and then the midpoint of the transverse process can be determined by measurement. In addition, during the process of nail placement, the force in the above-mentioned direction may also be applied to the main body 1 all the time, so as to fix the position of the main body 1.

[0047] Reference Figure 2 As a possible implementation of the present application, a recessed area 12 is further provided on one of the surfaces of the main body 1. In actual operation, when the main body 1 is inserted into the incision of the surgical site of the patient, the side of the main body 1 with the recessed area 12 is the side for screw insertion, and the side surface of the main body 1 away from the recessed area 12 is in contact with the muscle of the patient's incision area. In this way, a receiving space for screws to enter is formed in front of the recessed area 12, thereby providing sufficient operating space for the screw placement process, making it more convenient to place the screw.

[0048] In some embodiments, the main body 1 can be configured as a plate-like structure with an arc-shaped cross section, and the concave side of the plate-like structure forms the above-mentioned recessed area 12. In this way, the main body 1 is configured as a plate-like structure, which can minimize the space it occupies at the incision site of the patient, thereby reducing the pulling of the main body 1 on the muscles around the incision of the patient.

[0049] Since in the lumbar pedicle screw placement surgery, there is a certain angle between the axial direction of the screw and the sagittal plane of the vertebral body, and the angle is generally about 15°. Therefore, in order to ensure that the recessed area 12 can provide sufficient space for the inclination angle of the screw and play a certain reference role in the inclination angle of the screw, the present application arranges the limiter so that when the arc surface 11 is in contact with the articular process, the angle between the extension direction of the main body 1 and the sagittal plane of the lumbar vertebral body is 10°-30°.

[0050] In order to facilitate finding the midpoint of the transverse process, further, a scale mark is provided on the main body 1. Since the direction of nail insertion is roughly the same as the extension direction of the main body 1, the extension direction of the scale mark is set to be perpendicular to the extension direction of the main body 1. In this way, combined with the width value of the transverse process measured before surgery, the reading is started from one end of the scale mark, and the scale position where half of the width value of the transverse process is located is the midpoint of the transverse process. In this way, when inserting the nail, the scale position determined by the above process is used as the reference point for nail insertion. After determining the angle between the screw and the sagittal plane, the nail insertion can be started.

[0051] In order to expose the scale mark to the operator's field of vision as much as possible, in one embodiment of the present application, the scale mark is arranged at the end of the main body 1 away from the first end thereof.

[0052] Since the side where the recessed area 12 is located is the nail insertion side, it can be understood that the extension direction of the handheld portion 2 should be set on the back side of the recessed area 12 to prevent the handheld portion 2 from obstructing the nail insertion. Since the handheld portion 2 and the main body 1 are arranged crosswise, in one implementation, the scale mark can be set at the connection between the main body 1 and the handheld portion 2 to fully expose the scale mark to the operator's field of view. It should be noted that for the setting form of the scale mark, in order to facilitate observation, a flat plate-like component such as an acrylic plate can be set on the handheld portion 2, and then the scale mark is set on the flat plate-like component, or the handheld portion 2 can be directly set to a planar structure, and the scale mark is set on the plane. The specific form of the scale mark is not limited by this application, as long as it can improve the measurement accuracy and facilitate observation by the operator.

[0053] So far, the technical solutions of the present application have been described in conjunction with the preferred embodiments shown in the accompanying drawings. However, it is easy for those skilled in the art to understand that the protection scope of the present application is obviously not limited to these specific embodiments. Without departing from the principles of the present application, those skilled in the art can make equivalent changes or substitutions to the relevant technical features, and the technical solutions after these changes or substitutions will fall within the protection scope of the present application.

Claims

1. A positioning structure for assisting lumbar pedicle screw insertion, characterized in that: include: The main body has a first end and a second end opposite to each other. The first end is provided with a limiting member, which is used to fit with the side surface of the transverse process when the first end abuts against the outer edge of the articular process, thereby limiting the displacement of the main body.

2. The positioning structure according to claim 1, characterized in that: The limiting member includes a first clamping pin disposed on a first side of the first end, and the first clamping pin restricts the main body from moving in a direction away from the first side when in contact with the side surface of the transverse process of the lumbar vertebra; and / or The limiting member includes a second clamping pin disposed on the second side of the first end, and when the second clamping pin is in contact with the side surface of the transverse process of the lumbar vertebra, it limits the movement of the main body toward a direction away from the second side.

3. The positioning structure according to claim 1, characterized in that: The main body is provided with a recessed area, and the recessed area forms an accommodating space for the screw to enter.

4. The positioning structure according to claim 3, characterized in that: The main body is a plate-like structure with an arc-shaped cross section, and the concave side of the plate-like structure forms the recessed area.

5. The positioning structure according to claim 1, characterized in that: The main body is provided with a scale mark, and the extension direction of the scale mark is perpendicular to the extension direction of the main body.

6. The positioning structure according to claim 5, characterized in that: The scale mark is located at the second end.

7. The positioning structure according to claim 5, characterized in that: The second end is connected with a hand-held portion, and an extending direction of the hand-held portion is arranged at an angle with an extending direction of the main body portion.

8. The positioning structure according to claim 7, characterized in that: The scale mark is arranged at the connection between the main body and the hand-held part.

9. The positioning structure according to any one of claims 1 to 8, characterized in that: The first end is provided with an arcuate surface adapted to the outer edge of the articular process of the lumbar vertebra.

10. The positioning structure according to claim 9, characterized in that: The limiting member is configured such that when the arcuate surface is in contact with the articular process, an angle between an extending direction of the main body and a sagittal plane of the lumbar vertebral body is 10°-30°.

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