Automatic navigation device for percutaneous sacroiliac joint screw implantation based on C-arm fluoroscopy

Abstract

The utility model provides a percutaneous sacroiliac joint screw implantation automatic navigation device based on C-arm fluoroscopy. The percutaneous sacroiliac joint screw implantation automatic navigation device comprises an X-ray machine, a supporting seat, a first positioning mechanism, a second positioning mechanism, a positioning needle and a remote controller. The positions and the inclination angles of the first positioning frame and the second positioning frame are respectively controlled through the remote controller, so that the plane where the first positioning frame is located and the plane where the second positioning frame is located are crossed to form a guide channel for implanting sacroiliac joint screws; by improving positioning needles at the two ends of the body surface of the positioning frame, errors caused by C-arm perspective magnification amplification can be reduced, and the navigation precision is higher; compared with CT three-dimensional navigation and robot navigation, the manufacturing cost is low, through automatic operation, the operation steps are simplified, the operation difficulty is reduced, operation complications are reduced, a common traumatic orthopedist can conduct operation only by distinguishing the standard pelvis entrance position and the pelvis exit position, and the operation efficiency is improved. The technology for treating the pelvic posterior ring injury through the percutaneous sacroiliac joint penetrating screw can be popularized and applied in primary hospitals, and vast patients can be popularized.

Description

Technical Field

[0001] The utility model relates to the technical field of medical devices, and in particular to an automated navigation device for percutaneous sacroiliac joint screw implantation based on C-arm fluoroscopy. Background Art

[0002] Pelvic fractures are common and severe injuries in trauma orthopedics, mostly caused by high-energy trauma, accounting for about 3% of all fractures in the body, of which the incidence of unstable posterior pelvic ring injuries is 17%-30%. Since Matta and Saucedo et al. first reported in 1989 that lag screws were used to fix the ilium to sacral 1 (S1) and sacral 2 (S2) to fix unstable posterior pelvic ring fractures, percutaneous sacroiliac joint screw implantation has become a common minimally invasive surgery for fixing unstable posterior pelvic ring injuries. However, percutaneous sacroiliac joint screw fixation surgery has a high incidence of nerve and vascular injury, which is reported in the literature to be 3%-15%.

[0003] The traditional C-arm X-ray fluoroscopic positioning and navigation percutaneous sacroiliac joint screw implantation technology uses the principle of forming two cross-shaped planes by C-arm fluoroscopy of the pelvic inlet and outlet to achieve positioning (according to Figure 1 The method shown in the figure realizes the cross positioning of two planes. This technology first determines the standard pelvic entrance position through fluoroscopy (at this time, the projections of the cortical bones of the anterior edges of the S1 and S2 vertebrae on the C-arm overlap to form a line), then inserts a guide needle (2.5×250mm Kirschner wire) through the buttocks, and adjusts the guide needle under the fluoroscopy of the standard pelvic entrance position so that the projection of the guide needle on the C-arm is adjacent to the rear of the projection line of the cortical bones of the anterior edges of the S1 and S2 vertebrae. Then, the standard pelvic outlet position is determined through fluoroscopy (at this time, the projection of the upper edge of the pubic symphysis on the C-arm is adjacent to the lower edge of the projection of the anterior foramen of S1, and the projections of the bilateral S1 and S2 foramina can be clearly seen on the C-arm). Then adjust the Kirschner wire to the upper edge of the projection of the anterior foramen of S1 (close to the upper edge of the foramen of S1), or adjust it to between the projections of the foramen of S1 and S2, and then perform fluoroscopy of the pelvic entrance and exit positions, and repeatedly adjust the Kirschner wire, so that the projection of the Kirschner wire on the C-arm will eventually meet the requirements of being close to the rear of the projection line of the cortical bone of the anterior edge of the S1 and S2 vertebrae at the pelvic entrance position, and close to the upper edge of the foramen of S1 at the pelvic exit position, or adjust it to between the projections of the S1 and S2 foramen, and then insert the Kirschner wire into the opposite side while keeping the direction and angle of the Kirschner wire unchanged, and then introduce the hollow sacroiliac joint screw into the sacrum through the guide needle to complete the sacroiliac joint screw fixation surgery. This technique requires repeated adjustment of the position fluoroscopy of the C-arm machine, repeated adjustment of the position and angle of the Kirschner wire during the operation, and requires a surgeon with rich surgical skills to complete it.

[0004] In order to solve the shortcomings of percutaneous sacroiliac joint screw surgery under traditional C-arm fluoroscopy, intraoperative CT can implement three-dimensional navigation. The three-dimensional images in the sagittal, coronal and cross-sectional planes can be clearly displayed through intraoperative three-dimensional scanning, and the position of the screws can be accurately determined, which greatly reduces the risk of screws penetrating the bone cortex and damaging nerves and blood vessels. However, there are also complex operations, a long learning curve, and the need for special equipment and professional operators. The orthopedic robot system has the advantages of accurate positioning, real-time monitoring, and fewer fluoroscopy times in assisting the sacroiliac joint screw implantation and fixation treatment of posterior pelvic ring injuries. However, the cost of instruments and equipment is expensive, the operation is complex, the assembly and detection are difficult, professional training is required, and the high cost of maintenance and maintenance limits its promotion and popularization in clinical practice.

[0005] In response to a series of problems existing in the current percutaneous sacroiliac joint screw implantation, the applicant submitted a utility model patent application in 2023, entitled "A percutaneous sacroiliac joint screw navigation device", with patent publication number CN116585019A, which provides a new navigation method for the promotion and expansion of percutaneous sacroiliac joint screw technology in the treatment of posterior pelvic ring injuries. In actual clinical applications, it has obvious advantages over traditional freehand percutaneous sacroiliac joint screw surgery under C-arm fluoroscopy. The number of C-arm fluoroscopy times and guide needle adjustment and displacement times are significantly reduced, and the accuracy of guide needle implantation is significantly improved. The entire operation time is greatly shortened from an average of more than 90 minutes to about 20 minutes, and the number of intraoperative C-arm fluoroscopy times is reduced from more than 100 times to about 20 times. However, with the continuous use of the device, the utility model author found that the device still has some shortcomings, such as the laser marking instrument needs to be repeatedly adjusted when fixed on the C-arm machine, the laser cursor and the midline section of the C-arm machine are prone to errors, and the laser marking instrument during surgery is easy to touch the operating table drape guide. The laser line marker emits a beam of light that is projected onto the navigation positioning frame, and the back of the positioning frame needs to be repeatedly adjusted to be consistent with the cursor. The manual adjustment accuracy is poor, which affects the navigation accuracy. In addition, after adjusting the positioning frame to be consistent with the C-arm machine section, the first and second positioning frames need to be repeatedly displaced forward and backward under the C-arm fluoroscopy, so that the projection of the surface guide needle on the first positioning frame under the standard pelvic inlet fluoroscopy is adjacent to the rear of the cortical bone projection line of the anterior edge of the S1 and S2 vertebrae, and the projection of the surface guide needle on the second positioning frame under the standard pelvic outlet fluoroscopy is adjacent to the S1 and S2 vertebrae. The upper edge of the anterior hole projection (close to the upper edge of the sacral 1 hole), or between the projections of the sacral 1 and sacral 2 holes, and then insert the guide pin to the pelvis through the U-shaped slot of the first positioning frame and the intersection of the second positioning frame and the U-shaped slot. After the pelvic entrance and exit positions are fluoroscopically examined to determine that the guide pin is located on the ideal bone channel, the guide pin is inserted into the sacrum, and the hollow sacroiliac joint screw is screwed in through the guide pin to complete the screw implantation fixation. During this process, there is a certain error in adjusting the positioning frame. Each time the positioning frame is adjusted, the C-arm must be fluoroscopically examined once to determine whether the ideal position has been reached, which is cumbersome. In addition, due to the magnification problem of the C-arm, there is an error in navigation accuracy. After the guide pin is placed, the pelvic entrance and exit positions must be projected again to fine-tune the guide pin to the ideal sacral channel. Utility Model Content

[0006] To solve the above problems, the purpose of the utility model is to provide an automated navigation device for percutaneous sacroiliac joint screw implantation based on C-arm fluoroscopy, which can effectively solve the problems of navigation accuracy error and cumbersome operation in existing navigation devices, while further reducing the number of C-arm fluoroscopy times during surgery and reducing the problem of X-ray radiation to patients and medical staff.

[0007] The purpose of the utility model is achieved through the following technical solutions:

[0008] An automated navigation device for percutaneous sacroiliac joint screw implantation based on C-arm fluoroscopy comprises an X-ray machine, a support seat, a first positioning mechanism, a second positioning mechanism and a positioning needle.The support seat is a hollow box that is placed flat between the transmitting end and the receiving end of the X-ray machine and is X-ray-permeable and is composed of two layers of flat plates; a strip groove that is connected to the inside of the support seat is provided on the upper flat plate of the support seat along its length direction; the first positioning mechanism includes a first linear drive, a first bracket, a first rotating block, a first motor, a second motor and a first positioning frame; the first linear drive is installed on the lower flat plate of the support seat; the first bracket is installed on the moving part of the first linear drive and can move back and forth along the length direction of the strip groove under the drive of the first linear drive; the first rotating block is rotatably installed on the first bracket through the rotating shafts at its front and rear ends; the first motor is fixed to the first bracket and its driving shaft is connected to the rotating shaft of the first rotating block The second motor is fixed on the first rotating block and its driving shaft is rotatably installed in the first rotating block; the first positioning frame is long and is located above the upper flat plate of the support seat, and the lower part of the first positioning frame passes downward through the strip groove and then rotates to extend into the first rotating block and is connected to the driving shaft of the second motor, and a first hollow groove running through the front and rear side surfaces is provided in the middle of the side wall of the first positioning frame along its length direction; the second positioning mechanism includes a second linear drive, a second bracket, a second rotating block, a third motor, a fourth motor and a second positioning frame; the second linear drive is installed on the lower flat plate of the support seat; the second bracket is installed on the moving part of the second linear drive and can move back and forth along the length direction of the strip groove under the drive of the second linear drive The second rotating block is rotatably mounted on the second bracket through the rotating shafts at its front and rear ends; the third motor is fixed on the second bracket and its driving shaft is transmission-connected to the rotating shaft of the second rotating block; the fourth motor is fixed on the second rotating block and its driving shaft is rotatably mounted in the second rotating block; the second positioning frame is long and is located above the upper flat plate of the support seat, and the lower part of the second positioning frame passes downward through the strip groove and then rotates to extend into the second rotating block and is transmission-connected to the driving shaft of the fourth motor, and a second hollow groove that runs through the front and rear side surfaces is provided in the middle part of the side wall of the second positioning frame along its length direction; the middle part of the first positioning frame and the middle part of the second positioning frame intersect each other above the upper flat plate of the support seat; the positioning pin includes a first positioning pin, a second positioning pin, and a third positioning pin , the fourth positioning pin and the guide pin; the first positioning pin and the second positioning pin are both installed on the first positioning frame and are parallel to each other, wherein the first positioning pin is located above the intersection of the first positioning frame and the second positioning frame, and the second positioning pin is located below the upper plate of the support seat, and the first positioning pin, the second positioning pin and the first hollow groove are all located on the same plane; the third positioning pin and the fourth positioning pin are both installed on the second positioning frame and are parallel to each other, wherein the third positioning pin is located above the intersection of the first positioning frame and the second positioning frame, and the fourth positioning pin is located below the upper plate of the support seat, and the third positioning pin, the fourth positioning pin and the second hollow groove are all located on the same plane; the guide pin is movably sleeved in the cross hole formed by the intersection of the first hollow groove and the second hollow groove.

[0009] Furthermore, the first linear drive and the second linear drive are slidably installed on the lower flat plate of the support seat, and a third linear drive is installed on the lower flat plate of the support seat in front of the first linear drive and the second linear drive. The moving part of the third linear drive is respectively connected to the first linear drive and the second linear drive and can drive the first linear drive and the second linear drive to move back and forth along the length direction of the strip groove.

[0010] Furthermore, the first linear drive, the second linear drive and the third linear drive are all ball screw linear drive mechanisms, and the ball screw can achieve precise movement, ensure accurate and reliable positioning, and reduce errors.

[0011] Furthermore, the first linear drive and the second linear drive are connected in a straight line and installed on the lower flat plate of the support seat.

[0012] Furthermore, the automated navigation device for percutaneous sacroiliac joint screw implantation based on C-arm fluoroscopy also includes a motor controller, which is used to control the operation of the first motor, the second motor, the third motor, the fourth motor, the first linear drive, the second linear drive and the third linear drive respectively.

[0013] Furthermore, the automated navigation device for percutaneous sacroiliac joint screw implantation based on C-arm fluoroscopy also includes a remote controller with a display screen; the remote controller is connected to the motor controller via Bluetooth and controls the operation of the first motor, the second motor, the third motor, the fourth motor, the first linear drive, the second linear drive, and the third linear drive via the motor controller. After the motor controller establishes a wireless connection with the remote controller via Bluetooth, the fine movement of the first positioning frame and the second positioning frame is controlled by operating the remote controller during the operation to achieve precise navigation.

[0014] Furthermore, in order to reduce the amount of X-ray fluoroscopy and shorten the positioning time, angle sensors are installed on the first positioning frame and the second positioning frame respectively; an electronic angle measuring instrument is installed on the X-ray machine; the angle sensor and the electronic angle measuring instrument are electrically connected to the motor controller, and can display the measured figures on the display screen of the remote control in real time. The inclination angles of the pelvic entrance and pelvic outlet to the horizontal plane are measured by reading the electronic angle measuring instrument on the C-arm X-ray machine, and then the positioning frame is controlled by the remote control to adjust its inclination angle to be close to the inclination angle of the C-arm at the pelvic entrance or pelvic outlet horizontal plane. To improve the accuracy, the first motor is remotely controlled to drive the first positioning frame to rotate under perspective, so that the projections of the first guide needle and the second guide needle on the first positioning frame overlap when the C-arm perspective is at the pelvic entrance. This indicates that the first positioning frame and the C-arm perspective section are completely on the same plane at the pelvic entrance. The first linear motor is remotely controlled to drive the first positioning frame to move back and forth under perspective, so that the overlapping shadows of the first guide needle and the second guide needle are exactly adjacent. The projection line of the cortical bone of the anterior edge of the sacral 1 and sacral 2 vertebrae is behind; similarly, the third motor is remotely controlled to rotate the second positioning frame under fluoroscopy so that the projections of the second guide pin and the fourth guide pin on the second positioning frame overlap when the C-arm fluoroscopy pelvic outlet position is in progress. This indicates that the second positioning frame and the C-arm fluoroscopy section are completely in the same plane when the pelvic outlet position is in progress. The second linear motor is remotely controlled to move back and forth under fluoroscopy so that the overlapping shadows of the third guide pin and the fourth guide pin are located exactly at the upper edge of the projection of the sacral 1 hole or between the projection lines of the sacral 1 and sacral 2 holes, thereby reducing the need for repeated fluoroscopy when adjusting the angle of the positioning frame and reducing the error problem caused by the magnification of the C-arm fluoroscopy, thereby achieving the purpose of precise navigation.

[0015] Furthermore, to ensure the accuracy of the guide needle positioning, the middle part of the first positioning frame is a U-shaped structure, and the U-shaped opening of the U-shaped structure passes through the upper and lower surfaces of the first positioning frame and is connected to the first hollow groove. There are two first hollow grooves and they are symmetrically arranged on the front and back sides of the U-shaped structure.

[0016] Furthermore, the portion of the second positioning frame with the second hollow groove is cross-sheathed in the round-shaped opening of the round-shaped structure, and the second hollow groove crosses with the two first hollow grooves to form two cross holes.

[0017] Furthermore, the portion of the second positioning frame with the second hollow groove is provided with a hollow opening penetrating through the upper and lower surfaces thereof.

[0018] Furthermore, the first positioning needle, the second positioning needle, the third positioning needle, the fourth positioning needle and the guide needle are all Kirschner wires.

[0019] Furthermore, the X-ray machine is a C-arm X-ray machine.

[0020] Compared with the prior art, the utility model has the following beneficial effects:

[0021] The utility model remotely controls the position and inclination of the first positioning frame and the second positioning frame respectively, so that the standard pelvic inlet plane where the first positioning frame is located and the standard pelvic outlet plane where the second positioning frame is located intersect to form a guide channel for implanting sacroiliac joint screws. The positioning frame adjustment accuracy is higher and the operation is simplified in the whole process. By improving the positioning pin design at both ends of the positioning frame body surface, the principle of adjusting the two positioning pins under C-arm perspective to make their projections overlap to determine that the plane where the positioning frame is located is in the same plane as the X-ray perspective pelvic inlet or pelvic outlet is used, replacing the cumbersome operation of using a laser cursor to adjust the positioning frame and the X-ray perspective to be in the same plane and the error problem caused by it. In addition, the positioning pins are designed at both ends of the positioning frame, which can greatly reduce the error problem caused by the magnification of the C-arm perspective, and make the navigation accuracy higher. At the same time, compared with CT three-dimensional navigation and robot navigation, the device has low cost, and through automated operation, simplified operation, reduced surgical difficulty, and reduced surgical complications, so that ordinary trauma orthopedic surgeons only need to identify the standard pelvic inlet and pelvic outlet to perform surgical operations, so that the percutaneous sacroiliac joint screw treatment of posterior pelvic ring injury technology can be promoted and applied in grassroots hospitals and popularized to a large number of patients. BRIEF DESCRIPTION OF THE DRAWINGS

[0022] The utility model is further described in detail below in conjunction with the accompanying drawings.

[0023] Figure 1 This is a schematic diagram of the principle of using a C-arm to see through the pelvic inlet and outlet to form two cross planes for positioning. The figure is quoted from the paper "A novel biplanar positioning technique to guideiliosacral screw insertion: a retrospective study"--Yangyang Zhao, Pengju Cui, Zhenggang Xiong, Jiachun Zheng and Deguo Xing.

[0024] Figure 2 It is a structural schematic diagram of the automatic navigation device for percutaneous sacroiliac joint screw insertion of the utility model.

[0025] Figure 3 for Figure 2 Schematic diagram of the structure after removing the X-ray machine and the support base.

[0026] Figure 4 for Figure 3 The schematic diagram of the structure after removing the first linear drive, the second linear drive, and the third linear drive.

[0027] Figure 5When the C-arm X-ray machine is used to irradiate the pelvic entrance, the projection line of the bone cortex of the anterior edge of the S1 vertebra overlaps with the projection line of the bone cortex of the anterior edge of the S2 vertebra. When the guide needle is implanted close to the posterior edge of the overlapping line (not exceeding the anterior edge of the overlapping shadow) and parallel to it, the position of the guide needle in the bony channel of the S1 vertebra.

[0028] Figure 6 When the C-arm X-ray machine is used to irradiate the pelvic outlet, the guide needle is close to the upper edge of the S1 foramen (cannot enter the S1 foramen) and is parallel to the line connecting the bilateral S1 foramina (not intersecting), and the position of the guide needle in the bony channel of the S1 vertebra.

[0029] Figure 7 This is a CT image of the sacroiliac joint screw implanted in the bony channel of the S1 vertebra.

[0030] Figure 8 When the C-arm X-ray machine is used to irradiate the pelvic entrance, the projection line of the bone cortex of the anterior edge of the S1 vertebra overlaps with the projection line of the bone cortex of the anterior edge of the S2 vertebra. When the guide needle is implanted close to the posterior edge of the overlapping line (not exceeding the anterior edge of the overlapping shadow) and parallel to it, the position of the guide needle in the bony channel of the S2 vertebra.

[0031] Fig. 9 When the C-arm X-ray machine is used to irradiate the pelvic outlet, the guide needle is located between the projection line of the lower edges of the bilateral sacral 1 foramina and the projection line of the upper edges of the bilateral sacral 2 foramina, and is parallel to (not intersecting) the projection line of the lower edges of the bilateral sacral 1 foramina and the projection line of the upper edges of the bilateral sacral 2 foramina. The position of the guide needle in the bony channel of the S2 vertebrae.

[0032] Fig.10 This is a CT image of the sacroiliac joint screw implanted in the bony channel of the S2 vertebra.

[0033] As shown in the figure: 1-X-ray machine, 2-support seat, 3-first positioning mechanism, 31-first linear drive, 32-first bracket, 33-first rotating block, 34-first motor, 35-second motor, 36-first positioning frame, 361-first hollow groove, 362-first insertion hole, 363-reciprocating mouth, 4-second positioning mechanism, 41-second linear drive, 42-second bracket, 43-second rotating block, 44-third motor, 45-fourth motor, 46-second positioning frame, 461-second hollow groove, 462-second insertion hole, 463-hollow mouth, 5-positioning needle, 51-first positioning needle, 52-second positioning needle, 53-third positioning needle, 54-fourth positioning needle, 55-guide needle, 6-third linear drive, 61-connecting rod, 62-slider, 7-cross hole. DETAILED DESCRIPTION

[0034] The following is an explanation of the implementation of the present invention by specific embodiments. People familiar with the technology can easily understand other advantages and effects of the present invention from the contents disclosed in this specification. The described embodiments are only part of the embodiments of the present invention, not all of them. Based on the embodiments of the present invention, all other embodiments obtained by ordinary technicians in this field without creative work are within the scope of protection of the present invention.

[0035] It should be noted that the structures, proportions, sizes, etc. drawn in the drawings of this specification are only used to match the contents disclosed in the specification for people familiar with this technology to understand and read, and are not used to limit the limiting conditions for the implementation of the utility model, so they have no substantial technical significance. Any modification of the structure, change of the proportional relationship or adjustment of the size, without affecting the effects and purposes that can be achieved by the utility model, should still fall within the scope of the technical content disclosed by the utility model. At the same time, the terms such as "upper", "lower", "left", "right", "middle" and so on quoted in this specification are only for the convenience of description, and are not used to limit the scope of the implementation of the utility model. The change or adjustment of their relative relationship should also be regarded as the scope of the implementation of the utility model without substantial change of the technical content.

[0036] In the description of the present invention, it should be noted that, unless otherwise clearly specified and limited, the terms "connected" 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 ordinary technicians in this field, the specific meanings of the above terms in the present invention can be understood according to specific circumstances. Example 1

[0037] like Figure 2-4 As shown, this embodiment provides an automated navigation device for percutaneous sacroiliac joint screw implantation based on C-arm fluoroscopy, including an X-ray machine 1, a support seat 2, a first positioning mechanism 3, a second positioning mechanism 4, a positioning needle 5, a motor controller and a remote control.

[0038] The X-ray machine 1 is a C-arm X-ray machine (a conventional surgical device). The X-ray machine 1 mainly includes a transmitting end, a receiving end, an arm, etc. The transmitting end and the receiving end are arranged opposite to each other, and the arm is C-shaped.

[0039] The support base 2 is a hollow box body that is placed flat between the transmitting end and the receiving end of the X-ray machine 1 and is transparent to X-rays and is composed of two layers of flat plates (the two layers of flat plates are parallel to each other and hollowed out between them, forming a box body with front and rear openings); a strip groove 21 that is connected to the inside of the support base 2 is provided along its length direction on the upper flat plate of the support base 2. The support base 2 is made of a carbon fiber material that is transparent to X-rays, the upper flat plate is used for lying patients, and the lower flat plate is used as a mounting base. After the patient lies on the upper flat plate, the patient's pelvic position is located between the transmitting end and the receiving end of the X-ray machine 1.

[0040] The first positioning mechanism 3 includes a first linear drive 31, a first bracket 32, a first rotating block 33, a first motor 34, a second motor 35 and a first positioning frame 36; the first linear drive 31 is installed on the lower flat plate of the support seat 2, and adopts the existing ball screw linear drive mechanism, a slide groove is provided on the top of which; the first bracket 32 ​​is installed on the moving part (nut) of the first linear drive 31, and the lower end of the first bracket 32 ​​extends downward through the slide groove on the top of the first linear drive 31 and is fixedly connected to the nut on the screw rod of the first linear drive 31, and can move back and forth along the length direction of the strip groove 21 with the nut under the drive of the first linear drive 31; the first rotating block 33 is rotatably installed on the first bracket 32 ​​through the rotating shafts at its front and rear ends; the first motor 34 is fixed on the first bracket 32 ​​and its drive shaft is transmission-connected with the rotating shaft of the first rotating block 33 (coaxial The first positioning frame 36 is in the shape of an elongated strip and its middle and upper parts are both located above the upper flat plate of the support seat 2. The lower part of the first positioning frame 36 passes downward through the strip groove 21 and then rotates into the first rotating block 33 to be transmission-connected (coaxially connected) with the driving shaft of the second motor 35 (so that the first positioning frame 36 can rotate around the rotating axis of the first rotating block 33 with the first rotating block 33, and the first positioning frame 36 can also rotate axially under the drive of the second motor 35). In the middle part of the side wall of the first positioning frame 36, a first hollow groove 361 is provided along its length direction, which runs through its front and rear side surfaces. At least one first insertion hole 362 is provided on the upper side wall of the first positioning frame 361 along its length direction, which runs through its front and rear side surfaces and is used to insert the first positioning needle 51.

[0041] The second positioning mechanism 4 includes a second linear drive 41, a second bracket 42, a second rotating block 43, a third motor 44, a fourth motor 45 and a second positioning frame 46; the second linear drive 41 is installed on the lower flat plate of the support seat 2, and the second linear drive 41 also adopts the existing ball screw linear drive mechanism, and a slide groove is also provided on the top; the second bracket 42 is installed on the moving part (nut) of the second linear drive 41 and can move back and forth along the length direction of the strip groove 21 driven by the second linear drive 41, and the lower end of the second bracket 42 passes through the slide groove at the top of the second linear drive 41 and is fixedly connected with the nut inside the second linear drive 41, and can move back and forth linearly under the drive of the nut; the second rotating block 43 is rotatably installed on the second bracket 42 through the rotating shafts at its front and rear ends; the third The motor 44 is fixed on the second bracket 42 and its driving shaft is connected to the rotating shaft of the second rotating block 43; the fourth motor 45 is fixed on the second rotating block 43 and its driving shaft is rotatably installed in the second rotating block 43, and the fourth motor 45 can rotate with the second rotating block 43; the second positioning frame 46 is in the shape of a long strip and its middle and upper parts are both located above the upper plate of the support seat 2. The lower part of the second positioning frame 46 passes through the strip groove 21 downward and then rotates and extends into the second rotating block 43 to be connected to the driving shaft of the fourth motor 45. A second hollow groove 461 is provided in the middle of the side wall of the second positioning frame 46 along its length direction, which runs through its front and rear sides; the middle part of the first positioning frame 36 and the middle part of the second positioning frame 46 intersect each other above the upper plate of the support seat 2, and the first hollow groove 361 and the second hollow groove 461 intersect to form a cross hole 7. At least one second insertion hole 462 is provided on the upper side wall of the second positioning frame 46 along its length direction, which runs through its front and rear sides and is used to insert the third positioning needle 53.

[0042] The positioning needles include a first positioning needle 51, a second positioning needle 52, a third positioning needle 53, a fourth positioning needle 54 and a guide needle 55, wherein the first positioning needle 51, the second positioning needle 52, the third positioning needle 53, the fourth positioning needle 54 and the guide needle 55 are all Kirschner wires; the first positioning needle 51 and the second positioning needle 52 are both installed on the first positioning frame 36 and are parallel to each other, wherein the first positioning needle 51 is located above the intersection of the first positioning frame 36 and the second positioning frame 46 (one end of the first positioning needle 51 is vertically installed in one of the first insertion holes 362 on the upper part of the first positioning frame 36, and the other end extends above the patient's pelvis); the second positioning needle 52 is arranged below the upper flat plate of the support seat and is located below the intersection of the first positioning frame 36 and the second positioning frame 46 (one end of the second positioning needle 52 is installed at the lower part of the first positioning frame 36, and the other end extends below the patient's pelvis). The third positioning pin 53 and the fourth positioning pin 54 are both installed on the second positioning frame 46 and are parallel to each other, wherein the third positioning pin 53 is located above the intersection of the first positioning frame 36 and the second positioning frame 46 (one end of the third positioning pin 53 is vertically installed in one of the second insertion holes 462 on the upper part of the second positioning frame 46, and the other end extends above the patient's pelvis); the fourth positioning pin 54 is arranged below the upper flat plate of the support seat 2 and is located below the intersection of the first positioning frame 36 and the second positioning frame 46 (one end of the fourth positioning pin 54 is installed at the lower part of the second positioning frame 46, and the other end extends below the patient's pelvis); the guide pin 55 is movably sleeved in the cross hole 7 formed by the intersection of the first hollow groove 361 and the second hollow groove 461, specifically: one end of the guide pin 55 passes through the cross hole 7 formed by the intersection of the first hollow groove 361 and the second hollow groove 461, and the other end can move along the cross hole 7 toward the patient's ilium.

[0043] The first insertion hole 362 (the line connecting the centers of all the first insertion holes 362), the first hollow groove 361 (the center line along its length), the first positioning pin 51 (the center line), the second positioning pin 52 (the center line), the guide pin 55 and the cross hole 7 (the center line) are all located on the same plane. Let this plane be plane A. When the X-ray machine 1 is at the pelvic entrance position, plane A is parallel to the light beam of the X-ray machine 1 and the symmetrical cross section of the X-ray machine 1.

[0044] The second insertion holes 462 (the line connecting the centers of all the second insertion holes 462), the second hollow groove 461 (the center line along its length), the third positioning pin 53 (the center line), the fourth positioning pin 54 (the center line), the guide pin 55 and the cross hole 7 (the center line) are all located on the same plane, which is referred to as plane B. When the X-ray machine 1 is at the pelvic outlet position, plane B is parallel to the beam of the X-ray machine 1 and the symmetrical cross section.

[0045] The intersection of plane A and plane B is the center line of the cross hole 7, that is, after the guide needle 55 is inserted along the center line of the cross hole 7, the extension line of the guide needle 55 is located at the intersection of plane A and plane B. The intersection is located on the anterior side of the sacral vertebra S1 (close to the upper edge of the sacral 1 foramen) or the anterior side of the sacral vertebra S2, which is the safe needle insertion area.

[0046] The first linear drive 31 and the second linear drive 41 are slidably mounted on the lower flat plate of the support seat 2. A third linear drive 6 is mounted on the lower flat plate of the support seat 2 at a position in front of the first linear drive 31 and the second linear drive 41. The moving part (nut) of the third linear drive 6 is respectively connected to the first linear drive 31 and the second linear drive 41 and can drive the first linear drive 31 and the second linear drive 41 to move back and forth along the length direction of the strip groove 21. The third linear drive 6 is an existing ball screw linear drive mechanism like the first linear drive 31 and the second linear drive 41. The ball screw can achieve precise movement, ensure accurate and reliable positioning, and reduce errors. The third linear drive 6 is provided with a sliding groove on the side facing the first linear drive 31 and the second linear drive 41. A slider 61 fixedly connected to the nut of the third linear drive 6 is provided outside the sliding groove. The slider 61 is respectively connected to the first linear drive 31 and the second linear drive 41 through a connecting rod 62. The first linear drive 31 and the second linear drive 41 are connected in a line and mounted on the lower flat plate of the support seat 2. The third linear drive 6 can drive the structure formed by the first linear drive 31 and the second linear drive 41 , the first positioning mechanism 3 , the second positioning mechanism 4 and the positioning pin 5 to move back and forth on the support base 2 .

[0047] The motor controller (the existing motor controller can be selected) is used to control the operation of the first motor 34, the second motor 35, the third motor 44, the fourth motor 45, the first linear drive 31 (motor), the second linear drive 41 (motor) and the third linear drive 6 (motor), respectively. The first motor 34, the second motor 35, the third motor 44, the fourth motor 45, the motor of the first linear drive 31, the motor of the second linear drive 41 and the motor of the third linear drive 6 are all stepper motors. The remote control automatically displays the screen (a conventional remote control can be selected); the remote control is connected to the motor controller via Bluetooth and controls the operation of the first motor 34, the second motor 35, the third motor 44, the fourth motor 45, the first linear drive 31, the second linear drive 41 and the third linear drive 6 through the motor controller. After the motor controller establishes a wireless connection with the remote control via Bluetooth, the remote control is operated to control each motor during the operation to achieve fine movement of the first positioning frame 36 and the second positioning frame 46, thereby achieving precise navigation.

[0048] In addition, in order to reduce the amount of X-ray fluoroscopy and shorten the positioning time, angle sensors are installed on the first positioning frame 36 and the second positioning frame 46 respectively; an electronic angle measuring instrument is installed on the X-ray machine 1; the angle sensor and the electronic angle measuring instrument are electrically connected to the motor controller, and can display the measured figures on the display screen of the remote control in real time. By reading the inclination angles of the entrance and exit positions and the horizontal plane measured by the electronic angle measuring instrument on the C-arm X-ray machine 1, and then controlling the first positioning frame 36 through the remote control to adjust its inclination angle to be consistent with the inclination angle of the horizontal plane of the C-arm entrance or exit position, it is indicated that the first positioning frame 36 is parallel to the C-arm section (the beam of the X-ray machine 1), thereby reducing the need for repeated fluoroscopy when adjusting the positioning frame angle.

[0049] The operation steps of the above-mentioned percutaneous sacroiliac joint screw implantation automated navigation device are as follows:

[0050] S1. Place the support base 2 of the automated navigation device for percutaneous sacroiliac joint screw implantation on an operating table or bed, while the patient lies supinely on the upper flat plate of the support base 2.

[0051] S2. Control the third linear drive 6 through the remote control to move the automated navigation device (the structure except the third linear drive 6 and the support seat 2) for percutaneous sacroiliac joint screw implantation to the side of the patient's pelvis.

[0052] S3. Adjust the position of the X-ray machine 1 so that it irradiates the pelvic entrance position. At this time, the projection line of the bone cortex of the anterior edge of the sacral 1 vertebra overlaps with the projection line of the bone cortex of the anterior edge of the sacral 2 vertebra; read the inclination angle of the entrance position measured by the electronic angle measuring instrument on the C-arm X-ray machine and the horizontal plane, and control the first motor 34 through the remote control to control the inclination of the first positioning frame 36. After the angle sensor value is consistent with the value measured by the electronic angle measuring instrument, the remote control controls the first motor 34 to drive the first positioning frame 36 to make a fine adjustment rotation under X-ray fluoroscopy, so that the projections of the first positioning pin 52 and the second positioning pin 52 on the first positioning frame 36 overlap. At the same time, the first positioning frame 36 is controlled by controlling the second motor 35 to make an axial angle rotation, so that the projections of the first positioning pin 51 and the second positioning pin 52 overlap at the pelvic entrance position of the C-arm fluoroscopy and are parallel to the overlapping shadows of the cortical surfaces of the anterior edges of the sacral 1 and sacral 2 vertebrae, that is, the adjustment of the inclination angle of the first positioning frame 36 is completed. Then, the first linear driver 31 is controlled by the remote control, and the first linear driver 31 drives the first positioning frame 36 on which the inclination angle adjustment is completed to move back and forth in a straight line. Under X-ray irradiation, the overlapping line of the projection of the first positioning pin 51 and the projection of the second positioning pin 52 is closely attached to the rear edge of the projection line of the cortical bone of the anterior edge of the sacral 1 vertebra or closely attached to the rear edge of the projection line of the cortical bone of the anterior edge of the sacral 2 vertebra, thereby completing the positioning of the entrance plane A.

[0053] S4. Adjust the position of the X-ray machine 1 so that it irradiates the pelvic outlet; read the inclination angle between the entrance position and the horizontal plane measured by the electronic angle measuring instrument on the C-arm X-ray machine, control the third motor 44 through the remote control, and then control the inclination of the second positioning frame 46, and at the same time control the axial angle of the second positioning frame 46 by controlling the fourth motor 45. After the angle sensor value is consistent with the value measured by the electronic angle measuring instrument, the remote control controls the third motor 44 to drive the second positioning frame 46 to make fine-tuning rotation under X-ray fluoroscopy, so that the projection of the third positioning pin 53 and the fourth positioning pin 54 on the second positioning frame 46 overlap, and at the same time control the second motor 43 through the remote control to drive the second positioning frame 46 to make axial angle rotation, so that the overlapping shadows of the third positioning pin 53 and the fourth positioning pin 54 are parallel to the sacral 1 hole or the sacral 2 hole on both sides of the pelvis when the C-arm fluoroscopy pelvic outlet is performed, and the adjustment of the inclination angle of the second positioning frame 46 is completed. Then, the second linear driver 41 is controlled by the remote control, and the second linear driver 41 drives the second positioning frame 46 on which the inclination angle is adjusted to move back and forth in a straight line. Under X-ray irradiation, the coincidence line of the projection of the third positioning pin 53 and the projection of the fourth positioning pin 54 is made close to the projection line of the upper edge of the bilateral sacral 1 foramen (sacroiliac joint screws implanted in the sacral 1 vertebra) or between the projection line of the lower edge of the bilateral sacral 1 foramen and the projection line of the upper edge of the bilateral sacral 2 foramen (sacroiliac joint screws implanted in the sacral 2 vertebra), thus completing the positioning of the exit plane B. For example, the intersection of plane A and plane B is the center line of the cross hole 7, and the intersection is located on the anterior side of the sacral vertebra S1 (close to the upper edge of the sacral 1 foramen) or the anterior side of the sacral vertebra S2, which is the safe needle insertion area.

[0054] S5. Insert the guide needle 55 along the cross hole 7 formed by the intersection of the first hollow groove 361 and the second hollow groove 362, drill the guide needle 55 into the sacrum with an electric drill, and screw in the hollow sacroiliac joint screw through the guide needle 55 to complete the navigation of the sacroiliac joint screw implantation.

[0055] When a sacroiliac joint screw is to be implanted in the sacral 1 vertebra, Figure 5 As shown, when the C-arm X-ray machine 1 irradiates the pelvic entrance, the projection line of the front edge of the sacral 1 vertebral body cortex overlaps with the projection line of the front edge of the sacral 2 vertebral body cortex, and the guide needle 55 is implanted close to the rear edge of the overlapping line (cannot exceed the front edge of the overlapping shadow) and parallel to it. Then, the C-arm X-ray machine 1 is adjusted to irradiate the pelvic outlet, as shown in FIG. Figure 6 As shown, at this time, the guide needle 55 is closely attached to the upper edge of the sacral foramen 1 (cannot enter the sacral foramen 1) and tends to be parallel to the line connecting the bilateral sacral foramina 1 (does not intersect); Figure 7 As shown, after the sacroiliac joint screw is screwed in along the guide pin 55, the postoperative CT scan shows that the position of the sacroiliac joint screw is located in the bony safety channel of the S1 vertebra.

[0056] When a sacroiliac joint screw is to be implanted in the sacral 2 vertebra, Figure 8As shown, when the C-arm X-ray machine irradiates the pelvic entrance, the projection line of the front edge of the sacral 1 vertebral body cortex overlaps with the projection line of the front edge of the sacral 2 vertebral body cortex, and the guide pin 55 is implanted close to the rear edge of the overlapping line (cannot exceed the front edge of the overlapping shadow) and parallel to it. Then, the C-arm X-ray machine is adjusted to irradiate the pelvic outlet, as shown in FIG. Fig. 9 As shown, after the guide needle 55 is implanted between the projection line of the lower edge of the bilateral sacral foramen 1 and the projection line of the upper edge of the bilateral sacral foramen 2, the guide needle is just located between the projection line of the lower edge of the bilateral sacral foramen 1 and the projection line of the upper edge of the bilateral sacral foramen 2, and is parallel to the projection line of the lower edge of the bilateral sacral foramen 1 and the projection line of the upper edge of the bilateral sacral foramen 2 (not intersecting); as shown in FIG. Fig.10 As shown, after the sacroiliac joint screw is screwed in along the guide pin 55, the postoperative CT scan shows that the position of the sacroiliac joint screw is located in the bony safety channel of the S2 vertebra.

[0057] The utility model is based on the principle of two surfaces determining a line. First, the projection overlap of the two positioning pins on the positioning frame is adjusted under X-ray fluoroscopy to ensure that plane A and the cortical surface of the anterior edge of the sacral 1 vertebra and the cortical surface of the anterior edge of the sacral 2 vertebra are located on the same plane. Then, the plane B is perpendicularly intersected with the cortical surface of the anterior edge of the sacral 1 vertebra and the cortical surface of the anterior edge of the sacral 2 vertebra by the principle of plane phase, at the projection line close to the upper edge of the bilateral sacral 1 foramen (sacroiliac joint screws implanted in the sacral 1 vertebra) or perpendicularly intersected in the middle area between the projection line of the lower edge of the bilateral sacral 1 foramen and the projection line of the upper edge of the bilateral sacral 2 foramen (sacroiliac joint screws implanted in the sacral 2 vertebra), and the intersection line of plane B and plane A (that is, the trajectory of the guide pin 55 for implanting the sacroiliac joint screw) is obtained. The intersection line of plane B and plane A is located on the extension line of the center line of the cross hole 7 formed after the first positioning frame 36 and the second positioning frame 46 intersect. Example 2

[0058] The difference between this embodiment and embodiment 1 is that:

[0059] In order to provide a more stable and accurate positioning channel for the guide pin 55 and to achieve a better guiding effect of the cross hole 55, the middle part of the first positioning frame 36 is a round-shaped structure, and the round-shaped opening 363 of the round-shaped structure penetrates the upper and lower surfaces of the first positioning frame 36 and is connected to the first hollow groove 361. The first hollow groove 361 is two and is symmetrically arranged on the front and rear sides of the round-shaped structure. The part of the second positioning frame 46 with the second hollow groove 461 is cross-sheathed in the round-shaped opening 363 of the round-shaped structure. The second hollow groove 461 crosses with the two first hollow grooves 361 to form two cross holes 7. The guide pin 55 is inserted into the two cross holes 7 at the same time. The existence of the two cross holes 7 can further provide a more stable and accurate positioning channel for the guide pin 55. Example 3

[0060] The difference between this embodiment and embodiment 2 is that:

[0061] In order to reduce the deadweight of the second positioning frame 46, the second positioning frame 46 is provided with a hollow opening 463 penetrating the upper and lower surfaces thereof at the portion with the second hollow groove 461. After the deadweight of the second positioning frame 46 is reduced, when determining the position of the second positioning frame 46, the second positioning frame 46 is not easily deflected downward under the action of its deadweight, thereby ensuring the accuracy of positioning.

[0062] It should be noted that the terms "comprises", "includes" or any other variations are intended to cover non-exclusive inclusion, so that a process, method, article or apparatus that includes a series of elements includes not only those elements, but also other elements not explicitly listed, or also includes elements inherent to such process, method, article or apparatus.

[0063] The protection scope of the present utility model is not limited to the technical solutions disclosed in the specific implementation methods. Any modifications, equivalent replacements, improvements, etc. made to the above embodiments based on the technical essence of the present utility model shall fall within the protection scope of the present utility model.

Claims

1. An automated navigation device for percutaneous sacroiliac joint screw implantation based on C-arm fluoroscopy, comprising an X-ray machine, a support seat, a first positioning mechanism, a second positioning mechanism, and a positioning needle; characterized in that: The support base is a hollow box body that is placed flat on the operating table and is composed of two layers of flat plates and can be penetrated by X-rays; a strip groove that communicates with the interior of the support base is provided on one side of the upper flat plate of the support base along its length direction; The first positioning mechanism includes a first linear drive, a first bracket, a first rotating block, a first motor, a second motor and a first positioning frame; the first linear drive is installed on the lower flat plate of the support seat; the first bracket is installed on the moving part of the first linear drive and can move back and forth along the length direction of the strip groove under the drive of the first linear drive; the first rotating block is rotatably installed on the first bracket through the rotating shafts at its front and rear ends; the first motor is fixed on the first bracket and its driving shaft is transmission connected with the rotating shaft of the first rotating block; the second motor is fixed on the first rotating block and its driving shaft is rotatably installed in the first rotating block; the first positioning frame is long and is located above the upper flat plate of the support seat, and the lower part of the first positioning frame passes downward through the strip groove and then rotates and extends into the first rotating block and is transmission connected with the driving shaft of the second motor, and a first hollow groove running through its front and rear side surfaces is provided in the middle of the side wall of the first positioning frame along its length direction; The second positioning mechanism includes a second linear drive, a second bracket, a second rotating block, a third motor, a fourth motor and a second positioning frame; the second linear drive is installed on the lower flat plate of the support seat; the second bracket is installed on the moving part of the second linear drive and can move back and forth along the length direction of the strip groove under the drive of the second linear drive; the second rotating block is rotatably installed on the second bracket through the rotating shafts at its front and rear ends; the third motor is fixed on the second bracket and its driving shaft is transmission connected with the rotating shaft of the second rotating block; the fourth motor is fixed on the second rotating block and its driving shaft is rotatably installed in the second rotating block; the second positioning frame is long and is located above the upper flat plate of the support seat, and the lower part of the second positioning frame passes downward through the strip groove and then rotates and extends into the second rotating block and is transmission connected with the driving shaft of the fourth motor, and a second hollow groove running through its front and rear side surfaces is provided in the middle part of the side wall of the second positioning frame along its length direction; the middle part of the first positioning frame and the middle part of the second positioning frame intersect each other above the upper flat plate of the support seat; The positioning pins include a first positioning pin, a second positioning pin, a third positioning pin, a fourth positioning pin and a guide pin; the first positioning pin and the second positioning pin are both mounted on the first positioning frame and are parallel to each other, wherein the first positioning pin is located above the intersection of the first positioning frame and the second positioning frame, and the second positioning pin is located below the upper flat plate of the support seat, and the first positioning pin, the second positioning pin and the first hollow groove are all located on the same plane; the third positioning pin and the fourth positioning pin are both mounted on the second positioning frame and are parallel to each other, wherein the third positioning pin is located above the intersection of the first positioning frame and the second positioning frame, and the fourth positioning pin is located below the upper flat plate of the support seat, and the third positioning pin, the fourth positioning pin and the second hollow groove are all located on the same plane; the guide pin is movably sleeved in the cross hole formed by the intersection of the first hollow groove and the second hollow groove.

2. The automated navigation device for percutaneous sacroiliac joint screw implantation based on C-arm fluoroscopy according to claim 1, characterized in that: The first linear drive and the second linear drive are slidably installed on the lower flat plate of the support seat, and a third linear drive is installed on the lower flat plate of the support seat in front of the first linear drive and the second linear drive. The moving part of the third linear drive is respectively connected to the first linear drive and the second linear drive and can drive the first linear drive and the second linear drive to move back and forth along the length direction of the strip groove.

3. The automated navigation device for percutaneous sacroiliac joint screw implantation based on C-arm fluoroscopy according to claim 2, characterized in that: The first linear drive, the second linear drive and the third linear drive are all ball screw linear drive mechanisms.

4. The automated navigation device for percutaneous sacroiliac joint screw implantation based on C-arm fluoroscopy according to claim 3, characterized in that: The first linear drive and the second linear drive are connected in a line and installed on the lower flat plate of the support seat.

5. The automated navigation device for percutaneous sacroiliac joint screw implantation based on C-arm fluoroscopy according to claim 3, characterized in that: It also includes a motor controller, which is used to control the operation of the first motor, the second motor, the third motor, the fourth motor, the first linear drive, the second linear drive and the third linear drive respectively.

6. The automated navigation device for percutaneous sacroiliac joint screw implantation based on C-arm fluoroscopy according to claim 5, characterized in that: It also includes a remote controller with a display screen; the remote controller is connected to the motor controller via Bluetooth and controls the operation of the first motor, the second motor, the third motor, the fourth motor, the first linear drive, the second linear drive, and the third linear drive via the motor controller.

7. The automated navigation device for percutaneous sacroiliac joint screw implantation based on C-arm fluoroscopy according to claim 6, characterized in that: Angle sensors are installed on the first positioning frame and the second positioning frame respectively; an electronic angle measuring instrument is installed on the X-ray machine; the angle sensor and the electronic angle measuring instrument are electrically connected to the motor controller, and can display the measured numbers on the display screen of the remote control.

8. The automated navigation device for percutaneous sacroiliac joint screw implantation based on C-arm fluoroscopy according to any one of claims 1 to 7, characterized in that: The middle part of the first positioning frame is a round-shaped structure, the round-shaped opening of the round-shaped structure passes through the upper and lower surfaces of the first positioning frame and is connected to the first hollow groove. There are two first hollow grooves which are symmetrically arranged on the front and rear sides of the round-shaped structure.

9. The automated navigation device for percutaneous sacroiliac joint screw implantation based on C-arm fluoroscopy according to claim 8, characterized in that: The portion of the second positioning frame with the second hollow groove is cross-sheathed in the round-shaped opening of the round-shaped structure, and the second hollow groove crosses with the two first hollow grooves to form two cross holes.

10. The automated navigation device for percutaneous sacroiliac joint screw implantation based on C-arm fluoroscopy according to claim 9, characterized in that: The portion of the second positioning frame with the second hollow groove is provided with a hollow opening penetrating through the upper and lower surfaces thereof.

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