Pelvic anterior ring anatomical bone setting steel plate passing through perineum bypass

Abstract

The utility model belongs to the technical field of medical instruments for fracture, and provides a pelvic anterior ring anatomical type bone setting steel plate passing through a perineum side approach, which is integrally formed by a pubis superior branch fixing section, a pubis tuberosity lower fixing section and a pubis superior and subordinate branch transition position fixing section. The bending shape of the plate surface of the suprapubis ramus fixing section is matched with the anatomical structures of the suprapubis ramus and the front lower wall of the acetabulum; the bending shape of the plate surface of the fixing section below the pubic tuberosity is matched with the anatomical structure of the surface below the pubic tuberosity; and the bending shape of the plate surface of the pubis superior and superior ramus transition position fixing section is matched with the anatomical structure at the intersection of the pubis superior ramus and the pubis inferior ramus. The utility model discloses can be used for pelvic anterior ring including suprapubis ramus, pubis body, suprapubis ramus and suprapubis ramus transition, pubis joint, acetabular internal upside and other injury, can adopt the mode of perineum bypass approach treatment, the surgical incision is hidden, does not need to peel the rectus abdominis dead point, can avoid femoral vessel nerve and other important structures.

Description

TECHNICAL FIELD

[0001] The utility model belongs to the technical field of medical instruments for fracture, and provides a pelvic anterior ring dissection type bone fracture plate through a perineal lateral approach. BACKGROUND

[0002] The human body pubic bone is divided into a pubic body, a superior pubic ramus and an inferior pubic ramus, as shown in the attached Figure 2 The pubic body constitutes the lower 1 / 5 of the acetabulum, and the bone surface at the joint with the iliac body is rough and raised, which is called the ilio-pectineal eminence. The superior pubic ramus extends forward and inward from the ilio-pectineal eminence, and its end turns downward to become the inferior pubic ramus. The superior pubic ramus has a sharp ridge called the pubic ramus comb, which moves backward to become the arcuate line and terminates forward at the pubic tubercle. The upper edge of the pubic tubercle to the midline is the pubic ridge. The oval rough surface on the inner side of the transition between the superior and inferior pubic rami is called the pubic symphysis surface, and the two symphysis surfaces are connected by cartilage, which is called the pubic symphysis. The inferior pubic ramus extends backward, downward and outward to the ischiatic ramus, so that the pubic bone and the ischiatic bone together enclose the obturator foramen.

[0003] When a fracture occurs in the pelvic anterior ring (including the superior pubic ramus, the pubic body and the acetabulum), the conventional method is to make an abdominal incision and use a steel plate and screws to fix the fracture. For example, the utility model patent with the publication number CN211381705U, a pelvic bone anterior ring internal fixation bone plate, can effectively fix the pelvic anterior ring fracture and is suitable for pubic bone fracture, especially for pubic bone fracture near the pubic symphysis region. The bone plate adopts the pubic symphysis anterior approach (Pfannenstiel incision approach). For another example, the utility model patent with the publication number CN205359611U, a hip acetabulum square area bone plate, can effectively fix the acetabulum anterior and posterior column fractures at the same time, can increase the coverage and support of the acetabulum square area by fixing the arcuate line and the ischial spine part of the acetabulum square area, and can stably reconstruct the acetabulum anterior and posterior columns from the inside wall of the square area. The bone plate adopts the Stoppa or modified Stoppa surgical approach. Both of the two surgical methods need to separate the rectus abdominis muscle and cut off the muscle stop point, which may cause damage to organs (including the urinary bladder) and the "death crown" blood vessels, and may form an incisional hernia after the operation, which has a high incidence of complications. Therefore, designing a more suitable surgical approach for the pelvic anterior ring is an urgent problem to be solved in clinical practice.

[0004] The applicant's team has begun to explore and clinically apply the fracture reduction and internal fixation treatment model via the paraperineal approach in 2019. Basic anatomical research and clinical practice have shown that the paraperineal approach has a certain safety distance from the perineal branch of the posterior femoral cutaneous nerve, and the risk of injury to the perineal branch of the posterior femoral cutaneous nerve is small. The method of treating fractures using the paraperineal approach has the advantages of avoiding stripping of the rectus abdominis muscle, concealed incision, short operation time, and less bleeding. It is a safe approach for treating anterior pelvic ring fractures and can achieve relatively satisfactory short-term clinical efficacy. Based on this, for fractures of the anterior pelvic ring, the applicant has designed the utility model of the anterior pelvic ring anatomical bone fixation plate via the paraperineal approach. Utility Model Content

[0005] In order to solve the above problems, the purpose of the present invention is to provide an anterior pelvic ring anatomical osteosynthesis plate via a paraperineal approach. The present invention has a simple structure and can be used for fracture fixation in multiple locations such as the superior pubic ramus, the transition between the upper and lower pubic rami, the pubic symphysis, and the superior medial aspect of the acetabulum. Moreover, the plate can be treated via a paraperineal approach, which can avoid stripping of the rectus abdominis muscle, making the incision concealed, shortening the operation time, and reducing bleeding compared to the abdominal incision method.

[0006] In order to achieve the above-mentioned purpose, the technical solution adopted by the present utility model is:

[0007] A pelvic anterior ring anatomical bone plate for a paraperineal approach, wherein the bone plate is integrally formed by a superior pubic ramus fixing section, a fixing section below the pubic tubercle, and a fixing section at the transition between the superior and inferior pubic ramus; the front end of the superior pubic ramus fixing section starts from the pubic tubercle, passes through the pubic comb, and the rear end ends at the iliopectineal eminence; the curved shape of the plate surface of the superior pubic ramus fixing section matches the anatomical structure of the superior pubic ramus passing through; the curved shape of the plate surface of the fixing section at the transition between the superior and inferior pubic ramus matches the anatomical structure of the wider part where the superior and inferior pubic ramus intersect; One end of the fixing section below the pubic tubercle is connected to the outer side surface of the fixing section of the superior pubic branch near the front end, bends downward relative to the fixing section of the superior pubic branch, and passes obliquely through the bottom of the pubic tubercle. The other end is connected to the fixing section at the transition between the upper and lower pubic branches. The curved shape of the plate surface of the fixing section below the pubic tubercle is matched with the anatomical structure of the surface below the pubic tubercle; a plurality of screw holes are provided on the plate surface of the fixing section of the superior pubic branch in the length direction, and the plate surfaces of the fixing section below the pubic tubercle and the fixing section at the transition between the upper and lower pubic branches are also respectively provided with screw holes.

[0008] In the present invention, preferably, the outer surface of the superior pubic ramus fixing section near the rear end extends outward to form a side branch, which cooperates with the anatomical structure of the anterior and inferior wall of the acetabulum, and the acetabulum fixing screw hole is provided on the plate surface of the side branch.

[0009] In the present invention, preferably, the screw hole closest to the front end on the plate surface of the superior pubic ramus fixing segment is a universal hole.

[0010] Preferably, the screw holes on the plate surface of the pubic upper and lower branch transition fixed section are provided with two, arranged in upper and lower, and are all universal holes.

[0011] Preferably, the acetabular fixed screw hole on the side branch is a universal hole, and various models of screws with a length of 12-100mm are used in cooperation.

[0012] Preferably, the width of the pubic tubercle lower fixed section is less than the width of the pubic upper and lower branch transition fixed section and the width of the pubic upper branch fixed section.

[0013] Due to the adoption of the above technical scheme, the utility model has the following beneficial effects:

[0014] 1. The bone plate is integrally formed by the pubic upper branch fixed section, the pubic tubercle lower fixed section and the pubic upper and lower branch transition fixed section, and can be used for fracture fixation of multiple parts such as the pubic upper branch and the pubic upper and lower branch transition by using screws. In the utility model, the pubic upper branch fixed section and the pubic upper and lower branch transition fixed section have a wider plate surface, thereby having a larger adhesion stress area, and the screws can obtain better mechanical support, so that the fixed steel plate is more stable, and the situation that the screws are difficult to be locked when comminuted fracture occurs can be avoided, and the universality of the utility model is improved.

[0015] 2. The four universal holes cooperate with the use of screws, so that the bone plate can also realize the fixation of the fracture of the upper acetabulum and the pubic symphysis with a smaller volume, the function of the utility model is more comprehensive, and the difficulty of manufacturing and the difficulty of surgery are reduced.

[0016] 3. The steel plate of the utility model can adopt a perineal approach treatment mode, compared with the abdominal incision mode, the surgical incision is concealed, the rectus abdominis insertion point does not need to be stripped, important structures such as femoral vascular nerves can be avoided, the operation time is short, and bleeding is less. BRIEF DESCRIPTION OF DRAWINGS

[0017] Figure 1 is a structure schematic view of the pelvic anterior ring anatomical bone plate provided by the utility model.

[0018] Figure 2 is a structure schematic view of the pelvic anterior ring anatomical bone plate provided by the utility model.

[0019] Figure 3 is a structure schematic view of the pelvic anterior ring anatomical bone plate provided by the utility model.

[0020] Figure 4It is another use schematic view of the cooperation screw of the pelvis front ring anatomical type bone fracture plate.

[0021] Wherein, 1-supra pubic branch fixed section, 2-pubis tubercle below fixed section, 3-supra pubic branch transition fixed section, 4-screw hole, 401-first universal hole, 402-second universal hole, 403-third universal hole, 404-fourth universal hole, 5-screw, 6-acetabular screw, 7-acetabular transverse screw, 8-pubic symphysis, 9-supra pubic branch transition, 10-pubic branch, 11-pubis tubercle, 12-ischiatic branch, 13-obturator foramen, 14-supra pubic branch, 15-pubic ramus, 16-ischium, 17-pubic body, 18-acetabular anterior inferior wall, 19-iliac pubic eminence, 20-inferior medial acetabulum. DETAILED DESCRIPTION

[0022] The technical solutions in the embodiments of the utility model will be clearly and completely described below with reference to the drawings in the embodiments of the utility model. Obviously, the described embodiments are only part of the embodiments of the utility model, rather than all the embodiments. The drawings are only used for illustrative description, and the representation is only a schematic diagram, rather than a physical diagram, and should not be understood as a limitation on the patent. In order to better illustrate the specific embodiments of the utility model, some components in the drawings are omitted, enlarged or reduced, and do not represent the size of the actual product. For those skilled in the art, it is understandable that some known structures, components and their descriptions in the drawings can be omitted. Based on the embodiments in the utility model, all other embodiments obtained by those skilled in the art without creative labor fall within the scope of the utility model.

[0023] The utility model provides a kind of pelvis front ring anatomical type bone fracture plate of transperineal approach, its structural schematic diagram refers to Figure 1 It can be used for supra pubic branch 14, pubic body 17, supra pubic branch transition 9, pubic symphysis, acetabular medial superior 20 and so on Multiple parts of fracture fixation. First refer to Figure 2Figure 1 shows the anatomical structure of the human pelvis, the pubic body 17 constitutes the lower 1 / 5 of the front of the acetabulum, the joint of the acetabulum upper 20 is rough and protruding, called the ilio- pubic eminence 19, from which the superior pubic ramus 14 extends forward and inward, the end of which turns downward to become the inferior pubic ramus 10. The superior pubic ramus 14 has a sharp ridge called the pubic ramus 15, which moves backward to the arcuate line and terminates forward with the pubic tubercle 11. The thick and rough edge of the pubic tubercle 11 to the midline is the pubic ridge. The oval rough surface inside the transition of the superior and inferior pubic rami 9 is called the pubic symphysis 8, which is connected by cartilage on both sides, called the pubic symphysis. The inferior pubic ramus 10 extends backward to the posterior, inferior, and lateral, and is combined with the ischiatic ramus 12. In this way, the superior pubic ramus 14, the inferior pubic ramus 10, and the ischiatic ramus 12 together with the ischial body 16 form the obturator foramen 13. The ilio- pubic eminence 19 is behind the acetabular upper 20, and the lateral is the acetabular anterior wall 18.

[0024] Figure 3 A schematic diagram of the anatomical type of the pubic anterior ring of the transperineal approach is given. Now combined with Figure 1 and 3 the structure is described in detail.

[0025] Overall, the bone plate is composed of a superior pubic ramus fixation segment 1, a pubic tubercle below fixation segment 2, and a superior and inferior pubic ramus transition fixation segment 3, which are integrally formed into a three-dimensional structure. The integrally formed structure can be machined using a numerical control lathe, making it easy to process and eliminating the need for assembly during use.

[0026] The anterior end of the superior pubic ramus fixation segment 1 starts from the pubic tubercle 11, passes through the pubic ramus 15, and terminates at the ilio- pubic eminence 19. The curved shape of the plate surface of the superior pubic ramus fixation segment 1 is matched with the anatomical structure of the superior pubic ramus 14.

[0027] The curved shape of the plate surface of the superior and inferior pubic ramus transition fixation segment 3 is matched with the anatomical structure of the wider part of the junction of the superior pubic ramus 14 and the inferior pubic ramus 10, i.e. the transition of the superior and inferior pubic rami 9.

[0028] The two ends of the pubic tubercle below fixation segment 2 are connected to the superior pubic ramus fixation segment 1 and the superior and inferior pubic ramus transition fixation segment 3, respectively. Specifically, one end of the pubic tubercle below fixation segment 2 is connected to the lateral surface of the superior pubic ramus fixation segment 1 near the anterior end, which is bent downward relative to the superior pubic ramus fixation segment 1, and then obliquely passes below the pubic tubercle 11. The other end is connected to the side of the superior and inferior pubic ramus transition fixation segment 3 facing the obturator foramen 13. The curved shape of the plate surface of the pubic tubercle below fixation segment 2 is matched with the anatomical structure of the surface below the pubic tubercle 11.

[0029] The plate surface of the superior pubic branch fixing section 1 is provided with a plurality of screw holes 4 along the length direction, and preferably four screw holes 4 are arranged in a single row, and the plate surface of the inferior pubic tubercle fixing section 2 and the plate surface of the superior-inferior pubic branch transition fixing section 3 are also respectively provided with screw holes 4, and the diameter of the screw hole 4 is preferably 2-3mm.

[0030] The width of the inferior pubic tubercle fixing section 2 is smaller than the width of the superior-inferior pubic branch transition fixing section 3 and the width of the superior pubic branch fixing section 1, and the plate surface width of the superior pubic branch fixing section 1 can be set to about 1cm, so that a wider plate surface is provided, thereby having a larger fitting stress area, and better mechanical support can be obtained after being fixed with the screw 5, so that the fixed steel plate is more stable, and the situation that the screw cannot be locked when the comminuted fracture occurs can be avoided, thereby improving the universality of the utility model.

[0031] Based on the above structure, the bone fracture fixation plate of the utility model is applied to the fractures occurring at the superior pubic branch 14, the pubic body 17, the superior-inferior pubic branch transition 9 and the inferior pubic tubercle 11, and referring to Figure 3 The following operation steps can be adopted:

[0032] 1. A perineum approach is adopted, and the perineum approach axis is ac, wherein a point is 4cm outside the top point of the pubic symphysis angle, b point is the ischial tuberosity, and c point is 4cm from b point on the ab line.

[0033] 2. A 7cm incision is made from a point to c point, the skin is cut, the subcutaneous fat is separated to the muscle fascia, and the muscles on the surface of the superior-inferior pubic branch transition 9, the superior pubic branch 14, the pubic body 17 or the ilio- pubic junction are stripped from the inside of the incision.

[0034] 3. The fracture is reduced, and the steel plate of the utility model is placed and fitted on the surface of the superior pubic branch 14, the inferior pubic tubercle 11 and the superior-inferior pubic branch transition 9.

[0035] 4. The screw 5 is screwed into the screw hole 4, thereby being fixed, Figure 3 The screwing scheme is shown, and of course, the screwing scheme is not limited to this, and the length of the screw and the selection of the screw hole need to be determined according to the actual fracture position, so that the screw avoids the fracture and fixes the steel plate as a whole;

[0036] 5. After the surgical incision is washed, hemostasis is sutured and other treatments are performed, the bone fracture fixation surgery can be completed.

[0037] The present invention is also optimized on the basis of the above structure to obtain more functions. For example, the present invention is further preferably provided with a side branch extending outward from the outer surface of the superior pubic ramus fixation segment 1 near the rear end, and the side branch cooperates with the anatomical structure of the bone surface of the anterior inferior wall 18 of the acetabulum, and an acetabulum fixation screw hole is provided on the plate surface of the side branch.

[0038] The acetabulum fixing screw hole is a universal hole, denoted as the first universal hole 401, which is used with various screws of 12-100 mm in length. Figure 3 , when the fracture occurs in the upper 20 of the acetabulum ( Figure 3 The fracture line is shown here), and the acetabular transverse screw 7 is matched with the acetabular fixation screw hole, and the acetabular transverse screw 7 is driven through the fracture line 20 above the acetabulum to fix the fracture above the acetabulum 20. The selection and fixation of other screw holes are carried out according to the actual situation and are not limited to Figure 3 With this design, the length of the superior pubic ramus fixation segment 1 does not need to cover the upper part 20 of the acetabulum, and the fracture at the upper part 20 of the acetabulum can be fixed, so that the bone plate can achieve more functions with a smaller volume, and the difficulty of manufacturing the utility model and the difficulty of surgery are reduced.

[0039] Continue to see Figure 3 , when a fracture occurs at the ischial body 16 ( Figure 3 The fracture line is shown here), and the subacetabular screw 6 is matched with the screw hole on the rear end of the plate surface of the superior pubic ramus fixation segment 1, and the subacetabular screw 6 is driven through the ischium fracture line to fix the ischium fracture 16.

[0040] A more preferred embodiment is that the screw hole 4 closest to the front end on the plate surface of the superior pubic ramus fixing segment 1 is a universal hole, which is recorded as the second universal hole 402. Figure 3 When a fracture occurs at the transition between the upper and lower branches of the pubic bone 9, the screw is driven obliquely into the transition between the upper and lower branches of the pubic bone 9 by means of the screw in conjunction with the second universal hole 402, thereby further reinforcing the fracture in this section and achieving a better fixation effect. The selection and fixation of other screw holes are carried out according to the actual situation and are not limited to Figure 4 By means of this design, the fracture at the transition point 9 between the upper and lower pubic branches can be further reinforced, so that the bone plate can achieve better fixation function with a simple structure.

[0041] A more preferred embodiment is that there are at least two screw holes 4 on the plate surface of the fixing section 3 at the transition between the upper and lower pubic branches, which are arranged in an upper and lower manner and are both universal holes, denoted as the third universal hole 403 and the fourth universal hole 404, see ​When the pubic symphysis is separated, the screw is driven horizontally into the inside of the opposite pubic bone through the third universal hole 403 and the fourth universal hole 404, thereby connecting and fixing the pubic symphysis. The selection and fixation of other screw holes are carried out according to actual conditions and will not be illustrated or described here.

[0042] In summary, the present invention's bone plate can not only be used to fix fractures in multiple locations, such as the superior pubic ramus and the transition between the superior and inferior pubic rami, but can also, through the combination of universal holes and transverse screws, fix the superior medial 20° of the acetabulum and pubic symphysis dislocations without increasing the length of the plate or stripping more muscle tissue, thus offering the advantage of a wider range of applications. The present invention's plate can be used for treatment via a paraperineal approach, which, compared to an abdominal incision, eliminates the need for rectus abdominis stripping, provides a discreet incision, and shortens the surgical time.

[0043] The above description is a detailed description of the preferred embodiments of the present invention, but the embodiments are not intended to limit the scope of the patent application of the present invention. All equivalent changes or modifications completed under the technical spirit suggested by the present invention should fall within the patent scope covered by the present invention.

Claims

1. A pelvic anterior ring anatomical bone plate for a paraperineal approach, characterized in that: The bone plate is formed of an integral piece consisting of a pubic ramus fixing section, a pubic tubercle lower fixing section, and a pubic ramus upper and lower ramus transition fixing section; the front end of the pubic ramus fixing section starts from the pubic tubercle, passes through the pubic comb, and the rear end ends at the iliopectineal eminence. The curved shape of the plate surface of the pubic ramus fixing section matches the anatomical structure of the pubic ramus passing through; the curved shape of the plate surface of the pubic ramus transition fixing section matches the anatomical structure of the wider part where the pubic ramus and the lower ramus meet; the curved shape of the plate surface of the pubic ramus upper and lower ramus transition fixing section matches the anatomical structure of the wider part where the pubic ramus and the lower ramus meet; the curved shape of the plate surface of the pubic ramus lower ... One end is connected to the outer side surface of the superior pubic ramus fixing section near the front end, bends downward relative to the superior pubic ramus fixing section, and passes obliquely under the pubic tubercle. The other end is connected to the fixation section at the transition between the upper and lower pubic ramus. The curved shape of the plate surface of the fixation section below the pubic tubercle matches the anatomical structure of the surface below the pubic tubercle. A plurality of screw holes are provided on the plate surface of the superior pubic ramus fixing section along the length direction, and the plate surface of the fixation section below the pubic tubercle and the plate surface of the fixation section at the transition between the upper and lower pubic ramus are also respectively provided with screw holes.

2. The anterior pelvic ring anatomical bone fracture plate according to claim 1, characterized in that: The outer side of the superior pubic branch fixing section near the rear end extends outward to form a side branch, which matches the anatomical structure of the anterior and inferior wall of the acetabulum. The plate surface of the side branch is provided with an acetabulum fixing screw hole.

3. The anterior pelvic ring anatomical bone fracture plate according to claim 1, characterized in that: The screw hole closest to the front end on the plate surface of the superior pubic ramus fixing section is a universal hole.

4. The anterior pelvic ring anatomical bone fracture plate according to claim 1, characterized in that: There are two screw holes on the plate surface of the fixed section at the transition between the upper and lower branches of the pubic bone, which are arranged up and down and are both universal holes.

5. The anterior pelvic ring anatomical bone fracture plate according to claim 1, characterized in that: The width of the fixing section below the pubic tubercle is smaller than the width of the fixing section at the transition between the upper and lower pubic branches and the width of the fixing section of the upper pubic branch.

6. The anterior pelvic ring anatomical bone fracture plate according to claim 2, characterized in that: The acetabulum fixing screw hole on the side branch is a universal hole, which can be used with screws of various models with a length of 12-100 mm.

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