Lumbar intervertebral aperture mirror and Thoracolumbar disk percutaneous cervical arc root screw puncture positioning guider and itsNeedle localization methodTechnical field
The present invention relates to technical field of medical instruments, and in particular to a kind of lumbar intervertebral aperture mirror and Thoracolumbar disk percutaneous cervical arc rootScrew puncture positioning guider and its Needle localization method.
Background technology
The operation as two kinds of minimally invasive treatment Thoracolumbar disk diseases is fixed in foramen intervertebrale lens and micro-wound percutaneous pedicle screwMode, has the advantages that operation wound is small, patient recovers fast, spend few, carries out extensively in China in recent years.Carry out intervertebral foramenThe key of videoendoscopic surgery is in art that Needle localization Needle localization in the position of disc herniation, current art relies on doctor exactlyClinical experience carries out free-hand puncture, and puncture accuracy influence by doctor's level and subjective factor, easily occur puncture it is inaccurate,The problems such as being punctured repeatedly in art, causes to cause Surrounding muscles soft tissue unnecessary damage, and severe patient even damages abdominal cavityThe internal organs such as intestinal tube or the nerve root and dural sac at rear etc., cause abdominal cavity infection, lower limb paralysis and leakage of cerebrospinal etc. seriousComplication.Furthermore, it is that clear and definite puncture position need to carry out radioscopy repeatedly during puncturing repeatedly, to the health of patientAlso influence can be produced.
Key fixed in percutaneous cervical arc root screw is carried out to be to select suitable entry point and suitable leaning angle in art,Entry point more options are located at the outer upper limb of pedicle of vertebral arch lateral wall under fluoroscopy during operation, and the inclined angle for entering nail exists according to different centrumsBetween 10 ~ 20 degree.It is clinically at present to use free-hand puncture more, the quality of surgical quality depend critically upon doctor clinical experience andPerformance in art, the confirmation of entry point touches the heart according to the difference of different centrum screw entrance point anatomic landmarks by the hand of doctorX-ray examination in meeting and art repeatedly determines that excessive perspective is all a kind of injury for patient or doctor；The determination of leaning angleThe range estimation in doctor's art is even more relied on, is exerted oneself due to patient posture difference, the difference of doctors experience and by harder sclerotin, often there is leaning angle excessive or too small in the movement of centrum during puncture.Because pedicle diameter is limited, as first time wearsThorn position is undesirable, and the difficulty of adjustment change screw way is larger again in art, and sclerotin successfully can be also reduced to screw even if changing its courseHold, increases the postoperative risk for screw loosening displacement and operative failure occur.Such as puncture inaccurate, entry point partially in or it is interiorThe inclination angle pedicle screw bigger than normal that is likely to occur damages dural sac and neural possible into canalis spinalis, causes serious complication.It is free-handOperation can not realize the standardization for putting nail, can be had differences in the entry point and leaning angle of the pedicle screw of different centrums,The tail end of pedicle screw of the difference of screw end-position, i.e. the same side is in turn resulted in not point-blank, in long segmentFixed operation in above-mentioned difference can significantly increase the difficulty that pitman between screw is placed.
The content of the invention
The technical problem to be solved in the present invention be overcome the shortcomings of prior art exist there is provided one kind it is simple in construction, operateThe percutaneous vertebral arch of lumbar intervertebral aperture mirror and Thoracolumbar disk of security and success rate convenient, applied widely, that be greatly improved operationRoot screw puncture positioning guider and its Needle localization method.
In order to solve the above technical problems, the present invention uses following technical scheme：
A kind of lumbar intervertebral aperture mirror and Thoracolumbar disk percutaneous cervical arc root screw puncture positioning guider, including have graduated cunningDynamic rail road, puncture needle guide sleeve and the angle indication dial disc being slidedly arranged on the sliding rail, puncture needle guide sleeve edgeThe angle indication dial disc is radially arranged, and can be rotated on the angle indication dial disc, the puncture positioning guiderAlso include the retention bar located at sliding rail side, the sliding rail between the retention bar and angle indication dial discOn be also slidably equipped with a pedicle of vertebral arch body surface marking body, the pedicle of vertebral arch body surface marking body has with pedicle of vertebral arch in the side of body surface projectionThe summit on side carries out overlapping location reference point O；The card and the scale of the sliding rail of the angle indication dial disc refer toShow that face is parallel；And the axis L2 and plane A parallel to graduation indication face of puncture needle guide sleeve are crossed with crossing location reference point O simultaneouslyEssentially coincided parallel to the plane B in graduation indication face；The pedicle of vertebral arch body surface marking body is by the first fixation kit can lockMode is slidedly arranged on sliding rail；The angle indication dial disc and puncture needle guide sleeve are by the second fixation kit can lockTight mode is slidedly arranged on sliding rail.
Above-mentioned puncture positioning guider, it is preferred that the pedicle of vertebral arch body surface marking body is that a cross section is ovalThe axis of column, the minor axis L1 of the oval cross section of the pedicle of vertebral arch body surface marking body and the puncture needle guide sleeveL2 is in the same plane；The location reference point O is external for the minor axis L1 and pedicle of vertebral arch body surface marking of oval cross sectionThe intersection point of side wall.
Above-mentioned puncture positioning guider, it is preferred that the centers of pedicle of vertebral arch body surface marking Ti Wei mono- offer vertical logicalThe open column shape body in hole, and the cross section of through hole is ellipse；And open column shape body is in the ellipse projection and ellipse of body surfaceHot spot corresponds to projection of the different size pedicle of vertebral arch in body surface respectively.
Above-mentioned puncture positioning guider, it is preferred that the sliding rail offers the chute extended along its length, instituteThe side for stating angle indication dial disc is connected with the first sliding block and is slidedly arranged on by the first sliding block in chute, the pedicle of vertebral arch body surfaceMarked body is connected with the second sliding block and is slidedly arranged on by the second sliding block in chute.
Above-mentioned puncture positioning guider, it is preferred that first fixation kit includes the first locking nut and the first spiral shellBar, one end of first screw rod and the second sliding block are affixed, and the other end and the first locking nut are connected；Described second fixesComponent includes the second screw rod and the second locking nut, and one end of second screw rod and puncture needle guide sleeve are affixed, the other endIt is connected through angle indication dial disc and the first sliding block and the second locking nut.
Above-mentioned puncture positioning guider, it is preferred that set between the puncture needle guide sleeve and angle indication dial discThere is a dismountable pad, the puncture needle guide sleeve can be by dismantling pad against angle indication dial disc.
Above-mentioned puncture positioning guider, it is preferred that the length that the retention bar stretches out to sliding rail both sides differsCause.
Above-mentioned puncture positioning guider, it is preferred that one end of the sliding rail, which is provided with to be used to paste, is fixed to patientFixation blade on skin.
Above-mentioned puncture positioning guider, it is preferred that the retention bar is set close to the fixed blade.
Present invention also offers a kind of method that foramen intervertebrale lens Needle localization is carried out using above-mentioned puncture positioning guider, bagInclude following steps：
A. by finding the target area of puncture in x-ray, CT and/or magnetic resonance imaging data, and puncture road is designedLine, and then measure inserting needle puncture angle and skin surface entry point and open distance apart from the side of centrum spinous process line；
B. retention bar and patient spine spinous process line coincident, the retention bar are played into positioning action under having an X-rayed, to wearThe fixed position for piercing locating guider provides reference, is easy to the position of adjustment determination puncture needle guide sleeve in subsequent operation；
C. with operative incision diaphragm by sliding rail paste be fixed on the skin at patient back, according to entry point away fromFrom centrum spinous process line side open with a distance from, the relevant position of entry point is determined on sliding rail, then unclamp second fixComponent, makes puncture needle guide sleeve be close to angle indication dial disc, slides puncture needle guide sleeve to correct position；
D. the angle of puncture needle guide sleeve, puncture needle guide sleeve are regulated according to the scale of angle indication dial discTail end alignment locks the second fixation kit after puncturing entry point, now puncture needle guide sleeve, angle indication dial disc and slipThe position of track is relatively fixed, and completes positioning action.
Above-mentioned puncture positioning guider is used to carry out percutaneous cervical arc root screw Needle localization present invention also offers a kind ofMethod, comprises the following steps：
A. the introversion of the thickness and pedicle of vertebral arch of the skin soft tissue of patient is measured according to CT and/or MRI image dataAngle, and thickness and pedicle of vertebral arch leaning angle according to the skin soft tissue measured, calculate entry point and are thrown apart from pedicle of vertebral arch in body surfaceOpen distance in the side of the outer side edges of shadow；
B. during minimal invasion Pedicle Screw is oriented to, sliding rail is glued with operative incision diaphragmPatch is fixed on the skin at patient back, unclamps the position of adjustment pedicle of vertebral arch body surface marking body under the first fixation kit, X perspectives,Cross section is entered for the side wall and pedicle of vertebral arch of the open column shape pedicle of vertebral arch body surface marking body of ellipse in the outer side edges of body surface projectionRow is overlapping, locks the first fixation kit, and then determine the particular location for the outer side edges that pedicle of vertebral arch is projected in skin surface；
C. the second fixation kit is unclamped, distance is opened on the side of the outer side edges of body surface projection apart from pedicle of vertebral arch according to entry point,The relevant position of entry point is determined on sliding rail, puncture needle guide sleeve so far position is slided；
D. according to the scale of angle indication dial disc, according to the leaning angle of preoperative determination, puncture needle guide sleeve is regulatedAngle, the alignment of puncture needle guide sleeve tail end locks the second fixation kit after puncturing entry point, now pedicle of vertebral arch body surface markingBody, puncture needle guide sleeve, the position of angle indication dial disc and sliding rail are relatively fixed, and complete positioning action.
Compared with prior art, the advantage of the invention is that：The lumbar intervertebral aperture mirror and the percutaneous vertebral arch of Thoracolumbar disk of the present inventionRoot screw puncture positioning guider, can realize that lumbar intervertebral aperture mirror Needle localization is punctured with Thoracolumbar disk percutaneous cervical arc root screw simultaneouslyPositioning, can make retention bar with after the positioning of patient spine spinous process line coincident, entering further according to actual conditions under fluoroscopy during operationPosition and angle of inclination of the puncture needle guide sleeve on sliding rail are adjusted during row lumbar intervertebral aperture mirror Needle localization, is being enteredPedicle of vertebral arch body surface marking body and puncture needle guide sleeve are adjusted during percutaneous pedicle screw Needle localization on sliding railPosition and angle of inclination, so as to fast and accurately puncture puncture needle along puncture needle guide sleeve；In addition, horizontal using positioningBar is positioned with patient spine spinous process line coincident, determines that the position of puncture positioning guider is more simple when can operate Intraoperative positionJust, accurately, fast.The lumbar intervertebral aperture mirror of the present invention and its structure letter of Thoracolumbar disk percutaneous cervical arc root screw puncture positioning guiderIt is single, easy to operate, applied widely, without determining puncture position by the clinical experience and X-ray examination repeatedly of doctor in artAnd angle, it can be prevented effectively to puncture repeatedly in art and unnecessary damage and pain are caused to patient, it is to avoid occur clinical seriousComplication, substantially increase the security and success rate of operation.
Brief description of the drawings
Fig. 1 is the main structure diagram of puncture positioning guider of the present invention.
Fig. 2 is the overlooking the structure diagram of puncture positioning guider of the present invention.
Fig. 3 is the backsight structural representation of puncture positioning guider of the present invention.
Marginal data：
1st, sliding rail；11st, chute；2nd, pedicle of vertebral arch body surface marking body；3rd, angle indication dial disc；4th, puncture needle guide sleevesCylinder；5th, retention bar；6th, the first sliding block；7th, fixed blade；8th, pad；9th, the second sliding block；101st, the first screw rod；102nd, the first lockTight nut；201st, the second screw rod；202nd, the second locking nut.
Embodiment
The present invention is described in further detail below in conjunction with the drawings and specific embodiments.
As shown in Figure 1 to Figure 3, lumbar intervertebral aperture mirror of the invention and Thoracolumbar disk percutaneous cervical arc root screw Needle localization are oriented toDevice, including sliding rail 1, angle indication dial disc 3 and puncture needle guide sleeve 4, angle indication dial disc 3 are slidedly arranged on slipOn track 1, puncture needle guide sleeve 4 is radially arranged along angle indication dial disc 3, and can be turned on angle indication dial disc 3Dynamic adjustment angle of inclination, angle indication dial disc 3 slides rail provided with the scale for indicating the angle of inclination of puncture needle guide sleeve 4The retention bar 5 stretched out to the both sides of sliding rail 1, the cunning between retention bar 5 and angle indication dial disc 3 are additionally provided with road 1A pedicle of vertebral arch body surface marking body 2 is slidably equipped with dynamic rail road 1, pedicle of vertebral arch body surface marking body 2 has with pedicle of vertebral arch in body surface projectionThe summit of outer side edges carries out overlapping location reference point O, wherein, pedicle of vertebral arch is shaped as ellipse body surface projection, the summitFor the end points of the short axle of ellipse projection；The card of angle indication dial disc 3 is parallel with the graduation indication face of sliding rail 1；AndCross the axis L2 of puncture needle guide sleeve 4 and plane A parallel to graduation indication face is with crossing location reference point O and parallel to scaleThe plane B of index plane is essentially coincided；Pedicle of vertebral arch body surface marking body 2 by the first fixation kit with can locking mode be slidedly arranged on slipOn track 1, angle indication dial disc 3 and puncture needle guide sleeve 4 by the second fixation kit with can locking mode be slidedly arranged on cunningOn dynamic rail road 1.
The puncture positioning guider can be such that retention bar 5 is positioned with patient spine spinous process line coincident under fluoroscopy during operationAfterwards, further according to actual conditions, when carrying out lumbar intervertebral aperture mirror Needle localization, regulation puncture needle guide sleeve 4 is in sliding rail 1On position and angle of inclination, regulation pedicle of vertebral arch body surface marking body 2 and worn when carrying out percutaneous cervical arc root screw Needle localizationPosition and angle of inclination of the pricker guide sleeve 4 on sliding rail 1, so as to fast and accurately by puncture needle along puncture needleGuide sleeve 4 is punctured, and its is simple in construction, easy to operate, without the clinical experience and X-ray examination repeatedly in art by doctorTo determine puncture position and angle, it can be prevented effectively to puncture repeatedly in art and unnecessary damage and pain are caused to patient, keep awayExempt from clinical serious complication occur, substantially increase the security and success rate of operation.
Because pedicle of vertebral arch body surface marking body 2 and puncture needle guide sleeve 4 can slide adjustment position, mistake along sliding rail 1The axis L2 of puncture needle guide sleeve 4 and plane A parallel to graduation indication face and cross location reference point O and refer to parallel to scaleShow that the plane B in face is essentially coincided, make the location reference point O and pedicle of vertebral arch of pedicle of vertebral arch body surface marking body 2 in the outside of body surface projectionAfter the summit on side is overlapping, on the one hand, can be to adjust puncture needle guide sleeve 4 away from pedicle of vertebral arch on the side of the outer side edges of body surface projectionOpen distance and reference is provided, on the other hand, after the sliding position and angle adjustment of puncture needle guide sleeve 4 are good, its axis is just rightAnswer the medium position of pedicle of vertebral arch lateral wall, allow puncture needle be fast and accurately pierced into along puncture needle guide sleeve 4 pedicle of vertebral arch andIn centrum, and then ensure the accuracy of entry point position in subsequent procedures operating process, it is ensured that screw is located at most in pedicle of vertebral archAt big transverse diameter, it is to avoid screw is on the upper side or sub- pedicle of vertebral arch on the lower side in cut out, and then cause neurotrosis.
In the present embodiment, pedicle of vertebral arch body surface marking body 2 is the column that a cross section is ellipse, pedicle of vertebral arch body surface markingThe minor axis L1 of the oval cross section of body 2 and the axis L2 of puncture needle guide sleeve 4 are in the same plane；Above-mentioned positioning ginsengExamination point O is the minor axis L1 of oval cross section and the intersection point of the lateral wall of pedicle of vertebral arch body surface marking body 2.In Needle localization operationWhen, make the column lateral wall of ellipse overlapping in the outer side edges of body surface projection with pedicle of vertebral arch, facilitate operating personnel to observe and fastThe minor axis L1 of the whole oval cross section of velocity modulation is with the intersection point of the lateral wall of pedicle of vertebral arch body surface marking body 2 with pedicle of vertebral arch in body surface projectionThe summits of outer side edges essentially coincide.
Further, pedicle of vertebral arch body surface marking body 2 is preferably that a cross section is the open column shape body of ellipse, and open tubular columnThe endoporus of shape body is ellipse；And open column shape body is in ellipse projection and the elliptical spot corresponding different size respectively of body surfaceProjection of the pedicle of vertebral arch in body surface.The open column shape body of ellipse is easy to the outside of the observation pedicle of vertebral arch body surface marking body 2 in the case where X has an X-rayedWhether wall is overlapping with the outer side edges of the projection of pedicle of vertebral arch；Also, the edge of the elliptical spot of open column shape body can be additionally used inThe relatively small pedicle of vertebral arch of size body surface projection outer side edges it is overlapping positioned, expand the scope of application.
In the present embodiment, as shown in Figures 2 and 3, sliding rail 1 offers the chute 11 extended along its length, angleThe side of degree indication dial disc 3 is connected with the first sliding block 6 and is slidedly arranged on by the first sliding block 6 in chute 11, pedicle of vertebral arch body surface markNote body 2 is connected with the second sliding block 9 and is slidedly arranged on by the second sliding block 9 in chute 11.First fixation kit includes the first screw rod 101With the first locking nut 102, one end of the first screw rod 101 and pedicle of vertebral arch body surface marking body 2 be affixed, the other end and the first locking screwMother 102 is connected.First locking nut 102 and pedicle of vertebral arch body surface marking body 2 are divided into the both sides of sliding rail 1, are unscrewingDuring the first locking nut 102, pedicle of vertebral arch body surface marking body 2, the first screw rod 101 and the first locking nut 102 can be slided along chute 11Dynamic adjustment position, wherein, the scale on sliding rail 1 is easy to determine the sliding position of pedicle of vertebral arch body surface marking body 2；Tighten firstDuring locking nut 102, pedicle of vertebral arch body surface marking body 2 and the first locking nut 102 are fixedly clamped sliding rail 1, so as to make vertebraThe position of nut body surface marking body 2 keeps fixed.Second fixation kit includes the second screw rod 201 and the second locking nut 202,One end of second screw rod 201 and puncture needle guide sleeve 4 are affixed, the other end through the sliding block 6 of angle indication dial disc 3 and first withSecond locking nut 202 is connected；Puncture needle guide sleeve 4 is articulated with by the second screw rod 201 and the second locking nut 202On angle indication dial disc 3.When unscrewing the second locking nut 202, angle indication dial disc 3, puncture needle guide sleeve 4,Two screw rods 201 and the second locking nut 202 can slide adjustment position along chute 11, while puncture needle guide sleeve 4 can be around secondScale on the axis trimming angle of inclination of screw rod 201, sliding rail 1 and angle indication dial disc 3 is easy to determine that puncture needle drawsThe sliding position of guide pin bushing cylinder 4 and angle of inclination, so that fast and accurately finding side opens distance and puncture angle；Tighten the second lockingDuring nut 202, the locking nut 202 of puncture needle guide sleeve 4 and second is fixedly clamped angle indication dial disc 3 and sliding rail 1,So as to make the position of pedicle of vertebral arch body surface marking body 2 and angle indication dial disc 3 keep fixation.
In the present embodiment, one end of sliding rail 1, which is provided with, to be used to paste the fixation blade 7 being fixed on patient skin, shouldFixed blade 7 is in kidney ellipsoid.Fixed blade 7 can be pasted fixed on patient skin using operative incision diaphragm etc., so thatPuncture positioning guider is fixed, its fixing-stable is reliable, and ensure that the comfort level of patient.Above-mentioned retention bar 5 is closeFixed blade 7 is set.In other embodiments, it can also be not provided with fixing blade 7, directly will using operative incision diaphragm etc.The position that retention bar 5 is connected with sliding rail 1, which is pasted, to be fixed on patient skin.
In the present embodiment, the length that retention bar 5 stretches out to the both sides of sliding rail 1 is inconsistent, namely the both sides of sliding rail 1Retention bar 5 one is long and the other is short, be easy to have an X-rayed the rostral and caudal that judge backbone and centrum.
In the present embodiment, dismountable pad 8, pad are provided between puncture needle guide sleeve 4 and angle indication dial disc 38 are sleeved on the second screw rod 201, and the pad 8 makes the minor axis of pedicle of vertebral arch body surface marking body 2 and the axle of puncture needle guide sleeve 4Line is in the same plane, after the pad 8 between puncture needle guide sleeve 4 and angle indication dial disc 3 is removed, can make puncturePin guide sleeve 4 is close to angle indication dial disc 3, be easy to adjust in foramen intervertebrale lens operation technique puncture needle guide sleeve 4 toAccurate guide position.
The puncture positioning guider of the present embodiment is preoperative common by x-ray, CT and/or magnetic when carrying out foramen intervertebrale lens punctureShake and find the target area of puncture on imaging data, and design puncture route, and then measure inserting needle puncture angle and skinSurface entry point is apart from centrum spinous process line（That is centrum center line）Side open distance；By retention bar 5 and patient under fluoroscopy during operationSpinous process line coincident（I.e. where the center line of cone）, the retention bar 5 plays positioning action, is puncture positioning guiderFixed position provides reference, is easy to the position of adjustment determination puncture needle guide sleeve 4 in subsequent operation.Use operative incision diaphragmFixed blade 7 is pasted and is fixed on the skin at patient back, the side of preoperative measurement is determined according to the scale on sliding rail 1Relevant position of the distance on skin is opened, the second locking nut 202, slip angle indication dial disc 3 to suitable position is then unclampedThe angle of puncture needle guide sleeve 4 is put and regulates, the alignment of the tail end of puncture needle guide sleeve 4 tightens the second lock after puncturing entry pointTight nut 202, now the position of puncture needle guide sleeve 4, angle indication dial disc 3 and sliding rail 1 be relatively fixed, then willPuncture needle is punctured along the row of set puncture needle guide sleeve 4.
When carrying out Pedicle Screw, the preoperative skin that can measure patient according to CT and/or MRI image data is softThe length of the thickness of tissue, the leaning angle of pedicle of vertebral arch and screw used, and according to the thickness and vertebral arch of the skin soft tissue measuredRoot leaning angle, calculates entry point and opens distance on the side of the outer side edges of body surface projection apart from pedicle of vertebral arch；In minimal invasion pedicle of vertebral archIt is the open column shape pedicle of vertebral arch body surface marking body 2 of ellipse by cross section in advance under perspective during screw puts nail guidingLateral wall and pedicle of vertebral arch are overlapping in the outer side edges progress of body surface projection, and make location reference point O（The minor axis of oval cross sectionL1 and the lateral wall of pedicle of vertebral arch body surface marking body 2 intersection point）It is substantially overlapping on the summit of the outer side edges of body surface projection with pedicle of vertebral arch, enterAnd determine particular location of the pedicle of vertebral arch in the outer side edges of body surface projection, in order to determine that distance is opened on the preoperative side calculatedInitial calculation position, is easy to adjustment in subsequent operation to determine that the position of puncture needle guide sleeve 4 determines entry point；According to determinationThe position that distance adjusts puncture needle guide sleeve 4 according to the scale on sliding rail 1 is opened on side, passes through elastic second locking nutOpen distance in the side of 202 adjustment puncture needle guide sleeves 4（1.0cm left and right）And inclined angle, along puncture needle guide sleeve 4 by screwThe through bony surface of skin soft tissue is pierced into, perspective is lower to confirm puncture needle tip in the position of pedicle of vertebral arch lateral wall, and such as position is goodIt is good, then puncture needle is directly squeezed into pedicle of vertebral arch and centrum using hand drill or electric drill, by hollow reamer along puncture needleExpand duct, be afterwards directly threaded into screw in pedicle of vertebral arch and centrum along puncture needle.Clinical experience hand without depending on doctor in artTouch the heart and can determine whether entry point, as long as the tip of the lower guide pin of perspective is overlapping with the middle upper limb of pedicle of vertebral arch lateral wall, leaning angle withoutThe range estimation of doctor need to be leaned on, according to the difference of different centrum leaning angles, accurately regulation selection is suitable on angle indication dial disc 3Angle, it is to avoid the difference between the different pedicle screws that hand operation is brought, realize the mark of Pedicle ScrewStandardization is operated.
Described above is only the preferred embodiment of the present invention, and protection scope of the present invention is not limited merely to above-mentioned implementationExample.To those of ordinary skill in the art, the improvement and change resulting in the case where not departing from the technology of the present invention concept thereofChange and also should be regarded as protection scope of the present invention.