技术领域technical field
本发明属于医疗器械技术领域，尤其涉及一种结合透视的拆卸式皮外微创椎弓根螺钉导航装置。The invention belongs to the technical field of medical devices, in particular to a detachable extracutaneous minimally invasive pedicle screw navigation device combined with perspective.
背景技术Background technique
胸腰椎椎体压缩性和爆裂性骨折是脊柱骨折的常见类型，经后路椎弓根内固定系统是处理此类损伤的首选措施。因传统开放置钉手术创伤较大、组织切开的范围较广、手术中会对周围组织长时间牵拉，而影响患者术后功能恢复，所以近年来随着脊柱微创外科的发展，经皮椎弓根螺钉固定技术日益受到重视，术中椎弓根螺钉进钉点和钉道方向的确定是这一技术的关键，但胸腰椎解剖结构比较复杂且变异大, 常规的经皮椎弓根手术中往往需连续透视下置钉，造成医务人员和患者辐射剂量加大，长时间会导致白血病及皮肤癌的发生，徒手有限触摸的椎弓根置钉方法虽可减少透视，但延长了手术时间，且更难满足同一椎体双侧螺钉进钉点和方向的一致性，影响复位效果。Thoracolumbar compression and burst fractures are common types of spinal fractures, and the posterior pedicle fixation system is the first choice for dealing with such injuries. Due to the large trauma of traditional open nail placement surgery, the wide range of tissue incision, and the long-term stretching of surrounding tissues during the operation, which affects the postoperative functional recovery of patients, so in recent years, with the development of minimally invasive spinal surgery, through Skin pedicle screw fixation technology has been paid more and more attention. The determination of the pedicle screw entry point and the direction of the screw path during operation is the key to this technology. Pedicle screw placement under continuous fluoroscopy is often required in root surgery, resulting in increased radiation doses for medical staff and patients, which can lead to leukemia and skin cancer for a long time. Although the method of pedicle screw placement with bare hands and limited touch can reduce fluoroscopy, it prolongs time. The operation time is longer, and it is more difficult to meet the consistency of the entry point and direction of the screws on both sides of the same vertebra, which affects the reduction effect.
另外目前已经存在的皮外个体化模板，是以皮肤外部的形态为模板个体化设计，但皮肤软组织活动大，受体位等影响，且不容易固定，明显影响定位的准确性。In addition, the existing individualized templates outside the skin are individually designed based on the external shape of the skin, but the soft tissue of the skin moves a lot and is affected by the receptor position, and is not easy to fix, which obviously affects the accuracy of positioning.
发明内容Contents of the invention
为了解决上述技术问题，本发明提供一种结合透视的拆卸式皮外微创椎弓根螺钉导航装置，使脊柱微创手术中经皮椎弓根螺钉植入准确，同时减少患者和医护人员的辐射。In order to solve the above-mentioned technical problems, the present invention provides a detachable extracutaneous minimally invasive pedicle screw navigation device combined with fluoroscopy, so that the implantation of percutaneous pedicle screws in minimally invasive spinal surgery is accurate, and at the same time reduces the burden on patients and medical staff. radiation.
解决以上技术问题的本发明中的一种结合透视的拆卸式皮外微创椎弓根螺钉导板装置，其特征在于：所述导航装置由N>=3的单体模板组成，所述单体模板设有左横连和右横连，左横连一端设有卡块，右横连一端内设有卡槽，使用时卡块插入卡槽中使左横连和右横连形成一体；导板还设有横向透视定位针导向孔、可选择微创定位针导向孔、棘突定位针导向孔和纵向透视定位针导向孔，横向透视定位针导向孔用以穿过横向透视导针、可选择微创定位针导向孔用以穿过定位导针、棘突定位针导向孔用以穿过棘突透视定位针和纵向透视定位针导向孔用以穿过纵向透视导针。A detachable extracutaneous minimally invasive pedicle screw guide plate device in the present invention that solves the above technical problems is characterized in that: the navigation device is composed of a single template with N>=3, and the single The template is provided with left and right horizontal connections, one end of the left horizontal connection is provided with a card block, and one end of the right horizontal connection is provided with a card slot. There are also horizontal fluoroscopy positioning needle guide holes, minimally invasive positioning needle guide holes, spinous process positioning needle guide holes and longitudinal fluoroscopy positioning needle guide holes. The horizontal fluoroscopy positioning needle guide holes are used to pass through the horizontal fluoroscopy guide needles. The minimally invasive positioning needle guide hole is used to pass through the positioning guide needle, the spinous process positioning needle guide hole is used to pass through the spinous process perspective positioning needle, and the longitudinal perspective positioning needle guide hole is used to pass through the longitudinal perspective guide needle.
本发明中的优化方案中横向透视定位针导向孔为水平两侧贯通，分别设于左横连侧部和右横连侧部；可选择微创定位针导向孔为上下两表面贯通，两组，分别位于左横连和右横连上下表面上；纵向透视定位针导向孔为前后两侧贯通，位于左横连和右横连前后侧面上；棘突定位针导向孔为上下两表面贯通，两组，一组位于左横连上下表面，另一组位于卡块上下表面和右横连上下表面相对应的位置上。In the optimization scheme of the present invention, the guide holes of the horizontal fluoroscopy positioning needles are horizontally connected on both sides, and are respectively arranged on the left side and the right side of the horizontal connection; , respectively located on the upper and lower surfaces of the left and right transverse joints; the guide holes of the longitudinal perspective positioning needles penetrate through the front and rear sides, and are located on the front and rear sides of the left and right transverse joints; the guide holes of the spinous process positioning needles penetrate through the upper and lower surfaces, There are two groups, one group is located on the upper and lower surfaces of the left horizontal connection, and the other group is located on the position corresponding to the upper and lower surfaces of the clamping block and the upper and lower surfaces of the right horizontal connection.
所述可选择微创定位针导向孔两组对称位于棘突定位针导向孔两侧，棘突定位针导向孔错开平行分布，位于导板上下表面的中心位置。The two groups of optional minimally invasive positioning needle guide holes are symmetrically located on both sides of the spinous process positioning needle guide holes, and the spinous process positioning needle guide holes are staggered and distributed in parallel, and are located at the center of the upper and lower surfaces of the guide plate.
所述可选择微创定位针导向孔的数量>=20，优选可选择微创定位针导向孔的数量=90。The number of selectable minimally invasive positioning needle guide holes is >=20, preferably the number of selectable minimally invasive positioning needle guide holes=90.
所述可选择微创定位针导向孔（2）直径为2.1mm，所述的拆卸式皮外微创椎弓根螺钉导航装置依据可选择微创定位针导向孔（2）内倾角度的不同被设计成为多个导板装置，内倾角度分别为4°、6°、8°、10°、12°或14°。The diameter of the optional minimally invasive positioning pin guide hole (2) is 2.1mm, and the detachable extracutaneous minimally invasive pedicle screw navigation device is adjusted according to the inclination angle of the optional minimally invasive positioning pin guide hole (2). Designed as multiple guide plate devices with inclination angles of 4°, 6°, 8°, 10°, 12° or 14°.
本发明中的皮外导航模板为通用型模板，可选择微创定位针导向孔内倾角有4°、6°、8°、10°、12°、14°等多种型号，能够满足不同椎体不同患者的手术要求。The extracutaneous navigation template in the present invention is a general-purpose template, and various models such as 4°, 6°, 8°, 10°, 12°, 14°, etc. can be selected for the inclination angle of the guide hole of the minimally invasive positioning needle, which can meet the needs of different vertebral bodies. According to the surgical requirements of different patients.
所述左横连和右横连上表面分别设有度数标识。The upper surfaces of the left horizontal link and the right horizontal link are respectively provided with degree marks.
所述导板厚14-16mm。The thickness of the guide plate is 14-16mm.
所述横向透视定位针导向孔、棘突定位针导向孔和纵向透视定位针导向孔的孔径为2.1mm。The diameters of the guide holes of the transverse fluoroscopy positioning needle, the spinous process positioning needle and the longitudinal fluoroscopy positioning needle are 2.1 mm.
所述导板为长方体。The guide plate is a cuboid.
所述横向透视定位针导向孔为1个，纵向透视定位针导向孔为3个。There is one guide hole for the horizontal fluoroscopy positioning needle, and three guide holes for the longitudinal fluoroscopy positioning needle.
本发明中模板边缘还可钝化处理，以避免压伤皮肤。In the present invention, the edge of the template can also be passivated to avoid crushing the skin.
本发明中的模板完全放置于体外，通过透视辅助提高其准确性，模板可以通过各样克氏针（定位针）连接为一整体提高其稳定性，也可以在矢状位上适当的进行调整，适合不同的体位；同时减少医务人员和患者的放射暴露，床上也较小，具有较好的可推广性。The template in the present invention is completely placed outside the body, and its accuracy is improved through fluoroscopy. The template can be connected as a whole through various Kirschner wires (positioning pins) to improve its stability, and it can also be adjusted appropriately in the sagittal position. , suitable for different body positions; at the same time, it reduces the radiation exposure of medical staff and patients, and the bed is also smaller, which has better scalability.
本发明中所述可选择微创定位针导向孔形成向内的倾斜角度，以保证椎弓根螺钉能够内倾植入。因为导针放置后有一个向内的倾斜角度，若做成一个整体，不容易取出导板装置。本发明形成拆卸式，避免了导针放置后不容易取出的问题，增加了操作上的方便性；又将单独导航模板设计成一个整体的装置，减少拆卸式导航模板上下晃动的可能性，避免螺钉进钉时角度不好把握的问题，增加术中成功率。The guide hole of the minimally invasive positioning needle described in the present invention can be selected to form an inward oblique angle to ensure that the pedicle screw can be implanted inwardly. Because there is an inward inclination angle after the guide pin is placed, if it is made as a whole, it is not easy to take out the guide plate device. The invention forms a detachable type, which avoids the problem that the guide pin is not easy to be taken out after being placed, and increases the convenience of operation; the separate navigation template is designed as a whole device, which reduces the possibility of the detachable navigation template shaking up and down, avoids It is difficult to grasp the angle when the screw enters the nail, which increases the success rate of the operation.
本发明中结合透视辅助的个体化皮外微创椎弓根螺钉导航装置，通过术中透视辅助定位，解决了模板随皮肤移动变化的问题，另外也增加了固定于棘突的棘突透视定位针，防止移动。In the present invention, combined with the fluoroscopy-assisted individualized extracutaneous minimally invasive pedicle screw navigation device, through intraoperative fluoroscopy-assisted positioning, the problem that the template changes with the skin movement is solved, and the spinous process fluoroscopy positioning fixed on the spinous process is also added. needle to prevent movement.
本发明中的装置完全放置于体外，通过透视辅助提高其准确性，单体模板可以通过克氏针连接为一整体提高其稳定性，也可以在矢状位上适当的进行调整，适合不同的体位；同时减少医务人员和患者的放射暴露，床上也较小，具有较好的可推广性。The device in the present invention is completely placed outside the body, and its accuracy is improved through fluoroscopy. The single template can be connected as a whole through Kirschner wires to improve its stability, and can also be properly adjusted on the sagittal position, suitable for different patients. body position; at the same time, it reduces the radiation exposure of medical staff and patients, and the bed is also smaller, which has better scalability.
本发明中单体模板为通用型导航模板，适用于绝大多数胸腰椎骨折、骨病需要经皮穿刺椎弓根实施手术的患者，本装置通过X线透视辅保证穿刺的准确，可以同时穿刺多个椎体弓根，因而不仅可以减少患者的创伤，也可以减少医务人员和患者的放射暴露。The monomer template in the present invention is a general-purpose navigation template, which is suitable for the vast majority of patients with thoracolumbar fractures and bone diseases who need percutaneous pedicle puncture for surgery. Multiple vertebral pedicles can not only reduce the trauma of patients, but also reduce the radiation exposure of medical staff and patients.
附图说明Description of drawings
图1为本发明中导航装置的结构示意图Fig. 1 is the structural representation of navigation device among the present invention
图2为本发明中单体模板示意图Fig. 2 is the schematic diagram of monomer template in the present invention
图3和图4为本发明中导航装置与胸腰椎骨的结合示意图Figure 3 and Figure 4 are schematic diagrams of the combination of the navigation device and the thoracolumbar vertebrae in the present invention
图5为本发明中定位导针与胸腰椎骨的结合示意图Figure 5 is a schematic diagram of the combination of the positioning guide pin and the thoracolumbar vertebrae in the present invention
其中图中的具体标识如下: 1.横向透视定位针导向孔, 2.可选择微创定位针导向孔3.棘突定位针导向孔, 4、度数标识，5.纵向透视定位针导向孔,6.模板,7. 模板上下表面,8.模板前后侧面, 9-1.左横连侧部，9-2.右横连侧部，10. 左横连，11. 右横连，12.卡块,13.卡槽，14.皮肤，15.纵向透视导针，16.横向透视导针，17.定位导针，18.棘突透视定位针，19. 正常椎体,20.患椎，21.胸腰椎骨The specific marks in the figure are as follows: 1. Horizontal fluoroscopy positioning needle guide hole, 2. Optional minimally invasive positioning needle guide hole 3. Spinous process positioning needle guide hole, 4. Degree mark, 5. Longitudinal fluoroscopy positioning needle guide hole, 6. Formwork, 7. Upper and lower surfaces of the formwork, 8. Front and rear sides of the formwork, 9-1. The side of the left horizontal connection, 9-2. The side of the right horizontal connection, 10. The left horizontal connection, 11. The right horizontal connection, 12. Block, 13. Card slot, 14. Skin, 15. Longitudinal fluoroscopy guide pin, 16. Transverse fluoroscopy guide pin, 17. Positioning guide pin, 18. Spinous process fluoroscopy positioning pin, 19. Normal vertebral body, 20. Affected vertebra , 21. Thoracolumbar vertebrae
具体实施方式detailed description
以下用具体实施例对本发明作进一步的说明：The present invention will be further described with specific examples below:
实施例1Example 1
一种结合透视的拆卸式皮外微创椎弓根螺钉导航装置，导航装置由N=3的单体模板组成，单体模板设有左横连和右横连，左横连一端设有卡块，右横连一端内设有卡槽，使用时卡块插入卡槽中使左横连和右横连形成一体；导板还设有横向透视定位针导向孔、可选择微创定位针导向孔、棘突定位针导向孔和纵向透视定位针导向孔，横向透视定位针导向孔用以穿过横向透视导针、可选择微创定位针导向孔用以穿过定位导针、棘突定位针导向孔用以穿过棘突透视定位针和纵向透视定位针导向孔用以穿过纵向透视导针。A detachable extracutaneous minimally invasive pedicle screw navigation device combined with perspective. The navigation device is composed of a single template with N=3. The single template is provided with a left horizontal connection and a right horizontal connection. There is a card slot in one end of the right horizontal link, and the card block is inserted into the card slot when in use so that the left horizontal link and the right horizontal link are integrated; the guide plate is also equipped with a guide hole for a horizontal perspective positioning needle and a guide hole for a minimally invasive positioning needle. , Spinous process positioning needle guide hole and longitudinal fluoroscopy positioning needle guide hole, horizontal fluoroscopy positioning needle guide hole is used to pass through the horizontal fluoroscopy guide needle, minimally invasive positioning needle guide hole can be selected to pass through the positioning guide needle, spinous process positioning needle The guide hole is used to pass through the spinous process perspective positioning needle and the longitudinal perspective positioning needle guide hole is used to pass through the longitudinal perspective guide needle.
横向透视定位针导向孔为水平两侧贯通，分别设于左横连侧部和右横连侧部；可选择微创定位针导向孔为上下两表面贯通，两组，分别位于左横连和右横连上下表面上；纵向透视定位针导向孔为前后两侧贯通，位于左横连和右横连前后侧面上；棘突定位针导向孔为上下两表面贯通，两组，一组位于左横连上下表面，另一组位于卡块上下表面和右横连上下表面相对应的位置上，使用时插入棘突透视定位针以固定和连接左横连和右横连。The horizontal fluoroscopy positioning needle guide holes are horizontally connected on both sides, and are respectively located on the left and right transverse connection sides; the minimally invasive positioning needle guide holes can be selected to penetrate the upper and lower surfaces, and two groups are respectively located on the left and right horizontal connections. The upper and lower surfaces of the right transverse joint; the guide holes of the longitudinal fluoroscopy positioning needles run through the front and rear sides, and are located on the front and rear sides of the left and right transverse joints; The upper and lower surfaces of the transverse connection, and the other group is located at the corresponding position between the upper and lower surfaces of the block and the upper and lower surfaces of the right horizontal connection. When in use, insert the spinous process perspective positioning pin to fix and connect the left and right horizontal connections.
可选择微创定位针导向孔两组对称位于棘突定位针导向孔两侧，棘突定位针导向孔错开平行分布，位于导板上下表面的中心位置。Two groups of minimally invasive positioning needle guide holes can be selected to be symmetrically located on both sides of the spinous process positioning needle guide holes, and the spinous process positioning needle guide holes are staggered and distributed in parallel, and are located at the center of the upper and lower surfaces of the guide plate.
皮外导航模板为通用型模板（非个体化设计），可选择微创定位针导向孔有4°、6°、8°、10°、12°、14°等多种型号，能够满足不同椎体不同患者的手术要求，具有推广性。The extracutaneous navigation template is a general-purpose template (non-individualized design), and there are 4°, 6°, 8°, 10°, 12°, 14° and other models of minimally invasive positioning needle guide holes, which can meet the needs of different vertebral bodies. It can be generalized according to the surgical requirements of different patients.
可选择微创定位针导向孔的数量60个。60 guide holes for minimally invasive positioning needles can be selected.
术前通过CT个体化测量所需手术节段椎体椎弓根螺钉的内倾角度，选择相应度数的皮外导板，术中在保持内倾角度不变的情况下，直接在不同的孔道调整，更方便于术中操作。横向透视定位针导向孔、可选择微创定位针导向孔、棘突定位针导向孔和纵向透视定位针导向孔的孔径为2.1mm，刚好能穿过2mm直径克氏针。棘突表浅，在椎弓根低位。可以用棘突透视定位针固定避免移位。导板厚14-16mm，方便操作。Individually measure the inclination angle of the vertebral pedicle screw in the required surgical segment through CT before operation, select the corresponding degree of extracutaneous guide plate, and adjust it directly in different holes while keeping the inclination angle unchanged during the operation. It is convenient for intraoperative operation. The diameter of the guide hole of the horizontal fluoroscopy positioning needle, the guide hole of the optional minimally invasive positioning needle, the guide hole of the spinous process positioning needle and the guide hole of the longitudinal fluoroscopy positioning needle is 2.1mm, which can just pass through a 2mm diameter Kirschner wire. The spinous process is superficial and low in the pedicle. Can be fixed with spinous process fluoroscopy positioning pin to avoid displacement. The thickness of the guide plate is 14-16mm, which is easy to operate.
实施例2Example 2
一种结合透视的拆卸式皮外微创椎弓根螺钉导航装置，导航装置由N=4的单体模板组成，单体模板设有左横连和右横连，左横连一端设有卡块，右横连一端内设有卡槽，使用时卡块插入卡槽中使左横连和右横连形成一体；导板还设有横向透视定位针导向孔、可选择微创定位针导向孔、棘突定位针导向孔和纵向透视定位针导向孔，横向透视定位针导向孔用以穿过横向透视导针、可选择微创定位针导向孔用以穿过定位导针、棘突定位针导向孔用以穿过棘突透视定位针和纵向透视定位针导向孔用以穿过纵向透视导针。A detachable extracutaneous minimally invasive pedicle screw navigation device combined with perspective. The navigation device is composed of a single template with N=4. The single template is provided with a left horizontal connection and a right horizontal connection. There is a card slot in one end of the right horizontal link, and the card block is inserted into the card slot when in use so that the left horizontal link and the right horizontal link are integrated; the guide plate is also equipped with a guide hole for a horizontal perspective positioning needle and a guide hole for a minimally invasive positioning needle. , Spinous process positioning needle guide hole and longitudinal fluoroscopy positioning needle guide hole, horizontal fluoroscopy positioning needle guide hole is used to pass through the horizontal fluoroscopy guide needle, minimally invasive positioning needle guide hole can be selected to pass through the positioning guide needle, spinous process positioning needle The guide hole is used to pass through the spinous process perspective positioning needle and the longitudinal perspective positioning needle guide hole is used to pass through the longitudinal perspective guide needle.
横向透视定位针导向孔为水平两侧贯通，分别设于左横连侧部和右横连侧部；可选择微创定位针导向孔为上下两表面贯通，两组，分别位于左横连和右横连上下表面上；纵向透视定位针导向孔为前后两侧贯通，位于左横连和右横连前后侧面上；棘突定位针导向孔为上下两表面贯通，两组，一组位于左横连上下表面，另一组位于卡块上下表面和右横连上下表面相对应的位置上，使用时插入棘突透视定位针以固定和连接左横连和右横连。The horizontal fluoroscopy positioning needle guide holes are horizontally connected on both sides, and are respectively located on the left and right transverse connection sides; the minimally invasive positioning needle guide holes can be selected to penetrate the upper and lower surfaces, and two groups are respectively located on the left and right horizontal connections. The upper and lower surfaces of the right transverse joint; the guide holes of the longitudinal fluoroscopy positioning needles run through the front and rear sides, and are located on the front and rear sides of the left and right transverse joints; The upper and lower surfaces of the transverse connection, and the other group is located at the corresponding position between the upper and lower surfaces of the block and the upper and lower surfaces of the right horizontal connection. When in use, insert the spinous process perspective positioning pin to fix and connect the left and right horizontal connections.
可选择微创定位针导向孔的数量=90个，两组180个，术前通过CT个体化测量所需手术节段椎体椎弓根螺钉的内倾角度，选择相应度数的皮外导板，术中在保持内倾角度不变的情况下，直接在不同的孔道调整，更方便于术中操作。皮外导航模板为通用型模板（非个体化设计），可选择微创定位针导向孔直径为2.1mm，所述的拆卸式皮外微创椎弓根螺钉导航装置依据可选择微创定位针导向孔内倾角度的不同被设计成为多个导板装置，内倾角度分别为4°、6°、8°、10°、12°或14°。The number of minimally invasive positioning needle guide holes can be selected = 90, 180 in the two groups, and the inclination angle of the vertebral pedicle screws in the required surgical segment is measured individually by CT before operation, and the extracutaneous guide plate of the corresponding degree is selected. In the case of keeping the inclination angle unchanged, it can be directly adjusted in different channels, which is more convenient for intraoperative operation. The extracutaneous navigation template is a universal template (non-individualized design), and the diameter of the guide hole of the minimally invasive positioning pin is 2.1 mm. The detachable extracutaneous minimally invasive pedicle screw navigation device is based on the optional minimally invasive positioning pin The different inclination angles of the guide holes are designed as multiple guide plate devices, and the inclination angles are 4°, 6°, 8°, 10°, 12° or 14° respectively.
可选择微创定位针导向孔有4°、6°、8°、10°、12°、14°等多种型号，能够满足不同椎体不同患者的手术要求，具有推广性。There are 4°, 6°, 8°, 10°, 12°, 14° and other types of minimally invasive positioning needle guide holes that can be selected, which can meet the surgical requirements of different patients with different vertebral bodies and are popular.
横向透视定位针导向孔为1个，纵向透视定位针导向孔为3个，棘突定位针导向孔18个，分两组，每组9个，两组错开平行分布，位于导板上下表面的中心位置。There is 1 guide hole for the horizontal fluoroscopy positioning needle, 3 guide holes for the longitudinal fluoroscopy positioning needle, and 18 guide holes for the spinous process positioning needle, which are divided into two groups, 9 in each group, and the two groups are staggered and distributed in parallel. Location.
横向透视定位针导向孔、棘突定位针导向孔和纵向透视定位针导向孔的孔径为2.1mm，刚好能穿过2mm直径克氏针。棘突表浅，在椎弓根低位。可以用棘突透视定位针固定避免移位。The diameter of the guide hole of the horizontal fluoroscopy positioning needle, the guide hole of the spinous process positioning needle and the guide hole of the longitudinal fluoroscopy positioning needle is 2.1 mm, which can just pass through a 2 mm diameter Kirschner wire. The spinous process is superficial and low in the pedicle. Can be fixed with spinous process fluoroscopy positioning pin to avoid displacement.
模板上表面设有指示块，且模板边缘还可钝化处理，以避免压伤皮肤。An indicator block is provided on the upper surface of the template, and the edge of the template can also be passivated to avoid crushing the skin.
本发明中结合透视的拆卸式皮外微创椎弓根螺钉导航装置，通过术中透视辅助定位，解决了模板随皮肤移动变化的问题，另外也增加了固定于棘突的定位针，防止移动。The detachable extracutaneous minimally invasive pedicle screw navigation device combined with fluoroscopy in the present invention solves the problem that the template changes with the movement of the skin through intraoperative fluoroscopy to assist positioning, and also adds a positioning pin fixed on the spinous process to prevent movement .
本发明中的装置使经皮准确放置及容易固定，且装置完全设置在皮外，术中时不需要切口放置，另外设计棘突定位针加强定位效果。The device in the present invention enables accurate percutaneous placement and easy fixation, and the device is completely placed outside the skin, no incision is required during the operation, and a spinous process positioning needle is designed to enhance the positioning effect.
本发明中所述可选择微创定位针导向孔形成向内的倾斜角度，以保证椎弓根螺钉能够内倾植入。因为导针有一个向内的倾斜角度，若做成一个整体，不容易取出导板。本发明形设计成可拆卸式，避免了不容易取出导板的问题，增加了操作上的方便性；又将单独导航模板设计成一个整体的装置，减少拆卸式导航模板上下晃动的可能性，避免螺钉进钉时角度不好把握的问题，增加术中成功率。The optional minimally invasive positioning needle guide hole in the present invention forms an inward inclination angle to ensure that the pedicle screw can be implanted inward. Because the guide pin has an inward inclination angle, if it is made as a whole, it is not easy to take out the guide plate. The present invention is designed to be detachable, which avoids the problem that it is not easy to take out the guide plate, and increases the convenience of operation; the separate navigation template is designed as a whole device, which reduces the possibility of the detachable navigation template shaking up and down, avoids It is difficult to grasp the angle when the screw enters the nail, which increases the success rate of the operation.
本发明导航装置在术中的过程：The intraoperative process of the navigation device of the present invention:
术中内固定均为长臂单芯椎弓根螺钉系统，全麻后患者取悬空腹部的俯卧位。使用C型臂X线机以伤椎为中心标准正位摄片，确认棘突位于左右侧椎弓根投影连线的中心位置。体表标记伤椎及相邻头尾侧椎体上缘、各椎体棘突的连线及左右侧椎弓根投影的连线。选直径2mm克氏针多枚分别穿入上述各模板的导向孔中，用较短的直径2mm克氏针击入棘突并用手术粘性贴膜固定。The intraoperative internal fixation was the long-arm single-core pedicle screw system, and the patient was placed in the prone position with the abdomen suspended after general anesthesia. Use a C-arm X-ray machine to take standard anteroposterior photographs centered on the injured vertebra, and confirm that the spinous process is located at the center of the projection line connecting the left and right pedicles. The body surface marks the injured vertebra and the upper edge of the adjacent craniocaudal vertebral body, the line connecting the spinous processes of each vertebra, and the line connecting the left and right pedicle projections. Multiple Kirschner wires with a diameter of 2mm were selected and inserted into the guide holes of the above-mentioned templates respectively, and a shorter 2mm diameter Kirschner wire was driven into the spinous process and fixed with a surgical adhesive film.
以上述正位摄片为基准在模板上选择大致合适的导向孔，经皮依次击入直径2mm克氏针到达骨质后，行正侧位摄片，依据X线片选择临近导向孔调整定位克氏针，直至击入的克氏针调整到正位达到椎弓根投影边缘，侧位与椎体上终板平行（与术前设计相同），继续击入克氏针，使其针尖侧位达到椎体后壁时，正位位于椎弓根投影内侧，继续击入克氏征进入椎体前1/3。依次沿定位克氏针逐级放入扩张套筒和保护套筒，用中空丝攻沿定位克氏针扩大钉道，选择合适直径和长度的长臂单芯椎弓根螺钉沿定位克氏针拧入椎体，伤椎选用的螺钉长度稍短。适当调整手术床的角度，通过体位复位伤椎等。再置入螺钉尾帽，适当撑开复位椎体并锁紧，折断钉尾，术毕。Based on the above-mentioned anteroposterior radiographs, select a roughly suitable guide hole on the template. After the percutaneous Kirschner wires with a diameter of 2 mm reach the bone, perform anteroposterior and lateral radiographs, and select the adjacent guide holes to adjust the positioning according to the X-ray films. Kirschner wire until the inserted Kirschner wire is adjusted to the positive position and reaches the edge of the pedicle projection, and the lateral position is parallel to the upper endplate of the vertebral body (same as the preoperative design), continue to drive in the Kirschner wire so that the side of the needle tip When the position reaches the posterior wall of the vertebral body, it is positioned anteriorly on the medial side of the pedicle projection, and continues to enter the Klinefelter sign into the anterior 1/3 of the vertebral body. Insert expansion sleeves and protective sleeves step by step along the positioning Kirschner wires in sequence, expand the screw path along the positioning Kirschner wires with a hollow wire tap, and select long-arm single-core pedicle screws of appropriate diameter and length along the positioning Kirschner wires. Screw into the vertebral body, and the length of the screw used for the injured vertebra is slightly shorter. Properly adjust the angle of the operating table, and reset the injured vertebra through posture. Then insert the screw tail cap, properly propel and reset the vertebral body and lock it, break off the screw tail, and the operation is completed.
以上所述仅为本发明的较佳实施例而已，并不用以限制本发明，凡在本发明的精神和原则之内所作的任何修改、等同替换和改进等，均应包含在本发明的保护范围之内。The above descriptions are only preferred embodiments of the present invention, and are not intended to limit the present invention. Any modifications, equivalent replacements and improvements made within the spirit and principles of the present invention should be included in the protection of the present invention. within range.
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201710637055.7ACN107260286A (en) | 2017-07-31 | 2017-07-31 | Minimally invasive pedicle screw guider outside a kind of detachable skin of combination perspective |
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201710637055.7ACN107260286A (en) | 2017-07-31 | 2017-07-31 | Minimally invasive pedicle screw guider outside a kind of detachable skin of combination perspective |
| Publication Number | Publication Date |
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| CN107260286Atrue CN107260286A (en) | 2017-10-20 |
| Application Number | Title | Priority Date | Filing Date |
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| CN201710637055.7APendingCN107260286A (en) | 2017-07-31 | 2017-07-31 | Minimally invasive pedicle screw guider outside a kind of detachable skin of combination perspective |
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