Centering rotary radius offset-minimally invasive sacroiliac screw positioning guide deviceTechnical Field
The invention belongs to the technical field of medical appliances, and relates to a centering rotary radius offset-minimally invasive sacroiliac screw positioning guide device.
Background
The sacroiliac joint and the pelvic posterior ring injury such as dislocation of the peripheral fracture of the sacroiliac joint can cause unstable rotation and unstable vertical of the pelvis, and the superior method for realizing the fixation of the pelvic posterior ring is to implant sacroiliac screws in a patient. In recent years, both clinical and biomechanical studies of pelvic immobilization have demonstrated: the sacroiliac screw enters from the posterolateral aspect of the ilium, passes through the sacroiliac joint and enters the middle upper portion of the sacral 1 or sacral 2 vertebral body, is a good internal fixation. The percutaneous minimally invasive implantation of the sacroiliac screw can effectively reduce bleeding in operation, operation trauma and various complications, and becomes the first choice of clinicians.
The technical difficulty of the sacroiliac joint screw is the placement of a guide pin and the screw, and the current placement of the sacroiliac joint screw is mostly finished by bare hands under the perspective of a C-arm X-ray machine, and the technical difficulty is that: 1. in the nailing process, multiple angles of X-rays are needed to be repeatedly transmitted, positioning is inaccurate, stability is poor, and if a satisfactory fixing position cannot be achieved through multiple attempts, the fixing holding force is greatly reduced due to damage of a bone structure caused by the guide. 2. Because the screw is fixed across the joint, and needs to pass through 3 layers of cortical bone, accurate positioning of the screw feeding point is extremely difficult. 3. The sacrum is tilted backward anatomically, the sacroiliac screw has a certain angle in the cross section and sagittal plane, and the individual differences are large, so that the running direction of the screw is difficult to accurately determine. 4. The length of the screw should not break through the cortical bone of the contralateral sacrum, which is difficult to determine accurately by means of fluoroscopy. 5. The screw has a slight deviation from the anterior approach to the iliac blood vessel, the posterior approach to the caudal nerve in the vertebral canal and the superior approach to the intervertebral disc, so that the screw can not achieve effective fixation, and is extremely easy to damage important nerves and blood vessels and even endanger life. In summary, the placement of the screw lacks objective criteria in terms of the determination of the feed point, the direction of travel, the length of the screw, etc., and is not possible to succeed once, thus being technically very difficult and challenging.
In the existing sacroiliac screw guide device, a pedicle screw guide needle must be driven into a sacrum 1 vertebral body first, and then the guide needle of the sacroiliac screw is drilled into the sacroiliac screw in a point-to-point aiming mode through a pi/2 radian connecting rod. The device improves the accuracy and the safety of the nail placement to a certain extent, but has the following defects: 1. the guide pin of the pedicle screw of the sacrum 1 must be accurately placed, so that the technical threshold is greatly improved, and meanwhile, the fracture sacrum is damaged seriously; if the sacrum 1 pedicle lead cannot be accurately placed at one time, repeated operation can greatly reduce the fixation strength of the sacroiliac screw. 2. Because the guide needle of the sacroiliac screw is used as a reference in the direction of the guide needle of the pedicle screw, and the guide needle of the sacroiliac screw has an included angle with the sagittal plane and the upper cross section of the sacrum, and the individual difference is large, the included angle between the guide needle of the sacroiliac screw and the guide needle of the pedicle screw is difficult to select before and during the operation; thus, although the sacroiliac screw can enter the sacrum, the direction is not necessarily optimal, and the length and fixation strength of the screw are not necessarily optimal. 3. In the case of sacral pedicle fracture, it cannot be used. 4. Sacroiliac screws for the sacrum 2 and other segments cannot be used.
In the prior art, the sighting device which only depends on anatomical marks of lumbar vertebra and pelvis, has no obvious damage to pedicles, has low technical threshold, can randomly adjust the angle according to individual differences of patients, is simple and convenient to operate, and can be accurately placed into the sacroiliac screw guide pin at one time is lacking.
Disclosure of Invention
The invention aims to provide a centering rotary radius offset-minimally invasive sacroiliac screw positioning guide, which combines a rectangular main positioner with a transverse arc-shaped adjuster, can realize the functions of determining a nail feeding point according to different conditions of patients, adjusting the insertion direction of the sacroiliac screw and accurately inserting the sacroiliac screw at one time, and solves the problems in the prior art. The use of the lateral arc adjuster allows the operator to select different sacroiliac screw approach angles depending on the patient's condition.
In order to achieve the above purpose, the technical scheme adopted by the invention is as follows:
A positioning guide device for a centering rotary radius offset-minimally invasive sacroiliac screw comprises a rectangular main positioner, a hollow positioning rod, a transverse arc-shaped adjuster and a hollow sleeve.
The rectangular main positioner comprises a positioner body and a transverse arc sleeve arranged at the front end of the positioner body, wherein a sacrum positioning hole and an ilium fixing hole which are vertically transparent are formed in the positioner body, the sacrum positioning hole is used for being inserted by a guide pin and guiding the guide pin, and the rectangular main positioner can be fixed on ilium through screw nails by the ilium fixing hole. The sacrum locating hole and the ilium fixing hole are respectively provided with a locking component, a left-right through arc-shaped slideway is arranged on the transverse arc-shaped sleeve, and the locking component is arranged on the arc-shaped slideway.
The upper part and the lower part of the hollow positioning rod are cylindrical, the diameter of the lower part is smaller than that of the upper part, a detachably connected threaded guide needle is arranged in the hollow positioning rod, the top of the threaded guide needle is a cylinder, threads are arranged below the cylinder and outside the guide needle, and the hollow positioning rod can be movably inserted into a sacrum positioning hole and can be locked by a locking member on the sacrum positioning hole. The hollow positioning rod is matched with the threaded guide pin to be inserted into a sacrum positioning hole on the rectangular main positioning block body to be punctured into skin, the tip end of the hollow positioning rod is clung to the surface of the bone cortex of the outer side concave bone of the superior articular process of the first sacrum (the clung point of the hollow positioning rod is A point) or the bone surface of other key anatomical marks, and the threaded guide pin can be screwed into the sacrum to stabilize the hollow positioning rod or not screwed into the sacrum. Cumbersome and risky procedures that must rely on pedicle screws of the sacrum as a reference are avoided. A virtual straight line which is parallel to the sagittal plane and vertically enters the sacrum is made through the point A, a certain distance below the point A is selected as a point O (the point O is a rotation circle center) on the virtual straight line, the distance from the point A to the point O is a staggered distance, and the staggered distance can be set by adjusting the scale on a hollow positioning rod inserted into a sacrum positioning hole during operation.
The transverse arc adjuster comprises a rectangular guide block and an arc scale rod arranged on the rectangular guide block, an opening chute which is transparent front and back and is opened downwards is arranged on the rectangular guide block, a locking member is arranged on the opening chute, the hollow sleeve can be movably inserted into the opening chute and can be fastened by the locking member on the opening chute, scales are arranged on the arc scale rod, the arc scale rod can be movably inserted into the arc slide and can be fastened by the locking member on the arc slide, the arc scale rod is consistent with the radian of the arc slide, and the scales on the arc scale rod inserted into the arc slide can be adjusted according to different conditions of patients so as to determine the camber angles of different sacroiliac screw nail paths and human sagittal planes, so as to determine the implantation direction of the sacroiliac screw.
The upper part of the hollow sleeve is cylindrical, the lower part of the hollow sleeve is conical, the hollow sleeve is used for being inserted into the opening chute to reach the outer side of the ilium wing to play a role in positioning and guiding, and an extension line of the insertion direction passes through the rotating sphere center O point.
According to a further technical scheme, the sacrum positioning holes on the positioner body are arranged on the inner sides of the ilium fixing holes, four ilium fixing holes are longitudinally arranged, one sacrum positioning hole is arranged, the four ilium fixing holes are designed to be used for fixing ilium holes at different positions according to different conditions of patients, and one sacrum positioning hole is designed to be used for utilizing the outer concave cortical bone of the superior articular process of the first sacrum or other key anatomical marks as a positioning reference point.
According to a further technical scheme, the radian of the arc-shaped scale bar is of various specifications for selection.
The further technical scheme is that the locator body is further provided with a square connecting hole which is left and right transparent, and the square connecting hole is provided with a locking member.
The further technical scheme is that the inner surface of the cylindrical upper part of the hollow positioning rod is provided with an internal thread, and the outer surface of the cylindrical upper part is provided with scales; the top of the threaded guide pin is a cylinder, external threads are arranged below the cylinder and outside the guide pin, and the external threads of the guide pin are matched with the internal threads of the hollow positioning rod.
The technical scheme is that the device further comprises a contralateral fixing device, wherein the contralateral fixing device comprises a fixing block and a threaded nail. The fixed block is divided into a single-hole fixed block and a double-hole fixed block, a left-right transparent square connecting hole and an upper-lower transparent ilium fixed hole are arranged on the single-hole fixed block, locking members are arranged on the square connecting hole and the ilium fixed hole, a left-right transparent square connecting hole and a front-back transparent square connecting hole are arranged on the double-hole fixed block, and locking members are arranged on the left-right transparent square connecting hole and the front-back transparent square connecting hole.
According to the further technical scheme, the two single-hole fixing blocks are arranged, the two double-hole fixing blocks are arranged, the two threaded nails are arranged, the threaded nails can penetrate through the ilium fixing holes on the single-hole fixing blocks to be drilled into opposite ilium and locked by the locking members of the ilium fixing holes, and the effect of fixing the opposite-side fixing device is achieved.
The further technical scheme is, still include horizontal square connecting rod and vertical square connecting rod, the one end of horizontal square connecting rod is connected with the square connecting hole on the locator body, the square connecting hole of the other end through first single hole fixed block is connected with the penetrating square connecting hole about of diplopore fixed block to by the locking component locking on the three square connecting hole, vertical square connecting rod one end is connected with the penetrating square connecting hole around the diplopore fixed block, the other end is connected with the square connecting hole of the single hole fixed block of second, and by the locking component locking on two square connecting holes. The transverse square connecting rod and the longitudinal square connecting rod are used for connecting the positioner body and the opposite-side fixing device, and the function of stabilizing the rectangular main positioner is achieved.
The further technical scheme is that the included angle between the transverse square connecting rod and the longitudinal square connecting rod is 90 degrees.
The locking member is divided into a locking hole and a locking bolt detachably connected with the locking hole.
Compared with the prior art, the invention has the beneficial effects that:
1. The invention has simple structure, low cost and convenient use,
2. The invention does not need repeated X-ray perspective at multiple angles and puncture into bones, has accurate positioning and strong stability, and ensures the disposable success of safe implantation of the guide pin and the screw.
3. The hollow positioning rod is matched with the threaded guide needle to penetrate into the skin, the tip end of the hollow positioning rod is tightly clung to the bone surface of the concave cortical bone outside the superior articular process of the first sacrum or other key anatomical marks, and the threaded guide needle can be screwed into the sacrum to stabilize the hollow positioning rod or not screwed into the sacrum. Cumbersome and risky procedures that must rely on pedicle screws of the sacrum as a reference are avoided.
4. The use of the transverse arc-shaped regulator enables doctors to determine different camber angles of the sacroiliac screw nail paths and the sagittal plane of the human body by taking the O point in the sacrum as a virtual circle center and transversely regulating the arc-shaped scale bar according to the illness state of the patients.
Drawings
FIG. 1 is a schematic diagram of a combination structure of a rectangular main positioner and a lateral arc adjuster of the present invention.
Fig. 2 is a schematic structural view of a rectangular main positioner according to the present invention.
Fig. 3 is a schematic view of the structure of the lateral arc adjuster of the present invention.
FIG. 4 is a schematic view of the structure of the contralateral fixing device.
Fig. 5 is a schematic view of the structure of the hollow locating rod, the threaded guide pin and the hollow sleeve of the present invention.
Fig. 6 is a use state diagram of the present invention.
Fig. 7 is a partial enlarged view of region B in fig. 6.
In the figure: 1. a locator body; 2. a sacral positioning hole; 3. a hollow positioning rod; 4. a threaded guide pin; 5. ilium fixation holes; 6. a screw thread nail; 7. a locking bolt; 8. a transverse arc sleeve; 9. an arc scale bar; 10. a locking hole; 11. a hollow sleeve; 12. an opening chute; 13. rectangular guide blocks; 14. ilium bone; 15. a sacrum; 16. square connecting holes; 17. a transverse square connecting rod; 18. a double-hole fixing block; 19. a single hole fixed block; 20. a longitudinal square connecting rod; 21. an arc slideway.
Detailed Description
For a better understanding of the technical content of the present invention, specific examples are provided below and the present invention is further described with reference to the accompanying drawings.
As shown in fig. 1 to 7, the centering radius of rotation offset-minimally invasive sacroiliac screw positioning guide provided by the invention comprises a rectangular main positioner, a transverse arc-shaped adjuster, a hollow positioning rod 3 and a hollow sleeve 11.
The rectangular main positioner comprises a positioner body 1 and a transverse arc sleeve 8 arranged at the front end of the positioner body 1, wherein the positioner body 1 is provided with a sacrum positioning hole 2 and an ilium fixing hole 5 which are vertically transparent, the sacrum positioning hole 2 is used for being inserted by a guide pin and guiding the guide pin, and the ilium fixing hole 5 can fix the rectangular main positioner on ilium 14 through a screw nail 6. The sacrum positioning holes 2 on the positioner body 1 are located at the inner sides of the ilium fixing holes 5, four ilium fixing holes 5 are arranged longitudinally, only one sacrum positioning hole 2 is arranged, the four ilium fixing holes 5 are designed to use the ilium fixing holes 5 at different positions according to different conditions of patients, and one sacrum positioning hole 2 is designed to use the outer concave cortical bone of the superior articular process of the first sacrum 15 or other key anatomical marks as a reference point for positioning. The sacrum positioning hole 2 and the ilium fixing hole 5 are respectively provided with a locking component which is divided into a locking hole 10 and a locking bolt 7 which is detachably connected with the locking hole 10. The locking holes 10 on the sacrum positioning hole 2 and the ilium fixing hole 5 are all positioned on the locator body 1, each sacrum positioning hole 2 and the ilium fixing hole 5 are provided with two locking holes 10, the locking holes 10 of the sacrum positioning hole 2 are positioned on the right side of the locator body 1, the locking holes 10 of the ilium fixing hole 5 are positioned on the left side of the locator body 1, and when in use, the locking bolts 7 can be screwed in from the outside to lock the guide pins. The transverse arc sleeve 8 is provided with a left-right through arc slide way 21, the arc slide way 21 is provided with a locking member, and a locking hole 10 of the locking member is positioned on the transverse arc sleeve 8, and can be screwed in from the outside for locking by using the locking bolt 7 during use. The locator body 1 is also provided with a square connecting hole 16 which is left and right transparent, and the square connecting hole 16 is provided with a locking component.
The upper portion and the lower part of hollow locating lever 3 are cylindric and lower part diameter is less than upper portion diameter, are equipped with detachable threaded guide pin 4 who connects in hollow locating lever 3, and hollow locating lever 3 cylindric upper portion internal surface is equipped with the screw thread, and the surface is equipped with the scale, and threaded guide pin 4 top is the cylinder, and the lower part is the guide pin, is equipped with the screw thread in the below of cylinder, the outside of guide pin, and hollow locating lever 3 can the activity insert sacrum locating hole 2 and can be locked by the locking component on the sacrum locating hole 2. The hollow positioning rod 3 is matched with the threaded guide needle 4 to be inserted into the sacrum positioning hole 2 on the positioner body 1 to penetrate into the skin, the tip of the hollow positioning rod 3 is tightly attached to the surface of the bone cortex of the outer side concave bone of the superior articular process of the first sacrum 15 (the point of the hollow positioning rod 3 is A point) or the bone surface of other key anatomical marks, and the threaded guide needle 4 can be screwed into the sacrum 15 to stabilize the hollow positioning rod or not screwed into the sacrum 15. Avoiding cumbersome and risky procedures that must rely on pedicle screws of the sacrum 15 as a reference. A virtual straight line which is parallel to the sagittal plane and vertically enters the sacrum 15 downwards is made through the point A, a certain distance below the point A is selected as a point O (the point O is a rotation circle center) on the virtual straight line, the distance from the point A to the point O is a staggered distance, and the staggered distance can be set by adjusting the scale on the hollow positioning rod 3 inserted into the sacrum positioning hole 2 during operation.
The transverse arc adjuster comprises a rectangular guide block 13 and an arc scale rod 9 arranged on the rectangular guide block 13, an opening chute 12 which is transparent front and back and is downwards opened is arranged on the rectangular guide block 13, a locking member is arranged on the opening chute 12, a locking hole 10 of the locking member is arranged on the rectangular guide block 13, the radian of the arc scale rod 9 has various specifications for selection, and scales are arranged on the rod. The arc scale rod 9 can be movably inserted into the arc slide way 21 and can be fastened by a locking component on the arc slide way 21, the arc scale rod 9 is consistent with the radian of the arc slide way 21, and scales on the arc scale rod 9 inserted into the arc slide way 21 can be adjusted according to different conditions of patients so as to determine the camber angles of different sacroiliac screw nail tracts and sagittal planes of human bodies.
The upper part of the hollow sleeve 11 is cylindrical, the lower part is conical, and the hollow sleeve 11 can be movably inserted into the opening chute 12 and can be locked by a locking member on the opening chute 12. The hollow sleeve 11 is used for being inserted into the opening chute 12 to reach the rear outer side of the ilium 14 wing to play a role of positioning and guiding, and an extension line of the insertion direction passes through the O point.
Also included are contralateral fixing means comprising a fixing block and a screw 6, the fixing block being divided into a single hole fixing block 19 and a double hole fixing block 18. The number of the single-hole fixing blocks 19 is two, the number of the double-hole fixing blocks 18 is one, and the number of the threaded nails 6 is two. The left and right through square connecting holes 16 and the upper and lower through ilium fixing holes 5 are arranged on the single-hole fixing block 19, locking members are arranged on the square connecting holes 16 and the ilium fixing holes 5, the locking holes 10 of the two locking members are arranged on the single-hole fixing block 19, the left and right through and front and rear through square connecting holes 16 are arranged on the double-hole fixing block 18, locking members are arranged on the left and right through and front and rear through square connecting holes 16, the locking holes 10 of the two locking members are arranged on the double-hole fixing block 18, and the threaded nails 6 can penetrate through the ilium fixing holes 5 on the single-hole fixing block 19 to drill into the contralateral ilium 14 and be locked by the locking members of the ilium fixing holes 5, so that the effect of fixing the contralateral fixing device is achieved.
The locking device further comprises a transverse square connecting rod 17 and a longitudinal square connecting rod 20, wherein an included angle between the transverse square connecting rod 17 and the longitudinal square connecting rod 20 is 90 degrees, one end of the transverse square connecting rod 17 is connected with the square connecting hole 16 on the positioner body 1, the other end of the transverse square connecting rod passes through the square connecting hole 16 of the first single-hole fixing block 19, is connected with the left and right through square connecting holes 16 of the double-hole fixing block 18 and is locked by locking members on the three square connecting holes 16, one end of the longitudinal square connecting rod 20 is connected with the front and rear through square connecting holes 16 of the double-hole fixing block 18, and the other end of the longitudinal square connecting rod 20 is connected with the square connecting hole 16 of the second single-hole fixing block 19 and is locked by the locking members on the two square connecting holes 16. The transverse square connecting rod and the longitudinal square connecting rod are used for connecting the positioner body 1 and the opposite side fixing device, and play a role in stabilizing the rectangular main positioner.
The working principle of the invention is as follows:
before operation, the patient is prone to position, the upper surface of the sacrum 15 is vertical to the ground, then a grid-shaped positioner is placed on the lumbosacral part, the sacrum 15 is perspective to be righted, a point on the surface of the concave bone outside the articular process on the sacrum 15 is determined, the point is called a point A, a virtual straight line which is parallel to the sagittal plane and vertically downwards enters the inside of the sacrum is made through the point A, an O point is selected on the virtual straight line at a certain distance below the point A (the distance from the point A to the point O is the offset distance, the distance can be determined by CT measured data before operation and can be realized by adjusting the scale on the hollow positioning rod 3), the O point is taken as a virtual circle center, and a proper rotation radius is selected on a backward extension line of an OA connecting line. And determining an included angle alpha between the nail channel and the sagittal plane according to the CT measurement data.
In the operation process, the vertical horizontal plane is punctured, firstly, the hollow positioning rod 3 reaches the point A cortical bone, then the threaded guide pin 4 is inserted into the hollow positioning rod 3 and screwed into the point A cortical bone of the sacrum 15, then the sacrum positioning hole 2 of the rectangular main positioner is sleeved on the hollow positioning rod 3, the hollow positioning rod 3 is locked by the locking hole 10 on the sacrum positioning hole 2 and the locking bolt 7 to fix the rectangular main positioner, then different ilium fixing holes 5 on the positioner body 1 are selected according to different illness states of patients, the threaded nails 6 are inserted into the ilium fixing holes 5 to drill into the ilium 14, the threaded nails 6 are locked by the locking members on the ilium fixing holes 5 to stabilize the rectangular main positioner, and finally the rectangular main positioner and the opposite side fixing device are connected by the transverse square connecting rod 17 through the square connecting hole 16 on the positioner body 1 and the square connecting hole 16 of the opposite side fixing device, so that the stability of the rectangular main positioner is improved.
Since the rotational offset (i.e., the distance from the center of rotation O to the cortical surface of the bone at point a) and the angle α between the nail path and the sagittal plane have been determined prior to surgery, the arcuate scale bar 9 of the transverse arcuate adjustor is inserted into the arcuate slide 21 of the transverse arcuate sleeve 8, the abduction angle of the transverse arcuate adjustor is adjusted to α according to the scale on the arcuate scale bar 9, and locked with the arcuate slide 21 locking member located on the transverse arcuate sleeve 8.
The hollow sleeve 11 is inserted into an opening chute 12 of a rectangular guide block 13 of a transverse arc-shaped adjuster, so that the tip of the hollow sleeve 11 reaches the outer cortex of the ilium 14 wing, the extension line of the tip of the hollow sleeve passes through an O point, a locking component on the opening chute 12 is used for locking the hollow sleeve 11, a guide needle is inserted into the hollow sleeve 11 and is confirmed again through C-arm X-ray machine perspective, the guide needle is drilled into the outer cortex of the ilium 14 and the sacrum 15 through the hollow sleeve 11, and after the guide needle enters 30-40mm, the position of the hollow sleeve 11 is maintained, the guide needle is withdrawn, and the guide needle is replaced by an open circuit device.
The open circuit is continued by using the open circuit device, a proper limit resistance gear is selected, the open circuit device is advanced in the sacrum 15, the O point is passed in the advancing process until reaching the cortex of the contralateral bone of the sacrum 15, and the positive lateral position of the sacrum 15 can be seen through, and the sacroiliac screw with proper length and diameter is deepened and screwed in.
The foregoing description of the preferred embodiments of the invention is not intended to be limiting, but rather is intended to cover all modifications, equivalents, alternatives, and improvements that fall within the spirit and scope of the invention.