Soft tissue balancing device in knee joint replacement and application method thereofTechnical Field
The invention relates to the technical field of medical equipment, in particular to a soft tissue balancing device in knee joint replacement and a using method thereof.
Background
Knee joint replacement is to make artificial knee joint prosthesis according to the shape, structure and function of human joint, implant into human body through surgery, relieve the pain of patient's joint, resume joint function. After knee joint replacement, if the internal and external collateral ligaments of the knee joint are loose or too tight, the knee joint is unstable, and the problems of limited movement range, improper patella tracking, uneven wear of femur and tibia, arthritis, pain and the like can be caused.
Therefore, the quality of the soft tissue balance treatment in the knee joint replacement operation directly affects the function of the knee joint after operation. One technique used to balance collateral ligament tension in knee replacement surgery is "ligament release," which is a technique that reduces ligament tension by cutting fibers of one or both ligaments, and also because the "ligament release" technique cuts damaged ligament tissue, resulting in weakening of the ligament tissue.
The prior patent with the publication number of CN104970904A discloses a full knee replacement individuation positioning template design based on MRI. In the scheme, the design of the personalized positioning template is completed according to the joint morphology of the individual patient by aiming at the nuclear magnetic resonance imaging data of the lower limb of each patient. Each patient is matched through the design of the individualized positioning template, the nail hole position is determined according to the individualized positioning template, the knee joint prosthesis which is installed later is as consistent as possible with the original skeleton of the patient, and the problem that the collateral ligaments inside and outside the patient are loose or too tight is avoided.
However, the above technical solution has the problems that the process from nuclear magnetic resonance imaging to the personalized template design is time-consuming and high in cost, and the actual femur cutting amount and the setting position of the positioning template are not completely the same as those in the design in the operation process of the doctor of the main doctor. Therefore, there are still some patients with loose collateral ligaments or too tight collateral ligaments, and the way of individually positioning the template design cannot completely solve the problem.
The prior patent with publication number CN107802382A discloses a knee joint balance detection system in total knee arthroplasty and a balance judging method thereof. In the invention, whether the knee joint is balanced or not is judged by measuring the knee joint pressure in the knee joint replacement operation. If unbalanced, the knee joint is brought to equilibrium by appropriate bone repair or adjustment of the position of the prosthesis, and then remains in that position for surgical stapling.
The prior art scheme has the following defects that the femur is damaged when the prosthesis is repaired or adjusted every time (the prosthesis is fixed by drilling holes at a new position), and excessive damage is caused to the femur once the knee joint is still not balanced after multiple measurements and adjustments.
Disclosure of Invention
Aiming at the defects of the prior art, the invention aims to provide a soft tissue balancing device in knee joint replacement and a using method thereof.
The invention aims to solve the problem that excessive damage is caused to the femur by adjusting the position of the prosthesis for many times in knee joint replacement.
The second object of the invention is to provide a method for using the balancing device.
The soft tissue balancing device in knee joint replacement operation comprises a femur fixing piece and an adjusting and positioning assembly, wherein a waist-shaped groove is formed in the surface of the femur fixing piece, waist-shaped holes with the size smaller than that of the waist-shaped groove are formed in the bottom surface of each waist-shaped groove, the adjusting and positioning assembly comprises a positioning block with a bionic appearance and a connecting column connected to the positioning block, the diameter of the connecting column is smaller than that of the waist-shaped hole, a limiting piece is formed at one end of the connecting column penetrating through the waist-shaped hole, the diameter of the limiting piece is larger than that of the waist-shaped hole and smaller than that of the waist-shaped groove, and a positioning hole penetrating through the connecting column and the positioning block is formed in the middle of the connecting column.
Through adopting above-mentioned technical scheme, shaping waist type groove and waist type hole on the thighbone stationary blade, the spliced pole that is being connected on the locating piece passes behind the waist type hole, and the spacing piece that is connected at the spliced pole other end is located waist type inslot cooperation restriction locating piece and can not separate with the thighbone stationary blade. Because the diameter of spliced pole is less than the width of waist type hole, and the diameter of spacing piece is greater than the width of waist type hole, is less than the width of waist type groove, consequently after the femur stationary blade is fixed on the femur, still can follow waist type Kong Changkuan direction adjustment locating piece's position. When the detected knee joint pressure value is in a proper range, drilling holes in the femur at positions corresponding to the positioning holes through a drilling machine. Because repeated bone repair and drilling are not needed, the damage to the femur can be reduced by using the balancing device.
In a preferred example, the femur fixing piece is provided with two through holes, the positioning block is provided with a first avoidance hole in a position corresponding to the through holes, the thickness of the limiting piece is equal to or greater than the depth of the waist-shaped groove, and the screw passes through the through holes after passing through the first avoidance hole.
Through adopting above-mentioned technical scheme, set up the perforation on the femur stationary blade and make the screw pass the perforation after passing through the first hole of dodging, link together femur stationary blade and femur. Because the thickness of the limiting piece is equal to or greater than the depth of the waist-shaped groove, the limiting piece can be pressed on the femur when the screw is screwed down, so that the position of the positioning block is fixed. The inaccurate drilling position caused by the position change of the positioning block in the drilling process is avoided.
In a preferred example, the invention can be further configured that a connecting block is respectively formed at the position, close to two ends, of one side of the femur fixing piece facing the positioning block, and the perforation penetrates through the corresponding connecting block and the femur fixing piece.
Through adopting above-mentioned technical scheme, set up the connecting block and will perforate and offer on the connecting block for perforation position has better intensity.
The invention can be further configured in a preferred example to further comprise two adjusting gaskets positioned between the femur fixing piece and the adjusting and positioning component, the positioning block comprises a standing abutting part and a curved leg abutting part, the left end and the right end of one side of the standing abutting part facing the femur fixing piece are respectively provided with a track groove extending along the up-down direction, the track grooves extend to the curved leg abutting part, the upper surface of the curved leg abutting part and the bottom surface of the track groove are in smooth transition, the adjusting gaskets are made of materials with plastic deformation capability, each adjusting gasket comprises a guide plate positioned in the track groove and a supporting adjusting plate integrally formed at the lower end of the guide plate, the upper end surface of the standing abutting part is provided with a threaded hole communicated with the track groove, an adjusting bolt in threaded connection with the threaded hole penetrates into the track groove from top to bottom, and one end of the adjusting bolt extending into the track groove is in rotary connection with the adjusting gasket.
Through adopting above-mentioned technical scheme, through rotatory adjusting bolt, drive the up-and-down motion of adjusting pad. Because the adjusting gasket has certain plastic deformation capability, when the guide piece moves downwards to the transitional connection position of the standing abutting part and the curved leg abutting part, the guide piece deforms, so that the supporting adjusting piece is tilted to abut the femur, the distance between the femur and the curved leg abutting part is changed, the distance between the curved leg abutting part of the positioning block and the femur is adjusted, and the matching angle of the positioning block and the femur is adjusted.
In a preferred example, the invention can be further configured that two cylinders are formed at one end of the guide plate facing the standing abutting part, two locking plates are connected with one end of the adjusting bolt extending into the track groove in a threaded manner, and the two locking plates are respectively positioned at the upper side and the lower side of the cylinders.
Through adopting above-mentioned technical scheme, support the upper and lower both sides of cylinder through connecting two locking pieces on adjusting bolt for can drive adjusting washer and remove together when adjusting bolt's position changes.
In a preferred example, the lower end of the adjusting bolt is provided with an annular groove, one end of the guide piece, which faces the standing abutting part, is provided with two columns, the two columns are clamped into the annular groove in an arc shape, the radius of the opposite cambered surfaces of the two columns is equal to the radius of the bottom surface of the annular groove, and the distance between the two columns, which is far away from one end of the adjusting gasket, is slightly smaller than the diameter of the bottom surface of the annular groove.
Through adopting above-mentioned technical scheme, through at adjusting bolt lower extreme shaping ring channel for the cylinder on the guide plate is blocked in the ring channel with the form of half surrounding for can drive the adjusting washer and remove together when adjusting bolt's position change.
The present invention may be further configured in such a manner that a guide protrusion is formed at the bottom surface of the rail groove, and a guide hole having a width equal to that of the guide protrusion is formed at the middle of the guide piece.
Through adopting above-mentioned technical scheme, restrict the direction of movement of adjusting the gasket through the cooperation of guide protrusion and guiding hole for adjust the gasket and remove along the track direction that sets for.
In a preferred example, the invention can be further configured that an abutting convex block is formed on one side of the femur fixing plate facing the standing abutting part, a square groove is formed on one side of the standing abutting part facing the femur fixing plate, the abutting convex block is inserted into the square groove, and a spring abutting against the upper surface of the abutting convex block is arranged in the square groove.
By adopting the technical scheme, the butt lug is formed on the femur fixing piece and inserted into the square groove, and the acting force is applied by the spring to the butt lug, so that the supporting adjusting piece can always butt against the side surface of the femur, and cannot be separated from the femur.
In a preferred example, the invention can be further configured that a jack communicated with the square groove is formed at the position, above the square groove, of the surface of the standing abutting part, the width of the jack is larger than that of the square groove, and the upper end of the spring is fixedly connected with an inserting sheet inserted into the jack.
Through adopting above-mentioned technical scheme, with the spring coupling insert in the jack on the inserted sheet for the spring can install square inslot more conveniently.
The second object of the present invention is achieved by the following technical solutions:
A method of using a soft tissue balancing device in knee arthroplasty, comprising:
s1, placing balance device
Attaching the femur fixing piece to the end face of the femur after cutting, and abutting the supporting and adjusting piece with the side face of the femur;
s2, connecting the balancing device with the femur
Inserting a screw into the femur after passing through the perforation on the femur fixing piece, and connecting the balancing device with the femur;
s3, adjusting the position of the positioning block
When the original straight part of the adjusting gasket moves downwards to the transitional connection position of the standing abutting part and the curved leg abutting part, the adjusting gasket deforms, the supporting adjusting piece is tilted to abut the femur, the distance between the curved leg abutting part of the positioning block and the femur and the matching angle of the positioning block and the femur are adjusted;
s4, detecting knee joint pressure
Detecting knee joint pressure through an electronic pressure test pad;
S5, locking positioning block
Repeating the steps S3 and S4 until the knee joint pressure reaches the proper range of the human body when the detection result of the electronic pressure test pad shows that the knee joint pressure does not reach the proper value;
S6, drilling
Drilling holes at positions corresponding to the positioning holes on the femur by using a drilling machine;
s7, dismantling the balancing device.
By adopting the technical scheme, the position of the positioning block is adjusted so that the knee joint pressure value reaches a proper range when the positioning block is positioned at the position, and then the femur is drilled at the position opposite to the positioning hole. The fixation prosthesis is installed through the drilled hole so that the knee joint pressure value is in a proper range after the operation is finished.
In summary, the present invention includes at least one of the following beneficial technical effects:
1. After the femur fixing piece is fixed on the femur, the position of the positioning block can be still adjusted along the waist-shaped Kong Changkuan direction, when the pressure value of the knee joint is detected to be in a proper range, the drilling machine is used for drilling holes at the positions corresponding to the positioning holes on the femur, and the balancing device is not required to repair bones and drill holes repeatedly, so that the damage to the femur can be reduced;
2. When the screw is screwed down, the limiting piece can be pressed on the femur to fix the position of the positioning block, so that inaccurate drilling positions caused by position change of the positioning block in the drilling process are avoided.
Drawings
FIG. 1 is a front view of the first embodiment;
FIG. 2 is an exploded view of the first embodiment;
FIG. 3 is a schematic view of a femur anchor sheet in accordance with a first embodiment;
FIG. 4 is a schematic view of the structure of the adjusting and positioning assembly in the first embodiment;
FIG. 5 is a schematic view of the structure of an adjusting shim according to the first embodiment;
FIG. 6 is a schematic view of the structure of an adjusting washer and adjusting bolt in the second embodiment;
Fig. 7 is a schematic structural diagram of a balancing device in the third embodiment when the position of the positioning block is adjusted;
Fig. 8 is a schematic structural view of the balance device and femur cooperation when the position of the positioning block is adjusted in the third embodiment.
The device comprises a femoral fixing piece, a2, an adjusting and positioning component, a3, an adjusting gasket, a 4, a waist-shaped groove, a 5, a waist-shaped hole, a 6, a connecting block, 7, a through hole, 8, an abutting convex block, 9, a positioning block, 10, a connecting column, 11, a standing abutting part, 12, a curved leg abutting part, 13, a limiting piece, 14, a positioning hole, 15, a first avoidance hole, 16, a track groove, 17, a guide protrusion, 18, a threaded hole, 19, a square groove, 20, a jack, 21, an inserting piece, 22, a spring, 23, a guide piece, 24, a supporting adjusting piece, 25, a guide hole, 26, a second avoidance hole, 27, a column, 28, a locking piece, 29, an annular groove, 30, a screw, 31 and an adjusting bolt.
Detailed Description
The present invention will be described in further detail with reference to the accompanying drawings.
Embodiment one:
As shown in fig. 1 and 2, a soft tissue balancing device in knee joint arthroplasty comprises a femur fixing plate 1 attached to a femur, an adjusting and positioning assembly 2 for positioning a drilling position, and two adjusting gaskets 3 positioned between the femur fixing plate 1 and the adjusting and positioning assembly 2. Fig. 1 is a schematic view of the balancing apparatus from the perspective of the direction of knee joint from the sole side of a person lying on the foot, wherein the up-down, left-right direction of the balancing apparatus in fig. 1 is the up-down, left-right direction in the whole text, and the side facing the reader in the figure is the front in the description.
As shown in fig. 2 and 3, the femur fixing piece 1 has a plate shape, and waist-shaped grooves 4 are formed on the back surface of the femur fixing piece 1 at positions near both the left and right ends, and the length direction of the waist-shaped grooves 4 is along the up-down direction. The bottom surface of the waist-shaped groove 4 is provided with a waist-shaped hole 5 penetrating through the femur fixing piece 1, the size of the waist-shaped hole 5 is smaller than that of the waist-shaped groove 4, and the length direction of the waist-shaped hole 5 is consistent with the length direction of the waist-shaped groove 4. The front of the femur fixing piece 1 is provided with a connecting block 6 near the left end and the right end, the front side of each connecting block 6 is provided with a perforation 7 penetrating through the connecting block 6 and the femur fixing piece 1, and the perforation 7 is inclined towards the center direction of the femur fixing piece 1 from front to back. The middle part of the front surface of the femur fixing piece 1 is provided with a cuboid-shaped abutting lug 8.
As shown in fig. 2 and 4, the adjusting and positioning assembly 2 includes a positioning block 9 having a bionic shape (a shape simulating the shape of the femur connecting the tibia end) and two connecting posts 10 connecting the positioning block 9 and the femur fixing plate 1, the diameter of the connecting posts 10 being smaller than the width of the waist-shaped hole 5. The positioning block 9 comprises a standing abutting part 11 matched with the tibia when the leg is straightened and a curved leg abutting part 12 matched with the tibia when the leg is curved, wherein the curved leg abutting part 12 is integrally formed at the lower end of the standing abutting part 11 and extends backwards, and the joint of the connecting column 10 and the positioning block 9 is the back surface of the standing abutting part 11. The connecting column 10 passes through the outside of one end of the waist-shaped hole 5 and is formed with a limiting piece 13, the thickness of the limiting piece 13 is equal to or slightly larger than the depth of the waist-shaped groove 4, and the diameter of the limiting piece 13 is larger than the width of the waist-shaped hole 5 and smaller than the width of the waist-shaped groove 4. The middle part of the connecting column 10 is formed with a positioning hole 14 penetrating the connecting column 10 and the standing abutment 11. The back of the standing abutting portion 11 is close to the positions of the left side and the right side, a first avoiding hole 15 penetrating through the adjacent left side wall and the right side wall of the standing abutting portion 11 is formed in each position, when the femur fixing piece 1 is matched with the adjusting and positioning assembly 2, the connecting block 6 is located in the first avoiding hole 15, and the screw 30 penetrates through the first avoiding hole 15 from the penetrating side of the first avoiding hole 15 and penetrates through the perforation 7.
As shown in fig. 4, the back surface of the standing abutment 11 is formed with a rail groove 16 extending in the up-down direction at the position connecting the two connecting posts 10, the rail groove 16 extends to the curved leg abutment 12, and the upper surface of the curved leg abutment 12 and the bottom surface of the rail groove 16 smoothly transition. The guide protrusion 17 is integrally formed at a position below the connection post 10 on the bottom surface of the rail groove 16. The upper end surface of the standing abutment 11 is formed with a screw hole 18 communicating with the rail groove 16, and an adjusting bolt 31 screwed and engaged with the screw hole 18 penetrates into the rail groove 16 from top to bottom. A square groove 19 is formed in the middle of the back surface of the standing abutment 11, and the longitudinal direction of the square groove 19 is along the up-down direction. The back of the standing abutment 11 is formed with a receptacle 20 communicating with the square groove 19 at a position above the square groove 19, the receptacle 20 having a width greater than the width of the square groove 19. The inserting hole 20 is internally inserted with an inserting sheet 21 with the matched size, the lower end of the inserting sheet 21 is connected with a spring 22, and after the abutting convex block 8 is inserted into the square groove 19, the upper surface of the abutting convex block 8 abuts against the spring 22.
As shown in fig. 4 and 5, the adjusting shim 3 is made of plastic or other material having a certain plastic deformation capability, and the adjusting shim 3 includes a guide piece 23 positioned in the rail groove 16 and a support adjusting piece 24 integrally formed at a lower end of the guide piece 23. The guide piece 23 has a width equal to that of the rail groove 16, and a guide hole 25 having a width equal to that of the guide projection 17 is formed in the middle of the guide piece 23, and the length of the guide hole 25 is greater than that of the guide projection 17. The guide piece 23 is provided with a second avoidance hole 26 formed at a position above the guide hole 25, and the size of the second avoidance hole 26 is larger than that of the connecting column 10. Two columns 27 are integrally formed on the front side surface of each guide piece 23 near the upper end, the two columns 27 are inserted to the two sides of the corresponding adjusting bolt 31, and locking pieces 28 matched with the clamping columns 27 are connected on the positions, located on the upper side and the lower side of the columns 27, of the adjusting bolt 31 in a threaded mode.
Embodiment two:
as shown in fig. 6, a soft tissue balancing device for knee arthroplasty is different from the first embodiment in that the lower end of the adjusting bolt 31 is formed with an annular groove 29. The two columns 27 are clamped into the annular groove 29 in an arc shape, and the radius of the cambered surfaces of the two columns 27 in opposite directions is equal to the radius of the bottom surface of the annular groove 29. The distance between the ends of the two columns 27 away from the adjusting washer 3 is slightly smaller than the diameter of the bottom surface of the annular groove 29.
Embodiment III:
A method of using a soft tissue balancing device in knee arthroplasty, comprising:
s1, placing balance device
The femur fixing piece 1 is attached to the end face of the femur after cutting, and the support adjusting piece 24 abuts against the side face of the femur.
S2, connecting the balancing device with the femur
The screw 30 is inserted into the femur through the hole 7 in the femoral anchor plate 1 to connect the balancing device to the femur.
S3, adjusting the position of the positioning block 9
As shown in fig. 7 and 8, the adjusting washer 3 is moved up and down by rotating the adjusting bolt 31. Because the adjusting gasket 3 has certain plastic deformation capability, when the original straight part of the adjusting gasket 3 moves downwards to the transitional connection position of the standing abutting part 11 and the curved leg abutting part 12, the adjusting gasket 3 deforms, the supporting adjusting piece 24 tilts to abut the femur, the distance between the curved leg abutting part 12 of the positioning block 9 and the femur is adjusted, and the matching angle of the positioning block 9 and the femur is adjusted.
S4, detecting knee joint pressure
Knee joint pressure was measured by an electronic pressure pad.
S5, locking positioning block 9
And when the detection result of the electronic pressure test pad shows that the knee joint pressure does not reach the proper value, repeating the step S3 and the step S4 until the knee joint pressure reaches the proper range of the human body. The screw 30 is then tightened to fix the position of the positioning block 9.
S6, drilling
The femur is drilled with a drill at a location corresponding to the locating hole 14.
S7, dismantling the balancing device.
The embodiments of the present invention are all preferred embodiments of the present invention, and are not limited in scope by the present invention, so that all equivalent changes according to the structure, shape and principle of the present invention are covered by the scope of the present invention.