Three-dimensional accurate positioning front fork ligament dissects director in rebuilding tunnelTechnical Field
The invention belongs to the technical field of medical instruments, and particularly relates to a three-dimensional accurate positioning guide for a front fork ligament anatomy reconstruction tunnel.
Background
Knee joint is one of the most complex joints of human body, and is not only simple extension and flexion movement, but also rotation of tibia, rolling and sliding of femoral malleolus on tibia and the like in a series of complex three-dimensional movements in actual movement. The complex series of movements all rely on tendons and ligaments surrounding the knee to maintain the balance and stability of the joint during movement. The anterior cruciate ligament (Anterior cruciate ligament, ACL) has the function of limiting tibial advancement and regulating part of rotation.
ACL lesions were counted as 85% of the total lesions in the knee. The repair of ACLs requires the establishment of bone tunnels and ACL reconstruction. Studies by Thomas et al, eivind et al et al show that changes in bone tunnel positioning and strike can greatly affect bone tunnel length and knee joint stability, and therefore accurate positioning of bone tunnel position and strike will greatly improve ACL reconstruction success rate, reducing incidence of postoperative complications. However, the establishment of the bone tunnel in clinic at present mainly depends on the experience of doctors, the repeatability and the operability are low, the accuracy of bone tunnel reconstruction is also low, the success efficiency of the operation is low, and the occurrence rate of postoperative complications cannot be reduced.
Disclosure of Invention
The invention aims to solve the technical problem of providing a three-dimensional accurate positioning guide for a front fork ligament dissected reconstruction tunnel so as to solve the problem of low positioning accuracy of a bone tunnel in the existing operation.
In order to solve the problems, the technical scheme of the invention is as follows:
The invention relates to a three-dimensional accurate positioning anterior fork ligament anatomy tunnel reconstruction guider, which comprises a first positioning unit, a second positioning unit, a connecting unit, an initial coordinate positioning unit, an arc-shaped sliding arm and a guiding unit;
the output end of the first positioning unit and the output end of the second positioning unit are fixed on the femur and are used for positioning the coronal plane of the femur and forming a system coordinate system;
The initial coordinate positioning unit is connected with the first positioning unit or the second positioning unit, the output end of the initial coordinate positioning unit is slidably provided with the arc-shaped sliding arm and is used for adjusting the relative position of the circle center of the arc-shaped sliding arm relative to the system coordinate system, and the arc-shaped sliding arm is rotatably connected with the output end of the initial coordinate positioning unit and is used for adjusting the guiding angle of the guiding unit;
The guide unit is connected with the arc-shaped sliding arm in a sliding way, and the output end of the guide unit points to the circle center of the arc-shaped sliding arm.
The invention relates to a three-dimensional accurate positioning anterior fork ligament anatomy tunnel reconstruction guider, which comprises a first positioning arm, a first positioning column, a second positioning column and a first connecting rod, wherein the first positioning arm is connected with the first positioning column;
The first end of the first connecting rod is fixed on the first positioning arm, the second end of the first connecting rod is connected with one end of the connecting unit in a sliding way, the first end of the first positioning column is connected with the first positioning arm, the second end of the first positioning column is used for propping against the first side of the medial condyle and the lateral condyle at the far end of the femur;
The second positioning unit comprises a second positioning arm, a third positioning column, a fourth positioning column and a second connecting rod;
The first end of the second connecting rod is fixed on the second positioning arm, the second end of the second connecting rod is connected with the other end of the connecting unit in a sliding mode, the first end of the third positioning column is connected with the second positioning arm, the second end of the third positioning column is used for propping against the second side of the medial condyle and the lateral condyle at the far end of the femur, the first end of the fourth positioning column is detachably connected with the second positioning arm through threads, and the second end of the fourth positioning column is used for propping against a bone marking point on the second side of the femur.
The three-dimensional accurate positioning anterior fork ligament dissects the director of the reconstructed tunnel, the said connecting unit is the slide rail;
The second end of the first connecting rod is provided with a first sliding block and a first fastening piece, wherein the first sliding block is connected with the sliding rail in a sliding way, and the first fastening piece is used for fastening the relative position of the first sliding block and the sliding rail;
the second end of the second connecting rod is provided with a second sliding block and a second fastening piece, the second sliding block is connected with the sliding rail in a sliding way, and the second fastening piece is used for fastening the relative position of the second sliding block and the sliding rail.
According to the three-dimensional accurate positioning anterior fork ligament dissection reconstruction tunnel guider, at least one equidistant threaded hole is formed in each of the first positioning arm and the second positioning arm and is used for being in threaded connection with the second positioning column and the fourth positioning column.
The invention relates to a three-dimensional accurate positioning anterior fork ligament anatomy tunnel reconstruction guider, wherein an initial coordinate positioning unit comprises a vertical positioning block, a transverse positioning block, a first sliding rod and a second sliding rod;
The vertical positioning block is arranged on the first positioning unit or the second positioning unit, and a vertical chute is formed in the vertical positioning block; the first end of the first sliding rod is connected in the vertical sliding groove in a sliding way, the second end of the first sliding rod is fixedly connected with the transverse positioning block, and the transverse positioning block is provided with a transverse sliding groove which is perpendicular to the vertical sliding groove;
The first end of the second sliding rod is connected in the transverse sliding groove in a sliding manner, and the axial direction of the second sliding rod is perpendicular to the transverse sliding groove and the vertical sliding groove respectively;
the arc-shaped sliding arm slides along the axial direction of the second sliding rod and is rotationally connected with the second sliding rod.
According to the three-dimensional accurate positioning anterior fork ligament dissection reconstruction tunnel guider, the vertical positioning block, the transverse positioning block, the second sliding rod and the arc-shaped sliding arm are all provided with scale marks.
The three-dimensional accurate positioning front fork ligament dissecting and reconstructing tunnel guider is characterized in that an angle adjusting disc and a third fastening piece are arranged on an arc-shaped sliding arm, the axis of the angle adjusting disc and the rotation axis of the arc-shaped sliding arm are the same, a plurality of angle adjusting gears are uniformly distributed on the angle adjusting disc, and the third fastening piece is arranged at the connecting position of the arc-shaped sliding arm and the initial coordinate positioning unit and used for fastening the relative position between the arc-shaped sliding arm and the output end of the initial coordinate positioning unit.
The guide unit of the three-dimensional accurate positioning anterior fork ligament dissection reconstruction tunnel comprises a guide sleeve and a fourth fastening piece, wherein the guide sleeve is sleeved and connected to the arc-shaped sliding arm in a sliding mode, and the fourth fastening piece is arranged on the guide sleeve and used for fastening the relative position between the guide sleeve and the arc-shaped sliding arm.
The three-dimensional accurate positioning guide device for the anterior fork ligament dissection reconstruction tunnel comprises an arc-shaped sliding arm, wherein the cross section of the arc-shaped sliding arm is rectangular, a through groove is formed in the arc-shaped sliding arm along the circumferential direction, a guide hole of the guide sleeve corresponds to the through groove, and a drill bit penetrates through the guide hole, the through groove and the center of the arc-shaped sliding arm.
By adopting the technical scheme, the invention has the following advantages and positive effects compared with the prior art:
1. According to the embodiment of the invention, the first positioning unit and the second positioning unit are respectively arranged at two ends of the connecting unit in a sliding way, the two positioning units are matched to position the femoral coronal surface and form a system coordinate system, the initial coordinate positioning unit is arranged on the first positioning unit or the second positioning unit and is connected with the arc-shaped sliding arm in a sliding way, the initial coordinate positioning unit can drive the arc-shaped sliding arm to move up and down and back and forth, the arc-shaped sliding arm can move left and right relative to the initial coordinate positioning unit in a sliding way, so that the omnidirectional movement of the arc-shaped sliding arm is realized, the guide unit for guiding the drill bit is further arranged on the arc-shaped sliding arm, the circle center of the arc-shaped sliding arm is determined, the guide unit points to the circle center, therefore, the starting point position of the drill bit can be accurately determined through the rotation of the initial coordinate positioning unit and the arc-shaped sliding arm, the trend angle of the entering the tunnel can be accurately determined through the rotation of the arc-shaped sliding arm relative to the initial coordinate positioning unit, the positioning operation tunnel is realized, the positioning directional operation of the bone tunnel is realized, and the bone establishment accuracy is guaranteed, and the existing problem of the tunnel operation is not accurately positioned in the bone operation is solved.
2. According to the embodiment of the invention, the positioned positions are arranged on the two sides of the medial condyle and the lateral condyle at the distal end of the femur and the bone marking points on the two sides of the femur, so that the positioning can be realized without passing through a tibia tunnel, the independent establishment of the femur and the tibia tunnel can be realized, and the degree of freedom of proper adjustment among different cases is satisfied.
3. According to the embodiment of the invention, the parameterization of the bone tunnel positioning is realized through the transformation between the system coordinate system and the ideal coordinate system, so that the bone tunnel establishment has higher repeatability, easy operation and easy traceability.
4. According to the embodiment of the invention, through determining the complete positioning mode and the parameterization of bone tunnel positioning, accurate positioning can be assisted by CT perspective in operation, the field of view problem in the traditional operation positioning is avoided, and the wound area is reduced.
Drawings
FIG. 1 is a schematic illustration of a three-dimensional precisely positioned anterior fork ligament dissection reconstruction tunnel guide of the present invention;
FIG. 2 is an elevation view of a guide of the three-dimensional precisely positioned anterior fork ligament dissection reconstruction tunnel of the present invention;
fig. 3 is a top view of a three-dimensional precisely positioned anterior fork ligament dissection reconstruction tunnel guide of the present invention.
The numerical control device comprises a first positioning arm, a second positioning arm, a first positioning column, a third positioning column, a second positioning column, a fourth positioning column, a sliding rail, a first fastening piece, a second fastening piece, a first sliding block, a second sliding block, a vertical positioning block, a first sliding rod, a transverse positioning block, a second sliding rod, an arc-shaped sliding arm, an angle adjusting disc, a third fastening piece, a sleeve, a fourth fastening piece, a drill bit, a first connecting rod and a second connecting rod, wherein the first positioning arm, the second positioning arm, the third positioning column, the fourth positioning column, the sliding rail, the first fastening piece, the second fastening piece, the first sliding block, the first sliding rod, the transverse positioning block, the second sliding rod, the arc-shaped sliding arm, the angle adjusting disc, the third fastening piece, the sleeve, the fourth fastening piece, the drill bit, the fourth fastening piece, the first connecting rod and the second connecting rod.
Detailed Description
The invention provides a three-dimensional accurate positioning anterior fork ligament anatomy tunnel reconstruction guider which is further described in detail below with reference to the accompanying drawings and specific embodiments. Advantages and features of the invention will become more apparent from the following description and from the claims.
Referring to fig. 1 to 3, in one embodiment, a three-dimensional precise positioning anterior fork ligament anatomy tunnel guide comprises a first positioning unit, a second positioning unit, a connecting unit, an initial coordinate positioning unit, an arc-shaped sliding arm 16 and a guide unit.
The connecting end of the first positioning unit and the connecting end of the second positioning unit are respectively connected to the two ends of the connecting unit in a sliding mode. The output end of the first positioning unit and the output end of the second positioning unit are fixed on the femur and are used for positioning the femoral coronal plane and forming a system coordinate system.
The initial coordinate positioning unit may be disposed on either the first positioning unit or the second positioning unit. The output end of the initial coordinate positioning unit is slidably provided with an arc-shaped sliding arm 16 for adjusting the relative position of the circle center of the arc-shaped sliding arm 16 relative to the system coordinate system, and the arc-shaped sliding arm 16 is rotatably connected to the output end of the initial coordinate positioning unit for adjusting the guiding angle of the guiding unit.
The guiding unit is slidably connected to the arc-shaped sliding arm 16, and the output end of the guiding unit points to the center of the arc-shaped sliding arm 16.
According to the embodiment, the first positioning unit and the second positioning unit are respectively arranged at two ends of the connecting unit in a sliding mode, the two positioning units are matched to position the femoral crown surface and form a system coordinate system, the initial coordinate positioning unit is arranged on the first positioning unit or the second positioning unit and is connected with the arc-shaped slide arm 16 in a sliding mode, the initial coordinate positioning unit can drive the arc-shaped slide arm 16 to move up and down and back and forth, the arc-shaped slide arm 16 can move left and right relative to the initial coordinate positioning unit in a sliding mode, so that the omni-directional movement of the arc-shaped slide arm 16 is achieved, the guide unit for guiding the drill bit 21 is further arranged on the arc-shaped slide arm 16, the circle center of the arc-shaped slide arm 16 is determined, the guide unit points to the circle center, therefore, the starting point position of an entering path of the drill bit 21 can be accurately determined through the initial coordinate positioning unit and the arc-shaped slide arm 16, the ideal coordinate system can be obtained, the angle of the entering path of the drill bit 21 can be accurately determined through the rotation of the arc-shaped slide arm 16 relative to the initial coordinate positioning unit and the sliding of the guide unit on the arc-shaped slide arm 16, the angle of the entering path of the drill bit 21 can be accurately determined, the bone orientation is achieved, the bone reconstruction operation is guaranteed, and the bone orientation operation is accurately established, and the bone accuracy in the existing operation tunnel positioning is achieved.
Meanwhile, through the transformation between the system coordinate system and the ideal coordinate system, the parameterization of bone tunnel positioning is realized, so that the bone tunnel establishment has higher repeatability, easy operation and easy traceability.
The following describes the specific structure of the three-dimensional accurate positioning anterior fork ligament dissection reconstruction tunnel guide device in this embodiment:
In this embodiment, the first positioning unit includes a first positioning arm 1, a first positioning post 3, a second positioning post 5, and a first connecting rod 22. The second positioning unit comprises a second positioning arm 2, a third positioning column 4, a fourth positioning column 6 and a second connecting rod 22.
The first connecting rod 22 is fixed to the first positioning arm 1 at a first end, and is slidably connected to one end of the connecting unit at a second end. The first end of the first positioning column 3 is connected to the first positioning arm 1, and the second end is used for propping against the first side of the medial condyle and the lateral condyle of the distal femur. The first end thread of the second positioning column 5 is detachably connected to the first positioning arm 1, and the second end is used for propping against a bone marking point on the first side of the femur.
The first end of the second connecting rod 22 is fixed on the second positioning arm 2, and the second end is slidably connected to the other end of the connecting unit. The third positioning post 4 has a first end connected to the second positioning arm 2 and a second end adapted to contact the second side of the medial and lateral condyles of the distal femur. The first end of the fourth positioning column 6 is detachably connected to the second positioning arm 2 through threads, and the second end is used for propping against a bone marking point on the second side of the femur.
Further, the connection unit is a slide rail 7. The second end of the first connecting rod 22 is provided with a first slider 10 and a first fastener 8. The first slider 10 is slidably connected to the slide rail 7, and the first fastener 8 is used for fastening the relative position of the first slider 10 and the slide rail 7. The second end of the second connecting rod 22 is provided with a second slider 11 and a second fastener 9. The second slider 11 is slidably connected to the slide rail 7, and the second fastener 9 is used for fastening the relative position of the second slider 11 and the slide rail 7.
At least one equidistant threaded hole is respectively formed in the first positioning arm 1 and the second positioning arm 2 and is respectively used for being in threaded connection with the second positioning column 5 and the fourth positioning column 6. The number of second positioning posts 5 and fourth positioning posts 6 may be one or more.
During positioning, the first positioning arm 1 and the second positioning arm 2 are respectively arranged on two sides of a femur in parallel by sliding the first sliding block 10 and the second sliding block 11 on the sliding rail 7, the first sliding block 10 and the second sliding block 11 are close to the sliding rail 7, the first positioning column 3 and the third positioning column 4 are propped against two sides of an inner condyle and an outer condyle of the distal end of the femur, the first sliding block 10 and the second sliding block 11 are locked by the first fastening piece 8 and the second fastening piece 9, the second positioning column 5 and the fourth positioning column 6 are respectively rotated to bone marking points propped against two sides of the femur by equidistant threaded holes on the two positioning arms, and positioning of the femur is completed to the point, and a system coordinate system is determined. The detachable threaded connection of the second positioning column 5 and the fourth positioning column 6 enables the fixed position of the proximal hip section of the femur to be adjusted.
According to the embodiment, the positioned positions are arranged on the two sides of the inner and outer condyles at the distal end of the femur and the bone marking points on the two sides of the femur, positioning can be achieved without passing through a tibia tunnel, independent establishment of the femur and the tibia tunnel can be achieved, and the degree of freedom of proper adjustment among different cases is met.
In the present embodiment, the initial coordinate positioning unit includes a vertical positioning block 12, a horizontal positioning block 14, a first slide bar 13, and a second slide bar 15.
The vertical positioning block 12 is mounted on any one of the first positioning arm 1 or the second positioning arm 2, and a vertical chute is formed in the vertical positioning block 12. The first end of the first sliding rod 13 is slidably connected in the vertical chute. The second end of the first sliding rod 13 is fixedly connected with a transverse positioning block 14. The transverse positioning block 14 is provided with a transverse chute which is perpendicular to the vertical chute. The first end of the second sliding rod 15 is slidably connected in the transverse sliding groove, and the axial direction of the second sliding rod 15 is perpendicular to the transverse sliding groove and the vertical sliding groove respectively. One end of the arc-shaped sliding arm 16 is sleeved on the second sliding rod 15, and can slide along the axial direction of the second sliding rod 15 and rotate around the second sliding rod 15.
Wherein the second sliding rod 15 may be a cylindrical rod, the first end of the arc-shaped sliding arm 16 connected with the second sliding rod 15 may be provided with a circular hole, and is sleeved on the second sliding rod 15 through the circular hole,
Further, an angle adjusting disc 17 and a third fastening piece 18 can be arranged at the connection position of the arc-shaped sliding arm 16 and the second sliding rod 15, the axis of the angle adjusting disc 17 and the rotation axis of the arc-shaped sliding arm 16 are the same, and a plurality of angle adjusting gears of 30 degrees, 45 degrees, 60 degrees and the like are uniformly distributed on the angle adjusting disc 17. The third fastening member 18 is disposed at a connection position between the arc-shaped sliding arm 16 and the initial coordinate positioning unit, and is used for fastening a relative position between the arc-shaped sliding arm 16 and an output end of the initial coordinate positioning unit.
In this embodiment, the guiding unit may specifically comprise a guiding cannula 19, a fourth fastener 20. The guide sleeve 19 is sleeved and slidably connected to the arc-shaped slide arm 16. A fourth fastener 20 is provided on the guide sleeve 19 for fastening the relative position between the guide sleeve 19 and the arcuate slide arm 16.
The cross section of the arc-shaped sliding arm 16 can be rectangular or other non-circular shape, so as to avoid the situation that the guiding sleeve 19 rotates around the arc-shaped sliding arm 16 to be unable to point to the circle center. The arc-shaped sliding arm 16 is provided with a through groove along the circumferential direction, and the through groove is required to correspond to the circle center. The guide hole on the guide sleeve 19 may then correspond to the through slot for the drill bit 21 to pass through the guide hole and the through slot and be directed towards the center of the arc-shaped slide arm 16.
In this embodiment, scale marks are provided on the vertical positioning block 12, the horizontal positioning block 14, the second sliding rod 15 and the arc-shaped sliding arm 16.
In the present embodiment, the first fastener 8, the second fastener 9, the third fastener 18, and the fourth fastener 20 may each be a fastening screw.
The following further describes the operation flow of the guide device of the three-dimensional accurate positioning anterior fork ligament anatomical reconstruction tunnel:
First, the first positioning column 3 and the third positioning column 4 are aligned with the medial and lateral condyles of the distal femur by means of a perspective device, keeping the first positioning arm 1 and the second positioning arm 2 parallel to the axial direction of the femur. The relative positions of the first slider 10 and the second slider 11 are adjusted and fixed through the first fastener 8 and the second fastener 9, so that the first positioning column 3, the second positioning column 5, the third positioning column 4 and the fourth positioning column 6 can be clamped and fixed at the marking point position of the femur of the patient. After the fixing step is finished, the central positions of the first positioning column 3 and the third positioning column 4, namely the central positions of medial condyles and lateral condyles, are taken as a system coordinate system, the planes of the first positioning arm 1 and the second positioning arm 2 are femoral coronal planes, and the sagittal plane and the transverse plane which pass through the established system coordinate system and are perpendicular to the coronal planes can be correspondingly obtained.
Compared with the established system coordinate system, the ideal position of the initial point of the femur tunnel measured before operation can have certain offset, and the offset can be accurately determined. The center of the arc-shaped sliding arm 16 is an ideal coordinate system and represents the initial point position of the bone tunnel. The initial coordinate locator unit can realize the freedom degree of adjustment in the X-axis and Z-axis directions through manual adjustment, namely, the adjustment of up and down and front and back, and the scale mark can accurately determine the relative position between an ideal coordinate and a system coordinate system. After establishing the ideal coordinates in the X-axis and Z-axis directions, the coordinates on the Y-axis of the position of the arc-shaped slide arm 16 are further adjusted on the second slide bar 15 and preliminarily fixed with the third fastener 18, that is, the left-right position is adjusted, to confirm establishment of the ideal coordinate system.
The angle of the guide sleeve 19 relative to the crown surface is adjusted along the Y-axis direction by rotating the arc-shaped sliding arm 16 on the second sliding rod 15, the angle adjusting disk 17 of the arc-shaped sliding arm 16 is provided with common angle gears of 30 degrees, 45 degrees and 60 degrees as references, and the third fastener 18 is screwed down for fixation after the position of the arc-shaped sliding arm 16 is determined. The angle of the bone tunnel relative to the sagittal plane can be determined by moving the guide sleeve 19 over the curved slide arm 16. The three-dimensional trend of the bone tunnel starting point is realized immediately by the relative coronal and sagittal angles, and the guide sleeve 19 is screwed down to fasten the screw 13 to complete fixation when the angle adjusted by the guide coincides with the preoperative planned angle, thus completing the positioning and orientation operation of the bone tunnel establishment.
After the position and angle information is established, the drill bit 21 can be driven into the distal femur at the determined ideal position of ACL reconstruction through the guide sleeve 19, so that the accuracy of bone tunnel establishment is ensured.
The embodiments of the present invention have been described in detail with reference to the drawings, but the present invention is not limited to the above embodiments. Even if various changes are made to the present invention, it is within the scope of the appended claims and their equivalents to fall within the scope of the invention.