Medial collateral ligament protector for meniscus resection in knee joint replacementTechnical Field
The invention relates to the field of medical instruments, in particular to a medial collateral ligament protector for meniscus resection in knee joint replacement.
Background
The medial collateral ligament (medical collateral ligament, MCL) is in a flat strip shape, the length is 96.40 +/-4.49 mm, the width is 12.53 +/-2.22 mm, the thickness is 1.82+/-0.36 mm, the medial collateral ligament begins from the medial upper condyle of the femur and ends 7-10cm below the articular surface, the medial collateral ligament is divided into three layers from below, namely 1, the medial collateral ligament superficial layer and the medial collateral ligament anterior bundle, an oval attachment point is arranged on the femur, the distance is usually 3.2mm above the medial upper condyle of the femur, the distance is 4.8mm behind the medial upper condyle of the femur, the medial collateral ligament superficial layer extends distally to two dead points on the tibia, the proximal dead point mainly covers the dead point in front of the semi-membrane tendon by a layer of soft tissue, is positioned at the position about 12.2mm below the tibial articular line, the distal dead point is wider, is directly attached to the tibia, the distal end of the tibial articular line is about 61.2mm, and is positioned just in front of the medial side ridge. 2. The posterior cruciate ligament, also known as the medial collateral ligament, is still described with a large number of differences in the points of femoral attachment, and is believed to begin behind the superficial fibers of the medial condyle of the femur, fan downward, and terminate in the posterior half of the medial condyle of the tibia below the articular line. 3. The medial collateral ligament is deep, extends vertically downward from the inferior semi-peripheral bone surface of the medial epicondyle of femur (about 20.72.+ -. 2.52mm from joint level), attaches to the middle of the medial meniscus periphery, and terminates at the inferior bone surface of the medial articular surface at the medial border of the tibial plateau (about 7.32.+ -. 3.23 mm). The inner meniscus is C-shaped, the front end is narrow, the rear end is wide, and the middle part of the outer edge is connected with the joint capsule fiber layer and the inner collateral ligament deep layer.
When the meniscus is resected in the knee joint replacement, because the medial collateral ligament is tightly connected with the medial meniscus, when the knee joint is at the 90-degree buckling position, the medial collateral ligament forms a 78-degree included angle with the horizontal line, the contact area with the medial meniscus is increased, and the medial collateral ligament is extremely easy to be accidentally injured when the medial meniscus is resected in the knee joint replacement. While the medial collateral ligament is the most critical structure to maintain medial stability of the knee, if damaged, it will affect the long-term survival rate of the prosthesis, resulting in failure of the knee arthroplasty. At present, two common methods for protecting the medial collateral ligament in knee joint replacement are mainly used, namely, after a tibial plateau is fully exposed, a toothed forceps is used for clamping the medial collateral ligament, the medial collateral ligament is pulled away, then the meniscus is resected, but the medial collateral ligament is inevitably pulled away simultaneously in the process of pulling the medial meniscus due to the tight connection of the medial collateral ligament and the meniscus, the boundary between the medial collateral ligament and the medial collateral ligament is more blurred, so that the medial collateral ligament is damaged when the meniscus is resected, and an assistant pulls the medial collateral ligament away from the joint surface by using a drag hook when the meniscus is resected, but the contact area between the traditional drag hook and the medial collateral ligament is small, and the traditional drag hook only can be pulled to the surface of the medial collateral ligament, but can cause the deep layer of the medial collateral ligament to be closer to the meniscus, so that the contact position of the medial collateral ligament and the meniscus is difficult to be clearly exposed, and the medial collateral ligament is easily damaged when the meniscus is resected.
Because the gap formed between the inner meniscus, the joint capsule and the deep layer of the inner collateral ligament is narrow, the common drag hook is difficult to penetrate into the gap between the meniscus and the deep layer of the inner collateral ligament, so that a tool which can penetrate into the gap between the inner meniscus, the joint capsule and the deep layer of the inner collateral ligament and fully expose the contact part is required to be designed, and the tool has better protection effect on the inner collateral ligament.
Disclosure of Invention
The invention aims at overcoming the defects of the prior art, and provides a medial collateral ligament protector for meniscus resection in knee joint replacement, which can be inserted into a gap formed by a medial meniscus, a joint capsule and a medial collateral ligament deeply and can block the medial collateral ligament at the inner side of an arc of a shielding part, so that the upper edge and the lower edge of a contact part of the meniscus and the medial collateral ligament are fully exposed, and the medial collateral ligament protector plays a role in protecting the medial collateral ligament when the meniscus is resected.
The technical scheme is that the protector for the medial collateral ligaments in the knee joint replacement meniscus resection comprises a protector body which is in a strip shape and is flat in section, the rear end of the protector body is straightened and extends to form a handle, the front end of the protector body is bent in an arc shape with the radian of 2 pi/9 to form a shielding part for shielding the medial collateral ligaments, the total width of the front end of the shielding part is 22-24 mm, a trapezoid open slot for giving way to the meniscus is arranged at the front end, the trapezoid open slot extends backwards along the arc of the shielding part, the slot depth of the trapezoid open slot is 20-24 mm, the notch width of the trapezoid open slot is 6-8 mm as the open large end, the included angle between the oblique sides of the trapezoid open slot is 10 degrees, the trapezoid open slot is used for shielding the femur isolation part and the tibia isolation part, the width of the femur isolation part is 9-12 mm, and the width of the tibia isolation part is half of the femur isolation part.
Further, the shielding part is in a shape that the front end width tail end is gradually reduced, the tail end of the shielding part is connected with the front end of the handle, and an included angle between oblique sides of the shielding part is 10 degrees.
Further, the length of the handle is 200-210 mm, and the width of the handle is gradually increased from the front end to the rear end for holding.
Further, a hanging hole is formed in the rear end of the handle.
Furthermore, two corners at the outer side of the front end of the shielding part are arc chamfer angles, and two sides of a notch of a trapezoid open slot of the shielding part are arc chamfer angles.
Further, the thickness of the protector body is 1-2 mm.
By adopting the technical scheme, the protector comprises the protector body which is long-strip-shaped and the section of which is flat, the rear end of the protector body is straightened and extends to form the handle, the front end of the protector body is bent in an arc shape with the radian of 2 pi/9 to form the shielding part for shielding the inner collateral ligament, the shielding part can be inserted into a gap formed by the inner meniscus, the joint capsule and the inner collateral ligament, and the shielding part is bent in an arc shape, so that the shielding part can be attached to the inner collateral ligament after being inserted into the gap, and the inner collateral ligament can be blocked on the inner side of the arc shape of the shielding part. The front end total width of shielding part is 22~24mm, and the front end is set up a trapezoidal open slot that is used for stepping down for the meniscus in the protector body axis, and this trapezoidal open slot extends backward along shielding part arc, and the groove depth of trapezoidal open slot is 20~24mm, and the notch width of trapezoidal open slot is the opening big end, and the contained angle between the hypotenuse of trapezoidal open slot both sides is 10, and the width of trapezoidal open slot reduces gradually, can match the width of the junction of inboard meniscus and inboard collateral ligament of different grade type, makes the contact department of inboard meniscus and inboard collateral ligament can block in trapezoidal open slot. The trapezoidal open slot is with shielding part for femur isolation portion, tibia isolation portion, femur isolation portion's width is 9~12mm, tibia isolation portion's width is the half of femur isolation portion, this femur isolation portion is arranged in inserting femur condyle and inboard collateral ligament's clearance, tibia isolation portion is arranged in inserting tibia platform and interior survey collateral ligament's clearance, can increase shielding portion and the deep area of contact of inboard collateral ligament, inboard collateral ligament is located the arc inboard of shielding portion this moment, and laminate in the concave surface of arc shielding portion, then through handle application of force can draw inboard collateral ligament deep layer off bone joint face, thereby make inboard collateral ligament and inboard collateral ligament's contact department separation, thereby fully expose the upper and lower reason of inboard collateral ligament contact department of inboard meniscus and inboard, consequently the doctor cuts inboard meniscus at this moment and can not harm inboard collateral ligament, the operation of being convenient for, play the effect of protecting inboard collateral ligament, and shorten operation time, reduce postoperative complication.
The shielding part is in a shape that the front end is wide and the tail end is gradually reduced, the tail end of the shielding part is connected with the front end of the handle, the included angle between the oblique sides of the two sides of the shielding part is 10 degrees, namely, the widths of the front end and the rear end of the femur isolation part are kept consistent, and the widths of the front end and the rear end of the tibia isolation part are kept consistent, so that the rear ends of the two isolation parts can be smoothly inserted along with the insertion path of the front end, and meanwhile, whether the femur isolation part and the tibia isolation part of the shielding part are inserted in place or not is conveniently observed.
The length of the handle is 200-210 mm, and the width of the handle is gradually increased from the front end to the rear end for holding, so that the shielding of the handle to the surgical field can be reduced, and the handle is convenient for a doctor to hold and apply force during surgery.
The both corners in shielding part front end outside are the circular arc chamfer, and the notch both sides of shielding part trapezoidal open slot are the circular arc chamfer, avoid too sharp fish tail ligament or muscle tissue because of shielding part front end and trapezoidal open slot when inserting.
The thickness of the protector body is 1-2 mm, and the shielding part can be inserted into a narrow gap formed between the inner meniscus, the joint capsule and the MCL deep layer.
The invention is further described below with reference to the drawings and specific examples.
Drawings
FIG. 1 is a schematic diagram of the structure of the present invention;
FIG. 2 is a schematic view of the A-direction of FIG. 1;
Fig. 3 is a schematic diagram of direction B of fig. 2.
Detailed Description
Referring to fig. 1 to 3, an inner collateral ligament protector for knee joint replacement meniscus resection comprises a protector body which is long-strip-shaped and is flat in section, wherein the thickness of the protector body is 1-2 mm, the thickness of the protector body is 1mm to be optimal, and a shielding part 2 can be ensured to be smoothly inserted into a narrow gap formed between an inner meniscus, a joint capsule and an inner collateral ligament deep layer. The rear end of protector body straightens and extends and form handle 1, the length of handle 1 is 200~210mm, and the width increases gradually from front end rear end and is used for holding, can reduce the shielding of handle 1 to the operation field of vision, makes things convenient for the doctor to grip the application of force during the operation again, and handle 1 length of this embodiment adopts 200mm to be the best, can be applicable to most doctor's palm width, handle 1's rear end is equipped with hanging hole 6. The front end of the protector body is curved to form the shielding part 2 for shielding the inner side accessory ligament in an arc shape with the radian of 2 pi/9, the shielding part 2 is used for being inserted into a gap formed by the inner side meniscus, the joint capsule and the inner side accessory ligament, and the shielding part 2 is curved in an arc shape, so that the inner side accessory ligament can be attached to the inner side accessory ligament after being inserted into the gap, the inner side accessory ligament can be blocked on the inner side of the arc shape of the shielding part, the inner side accessory ligament is attached to the concave surface of the shielding part 2, and the force application is facilitated to pull the inner side accessory ligament away from the inner side meniscus. the total width of the front end of the shielding part 2 is 22-24 mm, a trapezoid open groove 3 for giving way to a meniscus is arranged at the front end deviated from the central axis of the protector body, the trapezoid open groove 3 extends backwards along the arc shape of the shielding part 2, the groove depth of the trapezoid open groove 3 is 20-24 mm, the groove depth of the trapezoid open groove 3 is the best 22mm, the notch width of the trapezoid open groove 3 is 6-8 mm as the open large end, the notch style of the trapezoid open groove 3 is the best 8mm in the embodiment, the included angle between the oblique sides of the trapezoid open groove 3 is 10 degrees, the notch width of the trapezoid open groove 3 is larger than the width of the groove bottom, the notch width and the groove depth of the trapezoid open groove 3 are at the dead point of the medial condyle of the femur according to the medial collateral ligament deep layer, The dead point position of the medial tibia condyle and the thickness of the contact part with the medial meniscus are designed, and the shape of the medial meniscus with the narrow front end and the wide rear end can be adapted during insertion, so that the contact part of the medial meniscus and the medial collateral ligament can be clamped in the trapezoid open slot 3, the width of the trapezoid open slot 3 is gradually reduced, and the width of the connection part of the medial meniscus and the medial collateral ligament of different types can be matched. Two corners outside the front end of the shielding part 2 are arc chamfer angles, and two sides of a notch of the trapezoid open slot 3 of the shielding part 2 are arc chamfer angles, so that ligament or muscle tissue is prevented from being scratched due to sharp edges of the front end of the shielding part 2 and the trapezoid open slot 3 during insertion. The trapezoid open slot 3 divides the shielding part 2 into a femur isolating part 4, The width of the femur isolation part 4 is 9-12 mm, the width of the femur isolation part 4 in this embodiment is 10mm as the best, the width of the femur isolation part 5 is one half of the femur isolation part 4, the femur isolation part 4 is used for being inserted into the gap between the femur condyle and the medial collateral ligament, the tibia isolation part 5 is used for being inserted into the gap between the tibia plateau and the medial collateral ligament, and because the gap between the femur condyle and the medial collateral ligament is larger than the gap between the tibia and the medial collateral ligament, the width of the femur isolation part 4 is larger than the width of the tibia isolation part 5, the contact area between the shielding part 2 and the medial collateral ligament can be increased, and the medial collateral ligament can be pulled away from the contact position of the medial meniscus during operation.
The protector is not limited to the above embodiment, the shielding part 2 may be in a shape with a gradually reduced front end and a gradually reduced rear end, the rear end of the shielding part 2 is connected with the front end of the handle 1, the included angle between the oblique sides of the two sides of the shielding part 2 is 10 °, that is, the width of the front end and the rear end of the femur isolation part 4 is kept consistent, and the width of the front end and the rear end of the tibia isolation part 5 is kept consistent, so that the rear ends of the two isolation parts can be smoothly inserted along with the insertion path of the front end, and meanwhile, whether the femur isolation part 4 and the tibia isolation part 5 are inserted in place is convenient to observe.
Figures 1-3 illustrate a protector for a right knee procedure where the femoral and tibial spacers of the protector for the left knee are positioned opposite the present embodiment. In the embodiment, when the protector for the right knee is used, the knee joint of a patient is in a 90-degree buckling state, a joint cavity is cleaned, redundant bone fragments are removed, gaps among the inner meniscus and the inner collateral ligament, the femur and the tibia are exposed, then a handle 1 of the protector is held by hand, an arc concave surface of the shielding part 2 faces the inner collateral ligament, a femur isolation part 4 is inserted into the gap between the inner collateral ligament and the inner condyle of the femur, meanwhile, a tibia isolation part 5 is inserted into the gap between the inner collateral ligament and the tibia platform, at this time, the contact part of the inner meniscus and the inner collateral ligament is clamped in a trapezoid open groove 3, the shielding part 2 is further stretched into until the contact position of the inner meniscus and the inner collateral ligament is completely clamped in the trapezoid open groove 3, at this time, the inner collateral ligament is blocked at the arc inner side of the shielding part 2 and is attached in the arc shielding part 2, and then the inner collateral ligament is deeply pulled away from the bone joint surface by applying force through the handle 1, so that the contact part of the inner collateral ligament and the inner collateral ligament are separated, at this time, the contact part of the inner meniscus and the inner collateral ligament are fully exposed, the upper edge and the lower edge of the inner collateral ligament are cut, the trapezoid open, and the operation of the meniscus is removed, and the protector is completed.
To sum up, the protector designs the shielding plate 2 according to the size of the gap formed by the inner meniscus, the joint capsule and the deep layer of the inner collateral ligament and the thickness of the meniscus, so that the problem that a common drag hook cannot go deep into the gap can be solved, the shielding plate 2 of the protector has large contact area with the deep layer of the inner collateral ligament and high fitting degree, the upper edge and the lower edge of the deep contact position of the meniscus and the inner collateral ligament can be fully exposed, and the inner collateral ligament can be blocked outside the trapezoid opening groove 3. Therefore, the surgical operation device can greatly improve the convenience of the surgeon in removing the inner meniscus, is convenient for the surgical operation, avoids damaging the inner collateral ligament, plays a role in protecting the inner collateral ligament, reduces postoperative complications, simplifies the surgical operation flow, shortens the surgical time, is simple, convenient, easy, quick and convenient, and has the advantages of simple structure, easy manufacture, safe and reliable use and convenient implementation and wide popularization and application.