CN114305608A - Angulation puncture outfit and percutaneous centrum fusion system through unilateral pedicle of vertebral arch thereof - Google Patents
Angulation puncture outfit and percutaneous centrum fusion system through unilateral pedicle of vertebral arch thereof Download PDFInfo
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- CN114305608A CN114305608A CN202111604938.0A CN202111604938A CN114305608A CN 114305608 A CN114305608 A CN 114305608A CN 202111604938 A CN202111604938 A CN 202111604938A CN 114305608 A CN114305608 A CN 114305608A
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- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y02—TECHNOLOGIES OR APPLICATIONS FOR MITIGATION OR ADAPTATION AGAINST CLIMATE CHANGE
- Y02A—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE
- Y02A50/00—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE in human health protection, e.g. against extreme weather
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Abstract
The invention discloses an angulation puncture outfit and a percutaneous vertebral body fusion system through a unilateral pedicle of vertebral arch, wherein the angulation puncture outfit comprises a handle component, a sheath core component and a sliding block component; the sliding block assembly is arranged in the handle assembly and comprises a sliding block and a sliding block support, the sheath core assembly penetrates through the sliding block support and is fixed with the sliding block support, and the sliding block is slidably sleeved in the middle of the sliding block support; the external thread of the sliding block passes through the sliding groove of the sliding groove piece to be matched with the internal thread of the inner surface of the sleeve. The angulation puncture outfit provided by the invention can use the bone hammer to knock and open the cavity when encountering harder tissues during puncture, and has stronger cavity-opening puncture capability, simpler and more convenient operation and labor saving. Based on the minimally invasive vertebral body fusion system provided by the angulation puncture outfit, multiple times of puncture and combined bone cement injection functions can be carried out through the unilateral vertebral pedicle of the local vertebral body, a radial channel filled with bone cement is provided, and after the bone cement is solidified, the integral fusion of three sections of vertebral bodies is completed.
Description
Technical Field
The invention relates to the field of medical instruments, in particular to an angulation puncture outfit and a percutaneous vertebral body fusion system through unilateral vertebral pedicle.
Background
With the increasing pace of modern social life and the increasing trend of aging, the incidence of spine diseases also increases year by year, and various degenerative changes of the spine, thoracolumbar spondylolisthesis, lateral curvature and other diseases seriously affect the life of people. Conventional spinal internal fixation fusion procedures typically use spinal rod systems, spinal plating systems, or implants that simultaneously cooperate with the interbody fusion cage. Such surgery is costly, traumatic and has a long post-operative recovery time, and elderly patients with poor bone conditions often are intolerant of the surgery.
In recent years, percutaneous angled vertebral body forming (PCVP) instruments are developed and matured day by day, the operation mode is that percutaneous transpedicular puncture enters a vertebral body, the bent angle shape design of an open cavity instrument is utilized to puncture to the opposite side of the vertebral body, and the effect of double-side puncture is achieved by single-side puncture.
The skilled person provides the following two devices for percutaneous transpedicular fusion:
patent CN107530095A provides a device for percutaneous pedicle fusion, comprising at least two straight pedicle cannulas, at least one guide sheath, a flexible cannula type drill, an injection device, and a closing device (9). This device has the following drawbacks:
(1) are only arranged in the intervertebral space for the fusion of the upper and lower vertebral bodies and can not be arranged in single or multiple vertebral bodies and multiple intervertebral spaces;
(2) the at least two straight pedicle insertion tubes are respectively arranged on the upper vertebra and/or the lower vertebra of the vertebral segment, and at least two passages are needed for the at least two straight pedicle insertion tubes, so that at least two skin incisions are needed to be formed on the body surface;
(3) the guide sheath and the flexible intubation type drill bit are designed into two independent instruments in a split mode, the flexible intubation type drill bit is driven by a driving system, so that the intubation type drill bit can be driven to rotate back and forth, the slotting process is fast, the reaction time is short, process feedback is avoided, blind chiseling can be performed under minimally invasive non-visual field direct vision, excessive puncture can be caused, debris can be generated, a physiological saline solution needs to be injected and pumped for cleaning, and incomplete cleaning can be caused due to the fact that the diameter and the number of channels are limited;
(4) the injection device is connected to a straight pedicle cannula to inject the implant into the intervertebral space; the straight cannula is arranged on a vertebra, the intervertebral space is beside the vertebra, a graft needs to pass through a bending channel when being injected into the intervertebral space from the straight cannula, the channel is generated by slotting with a flexible cannula type drill, the flexible cannula type drill is arranged in a guide sheath, the guide sheath is arranged in the straight cannula, and the flexible cannula type drill does not have an expansion structure, so that the diameter of the bending channel of the slotting of the flexible cannula type drill is smaller than the inner diameter of the straight cannula, a granular suspension implant prepared from the autogenous bone can be blocked when passing through the straight cannula to the region with the reduced inner diameter of the bending channel due to the fluidity smaller than liquid, and the filling is not smooth, in addition, the graft is the autogenous iliac crest bone, the bone is required to be extracted from the autogenous iliac crest bone, a bone extraction channel is formed during the operation, which is contrary to the traditional minimally invasive operation concept, in addition, the bone extraction on the iliac crest is caused by the bone extraction and the integrity is damaged, in addition, after the bone is taken out through the operation, chronic injury exists, and continuous pain exists during recovery, so that secondary injury is caused;
(5) the closing means is screwed in the hole that leaves the space after withdrawing straight pedicle of vertebral arch intubate, and closing means is vertebra fixing device's pedicle of vertebral arch screw for can place and fixed connecting rod, still need use pedicle of vertebral arch screw to assist fixedly even the operation with this apparatus, can prolong operation time, it is long when increasing the anesthesia, still can charge to being used for confined pedicle of vertebral arch screw simultaneously, increase patient's economic burden.
Patent CN112043466A discloses a transpedicular intervertebral fusion system, including puncture needle subassembly, protection sleeve subassembly, delivery tube subassembly and sheath core subassembly, the connection can be dismantled with the conveyer pipe to the sheath core, and sheath core head end is crooked, then the delivery tube head end is crooked, and the slider is fixed in the conveyer pipe, and the connection can be dismantled to sheath core and conveyer pipe. The puncture principle is as follows: continuously rotating the handle, the matched thread drives the sliding block to move back and forth, the conveying pipe is driven to move back and forth, the head end of the conveying pipe is bent, the head end of the sheath core is bent, and the sheath core moves back and forth, namely, the centrum tissue is punctured by rotating the handle to apply force. This device has the following drawbacks:
(1) if hard tissues such as vertebral endplates are encountered, the handle is rotated, the sliding block is driven to move through the matched threads, the sliding block drives the conveying pipe to move, the conveying pipe drives the sheath core, force application is insufficient at the moment, and the hard tissues are difficult to puncture to form a channel;
(2) the conveying pipe and the sheath core head end are bent doubly, so that when relative movement is needed, internal force consumption of mutually staggered bent sections can be overcome, and head end puncture force is insufficient;
(3) the puncture assembly and the protective sleeve are integrated into a whole without moving degree.
Therefore, when the surgical instrument in the prior scheme is applied to the puncture of two adjacent vertebral bodies and intervertebral spaces, the puncture force is insufficient, and the function of opening the channel by multiple times of puncture is difficult to realize. There is a need for a minimally invasive vertebral body fusion system through vertebral pedicle, which has stronger open cavity puncture capability, simpler and more convenient and labor-saving operation, can puncture for multiple times through the unilateral vertebral pedicle of the local vertebral body and combines the bone cement injection function.
Disclosure of Invention
In order to achieve the technical purpose, the invention provides an angulation puncture outfit and a percutaneous vertebral body fusion system through a unilateral pedicle.
In a first aspect, the present invention provides an angled puncture instrument comprising:
the handle assembly comprises an outer tube, and further comprises a sliding groove piece, a sleeve, a rotating handle and a grab handle which are sleeved in sequence from inside to outside; the near end of the outer pipe is fixed with the far end of the grab handle, the far end of the sliding groove piece is fixed with the far end of the grab handle, the far end of the sleeve and the far end of the grab handle are axially limited and circumferentially and rotatably fixed, and the near end of the sleeve is detachably and fixedly connected with the rotating handle;
the sheath core assembly comprises a sheath core, a head cutting edge, a sheath core bending part, a reinforcing pipe and a sheath core handle;
the sliding block assembly comprises a sliding block and a sliding block support; the sliding block assembly is arranged in the sliding groove piece, a through hole is formed in the sliding block support in the central shaft direction, the sheath core assembly penetrates through the through hole, and the outer surface of the sheath core assembly is fixed with the inner surface of the through hole; the sliding block support is dumbbell-shaped, and the sliding block is slidably sleeved in the middle of the sliding block support; the external thread of the sliding block penetrates through the sliding groove of the sliding groove piece to be matched with the internal thread of the inner surface of the sleeve.
Preferably, the proximal end of the sheath core passes through the outer tube, the chute and the rotation handle in sequence; the sheath core bending part is arranged at the distal end of the sheath core; the sheath core is sleeved with the reinforcing tube, the distal end of the reinforcing tube is provided with a bending section, the distal end of the reinforcing tube is fixedly connected with the cutting edge of the head part, and the proximal end of the reinforcing tube is fixedly connected with the sheath core handle; the distal end of the sheath core abuts against the cutting edge of the head part, and the proximal end of the sheath core abuts against the sheath core handle.
Preferably, the distal end of the reinforcing tube is cut into a curved section in the circumferential direction with an uncut section remaining.
Preferably, the internal thread and the external thread are trapezoidal threads.
Preferably, the radius of the sheath core bend is 15-35 mm.
Preferably, the sleeve surface is equipped with first arch, rotatory handle cover is established the outer inside wall of sleeve is equipped with first recess, first arch with first recess mutual adaptation makes rotatory handle with the spacing axis slidable fixed connection of sleeve circumference.
In a second aspect, the present invention provides a percutaneous transpedicular vertebral body fusion system comprising a penetrator, the above-described angled penetrator, a conveyor and a filler.
In a third aspect, the invention provides a percutaneous unilateral pedicle vertebral body fusion method, which adopts the percutaneous unilateral pedicle vertebral body fusion system, and specifically comprises the following steps:
step A1, establishing a puncture channel;
step A2, establishing a radial channel penetrating three segments of vertebral bodies:
step a3, bone cement fills the radial passage.
Preferably, step a2 specifically operates as:
step A21: penetrating the local vertebral body along the puncture channel by using the angulation puncture outfit, sequentially puncturing the local vertebral body through a lower end plate of the local vertebral body, a lower intervertebral space and an upper end plate of the lower vertebral body, and entering the lower vertebral body;
step A22: adjusting the depth and deflection angle of the angled puncture outfit entering the pedicle of vertebral arch, repeating the step A21 for multiple times, and then withdrawing the angled puncture outfit;
step A23: sequentially puncturing an upper endplate, an upper intervertebral space and a lower endplate of the upper vertebral body by using an angulation puncture outfit, and entering the upper vertebral body;
step A24: adjusting the depth and deflection angle of the angled penetrator into the pedicle, repeating step A23 multiple times, and then retracting the angled penetrator.
Step A25: puncturing a local vertebral body by using an angulation puncture outfit;
step A26: and adjusting the depth and deflection angle of the angled puncture outfit entering the vertebral pedicle, repeating the step A25 for multiple times, and withdrawing the angled puncture outfit.
Preferably, the puncture is through the inferior endplate of the local vertebral body, the inferior intervertebral space and the superior endplate of the inferior vertebral body, and the puncture crosses the midline of the inferior intervertebral space and the midline of the inferior vertebral body in the process of entering the inferior vertebral body; the puncture is through the superior endplate of the local vertebral body, the superior intervertebral space and the superior vertebral body endplate, and the puncture crosses the superior intervertebral space midline and the superior vertebral body midline in the process of entering the superior vertebral body; the vertebral body is punctured transversely and the puncture crosses the midline of the vertebral body.
By adopting the technical scheme, compared with the prior art, the invention has the following technical effects:
(1) the invention provides a minimally invasive vertebral body fusion system through vertebral pedicle, which has stronger open cavity puncture capability, simpler and more convenient and labor-saving operation and can perform multiple times of puncture and combine the bone cement injection function through the unilateral vertebral pedicle of the local vertebral body.
(2) Based on the PCVP surgical approach and puncture mode, the percutaneous vertebral arch sequentially punctures through the unilateral vertebral pedicle to enter the lower vertebral body, the lower intervertebral space, the local vertebral body, the upper intervertebral space and the upper vertebral body, establishes a radial channel and injects bone cement into the channel, so that two adjacent vertebral bodies can be effectively corrected and fixed, and pain and discomfort can be relieved and treated.
(3) According to the angulation puncture outfit provided by the invention, when hard tissues are encountered during puncture, the bone hammer can be used for knocking the sheath core handle of the angulation puncture outfit and transferring the sheath core handle to the cutting edge at the head part of the sheath core assembly, the hard tissues are broken through by moving, if the hard tissues need to be further broken through, the steps are repeated after the rotating handle is rotated, and the hard tissues can be broken through step by step through knocking; in the knocking process, the hammer can give force feedback when being knocked, so that the tissue firmness degree is felt, the follow-up operation is guided, the process can be gradual, and the operation safety is improved.
(4) By adopting the fusion method provided by the invention, only the unilateral vertebral pedicle of the local vertebral body is needed to be passed, so that the three segments of vertebral bodies can be strengthened, and the integral fusion of the three segments of vertebral bodies can be completed. The incision wound is small, and only a puncture channel with the diameter less than 5mm is needed.
(5) The bone cement dispersed between the multichannel bone cement columns and the loose sclerotin can effectively fix and strengthen adjacent three-section centrums without an additional internal fixation spinal column nail rod or bone grafting fusion process, and has the advantages of minimally invasive operation, small wound, simple operation and quick postoperative recovery. On the premise of achieving the same treatment purpose, the medical treatment device uses less configuration resources, simpler operation process, less operation cost and less operation wound, and benefits doctors and patients.
Drawings
FIG. 1 is a schematic view of an angled puncture instrument according to the present invention;
FIG. 2 is a cross-sectional view of an angled puncture instrument according to the present invention;
FIG. 3 is a schematic view of the puncture instrument;
FIG. 4 is a schematic view of the conveyor;
FIG. 5 is a schematic view of the construction of the filler;
FIG. 6 is a schematic front view of a radial passage formed by penetration of an angled penetrator;
FIG. 7 is a rear schematic view of a radial channel formed by penetration of an angled penetrator;
FIG. 8 is a left side schematic view of a radial channel formed by penetration of an angled puncture instrument;
FIG. 9 is a right side schematic view of the radial passage formed by the penetration of the angled penetrator;
the symbols in the drawings indicate the description:
1-handle component, 11-outer tube, 12-grab handle, 13-rotating handle, 14-sleeve, 15-sliding groove component, 16-fixing component, 2-sheath core component, 21-sheath core, 22-head cutting edge, 23-sheath core bending part, 24-reinforcing tube, 25-sheath core handle, 3-sliding block component, 31-sliding block and 32-sliding block support.
Detailed Description
The present invention will be described in detail and specifically with reference to the following examples to facilitate better understanding of the present invention, but the following examples do not limit the scope of the present invention. In the following description, the direction close to the operator is the proximal end, and the direction away from the operator is the distal end.
Example 1
Referring to fig. 1 and 2, the present embodiment provides an angled puncture instrument comprising a handle assembly 1, a sheath core assembly 2, and a slider assembly 3.
Specifically, the handle assembly 1 includes an outer tube 11, a grip handle 12, a rotation handle 13, a sleeve 14, and a chute member 15. The chute member 15, the sleeve 14, the rotary handle 13 and the handle 12 are sleeved in sequence from inside to outside.
The near end of the outer tube 11 is fixed with the far end of the handle 12, the far end of the sliding groove piece 15 is fixed with the far end of the handle 12, the sliding groove piece 15 is sleeved in the handle 12, and the wall surface of the sliding groove piece 15 is provided with a sliding groove.
The far end of the sleeve 14 and the far end of the grab handle 12 are axially limited and circumferentially and rotatably fixed, and the sleeve 14 is sleeved between the sliding groove piece 15 and the grab handle 12; the sleeve 14 is provided with an internal thread, preferably a trapezoidal thread, so that the thread can transmit a sufficiently large force.
The distal end of the rotary handle 13 is inserted between the proximal end of the grip 12 and the proximal end of the sleeve 14, and the proximal end of the sleeve 14 is detachably and fixedly connected to the rotary handle 13. The rotating handle 13 is T-shaped, a through hole is arranged on the central shaft of the rotating handle 13, and the sheath core assembly 2 passes through the through hole and is fixedly connected with the sheath core handle 25.
In a preferred embodiment, the sleeve 14 is provided with a first protrusion on the outer surface, and the inner side wall of the rotating handle 13 sleeved outside the sleeve 14 is provided with a first groove, and the first protrusion and the first groove are mutually matched, so that the rotating handle 13 can drive the sleeve 14 to rotate when rotating.
In a preferred embodiment, the outer wall surface of the far end of the sleeve 14 is provided with a second protrusion, the inner side wall of the grip 12 sleeved outside the sleeve 14 is provided with a second groove, the second protrusion and the second groove are mutually matched, the outer wall surface of the part of the far end of the sliding groove piece 15, which is positioned outside the sleeve 14, is provided with a third protrusion, the far end of the second groove in the grip 12 is provided with a third groove with a deeper depth, when the third protrusion and the third groove are mutually matched, the third protrusion of the sliding groove piece 15 fixes the second protrusion of the sleeve 14 in the second groove, and the axial limiting and circumferential rotatable fixation of the sleeve 14 and the grip 12 is realized.
In another preferred embodiment, the outer wall surface of the distal end of the sleeve 14 is provided with a ring of second protrusions, the inner side wall of the handle 12 sleeved outside the sleeve 14 is provided with a ring of second grooves, the second bulge is matched with the second groove, the outer wall surface of the part of the far end of the sliding groove piece 15, which is positioned outside the sleeve 14, is provided with a circle of third bulge, the diameter of the outer edge of the third bulge is larger than that of the outer edge of the second bulge, the far end of the second groove in the grab handle 12 is internally hollow to form a fixed cavity, the diameter of the fixed cavity is larger than or equal to that of the third bulge, the inner surface of the fixed cavity is provided with threads, in cooperation with the external thread of the fixing member 16, after the fixing member 16 is combined with the sleeve 14, the third projection is fixed to the proximal end of the fixing cavity, meanwhile, the third protrusion of the sliding groove piece 15 fixes the second protrusion of the sleeve 14 in the second groove, so that the sleeve 14 and the handle 12 are axially limited and circumferentially and rotatably fixed. The fixing member 16 has a through hole formed in a central axis thereof, and the proximal end of the outer tube 11 is inserted and fixed into the through hole.
Specifically, the sheath core assembly 2 includes a sheath core 21, a nose cutting edge 22, a sheath core bending portion 23, a reinforcing tube 24, and a sheath core handle 25. The proximal end of the sheath core assembly 2 passes through the handle assembly 1 and the slider assembly 3 within the handle assembly 1.
The proximal end of the sheath core 21 passes through the outer tube 11, the sliding groove 15 and the rotating handle 13 in sequence, the distal end of the sheath core 21 abuts against the nose cutting edge 22, and the proximal end of the sheath core 21 abuts against the sheath core handle 25. The distal end of the sheath core 21 is provided with a sheath core bending part 23, and the radius of the sheath core bending part 23 is 15-35 mm.
The sheath core 21 is externally sleeved with the reinforcing tube 24, the distal end of the reinforcing tube 24 is subjected to laser cutting treatment to form a bending section, preferably, the cutting mode is circumferential cutting, and an uncut section is reserved, namely, the whole circle cutting is not performed, so that the reinforcing tube 24 can be smoothly attached to the sheath core bending part 23, and meanwhile, the torsion resistance of the sheath core bending part 23 can be enhanced. The near end of the reinforced tube 24 is fixedly connected with the sheath core handle 25, the far end of the reinforced tube 24 is fixedly connected with the cutting edge 22 of the head, and the cutting edge 22 of the head is used for puncturing the tissue to open the cavity.
In particular use, since the distal end of the stiffening tube 24 is fixedly connected to the cutting edge 22 of the nose, the proximal end of the stiffening tube 24 is fixedly connected to the sheath-core handle 25, the distal end of the sheath-core 22 abuts the cutting edge 22 of the nose, and the proximal end of the sheath-core 22 abuts the sheath-core handle 25, when a distally directed tapping force is applied to the sheath-core handle 25, the force can be transmitted from the sheath-core handle 25 through the stiffening tube 24 and the sheath-core 22 to the cutting edge 22 of the nose, the tapping force being used to open the channel through the harder tissue.
Specifically, the slider assembly 3 includes a slider 31 and a slider holder 32. The slider assembly 3 is disposed within the chute member 15.
The slider holder 32 is dumbbell-shaped, and one side of the both ends of the slider holder 32 close to the runner of the runner part 15 is clamped in the runner, and the part protruding out of the runner is subjected to plane processing, so that the slider holder 32 can relatively slide in the runner without being limited by the sleeve 14.
The sliding block 31 is sleeved on a cross bar in the middle of the sliding block support 32, and gaps are reserved between the far end surface and the near end surface of the sliding block 31 and two ends of the sliding block support 32; so that the slider 31 can move back and forth on the bar of the slider holder 32.
A through hole is arranged in the central axis direction of the sliding block support 32, the sheath core assembly 2 penetrates through the through hole, and the outer surface of the sheath core assembly 2 is fixed with the inner surface of the through hole. In a specific embodiment, the through-hole of the slider holder 31 is fixedly connected to the outer surface of the reinforcing tube 24.
The external thread on the outer surface of the sliding block 31 passes through the sliding slot of the sliding slot member 15 and is matched with the internal thread of the sleeve 14. Preferably, the external thread is also a trapezoidal thread. When the sleeve 14 rotates, the slider 31 can move only back and forth due to the limitation of the circumferential direction of the sliding groove.
Example 2
The embodiment provides a specific use method of the angled puncture outfit in embodiment 1, which specifically comprises the following steps:
step S1, preparation: cutting a 5mm incision on the skin, puncturing a pedicle of vertebral arch channel by using a puncture outfit, withdrawing a needle core of the puncture outfit, reserving a needle tube of the puncture outfit, and penetrating the local vertebral body along the needle tube channel of the puncture outfit by using an angled puncture outfit;
step S2, start puncturing: when the sleeve 14 is driven to rotate by the rotating handle 13, because the external threads on the outer surface of the sliding block 31 are matched with the internal threads of the sleeve 14, the sliding block moves towards the far end along the sliding groove of the sliding groove piece 15, the sliding block 31 can abut against the far end of the sliding block support 32, when the sliding block 31 continues to move towards the far end, the sliding block 31 can move towards the far end against the sliding block support 32, because the sliding block support 31 is fixedly connected with the reinforced pipe 24, the sliding block support 31 can move towards the far end against the reinforced pipe 24, the reinforced pipe 24 drives the sheath core handle 25 to move towards the far end, the sheath core handle 25 moves towards the far end against the sheath core 21, and the sheath core 21 and the reinforced pipe 24 puncture towards the far end against the nose cutting edge 22;
step S3, encountering hard tissue puncture: at the moment, the slide block 31 is attached to the far end of the slide block support 32, a large gap is left between the slide block 31 and the near end of the slide block support 32, a knocking force is applied on the sheath core handle 25, the knocking force is transmitted to the nose cutting edge 22 through the sheath core handle 25, the sheath core 21 and the reinforcing tube 24, so that the nose cutting edge 22 is further exposed out of the outer tube 11, the cavity is punctured towards the far end, meanwhile, the sheath core handle 25 carries the reinforcing tube 24 to move towards the far end, the reinforcing tube 24 carries the slide block support 32 to move towards the far end, the slide block 31 cannot move when the sleeve 14 is not rotated due to the threaded fit of the slide block 31 and the sleeve 14, the slide block support 32 slides towards the far end relative to the slide block 31, when the rear end of the slide block support 32 is attached to the slide block 31, the sheath core handle 25 is hammered at the moment, the nose cutting edge 22 cannot be further exposed out of the outer tube 11 to puncture, and the play of the sheath core assembly 3 towards the far end stops;
step S4, further puncturing hard tissue: if the hard tissue is not completely broken through after the step S3 is finished, and if the hard tissue needs to be broken through by knocking, the sleeve 14 is driven to rotate by the rotating handle 13, the slide block 31 moves towards the far end due to thread matching, so that the slide block 31 is attached to the far end of the slide block support 32 again, a larger gap is reserved between the slide block 31 and the rear end of the slide block support 32 again, knocking force can be applied to the sheath core handle 25 again, the hard tissue at the far end is broken through by continuously knocking with the bone hammer, and the hard tissue in the vertebral body can be gradually broken through as long as the stepping process is repeated, so that a through channel is formed.
In the knocking process, the force is applied through the bone hammer, force feedback exists during knocking, the force feedback is matched with the conventional operation experience of a doctor, and the hardness of the tissue can be identified through the force feedback to guide the subsequent operation.
Example 3
The present embodiment provides a percutaneous transpedicular vertebral body fusion system comprising a penetrator (as shown in fig. 3), the angled penetrator of embodiment 1 (as shown in fig. 1-2), a transporter (as shown in fig. 4), and a filler (as shown in fig. 5).
Example 4
The embodiment provides a percutaneous unilateral pedicle vertebral body fusion method, which adopts the percutaneous unilateral pedicle vertebral body fusion system as in embodiment 3, and specifically comprises the following steps:
step A1, establishing a puncture channel: cutting a 5mm incision on the skin, puncturing the pedicle of vertebral arch of the local centrum by using a puncture outfit to form a channel, withdrawing the needle core of the puncture outfit, and reserving a needle tube of the puncture outfit to form a puncture channel;
step A2, establishing radial channels penetrating three segments of vertebral bodies (as shown in figures 5-9):
step A21: an angulation puncture outfit is used for penetrating into the local centrum along the needle tube channel of the puncture outfit, sequentially penetrating through the lower end plate of the local centrum, the space between the lower vertebra and the upper end plate of the lower centrum, entering the lower centrum, and penetrating through the midline of the lower centrum;
step A22: adjusting the depth and deflection angle of the angled puncture outfit entering the pedicle of vertebral arch, repeating the step A21 for multiple times, and then withdrawing the angled puncture outfit;
step A23: sequentially puncturing an upper end plate, an upper vertebral gap and a lower end plate of the upper vertebral body by using an angulation puncture outfit, entering the upper vertebral body, and puncturing to cross the midline of the upper vertebral body;
step A24: adjusting the depth and deflection angle of the angled puncture outfit entering the pedicle of vertebral arch, repeating the step A23 for multiple times, and then withdrawing the angled puncture outfit;
step A25: puncturing the centrum of the local position by using an angulation puncture outfit, and puncturing the midline of the centrum of the local position;
step A26: and adjusting the depth and deflection angle of the angled puncture outfit entering the vertebral pedicle, repeating the step A25 for multiple times, and withdrawing the angled puncture outfit.
Step A3, filling the radial channel with bone cement: the bone cement is filled in the local vertebral body along the conveyor channel and filled in the lower vertebral body, the lower vertebral gap, the upper vertebral body, the upper vertebral gap and the local vertebral body along the radial channel.
After the bone cement is solidified, the lower vertebral body, the lower intervertebral space, the home vertebral body, the superior intervertebral space and the superior vertebral body are fused into a whole.
In a preferred embodiment, the puncture is through the inferior endplate of the inferior vertebral body, the inferior intervertebral space, the superior endplate of the inferior vertebral body, and into the inferior vertebral body, the puncture is across the inferior intervertebral space midline and the inferior vertebral body midline; the puncture is through the superior endplate of the vertebra, the superior intervertebral space and the superior endplate of the vertebra, and the puncture crosses the medial line of the superior intervertebral space and the medial line of the superior vertebra when entering the superior vertebra.
Because of radial passageway has all crossed the lower centrum, lower intervertebral space, the local centrum, superior intervertebral space, the central line of superior centrum, then bone cement all can fill to lower centrum, lower intervertebral space, the local centrum, superior intervertebral space, the offside of superior centrum, form and link up the radial passageway of lower centrum local side and offside, lower intervertebral space local side and offside, local centrum local side and offside, superior intervertebral space local side and offside, superior centrum local side and offside, the passageway starting point all is located the pedicle of vertebral arch root on local centrum one side. After the bone cement is solidified, the reinforcement of the lower vertebral body, the lower intervertebral space, the local vertebral body, the upper intervertebral space and the upper vertebral body is achieved.
In conclusion, the three segments of vertebral bodies can be strengthened and the integral fusion of the three segments of vertebral bodies can be completed only by the unilateral vertebral pedicle of the local vertebral body by adopting the fusion method. The minimally invasive vertebral body fusion system through the pedicle has small incision wound and only needs one puncture channel with the diameter less than 5 mm. In addition, the bone cement dispersed between the multichannel bone cement columns and the loose sclerotin can effectively fix and strengthen adjacent three-section vertebral bodies, an additional internal fixation spinal column nail rod or bone grafting fusion process is not needed, the operation is minimally invasive, the wound is small, the operation is simple, and the postoperative recovery is fast. On the premise of achieving the same treatment purpose, the medical treatment device uses less configuration resources, simpler operation process, less operation cost and less operation wound, and benefits doctors and patients.
The embodiments of the present invention have been described in detail, but the embodiments are merely examples, and the present invention is not limited to the embodiments described above. Any equivalent modifications and substitutions to those skilled in the art are also within the scope of the present invention. Accordingly, equivalent changes and modifications made without departing from the spirit and scope of the present invention should be covered by the present invention.
Claims (10)
1. An angled puncture instrument, comprising:
the handle assembly (1) comprises an outer tube (11), and further comprises a sliding groove piece (15), a sleeve (14), a rotating handle (13) and a grab handle (12) which are sleeved in sequence from inside to outside; the near end of the outer tube (11) is fixed with the far end of the grab handle (12), the far end of the sliding groove piece (15) is fixed with the far end of the grab handle (12), the far end of the sleeve (14) is axially limited and circumferentially and rotatably fixed with the far end of the grab handle (12), and the near end of the sleeve (14) is detachably and fixedly connected with the rotating handle (13);
the sheath core assembly (2) comprises a sheath core (21), a head cutting edge (22), a sheath core bending part (23), a reinforcing pipe (24) and a sheath core handle (25);
the sliding block assembly (3) comprises a sliding block (31) and a sliding block support (32); the sliding block assembly (3) is arranged in the sliding groove piece (15), a through hole is formed in the sliding block support (32) in the central shaft direction, the sheath core assembly (2) penetrates through the through hole, and the outer surface of the sheath core assembly (2) is fixed with the inner surface of the through hole; the sliding block support (32) is dumbbell-shaped, and the sliding block (31) is slidably sleeved in the middle of the sliding block support (32); the external thread of the sliding block (31) passes through the sliding groove of the sliding groove piece (15) to be matched with the internal thread of the inner surface of the sleeve (14).
2. The angled puncture instrument according to claim 1, wherein a proximal end of the sheath core (21) passes through the outer tube (11), the chute (15), and the rotation handle (13) in this order; the far end of the sheath core (21) is provided with a sheath core bending part (23); the sheath core (21) is sleeved with the reinforcing tube (24), the distal end of the reinforcing tube (24) is provided with a bending section, the distal end of the reinforcing tube (24) is fixedly connected with the nose cutting edge (22), and the proximal end of the reinforcing tube (24) is fixedly connected with the sheath core handle (25); the distal end of the sheath core (21) is pressed against the nose cutting edge (22), and the proximal end of the sheath core (21) is pressed against the sheath core handle (25).
3. The angled puncture instrument according to claim 2, wherein the distal end of the stiffening tube (24) is cut into a curved section through the circumferential direction leaving an uncut section.
4. The angled puncture instrument of claim 1, wherein the internal threads and the external threads are trapezoidal threads.
5. The angled puncture instrument according to claim 1, wherein the radius of the sheath-core bend (23) is 15-35 mm.
6. The angled puncture instrument as claimed in claim 1, wherein the sleeve (14) is provided with a first protrusion on the outer surface thereof, the inner side wall of the rotation handle (13) which is sleeved outside the sleeve (14) is provided with a first groove, and the first protrusion and the first groove are adapted to each other, so that the rotation handle (13) and the circumferential limit axis of the sleeve (14) can be slidably and fixedly connected.
7. A percutaneous transpedicular vertebral fusion system comprising a penetrator, the angled penetrator of any of claims 1-6, a conveyor, and a filler.
8. A percutaneous transpedicular vertebral body fusion method using the percutaneous transpedicular vertebral body fusion system according to claim 7, comprising the steps of:
step A1, establishing a puncture channel;
step A2, establishing a radial channel penetrating through the three vertebral bodies;
step a3, bone cement fills the radial passage.
9. The method for vertebral body fusion of claim 8 wherein step a2 is specifically performed by:
step A21: penetrating the local vertebral body along the puncture channel by using the angulation puncture outfit, sequentially puncturing the local vertebral body through a lower end plate of the local vertebral body, a lower intervertebral space and an upper end plate of the lower vertebral body, and entering the lower vertebral body;
step A22: adjusting the depth and deflection angle of the angled puncture outfit entering the pedicle of vertebral arch, repeating the step A21 for multiple times, and then withdrawing the angled puncture outfit;
step A23: sequentially puncturing an upper endplate, an upper intervertebral space and a lower endplate of the upper vertebral body by using an angulation puncture outfit, and entering the upper vertebral body;
step A24: adjusting the depth and deflection angle of the angled penetrator into the pedicle, repeating step A23 multiple times, and then retracting the angled penetrator.
Step A25: puncturing a local vertebral body by using an angulation puncture outfit;
step A26: and adjusting the depth and deflection angle of the angled puncture outfit entering the vertebral pedicle, repeating the step A25 for multiple times, and withdrawing the angled puncture outfit.
10. The method of vertebral body fusion according to claim 9 wherein the puncture is through the inferior endplate of the local vertebral body, the inferior intervertebral space, the superior endplate of the inferior vertebral body, and into the inferior vertebral body, the puncture is across the inferior intervertebral space midline and the inferior vertebral body midline; the puncture is through the superior endplate of the local vertebral body, the superior intervertebral space and the superior vertebral body endplate, and the puncture crosses the superior intervertebral space midline and the superior vertebral body midline in the process of entering the superior vertebral body; the vertebral body is punctured transversely and the puncture crosses the midline of the vertebral body.
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| CN114305608B (en) | 2023-08-15 |
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