CN109009357A - A kind of intervertebral foramen of lumbar vertebra videoendoscopic surgery puncture positioning device and its application method - Google Patents
A kind of intervertebral foramen of lumbar vertebra videoendoscopic surgery puncture positioning device and its application method Download PDFInfo
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- CN109009357A CN109009357A CN201811053058.7A CN201811053058A CN109009357A CN 109009357 A CN109009357 A CN 109009357A CN 201811053058 A CN201811053058 A CN 201811053058A CN 109009357 A CN109009357 A CN 109009357A
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- 238000001356 surgical procedure Methods 0.000 title claims abstract description 32
- 238000000034 method Methods 0.000 title claims abstract description 16
- 238000005452 bending Methods 0.000 claims description 17
- 208000003618 Intervertebral Disc Displacement Diseases 0.000 claims description 14
- 229910000831 Steel Inorganic materials 0.000 claims description 14
- 239000010959 steel Substances 0.000 claims description 14
- 241000135309 Processus Species 0.000 claims description 10
- 238000002674 endoscopic surgery Methods 0.000 claims description 6
- 238000005259 measurement Methods 0.000 claims description 5
- 230000013011 mating Effects 0.000 claims description 4
- 229920000049 Carbon (fiber) Polymers 0.000 claims description 3
- 238000005481 NMR spectroscopy Methods 0.000 claims description 3
- 210000001217 buttock Anatomy 0.000 claims description 3
- 239000004917 carbon fiber Substances 0.000 claims description 3
- VNWKTOKETHGBQD-UHFFFAOYSA-N methane Chemical group C VNWKTOKETHGBQD-UHFFFAOYSA-N 0.000 claims description 3
- 239000000203 mixture Substances 0.000 claims description 3
- 239000000284 extract Substances 0.000 claims description 2
- 208000029215 central polydactyly of fingers Diseases 0.000 claims 1
- 238000010586 diagram Methods 0.000 description 11
- 238000002595 magnetic resonance imaging Methods 0.000 description 6
- 208000012287 Prolapse Diseases 0.000 description 5
- 208000027418 Wounds and injury Diseases 0.000 description 4
- 230000006378 damage Effects 0.000 description 4
- 208000014674 injury Diseases 0.000 description 4
- 238000005516 engineering process Methods 0.000 description 3
- 208000024248 Vascular System injury Diseases 0.000 description 2
- 208000012339 Vascular injury Diseases 0.000 description 2
- 230000003187 abdominal effect Effects 0.000 description 2
- 230000005540 biological transmission Effects 0.000 description 2
- 239000008280 blood Substances 0.000 description 2
- 210000004369 blood Anatomy 0.000 description 2
- 210000004204 blood vessel Anatomy 0.000 description 2
- 238000001514 detection method Methods 0.000 description 2
- 210000004126 nerve fiber Anatomy 0.000 description 2
- 238000011084 recovery Methods 0.000 description 2
- 238000004904 shortening Methods 0.000 description 2
- 210000001835 viscera Anatomy 0.000 description 2
- XLYOFNOQVPJJNP-UHFFFAOYSA-N water Substances O XLYOFNOQVPJJNP-UHFFFAOYSA-N 0.000 description 2
- 208000034657 Convalescence Diseases 0.000 description 1
- 241000425571 Trepanes Species 0.000 description 1
- 206010052428 Wound Diseases 0.000 description 1
- 230000015572 biosynthetic process Effects 0.000 description 1
- 238000002591 computed tomography Methods 0.000 description 1
- 230000007423 decrease Effects 0.000 description 1
- 230000000694 effects Effects 0.000 description 1
- 210000005096 hematological system Anatomy 0.000 description 1
- 210000000653 nervous system Anatomy 0.000 description 1
- 230000005311 nuclear magnetism Effects 0.000 description 1
- 239000007787 solid Substances 0.000 description 1
- 238000003786 synthesis reaction Methods 0.000 description 1
- 230000008733 trauma Effects 0.000 description 1
- 230000029663 wound healing Effects 0.000 description 1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3403—Needle locating or guiding means
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
- A61G13/00—Operating tables; Auxiliary appliances therefor
- A61G13/10—Parts, details or accessories
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
- A61G13/00—Operating tables; Auxiliary appliances therefor
- A61G13/10—Parts, details or accessories
- A61G13/101—Clamping means for connecting accessories to the operating table
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3403—Needle locating or guiding means
- A61B2017/3405—Needle locating or guiding means using mechanical guide means
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Abstract
A kind of intervertebral foramen of lumbar vertebra videoendoscopic surgery puncture positioning device and its application method, belong to medical instruments field, the operation puncturing positioning device includes operating bed fixing clamp, the column vertical with bed surface is connected on fixing clamp, cross bar one end is slidably connected on column, cross bar other end end is shaft, adjusting rotating cylinder is rotatably connected in shaft, it adjusts rotating cylinder and close end side is provided with the positioning tube vertical with rotating shaft core, pilot pin is provided in positioning tube, the long stick of horizontal survey is respectively arranged in the shaft and adjusting rotating cylinder of positioning tube side and long stick is surveyed in inclination, it adjusts rotating cylinder periphery and is provided with long arc-shaped holes in rotational direction, long arc-shaped holes are moved along the horizontal long stick of survey when adjusting drum rotation, it can be accurately positioned using the present apparatus and puncture direction and puncture angle, operating time can be shortened, guarantee going on smoothly for operation, reduce patient suffering, subtract Few doctor's is overworked.
Description
Technical field
The present invention relates to a kind of surgery positioning device and its application method, in particular to a kind of intervertebral foramen of lumbar vertebra videoendoscopic surgery is worn
Positioning device and its application method are pierced, medical instruments field is belonged to.
Background technique
When the operation at the backbones such as prolapse of lumbar intervertebral disc position, traditional prolapse of lumbar intervertebral disc Nuclectomy operation is open hand
Art can bring biggish pain and wound to patient, and convalescence is long, and wound healing is slow.
In recent years, with the development of science and technology using endoscope under Micro trauma situation, the operation of backbone position has been carried out
Through become a kind of common method, still, when performing the operation to the backbones such as prolapse of lumbar intervertebral disc position, correctly puncture enter thorn point and
Correctly puncturing direction is the key that successful surgery, and incidence of complications can also be substantially reduced, generally need at the time of surgery,
Patient lies prone can also take lateral position, on operating table, need to diseased region i.e.: target spot or protrusion of lumber intervertebral disc position,
The synthetic degree of angle of point of puncture and the positioning for puncturing direction, head inclination angle and top rake is to puncture direction.
So far, there are mainly two types of for the method at clinical progress head inclination angle and top rake positioning.
Determine head degree of tilt (or tail degree of tilt) and forward leaning angle method one:
1, determine that skin enters thorn point and punctures direction on lumbar vertebrae CT, MRI and X-ray film.Determine what puncture needle reached according to the state of an illness
Final position isWaistThe upper soleplate rear midpoint of the next centrum of disc herniation, target spot or disc herniation position, by upper soleplate
A line is done in midpoint or target spot and protrusion of lumber intervertebral disc side lower centrum processus articular superior tip, this line horizontal plane projection with
Angle formed by the human body longitudinal axis vertical line of the upper soleplate rear midpoint of the next centrum of logical protrusion of lumber intervertebral disc or target spot is quasi-
The head that row punctures direction inclines or tail degree of tilt；
2, the upper soleplate rear midpoint of the next centrum of protrusion of lumber intervertebral disc or target spot and the next centrum protrusion of lumber intervertebral disc side is upper
The angle of articular process tip line and horizontal plane is forward leaning angle.This angle can measure in CT or MRI on piece.
Determine head degree of tilt or tail degree of tilt and forward leaning angle method two:
1, determine that skin enters thorn point and punctures direction on lumbar vertebrae CT, MRI and X-ray film.Determine what puncture needle reached according to the state of an illness
The upper soleplate rear midpoint of the next centrum of final position, that is, protrusion of lumber intervertebral disc, target spot or disc herniation position, lumber ertebral disc
Above the processus articular superior tip of soleplate rear midpoint or target spot and the next centrum protrusion of lumber intervertebral disc side does one to bottom centrum outstanding
Line, this line are as quasi- in the projection of horizontal plane and angle formed by the human body longitudinal axis vertical line by soleplate midpoint or target spot
The head that row punctures direction inclines or tail degree of tilt；
2, for the skin incision of the segment L5/S1 at away from 12 cm of posterior median line, the segment L4/L5 or L3/L4 is 10 cm,
And the segment L2/L3 is then 8 cm；
3, according to CT and MRI measurement terminal plate of vertebral body midpoint or target spot to skin distance；
4, forward leaning angle is determined further according to 2 and 3；
Incline by the human body longitudinal axis vertical line and head at the upper soleplate rear midpoint of the next centrum of protrusion of lumber intervertebral disc or target spot or tail inclines
Angle crosses in body surface and skin is marked to enter and pierces a little: one piece of steel needle is placed in the next centrum above eventually perpendicular to human body longitudinal axis outline
Plate or target position, C-arm normotopia perspective, which determines, crosses after position is accurate along steel needle.Incline according to the head of preoperative measurement or tail inclination angle
Degree places another piece of steel needle by soleplate midpoint or target spot direction, and C-arm normotopia perspective is to determine that this steel needle is projected in horizontal plane
Whether be soleplate midpoint or target spot and the next centrum protrusion of lumber intervertebral disc side processus articular superior tip line, and appropriate adjustment, position
It crosses after setting accurately along this steel needle.Skin is marked to enter to pierce a little on this line according to method two, 2, or in CT or MRI piece lumber ertebral disc
The processus articular superior tip line of the upper soleplate rear midpoint of bottom centrum outstanding or target spot and the next centrum disc herniation side and
The intersection point of this line is into piercing a little.
Fig. 8 is the section structure diagram of vertebral part.In Fig. 8, dotted portion respectively represents a plane, in prone position
When, the upper 35 rear midpoint 30 of soleplate of lumber ertebral disc bottom centrum or target spot are the points of puncture being finally reached, under lumber ertebral disc
Upper soleplate plane 36 and horizontal plane 34 where the upper soleplate 35 of position centrum is perpendicular, on the centrum of lumber ertebral disc bottom after soleplate 35
Edge midpoint 30 or target spot and 31 line of the next centrum processus articular superior tip of protrusion of lumber intervertebral disc side are puncture line 37, puncture line
37 in head inclination angle vertical plane 38, and upper soleplate plane 36 forms back with head inclination angle vertical plane 38 in patient's back skin 40
Portion's skin intersection point 33, by skin of back intersection point 33 respectively 38 in upper soleplate plane 36 with inclined vertical plane in make two water
Flat line, this two straight lines are respectively two 38a of one 36a of horizontal line and horizontal line, the folder of two 38a of one 36a of horizontal line and horizontal line
Angle is head inclination alpha, and the angle of puncture line 37 and two 38a of horizontal line are top rake β, and 39 be that skin enters to pierce point, 32 is puncture line 37
The two line intersection points of two 38a of horizontal line.
Determine that head inclines or tail degree of tilt α and top rake β degree are that operation is determining in the sky due to described, can not determine accurately
Angle can not also be determined from the puncture position outside patient skin, be to be positioned and oriented by rule of thumb in most cases, this is just deposited
In certain risk.
Although there are also the tools for determining forward leaning angle to operate comparatively laborious, be not easy since structure is complicated
It grasps, and the time for using cost is too long, is unfavorable for the pain for shortening operating time, reducing patient, it is simple and practical
Puncture positioning device is the medical instrument being badly in need of in current backbone endoscopic surgery.
Summary of the invention
For the backbones such as current prolapse of lumbar intervertebral disc position operation when, the head inclination angle of puncture and top rake are not easy determining
Situation, the present invention provide a kind of intervertebral foramen of lumbar vertebra videoendoscopic surgery puncture positioning device and its application method, its purpose is to accurate
Head inclination angle and top rake are held, final determine punctures direction, accurately carries out hand to prolapse of lumbar intervertebral disc, Waist disc diseased region
Art prevents from improving operative speed because of the inaccurate injury nervous system, hematological system of angle, shortening operating time, reduce patient's pain
Hardship reduces the overworked of doctor, guarantees smoothly completing for operation.
The technical scheme is that a kind of intervertebral foramen of lumbar vertebra videoendoscopic surgery puncture positioning device, the operation puncturing positioning
Device includes operating bed fixing clamp, and the column vertical with bed surface is connected on fixing clamp, flexible bending is slidably connected on column
Type cross bar one end, cross bar other end end are shaft, are rotatably connected in shaft using shaft as the forward leaning angle of axis rotation
Rotating cylinder is adjusted, rotating cylinder is adjusted by close end side and is provided with the positioning tube vertical with rotating shaft core, positioning is provided in positioning tube
Needle, the shaft of positioning tube side and adjusting are respectively arranged with the survey long stick perpendicular to axle center and connects wire hole, shaft and adjusting on rotating cylinder
It surveys in long stick connection wire hole to be connected separately with the long stick of level survey and tilt on rotating cylinder and surveys long stick, adjusting rotating cylinder periphery is provided with edge and turns
The long arc-shaped holes in dynamic direction, long arc-shaped holes are moved along the horizontal long stick of survey when adjusting drum rotation；
Further, the flexible bending-type cross bar one end end being slidably connected on the column is sliding part, and sliding part is provided with height
Spend clamping screw；
Further, it is provided with the articulated shaft rotated along the horizontal plane among the flexible bending-type cross bar, is provided with bending on cross bar
Angle lock screw；
Further, the long stick of survey being connected in shaft is the horizontal long stick of survey, and level, which is surveyed on long stick, is provided with scale, and level is surveyed
Long stick diameter is 2mm；
Further, the long stick of survey connected in rotating cylinder wire hole that adjusts is that long stick is surveyed in inclination, and inclination is surveyed long stick and turned with rotating cylinder is adjusted
Dynamic, it is consistent with the pilot pin direction in positioning tube that long stick extending direction is surveyed in inclination；
Further, the pilot pin is plug-type pilot pin, and the inner sleeve of different-diameter is configured on the mating inner hole of positioning tube,
Inner sleeve is matched from different surgical instrument outer diameters；
Further, the maximum rotation angle that long stick is surveyed in the inclination is more than or equal to forward leaning angle.
A kind of application method of intervertebral foramen of lumbar vertebra videoendoscopic surgery puncture positioning device, structure are above-mentioned lumbar intervertebral aperture mirror
Operation puncturing positioning device, steps are as follows for the use of the intervertebral foramen of lumbar vertebra videoendoscopic surgery puncture positioning device:
(1), preoperative using in the upper soleplate rear of the next centrum in CT or nuclear magnetic resonance measuring target spot or Nucleus pulposus stage
Point arrives distance H between human body back skin subpoint；
(2), under C-arm perspective, a horizontal wire is placed in the horizontal direction perpendicular to backbone and is located at disc herniation bottom
It is lower positioned at bottom to place another inclination steel wire perspective then in the plane parallel with bed surface for soleplate horizontal line on centrum
Soleplate rear midpoint to disc herniation side processus articular superior tip line line, the angle that two steel wires are planar formed on centrum
For head inclination angle, intersection point is vertebra central point；
(3), the operating bed fixing clamp of intervertebral foramen of lumbar vertebra videoendoscopic surgery puncture positioning device is fixed on to the hand of protrusion of lumber intervertebral disc side
On art bed edge of bed, fixed bit is in the corresponding bedside locations of patient's buttocks；
(4), it stretches bending-type cross bar height and position along post adjustment, height is interim to lock about in patient's 25cm height and position
Tight bolt；
(5), pilot pin is inserted into positioning tube, bending cross bar is consistent the direction of pilot pin with the head inclination angle in above-mentioned (2),
Lock screw is completed head inclination angle angle and is determined, temporarily takes out pilot pin；
(6), measurement skin enters thorn point with the next centrum and above soleplate rear midpoint is at a distance from subpoint in human body back skin
L enters thorn point on L line, the parallel ground of L line；
(7), the horizontal long stick of survey is threadedly coupled in shaft, level surveys a long side of the stick extending direction far from operating bed；
(8), it is threadedly coupled inclination on adjusting rotating cylinder and surveys long stick, so that inclination is surveyed long stick and be directed away from one side of patient；
(9), it surveys on long stick and is found apart from the position of shaft axis in level, made marks；
(10), the long stick of inclination survey is rotated along long arc-shaped holes, surveys mark position on the horizontal long stick of survey on long stick vertically to inclination
Distance is equal to the height of the distance H in above-mentioned (1), clamping screw；
(11), long stick is surveyed in inclination and horizontal survey forms a top rake β between long stick；
(12), pilot pin is inserted into positioning tube, pilot pin pointed location is exactly endoscopic surgery position, is done on a patient body
Enter thorn point label well；
(13), it extracts pilot pin out, is punctured along positioning tube direction, complete the operation of the present apparatus,
Further, the intervertebral foramen of lumbar vertebra videoendoscopic surgery puncture positioning device is carbon fiber, plastic products composition.
The good effect that the present invention has is: by having an X-rayed in C-arm anteroposterior position, determining on the centrum of disc herniation bottom
Soleplate horizontal line and the next centrum go up soleplate rear midpoint to disc herniation side processus articular superior tip line line, rear-projection after human body
Hachure horizontal line one and two point of intersection of horizontal line are marked with marking pen, it may be determined that two lines soleplate rear midpoint on the next centrum
The intersection point of vertical line and human skin；By the way that fixing clamp is arranged on intervertebral foramen of lumbar vertebra videoendoscopic surgery puncture positioning device, can incite somebody to action
This endoscopic surgery position is integrally attached on operating bed, it is ensured that operation consent is sought to puncture direction and puncture position；By solid
Clamp Vertical Square sets up column, and setting height can be slided on column；By sliding on column, flexible bending is set
Type cross bar, and be arranged in crossbar end shaft periphery and adjust rotating cylinder, it can planar be had an X-rayed, will be stretched using C-arm first
The bending of bending-type cross bar, is consistent the pilot pin adjusted in rotating cylinder inner hole with head inclination angle, then in hanging down where pilot pin
Determining top rake is tilted down along vertical direction in straight plane, finally determines top rake.
Why cross bar of the present invention is designed to flexible bending-type structure, is because determination does not make pilot pin in this setting
The function of being moved along pilot pin and adjusting rotating cylinder along horizontal plane, if it is complex to have the functional structure, as long as utilizing water
Above-mentioned function can be realized in bending articulated shaft in plane, that is to say, that can be realized pilot pin direction and head inclination direction and is hanging down
The purpose that histogram is consistent upwards, in addition, the pilot pin that can will be in horizontal plane top inclination direction by adjusting rotating cylinder,
It is further tilted downwards along the vertical plane where pilot pin, determines top rake, when determining positioning syringe needle inclination angle and top rake,
It is to survey long stick using the level on parallel lines corresponding angles and vertically survey what long stick determined, the horizontal length surveyed on long stick is cross
Bar side positioning tube end center utilizes CT or nuclear-magnetism when the vertical edges to the horizontal direction distance L of vertebra central point vertical line
Distance H between the upper soleplate rear midpoint skin projection of the next centrum of the protrusion of lumber intervertebral disc of resonance detection, two right-angle sides determine
The angle of bevel edge, so that it is determined that puncture direction.
For the present apparatus for the puncture direction of three-dimensional structure, structure is simple, easy to use, it is convenient to determine puncture side
To and forward leaning angle, when expanding puncture channel, when needing replacing instrument, can guarantee that direction will not change, avoid changer
Direction offset causes operation difficult or increases operation risk when tool；Because paracentesis depth has been set before puncture, can avoid
That wears when puncture too deep injures blood vessel and abdominal viscera；The time is saved in puncture, and it is accurate to puncture；Perspective number is reduced, doctor is reduced
And injury number of the patient by ray；Since the invention reduces localised puncture difficulty, clinician can be easier to grasp
The technology can reduce pain, can more importantly take care of yourself success rate of operation, caused by avoiding because of direction and position inaccuracy
Nerve fiber is damaged or the excessive blood loss of vascular injury, also helps the recovery from illness and rehabilitation of patient.
Detailed description of the invention
Positive structure schematic Fig. 1 of the invention.
Fig. 2 is inserted with the side structure schematic diagram of pilot pin.
Fig. 3 determines steel wire setting direction when patient head inclination angle.
Pilot pin and the situation of the long stick of survey when Fig. 4 determines top rake.
Fig. 5 determines head inclination angle schematic diagram.
Fig. 6 determines the schematic diagram of top rake.
After Fig. 7 cross bar bending and the schematic diagram at head inclination angle, top rake.
The section structure diagram of Fig. 8 vertebral part.
Label declaration: 10- fixing clamp, 10a- lock screw, 10b- open spring, 11- column, 12- scale, 13- height
Clamping screw, 14- sliding part, 15- articulated shaft one, 16- cross bar, 16a- lock screw, 16b- shaft, 17- articulated shaft two, 18-
Slip joint, 19- adjust rotating cylinder, 20- level surveys long stick connection wire hole, long stick connection wire hole is surveyed in 21- inclination, 22- elastic ejector,
23- long arc-shaped holes, 24- positioning tube inner hole, 25- positioning tube, 26- pilot pin, 27a- operating bed long side, 27b- operating bed short side,
28- level surveys long stick, long stick, α-head inclination angle, β-top rake, 30- upper soleplate rear midpoint, 31- upper joint spur are surveyed in 29- inclination
Portion, two line intersection point of 32-, 33- skin of back intersection point, 34- skin horizontal plane, the upper soleplate of the bottom 35- centrum, on the centrum of the bottom 36-
Soleplate plane, 36a- horizontal line one, 37- puncture line, 38- inclination angle vertical planes, 38a- horizontal line two, 39- skin enter to pierce point,
40- back skin.
Specific embodiment
This is described in detail using novel specific embodiment is provided referring to the drawings.Prone position hand is pressed below
Art is illustrated.The final position that point of puncture i.e. puncture needle reach in the following description, it may be assumed that the upper soleplate of the next centrum
Midpoint or target spot (disc herniation position).
The technical scheme is that a kind of intervertebral foramen of lumbar vertebra videoendoscopic surgery puncture positioning device, Fig. 1 is front of the invention
Structural schematic diagram.Namely it is arranged on operating bed long side 27a from bedside lateral direction view.Fig. 2 is inserted with pilot pin 26
Side structure schematic diagram, that is, the view from the side operating bed short side 27b.Fig. 3 determines steel wire setting when patient head inclination angle
Direction.Pilot pin and the situation of the long stick of survey when Fig. 4 is determining top rake.
The operation puncturing positioning device includes operating bed fixing clamp 10, and vertical with bed surface stand is connected on fixing clamp 10
Column 11, flexible 16 one end of bending-type cross bar is slidably connected on column 11, and 16 other end end of cross bar is shaft 16b, shaft 16b
On be rotatably connected to using shaft 16b as the adjusting rotating cylinder 19 of the top rake β degree of axis rotation, shaft 16b and adjust rotating cylinder 19 it
Between be provided with elastic ejector 22, adjust rotating cylinder 19 by close end side and be provided with the positioning tube 25,24 with shaft 16b axis perpendicular
For positioning tube inner hole, it is provided with pilot pin 26 in positioning tube inner hole 24, the shaft 16b of 25 side of positioning tube and adjusts on rotating cylinder 19 point
It is not provided perpendicular to the long stick connection wire hole of survey of rotating shaft core, 20 be that the level being arranged on shaft 16b surveys long stick connecting filament
Hole, 21 are that the inclination adjusted on rotating cylinder is arranged in survey long stick 29, and level surveys long stick connection wire hole 20 and long stick wire hole 21 is surveyed in inclination
It is inside connected separately with level and surveys long stick 28 and the long stick 29 of inclination survey, it is long that adjusting 19 periphery of rotating cylinder is provided with arc in rotational direction
Hole 23 adjusts long arc-shaped holes 23 when rotating cylinder 19 rotates and moves along the long stick 28 of level survey.
The inside of the fixing clamp 10 is provided with fishbolt 10a, and the periphery of fishbolt 10a, fishbolt are provided with
Fixing clamp 10 can be fixed on operating bed long side 27a by tension spring 10b by rotation fishbolt 10a.
The 16 one end end of flexible bending-type cross bar being slidably connected on the column 11 is sliding part 14, is provided on column
Scale 12, it may be determined that promoted or the distance of decline, sliding part 14 are provided with height clamping screw 13, sliding part 14 and flexible bending
The one end of type cross bar 16 is provided with articulated shaft 1, can make flexible bending-type cross bar 16 around articulated shaft 1 along horizontal plane
It is mobile, the middle position of flexible bending-type cross bar 16 be additionally provided with can bending articulated shaft 2 17, be provided with folding on cross bar 16
Bending angle lock screw 16a；In use, bending part is generally mobile away from patient side, after bending angle determines, tighten
Lock screw 16a, is provided with telescopic rod in flexible flexible bending-type cross bar 16 of the bending-type cross bar 16 far from sliding part 14, and 18
For slip joint, one end end of the telescopic rod far from sliding part is shaft 16b.
The long stick of survey being connected on shaft 16b is the horizontal long stick 28 of survey, and the long stick 28 of level survey, which is presented, is provided with scale,
It is 2mm that level, which surveys long 28 diameter of stick,.
The long stick of survey connected in 19 wire hole of rotating cylinder that adjusts surveys long stick 29 for inclination, and inclination surveys long stick 29 with adjusting rotating cylinder
19 rotations, it is consistent with 26 direction of pilot pin in positioning tube 25 that long 29 extending direction of stick is surveyed in inclination.
The pilot pin 26 is plug-type pilot pin 26, is configured with the interior of different-diameter on the mating inner hole of positioning tube
Set, inner sleeve are matched from different surgical instrument outer diameters, and described difference surgical instrument such as puncture needle, trepan, foramen intervertebrale lens etc. in this way may be used
Changing direction when to avoid replacement instrument causes to damage nervus vasculairs, causes operation difficult, and the time extends, while can be to avoid helping
The pushing time helps foramen intervertebrale lens, and human factor causes scope movement to cause undesirable element, as long as on the mating inner hole of positioning tube
Instrument can be steadily set by the way that inner sleeve matched with surgical instrument is arranged.
The maximum rotation that long stick 29 is surveyed in the inclination is more than or equal to the angle of top rake β.
A kind of application method of intervertebral foramen of lumbar vertebra videoendoscopic surgery puncture positioning device, structure are above-mentioned lumbar intervertebral aperture mirror
Operation puncturing positioning device, by figure 4 above it is found that the angle that 26 direction of pilot pin is constituted with operating bed bed surface horizontal direction is to lean forward
Angle beta angle, the angle and the long stick 28 of horizontal survey survey the angle that long stick 29 is constituted with inclination as corresponding angles, and equal angle is β
Angle can determine top rake β as long as determining that the long stick 28 of horizontal survey surveys the angle that long stick 29 is constituted with inclination, and head inclination alpha is with before
The angle of angle of inclination beta synthesis is exactly puncture angle, to obtain the horizontal distance for surveying long stick 28 and another vertical edges, can must incline
Tiltedly survey long stick 29 and the horizontal angle surveyed between long stick 28 i.e.: top rake β, two vertical edges are measured apart from opposing triangular,
That is: in Fig. 8 on the centrum of lumber ertebral disc bottom 35 rear midpoint 30 of soleplate and 33 point-to-point transmission of skin of back intersection point away from
From for H, distance is L between skin of back intersection point 33 and two line intersection points 32, and two line intersection points 32 are crossbar end positioning tube inner hole 24
Or 25 center of positioning tube, it is at a distance from 30 point-to-point transmission of upper soleplate rear midpoint and upper by skin of back intersection point 33 below
Distance between soleplate rear midpoint 30 and two line intersection points 32 obtains H and L to obtain top rake β, the intervertebral foramen of lumbar vertebra videoendoscopic surgery
Steps are as follows for the use of puncture positioning device:
(1), preoperative using in the upper soleplate rear of the next centrum in CT or nuclear magnetic resonance measuring target spot or Nucleus pulposus stage
Point 30, i.e., upper soleplate rear midpoint 30 to distance H between human body back skin subpoint；
(2), steel wire setting direction when Fig. 3 is determining patient's head inclination angle is located at interverbebral disc under C-arm perspective referring to Fig. 3
The prominent upper soleplate horizontal line of bottom centrum is placed under another inclination steel wire perspective then in the plane parallel with bed surface
Positioned at upper soleplate rear midpoint to the disc herniation side processus articular superior tip line line of the next centrum, two steel wires planar shape
At angle be head inclination alpha, intersection point be vertebra central point；
(3), the operating bed fixing clamp 10 of intervertebral foramen of lumbar vertebra videoendoscopic surgery puncture positioning device is fixed on protrusion of lumber intervertebral disc side
On operating bed edge of bed, fixed bit is in the corresponding bedside locations of patient's buttocks；
(4), flexible 16 height and position of bending-type cross bar is adjusted along column 11, height is faced about in patient's 25cm height and position
When lock clamping screw；
(5), Fig. 5 is determining head inclination angle schematic diagram, is inserted into pilot pin 26 in positioning tube 25, bending cross bar 16 makes pilot pin 26
Direction is consistent with the head inclination alpha in above-mentioned (2), lock screw, is completed head inclination alpha and is determined, temporarily takes out pilot pin 26；
(6), measurement skin enters thorn point i.e.: the upper 35 rear midpoint 30 of soleplate of lumber ertebral disc bottom centrum or target spot and the next centrum
The distance of the subpoint in human body back skin of upper soleplate rear midpoint 30 is L, enters thorn point on L line, the parallel ground of L line；
(7), the horizontal long stick 28 of survey is threadedly coupled on shaft 16b, level surveys a long side of 28 extending direction of stick far from operating bed；
(8), it is threadedly coupled inclination on adjusting rotating cylinder 19 and surveys long stick 29, so that inclination is surveyed long stick 29 and be directed away from one side of patient；
(9), it in the horizontal position surveyed on long stick 28 and found apart from shaft 16b axis, makes marks；
(10), inclination is rotated along long arc-shaped holes 23 and survey long stick 29, make horizontal mark position of surveying on long stick 28 to the long stick of inclination survey
Vertical range is equal to the height of the distance H in above-mentioned (1) on 29；
(11), Fig. 6 is the schematic diagram of determining top rake, and long stick 29 is surveyed in inclination and horizontal survey forms a top rake between long stick 28
β；
(12), pilot pin 26 is inserted into positioning tube 25,26 pointed location of pilot pin is exactly endoscopic surgery position, in patient's body
It carries out on body and is marked into thorn point 39；
(13), Fig. 7 is the schematic diagram at after cross bar bending and head inclination angle, top rake, pilot pin 26 is extracted out, along 25 side of positioning tube
To puncture, the operation of the present apparatus is completed；
Further, the intervertebral foramen of lumbar vertebra videoendoscopic surgery puncture positioning device is carbon fiber, plastic products composition.
The present invention determines the upper soleplate horizontal line of disc herniation bottom centrum and bottom by having an X-rayed in C-arm anteroposterior position
31 line of soleplate rear midpoint 30 to disc herniation side processus articular superior tip on centrum, human body back projection line horizontal line one
36a and two 38a point of intersection of horizontal line are marked with marking pen, it may be determined that two lines soleplate rear midpoint 30 on the next centrum is vertical
Line and human body back skin intersection point 33；It, can by the way that fixing clamp 10 is arranged on intervertebral foramen of lumbar vertebra videoendoscopic surgery puncture positioning device
This endoscopic surgery position is integrally attached on operating bed, it is ensured that operation consent is sought to puncture direction and puncture position；By
10 Vertical Square of fixing clamp sets up column 11, and setting height can be slided on column 11；It is set by being slided on column 11
Flexible bending-type cross bar 16 is set, and is arranged in 16 periphery end part rotating shaft 16b of cross bar and adjusts rotating cylinder 19, it can be planar sharp first
With CT or MRI scan, flexible bending-type cross bar 16 is bent, makes to adjust the pilot pin 26 and head inclination alpha one in rotating cylinder 19
Directly, determining top rake β then is tilted down along vertical direction in the vertical plane where pilot pin 26, the puncture angle is
Why the accumulated angle of head inclination alpha and top rake β, cross bar 16 of the present invention are designed to flexible bending-type structure, are because of this setting
Middle pilot pin 26 and adjusting rotating cylinder 19 and shaft junction are not provided with along the function of moving horizontally, if having the function
Structure is complex, as long as above-mentioned function can be realized using bending articulated shaft on horizontal plane, that is to say, that it is fixed to can be realized
The purpose that position 26 direction of needle and head inclination alpha direction are consistent in vertical direction, in addition, can will be located by adjusting rotating cylinder 19
Pilot pin 26 in horizontal plane top inclination alpha direction further tilts downwards along pilot pin 26 along head inclination angle vertical plane 26,
It determines top rake β, is to survey long stick using the level on parallel lines corresponding angles when determining that 26 inclination alphas of pilot pin and top rake β are spent
28 and vertically survey what long stick determined, the horizontal length surveyed on long stick 28 is 16 side positioning cylinder of cross bar, 25 end center to vertebra
The horizontal direction distance L of central point vertical line, using under CT or the protrusion of lumber intervertebral disc of magnetic resonance detection when the vertical edges
Distance H between the upper soleplate rear midpoint skin projection of position centrum, two right-angle sides have determined the angle of bevel edge, so that it is determined that before
The direction of angle of inclination beta.
For the present apparatus for the puncture direction of three-dimensional structure, structure is simple, easy to use, it is convenient to determine puncture side
To and forward leaning angle, when expanding puncture channel, when needing replacing instrument, can guarantee that direction will not change, avoid changer
Direction offset causes operation difficult or increases operation risk when tool；Because paracentesis depth has been set before puncture, can avoid
That wears when puncture too deep injures blood vessel and abdominal viscera；The time is saved in puncture, and it is accurate to puncture；Perspective number is reduced, doctor is reduced
And injury number of the patient by ray；Since the invention reduces localised puncture difficulty, clinician can be easier to grasp
The technology can reduce pain, can more importantly take care of yourself success rate of operation, caused by avoiding because of direction and position inaccuracy
Nerve fiber is damaged or the excessive blood loss of vascular injury, also helps the recovery from illness and rehabilitation of patient.
Claims (9)
1. a kind of intervertebral foramen of lumbar vertebra videoendoscopic surgery puncture positioning device, it is characterised in that: a kind of intervertebral foramen of lumbar vertebra videoendoscopic surgery puncture is fixed
Position device, the operation puncturing positioning device includes operating bed fixing clamp, and the column vertical with bed surface is connected on fixing clamp, is stood
Flexible bending-type cross bar one end is slidably connected on column, cross bar other end end is shaft, is rotatably connected in shaft with shaft
For the adjusting rotating cylinder of the forward leaning angle of axis rotation, rotating cylinder is adjusted by close end side and is provided with the positioning vertical with rotating shaft core
Cylinder is provided with pilot pin in positioning tube, and the survey being respectively arranged in the shaft and adjusting rotating cylinder of positioning tube side perpendicular to axle center is long
Stick connects wire hole, shaft with adjust surveyed on rotating cylinder long stick connect in wire hole be connected separately with it is horizontal survey long stick and tilt the long stick of survey,
It adjusts rotating cylinder periphery and is provided with long arc-shaped holes in rotational direction, long arc-shaped holes are moved along the horizontal long stick of survey when adjusting drum rotation
It is dynamic.
2. a kind of intervertebral foramen of lumbar vertebra videoendoscopic surgery puncture positioning device according to claim 1, it is characterised in that: the column
On flexible bending-type cross bar one end end for being slidably connected be sliding part, sliding part is provided with height clamping screw.
3. a kind of intervertebral foramen of lumbar vertebra videoendoscopic surgery puncture positioning device according to claim 1, it is characterised in that: described flexible
It is provided with the articulated shaft rotated along the horizontal plane among bending-type cross bar, bending angle lock screw is provided on cross bar.
4. a kind of intervertebral foramen of lumbar vertebra videoendoscopic surgery puncture positioning device according to claim 1, it is characterised in that: the connection
The long stick of survey in shaft is the horizontal long stick of survey, and level, which is surveyed on long stick, is provided with scale, and level surveys long stick diameter as 2mm.
5. a kind of intervertebral foramen of lumbar vertebra videoendoscopic surgery puncture positioning device according to claim 1, it is characterised in that: the adjusting
The long stick of survey connected in rotating cylinder wire hole is that long stick is surveyed in inclination, and inclination surveys long stick and surveys long stick extension side with drum rotation, inclination is adjusted
To consistent with the pilot pin direction in positioning tube.
6. a kind of intervertebral foramen of lumbar vertebra videoendoscopic surgery puncture positioning device according to claim 1, it is characterised in that: the positioning
Needle is plug-type pilot pin, is configured with the inner sleeve of different-diameter on the mating inner hole of positioning tube, inner sleeve and different surgical instruments
Outer diameter matching.
7. a kind of intervertebral foramen of lumbar vertebra videoendoscopic surgery puncture positioning device according to claim 1, it is characterised in that: the inclination
The maximum rotation angle for surveying long stick is more than or equal to forward leaning angle.
8. a kind of application method of intervertebral foramen of lumbar vertebra videoendoscopic surgery puncture positioning device, structure is above-mentioned lumbar intervertebral aperture mirror hand
Art puncture positioning device, steps are as follows for the use of the intervertebral foramen of lumbar vertebra videoendoscopic surgery puncture positioning device:
(1), preoperative using in the upper soleplate rear of the next centrum in CT or nuclear magnetic resonance measuring target spot or Nucleus pulposus stage
Point arrives distance H between human body back skin subpoint；
(2), under C-arm perspective, a horizontal wire is placed in the horizontal direction perpendicular to backbone and is located at disc herniation bottom
It is lower positioned at bottom to place another inclination steel wire perspective then in the plane parallel with bed surface for soleplate horizontal line on centrum
Soleplate rear midpoint to disc herniation side processus articular superior tip line line, the angle that two steel wires are planar formed on centrum
For head inclination angle, intersection point is vertebra central point；
(3), the operating bed fixing clamp of intervertebral foramen of lumbar vertebra videoendoscopic surgery puncture positioning device is fixed on to the hand of protrusion of lumber intervertebral disc side
On art bed edge of bed, fixed bit is in the corresponding bedside locations of patient's buttocks；
(4), it stretches bending-type cross bar height and position along post adjustment, height is interim to lock about in patient's 25cm height and position
Tight bolt；
(5), pilot pin is inserted into positioning tube, bending cross bar is consistent the direction of pilot pin with the head inclination angle in above-mentioned (2),
Lock screw is completed head inclination angle angle and is determined, temporarily takes out pilot pin；
(6), measurement skin enters thorn point with the next centrum and above soleplate rear midpoint is at a distance from subpoint in human body back skin
L, point of puncture is on L line, the parallel ground of L line；；
(7), the horizontal long stick of survey is threadedly coupled in shaft, level surveys a long side of the stick extending direction far from operating bed；
(8), it is threadedly coupled inclination on adjusting rotating cylinder and surveys long stick, so that inclination is surveyed long stick and be directed away from one side of patient；
(9), it surveys on long stick and is found apart from the position of shaft axis in level, made marks；
(10), the long stick of inclination survey is rotated along long arc-shaped holes, surveys mark position on the horizontal long stick of survey on long stick vertically to inclination
Distance is equal to the height of the distance H in above-mentioned (1), clamping screw；
(11), long stick is surveyed in inclination and horizontal survey forms a top rake β between long stick；
(12), pilot pin is inserted into positioning tube, pilot pin pointed location is exactly endoscopic surgery position, is done on a patient body
Enter thorn point label well；
(13), it extracts pilot pin out, is punctured along positioning tube direction, complete the operation of the present apparatus.
9. a kind of intervertebral foramen of lumbar vertebra videoendoscopic surgery puncture positioning device according to claim 8, it is characterised in that: the lumbar vertebrae
Foramen intervertebrale lens operation puncturing positioning device is carbon fiber, plastic products composition.
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| CN201811053058.7A CN109009357A (en) | 2018-09-10 | 2018-09-10 | A kind of intervertebral foramen of lumbar vertebra videoendoscopic surgery puncture positioning device and its application method |
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| CN201811053058.7A CN109009357A (en) | 2018-09-10 | 2018-09-10 | A kind of intervertebral foramen of lumbar vertebra videoendoscopic surgery puncture positioning device and its application method |
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| CN109620399A (en) * | 2019-02-18 | 2019-04-16 | 大连医科大学附属第医院 | A method of for 2 dorsal root ganglion radio frequency of neck puncture positioning device and utilize its Needle localization |
| CN109671347A (en) * | 2019-01-24 | 2019-04-23 | 商奇 | A kind of human dissection simulation teching device |
| CN109692033A (en) * | 2019-03-07 | 2019-04-30 | 谢林 | A kind of percutaneous lumbar intervertebral foramen mirror puncture auxiliary locator |
| CN109771007A (en) * | 2019-03-01 | 2019-05-21 | 常州市第二人民医院 | Percutaneous foramen intervertebrale lens service aisle locating guider |
| CN109805992A (en) * | 2019-03-21 | 2019-05-28 | 青岛市市立医院 | Puncturing operation positioning device under nuclear magnetic resonance |
| CN110559149A (en) * | 2019-09-04 | 2019-12-13 | 山西医科大学第一医院 | lumbar puncture auxiliary device |
| CN110731811A (en) * | 2019-11-25 | 2020-01-31 | 柳州市柳铁中心医院 | spinal puncture positioning device |
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| CN111658170A (en) * | 2020-06-04 | 2020-09-15 | 海宁市中医院(海宁市肿瘤医院、海宁市肿瘤防治研究所) | Multifunctional preoperative target point positioning device for intervertebral foramen |
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| CN109771007A (en) * | 2019-03-01 | 2019-05-21 | 常州市第二人民医院 | Percutaneous foramen intervertebrale lens service aisle locating guider |
| CN109771007B (en) * | 2019-03-01 | 2024-04-30 | 常州市第二人民医院 | Percutaneous intervertebral foramen mirror working channel positioning guider |
| CN109692033B (en) * | 2019-03-07 | 2023-08-11 | 谢林 | Percutaneous lumbar intervertebral foramen mirror puncture auxiliary positioning ware |
| CN109692033A (en) * | 2019-03-07 | 2019-04-30 | 谢林 | A kind of percutaneous lumbar intervertebral foramen mirror puncture auxiliary locator |
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| CN110731811A (en) * | 2019-11-25 | 2020-01-31 | 柳州市柳铁中心医院 | spinal puncture positioning device |
| CN111134800A (en) * | 2020-02-24 | 2020-05-12 | 梧州市红十字会医院 | Intervertebral foramen mirror puncture positioning device |
| CN111421486A (en) * | 2020-05-19 | 2020-07-17 | 江门市大长江集团有限公司 | Universal positioning tool |
| CN111658170A (en) * | 2020-06-04 | 2020-09-15 | 海宁市中医院(海宁市肿瘤医院、海宁市肿瘤防治研究所) | Multifunctional preoperative target point positioning device for intervertebral foramen |
| CN116371738A (en) * | 2023-06-06 | 2023-07-04 | 山东群峰重工科技股份有限公司 | Light and heavy substance separation device |
| CN116371738B (en) * | 2023-06-06 | 2023-08-01 | 山东群峰重工科技股份有限公司 | Light and heavy substance separation device |
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Application publication date: 20181218 |