CN110680489A - Thoracic vertebra ligamentum flavum ossification complex backward moving device and use method thereof - Google Patents
Thoracic vertebra ligamentum flavum ossification complex backward moving device and use method thereof Download PDFInfo
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- CN110680489A CN110680489A CN201911082038.7A CN201911082038A CN110680489A CN 110680489 A CN110680489 A CN 110680489A CN 201911082038 A CN201911082038 A CN 201911082038A CN 110680489 A CN110680489 A CN 110680489A
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- 210000000115 thoracic cavity Anatomy 0.000 title claims abstract description 63
- 230000011164 ossification Effects 0.000 title claims abstract description 39
- 210000004749 ligamentum flavum Anatomy 0.000 title claims abstract description 30
- 238000000034 method Methods 0.000 title claims abstract description 30
- 210000003041 ligament Anatomy 0.000 claims description 14
- 210000000278 spinal cord Anatomy 0.000 claims description 7
- 239000000126 substance Substances 0.000 claims description 7
- 230000006837 decompression Effects 0.000 claims description 5
- 238000001514 detection method Methods 0.000 claims description 5
- 238000003780 insertion Methods 0.000 claims description 3
- 230000037431 insertion Effects 0.000 claims description 3
- 238000002595 magnetic resonance imaging Methods 0.000 claims description 3
- 230000036244 malformation Effects 0.000 claims description 3
- 230000000149 penetrating effect Effects 0.000 claims description 3
- 108010048734 sclerotin Proteins 0.000 claims description 3
- 238000005728 strengthening Methods 0.000 claims description 2
- 210000001951 dura mater Anatomy 0.000 abstract description 7
- 208000020431 spinal cord injury Diseases 0.000 abstract description 3
- 238000000926 separation method Methods 0.000 abstract description 2
- 230000000740 bleeding effect Effects 0.000 description 2
- 208000015181 infectious disease Diseases 0.000 description 2
- 238000001356 surgical procedure Methods 0.000 description 2
- 206010008164 Cerebrospinal fluid leakage Diseases 0.000 description 1
- 206010063395 Dural tear Diseases 0.000 description 1
- 208000032843 Hemorrhage Diseases 0.000 description 1
- 238000005481 NMR spectroscopy Methods 0.000 description 1
- 206010041549 Spinal cord compression Diseases 0.000 description 1
- 230000004075 alteration Effects 0.000 description 1
- 208000034158 bleeding Diseases 0.000 description 1
- 210000000988 bone and bone Anatomy 0.000 description 1
- 230000007547 defect Effects 0.000 description 1
- 230000000694 effects Effects 0.000 description 1
- 230000004927 fusion Effects 0.000 description 1
- 238000005259 measurement Methods 0.000 description 1
- 239000012528 membrane Substances 0.000 description 1
- 238000003825 pressing Methods 0.000 description 1
- 238000002271 resection Methods 0.000 description 1
- 238000006467 substitution reaction Methods 0.000 description 1
- 210000001258 synovial membrane Anatomy 0.000 description 1
- 210000002978 thoracic duct Anatomy 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
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
- A61B17/7032—Screws or hooks with U-shaped head or back through which longitudinal rods pass
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- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
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Abstract
The invention provides a thoracic vertebra ligamentum flavum ossification complex backward moving device and a use method thereof. The thoracic vertebra ligamentum flavum ossification complex backward moving device and the use method thereof have the advantages of simple structure and convenient use, are provided with the adjustable lifting device, can avoid serious complications such as spinal cord injury, dura mater tearing and the like caused by direct separation and excision, remarkably improve the safety of the operation, have great clinical significance for patients with dura mater adhesion and ossification, and are worthy of popularization and application in the operation treatment of thoracic vertebra ligamentum flavum ossification patients.
Description
Technical Field
The invention relates to the technical field of medical instruments, in particular to a thoracic vertebra ligamentum flavum ossification complex backward moving device and a using method thereof.
Background
Severe ossification of the ligamentum flavum of the thoracic vertebra with spinal cord compression is one of the key points and difficulties in spinal surgery. Especially when accompanied by adhesions of synovium ossicles with dura mater and even dura mater ossification, the difficulty and risk of surgery are significantly increased.
Severe ligamentum flavum ossification (Sato type IV or V patient), and patients with dura mater adhesion or dura mater ossification, usually adopt thoracic duct posterior decompression bone grafting fusion internal fixation, the operation process tries to separate the ossified ligamentum flavum and the dura mater with severe adhesion, and resects the ligamentum flavum ossification seriously pressing the spinal cord, so as to realize spinal duct enlargement and spinal cord decompression, and carries out thoracic pedicle screw and rod device fixation on both sides, so as to avoid the occurrence of secondary unstable thoracic vertebra.
However, this procedure, especially when attempting to separate and resect the ossified ligamentum flavum, carries a significant risk of spinal cord injury, dural tears, bleeding, etc., significantly increasing the infection rate and prolonging the procedure time. The risk of dural defects and cerebrospinal fluid leakage, especially when the patient incorporates a dural ossification, is almost an unavoidable serious consequence of the procedure. The difficulty and risk of this procedure carries with it significant risks and catastrophic consequences for the spinal surgeon and the patient.
Therefore, there is a need to develop a novel medical instrument for thoracic vertebrae ligamentum flavum ossification operation and an operation method used in cooperation with the same, so as to expand the thoracic vertebrae canal and complete decompression of the thoracic spinal cord under the condition of avoiding separation and removal of thoracic vertebrae ligamentum flavum ossification substances, thereby improving the curative effect of the operation and reducing the probability of related risks.
Disclosure of Invention
In order to solve the problems, the invention provides a thoracic vertebra ligamentum flavum ossicle complex backward moving device and a using method thereof.
The technical scheme of the invention is as follows: a thoracic vertebra yellow ligament ossification complex moves backward device which characterized in that: the pedicle screw connecting rod is detachably connected with a plurality of groups of pedicle screws; the two pedicle screw connecting rods are detachably connected with a plurality of lifting devices; the lifting device comprises two fixed connecting pieces with the same specification, and a transverse connecting type lifting rod is detachably connected in the two fixed connecting pieces; the fixed connecting piece comprises a fixed part, and the fixed part is connected with the pedicle screw connecting rod; an adjusting disc is movably connected above the fixing part; the upper part of the adjusting disc is movably connected with a transverse connecting type lifting rod clamping part.
Furthermore, the fixing part comprises a first small hole arranged in the middle, a first clamping piece and a second clamping piece arranged at the lower part, and a first groove arranged at the upper part
Further, the size of the first small hole is matched with that of the pedicle screw connecting rod; the first clamping piece is provided with a second small hole, and the second clamping piece is provided with a first threaded hole; the second small hole and the first threaded hole are detachably connected with screws; and a screw is arranged in the first groove.
Furthermore, the adjusting disc comprises a housing arranged at the lower part, a rotating wheel arranged at the middle part and a connecting disc arranged at the upper part; a second threaded hole is formed in the adjusting disc in a penetrating mode, and the second threaded hole is matched with the screw; the outer surface of the housing is also provided with scale marks.
Furthermore, a spring is sleeved outside the screw rod, one end of the spring abuts against the lower end face of the first groove, and the other end of the spring abuts against the upper end face of the housing.
Furthermore, the clamping part of the transverse connecting type lifting rod comprises two clamping sheets with the same specification; the lower part of the clamping piece is provided with a space avoiding position; the lower end of the clamping piece is also provided with a clamping groove; the middle part of the clamping piece is provided with a third small hole; a third threaded hole is formed in the upper part of the clamping sheet; and a first fastening screw is detachably connected in the third threaded hole.
Furthermore, two positioning grooves with the same specification are arranged in the transverse connecting type lifting rod; the transverse connecting type lifting rod penetrates through the third small hole; the lower end of the first set screw can press the positioning groove.
Furthermore, the pedicle screw comprises a mounting part arranged at the upper part, and a thread groove is arranged in the mounting part; the pedicle screw connecting rod is arranged at the bottom of the threaded groove, and a second fastening screw is detachably connected in the threaded groove; the upper end of the mounting part is also provided with a nail cap.
A thoracic vertebrae yellow ligament ossification complex retropulsion device comprises the following steps:
a. the patient firstly carries out preoperative thoracic vertebra X-ray positive side position sheet, CT axial position sheet, malformation and coronal position reconstruction and Magnetic Resonance Imaging (MRI) detection, and determines the number of pedicle screws, the number of lifting devices and the height to be lifted according to preoperative detection results;
b. the operator firstly exposes the operation position of the relevant thoracic vertebra centrum of the patient, the spinous process, the vertebral lamina and the needle insertion point of the pedicle screw; pedicle screws are placed into the corresponding segments and connected and fixed through pedicle screw connecting rods, and screw caps are fixed at the upper ends of the mounting parts;
c. the operator then slots at the vertebral plates at the two sides of the segment where the ossification substance of the thoracic vertebra ligamentum flavum affects, and the slots are separated from the far and near ends, so that the ossification substance complex of the thoracic vertebra ligamentum flavum floats;
d. the surgeon selects the sclerotin strengthening part of the spinous process of the thoracic vertebra, and the transverse pull rod passes through the spinous process and is fixed in the fixed connecting pieces at the two sides;
e. according to the height which needs to be lifted and pulled before the operation, the rotating wheels at the two sides are twisted, and the thoracic vertebra ligamentum flavum ossification complex is lifted and pulled backwards, so that the processes of expanding the thoracic vertebra tube volume and decompressing the thoracic spinal cord are achieved.
The thoracic vertebra ligamentum flavum ossium complex backward moving device is simple in structure and convenient to use, compared with the traditional thoracic vertebra pedicle screw device, the lifting device is designed, when the device is used, a transverse connecting lifting rod in the lifting device can penetrate through the spinous process on the thoracic vertebra and is fixed, and the free thoracic vertebra ligamentum flavum ossium complex in the operation is lifted backwards through the spinous process by an adjusting disc in the lifting device, so that the expansion of the vertebral canal and the sufficient decompression of the thoracic spinal cord are realized. Compared with the traditional operation method for the resection of the ossified matter of the ligamentum flavum of the thoracic vertebra, the method can avoid the disadvantages of spinal cord injury, dural membrane tearing, bleeding, infection, obvious prolongation of operation time and the like caused by directly resecting and separating the ossified matter of the ligamentum flavum of the thoracic vertebra, greatly improves the safety and operability of the operation, and has great clinical significance for patients with the ossification of the ligamentum flavum of the thoracic vertebra accompanied by dural adhesion and even dural ossification.
Drawings
FIG. 1 is a schematic structural view of the present invention;
FIG. 2 is a sectional view showing the internal structure of the pulling apparatus;
FIG. 3 is an exploded view of the structure of the pulling apparatus;
FIG. 4 is a schematic structural view of a transverse lifting rod;
fig. 5 is a schematic view of a pedicle screw.
In the figure, 1-pedicle screw connecting rod, 2-pedicle screw and 3-lifting device; 2.1-mounting part, 2.2-thread groove, 2.3-second set screw and 2.4-nail cap; 3.1-fixed connecting piece, 3.2-horizontal connecting type lifting rod, 3.3-fixed part, 3.4-adjusting disk and 3.5-horizontal connecting type lifting rod clamping part; 3.2.1-positioning groove; 3.3.1-first orifice; 3.3.2-first clamping piece, 3.3.3-second clamping piece, 3.3.4-first groove, 3.3.5-second eyelet, 3.3.6-first threaded hole, 3.3.7-screw, 3.3.8-screw, 3.3.9-spring; 3.4.1-housing, 3.4.2-rotating wheel, 3.4.3-connecting disc, 3.4.4-second threaded hole, 3.4.5-scale mark; 3.5.1-clamping sheet, 3.5.2-avoiding space, 3.5.3-clamping groove, 3.5.4-third small hole and 3.5.5-third threaded hole; 3.5.6-first set screw.
Detailed Description
The invention relates to a thoracic vertebra ligamentum flavum ossium complex posterior moving device and a using method thereof, which are described in detail in the following with reference to the accompanying drawings.
As shown in fig. 1, 2, 3, 4 and 5, a thoracic vertebrae yellow ligament ossification complex backward moving device comprises two pedicle screw connecting rods 1 arranged at the left and right sides, wherein a plurality of groups of pedicle screws 2 are detachably connected on the two pedicle screw connecting rods 1; the two pedicle screw connecting rods 1 are detachably connected with a plurality of lifting devices 3; the lifting device 3 comprises two fixed connecting pieces 3.1 with the same specification, and a transverse connecting type lifting rod 3.2 is detachably connected in the two fixed connecting pieces 3.1; the fixed connecting piece 3.1 comprises a fixed part 3.3, and the fixed part 3.3 is connected with the pedicle screw connecting rod 1; an adjusting disc 3.4 is movably connected above the fixing part 3.3; a transverse connecting type lifting rod clamping part 3.5 is movably connected above the adjusting disc 3.4; the fixing part 3.3 comprises a first small hole 3.3.1 arranged in the middle, a first clamping piece 3.3.2 and a second clamping piece 3.3.3 arranged at the lower part and a first groove 3.3.4 arranged at the upper part; the size of the first small hole 3.3.1 is matched with that of the pedicle screw connecting rod 1; a second small hole 3.3.5 is arranged in the first clamping piece 3.3.2, and a first threaded hole 3.3.6 is arranged in the second clamping piece 3.3.3; the second small hole 3.3.5 and the first threaded hole 3.3.6 are detachably connected with screws 3.3.7; a screw 3.3.8 is arranged in the first groove 3.3.4; the adjusting disc 3.4 comprises a housing 3.4.1 arranged at the lower part, a rotating wheel 3.4.2 arranged at the middle part and a connecting disc 3.4.3 arranged at the upper part; a second threaded hole 3.4.4 is further formed in the adjusting disc 3.4 in a penetrating mode, and the second threaded hole 3.4.4 is matched with the screw 3.3.8; the outer surface of the housing 3.4.1 is also provided with scale marks 3.4.5; a spring 3.3.9 is sleeved outside the screw 3.3.8, one end of the spring 3.3.9 abuts against the lower end face of the first groove 3.3.4, and the other end abuts against the upper end face of the housing 3.4.1; the transverse connecting type lifting rod clamping part 3.5 comprises two clamping sheets 3.5.1 with the same specification; a clearance position 3.5.2 is arranged at the lower part of the clamping sheet 3.5.1; the lower end of the clamping piece 3.5.1 is also provided with a clamping groove 3.5.3; the middle part of the clamping piece 3.5.1 is provided with a third small hole 3.5.4; the upper part of the clamping sheet 3.5.1 is provided with a third threaded hole 3.5.5; a first set screw 3.5.6 is detachably connected in the third threaded hole 3.5.5; two positioning grooves 3.2.1 with the same specification are arranged in the transverse connecting type lifting rod 3.2; and the transverse connecting type lifting rod 3.2 passes through the third small hole 3.5.4; the lower end of the first set screw 3.5.6 can press the positioning groove 3.2.1; the pedicle screw 2 comprises a mounting part 2.1 arranged at the upper part, and a thread groove 2.2 is arranged in the mounting part 2.1; the pedicle screw connecting rod 1 is arranged at the bottom of the thread groove 2.2, and a second fastening screw 2.3 is detachably connected in the thread groove 2.2; the upper end of the mounting part 2.1 is also provided with a nail cap 2.4.
A thoracic vertebra ligamentum flavum ossicle complex backward moving device comprises the following steps:
a. the patient firstly carries out X-ray positive lateral position film of thoracic vertebra before operation, axial position film, malformation and coronary position reconstruction of CT, and nuclear Magnetic Resonance (MRI) detection, determines yellow ligament ossification of thoracic vertebra, involved sections, width and thickness, and carries out related measurement; wherein, the accumulated segment of the thoracic vertebra yellow ligament ossicle is used for determining the number of the pedicle screws 2 and the lifting device 3 and the length of the pedicle screw connecting rod 1 in the operation process; measuring the width, and determining the positions and cautions of the slots of the vertebral plates on the left and right sides; the measured thickness is used for determining the height required by pulling backwards after the ossified complex of the ligamentum flavum of the thoracic vertebra dissociates;
b. the operator firstly exposes the operation position of the relevant thoracic vertebra centrum of the patient, the spinous process, the vertebral lamina and the needle insertion point of the pedicle screw 2; placing pedicle screws 2 into the corresponding segments, connecting and fixing the pedicle screw connecting rods 1, and fixing screw caps 2.5 at the upper ends of the mounting parts 2.1;
c. the operator then slots at the vertebral plates at the two sides of the segment where the ossification substance of the thoracic vertebra ligamentum flavum affects, and the slots are separated from the far and near ends, so that the ossification substance complex of the thoracic vertebra ligamentum flavum floats;
d. the operator selects the position of the spinous process of the thoracic vertebra with strong sclerotin, a hole is drilled at the position, and the transverse connecting lifting rod 3.2 passes through the hole on the spinous process; the fixed connecting piece 3.1 slides on the pedicle screw connecting rod 1 and is adjusted to a proper position; the two ends of the transverse connecting type lifting rod 3.2 pass through the third small holes 3.5.4; screwing down the screws 3.3.7 to fix the fixed connecting piece 3.1 on the pedicle screw connecting rod 1; the first fastening screw 3.5.6 is tightened to make the lower ground of the first fastening screw 3.5.6 abut against the positioning slot 3.2.1, thereby fixing the transverse lifting rod 3.2.
e. According to the height to be lifted and pulled measured before the operation, the rotating wheels 3.4.2 on two sides are screwed, at the moment, the second threaded holes 3.4.4 interact with the screw 3.3.8, so that the adjusting disc 3.4 moves upwards, the adjusting disc 3.4 drives the transverse connecting type lifting rod clamping part 3.5 to move upwards, the transverse connecting type lifting rod clamping part 3.5 drives the transverse connecting type lifting rod 3.2 to move upwards, and the transverse connecting type lifting rod 3.2 lifts the thoracic vertebra ligamentum ossification complex backwards, so that the processes of expanding the thoracic vertebra tube volume and decompressing the thoracic spinal cord are achieved; meanwhile, the operator can control the upward moving distance by observing the scale mark 3.4.5.
Although the present invention has been described with reference to a preferred embodiment, it should be understood that various changes, substitutions and alterations can be made herein without departing from the spirit and scope of the invention as defined by the appended claims.
Claims (9)
1. A thoracic vertebra yellow ligament ossification complex moves backward device which characterized in that: the vertebral pedicle screw connecting rod comprises two vertebral pedicle screw connecting rods (1) arranged on the left side and the right side, wherein a plurality of groups of vertebral pedicle screws (2) are detachably connected to the two vertebral pedicle screw connecting rods (1); the two pedicle screw connecting rods (1) are detachably connected with a plurality of lifting devices (3); the lifting device (3) comprises two fixed connecting pieces (3.1) with the same specification, and a transverse connecting type lifting rod (3.2) is detachably connected in the two fixed connecting pieces (3.1); the fixed connecting piece (3.1) comprises a fixed part (3.3), and the fixed part (3.3) is connected with the pedicle screw connecting rod (1); an adjusting disc (3.4) is movably connected above the fixed part (3.3); a transverse connecting type lifting rod clamping part (3.5) is movably connected above the adjusting disc (3.4).
2. The thoracic spine yellow ligament ossification complex posterior device according to claim 1, wherein: the fixing part (3.3) comprises a first small hole (3.3.1) arranged in the middle, a first clamping piece (3.3.2) and a second clamping piece (3.3.3) arranged at the lower part and a first groove (3.3.4) arranged at the upper part.
3. The thoracic spine yellow ligament ossification complex posterior device according to claim 2, wherein: the size of the first small hole (3.3.1) is matched with that of the pedicle screw connecting rod (1); a second small hole (3.3.5) is formed in the first clamping piece (3.3.2), and a first threaded hole (3.3.6) is formed in the second clamping piece (3.3.3); a screw (3.3.7) is detachably connected in the second small hole (3.3.5) and the first threaded hole (3.3.6); a screw (3.3.8) is arranged in the first groove (3.3.4).
4. The thoracic spine yellow ligament ossification complex posterior device according to claim 3, wherein: the adjusting disc (3.4) comprises a housing (3.4.1) arranged at the lower part, a rotating wheel (3.4.2) arranged at the middle part and a connecting disc (3.4.3) arranged at the upper part; a second threaded hole (3.4.4) is further formed in the adjusting disc (3.4) in a penetrating mode, and the second threaded hole (3.4.4) is matched with the screw (3.3.8); the outer surface of the housing (3.4.1) is also provided with scale marks (3.4.5).
5. The thoracic vertebrae yellow ligament ossification complex posterior device according to claim 4, wherein: the screw rod (3.3.8) overcoat be equipped with spring (3.3.9), and spring (3.3.9) one end support the lower terminal surface of first recess (3.3.4), the other end support the up end of housing (3.4.1).
6. The thoracic vertebrae yellow ligament ossification complex posterior device according to claim 5, wherein: the clamping part (3.5) of the transverse connecting type lifting rod comprises two clamping sheets (3.5.1) with the same specification; the lower part of the clamping sheet (3.5.1) is provided with a space avoiding position (3.5.2); the lower end of the clamping sheet (3.5.1) is also provided with a clamping groove (3.5.3); the middle part of the clamping sheet (3.5.1) is provided with a third small hole (3.5.4); the upper part of the clamping sheet (3.5.1) is provided with a third threaded hole (3.5.5); a first set screw (3.5.6) is detachably connected in the third threaded hole (3.5.5).
7. The thoracic vertebrae yellow ligament ossification complex posterior device according to claim 6, wherein: two positioning grooves (3.2.1) with the same specification are arranged in the transverse connecting type lifting rod (3.2); the transverse connecting type lifting rod (3.2) penetrates through the third small hole (3.5.4); the lower end of the first set screw (3.5.6) can press the positioning groove (3.2.1).
8. The thoracic spine yellow ligament ossification complex posterior device according to claim 1, wherein: the pedicle screw (2) comprises a mounting part (2.1) arranged at the upper part, and a thread groove (2.2) is arranged in the mounting part (2.1); the pedicle screw connecting rod (1) is arranged at the bottom of the thread groove (2.2), and a second fastening screw (2.3) is detachably connected in the thread groove (2.2); the upper end of the mounting part (2.1) is also provided with a nail cap (2.4).
9. A thoracic vertebrae yellow ligament ossification complex retropulsion device comprises the following steps:
a. the patient firstly carries out preoperative thoracic vertebra X-ray positive side position sheet, CT axial position sheet, malformation and coronal position reconstruction and Magnetic Resonance Imaging (MRI) detection, and determines the number of pedicle screws (2), the number of lifting devices (3) and the height required to be lifted according to preoperative detection results;
b. the operator firstly exposes the operation position of the relevant thoracic vertebra centrum of the patient, the spinous process, the vertebral lamina and the needle insertion point of the pedicle screw (2); pedicle screws (2) are placed into the corresponding segments and connected and fixed through pedicle screw connecting rods (1), and screw caps (2.5) are fixed at the upper ends of the mounting parts (2.1);
c. the operator then slots at the vertebral plates at the two sides of the segment where the ossification substance of the thoracic vertebra ligamentum flavum affects, and the slots are separated from the far and near ends, so that the ossification substance complex of the thoracic vertebra ligamentum flavum floats;
d. the surgeon selects the sclerotin strengthening part of the spinous process of the thoracic vertebra, and the transverse lifting rod (3.2) passes through the spinous process and is fixed in the fixed connecting pieces (3.1) at the two sides;
e. according to the height which needs to be lifted and pulled and measured before the operation, the rotating wheels (3.4.2) at the two sides are twisted, and the thoracic vertebra ligamentum flavum ossification complex is pulled backwards, so as to achieve the process of thoracic vertebra canal volume expansion and thoracic spinal cord decompression.
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