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CN110680489B - Thoracic vertebra yellow ligament ossification compound backward moving device and application method thereof - Google Patents

Thoracic vertebra yellow ligament ossification compound backward moving device and application method thereof Download PDF

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Publication number
CN110680489B
CN110680489B CN201911082038.7A CN201911082038A CN110680489B CN 110680489 B CN110680489 B CN 110680489B CN 201911082038 A CN201911082038 A CN 201911082038A CN 110680489 B CN110680489 B CN 110680489B
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thoracic
pedicle screw
clamping piece
yellow ligament
rod
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CN110680489A (en
Inventor
张骏
黄亚增
赵廷潇
邵海宇
金梦然
陈锦平
陈炘佶
毕擎
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Zhejiang Provincial Peoples Hospital
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Zhejiang Provincial Peoples Hospital
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical 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
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7032Screws or hooks with U-shaped head or back through which longitudinal rods pass

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Neurology (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)
  • Prostheses (AREA)

Abstract

The invention provides a thoracic vertebra yellow ligament ossification compound backward moving device and a use method thereof, wherein a plurality of lifting devices are arranged on a pedicle screw connecting rod, each lifting device comprises a fixed connecting piece and a transverse connection type lifting rod, each fixed connecting piece comprises an adjustable adjusting disc and a transverse connection type lifting rod clamping part, and when the thoracic vertebra yellow ligament ossification compound backward moving device is used, the thoracic vertebra yellow ligament ossification compound can be prevented from being directly resected by only floating and realizing controllable backward lifting and fixing, so that the purpose of expanding vertebral canal and thoracic marrow decompression is achieved. The thoracic yellow ligament ossification compound backward moving device and the use method thereof have simple structure and convenient use, are designed with the adjustable lifting device, can avoid serious complications such as spinal cord injury, dural tear and the like caused by direct separation and excision, obviously improve the safety of operation, have great clinical significance especially for patients accompanied by dural adhesion and ossification, and are worthy of popularization and application in the operation treatment of thoracic yellow ligament ossification patients.

Description

Thoracic vertebra yellow ligament ossification compound backward moving device and application method thereof
Technical Field
The invention relates to the technical field of medical appliances, in particular to a thoracic vertebra yellow ligament ossification compound complex backward moving device and a using method thereof.
Background
Serious thoracic yellow ligament ossification is accompanied by spinal cord compression, and is one of the key points and difficulties in spinal surgery. Especially when the ligamentum flavum ossificans are adhered with the dura mater, even the dura mater ossificans are accompanied, the difficulty and the risk of the operation are obviously increased.
Severe yellow ligament ossification (Sato type IV or V type patient), and patient with dural adhesion or dural ossification usually adopts a thoracic spine posterior decompression bone grafting fusion internal fixation, and the operation process tries to separate ossified yellow ligament and dural with serious adhesion, and resects the yellow ligament ossification which seriously presses spinal cord, so as to realize expansion of spinal canal and decompression of spinal cord, and fix the spinal pedicle screw rod device at two sides, so as to avoid secondary thoracic instability.
However, in the implementation process of the operation, particularly when the ossified ligamentum flavum is attempted to be separated and resected, the risk of spinal cord injury, dura mater tearing, bleeding and the like is extremely high, the infection rate is obviously improved, and the operation time is prolonged. Particularly when the patient incorporates a epidural ossification, the risk of epidural defects and leakage of cerebrospinal fluid is almost an unavoidable serious consequence of this procedure. The difficulty and risk of this procedure presents tremendous risks and catastrophic consequences to the spinal surgeon and patient.
Therefore, there is a need to develop a novel medical device for thoracic yellow ligament ossification surgery and a surgical method for use with the same, so as to expand the thoracic spinal canal and complete decompression of the thoracic spinal cord, improve the curative effect of the surgery, and reduce the probability of related risks while avoiding separation and excision of thoracic yellow ligament ossifications.
Disclosure of Invention
In order to solve the problems, the invention provides a thoracic vertebra yellow ligament ossification compound complex posterior device and a using method thereof.
The technical scheme of the invention is as follows: a thoracic vertebra yellow ligament ossification compound complex posterior device, which is characterized in that: the two pedicle screw connecting rods are detachably connected with a plurality of groups of pedicle screws; a plurality of lifting devices are detachably connected to the two pedicle screw connecting rods; the lifting device comprises two fixed connecting pieces with consistent specification, wherein transverse connection type lifting rods are 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 fixed part; the upper part of the adjusting disc is movably connected with a transverse connection type lifting rod clamping part.
Further, the fixing part comprises a first small hole arranged in the middle part, 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 the size 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; screws are detachably connected in the second small hole and the first threaded hole; the first groove is internally provided with a screw rod.
Further, 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 rod; the outer surface of the housing is also provided with scale marks.
Further, a spring is sleeved outside the screw, 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.
Further, the clamping part of the transverse connecting type lifting rod comprises two clamping pieces with consistent specification; the lower part of the clamping piece is provided with a clearance space; 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; the upper part of the clamping piece is provided with a third threaded hole; and a first set screw is detachably connected in the third threaded hole.
Further, two positioning grooves with the same specification are arranged in the transverse connection type lifting rod; the transverse connection type lifting rod passes through the third small hole; the lower end of the first set screw can be pressed against the positioning groove.
Further, 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 thread groove, and a second set screw is detachably connected in the thread groove; the upper end of the installation part is also provided with a nail cap.
A thoracic yellow ligament bone complex posterior device, the method of use comprising the steps of:
a. The patient firstly carries out the pre-operation thoracic X-ray positive lateral position slice, the CT axial position slice, the dislocation position and the coronary position reconstruction, nuclear Magnetic Resonance (MRI) detection, and determines the number of pedicle screws, the number of lifting devices and the height required to be lifted according to the pre-operation detection result;
b. The operator exposes the operation part of the relevant thoracic vertebral body of the patient, the spinous process, the vertebral lamina and the needle insertion point of the pedicle screw; pedicle screws are placed in the corresponding sections and connected and fixed by pedicle screw connecting rods, and the screw caps are fixed at the upper ends of the mounting parts;
c. The operator opens a slot at the vertebral plates at two sides of the related section of the yellow ligament ossification of the thoracic vertebra and releases the slot with the far and near ends, so that the complex of the yellow ligament ossification of the thoracic vertebra floats;
d. The operator selects the bone strength of the spinous process of the thoracic vertebra, and passes the transverse connecting type lifting rod through the spinous process to be fixed in the fixed connecting pieces at the two sides;
e. according to the height required to be lifted measured before operation, the rotating wheels on the two sides are screwed, and the thoracic vertebra yellow ligament ossification compound complex is lifted backwards, so that the processes of expansion of the thoracic vertebral canal volume and decompression of the thoracic spinal cord are achieved.
Compared with the traditional thoracic vertebra pedicle screw device, the thoracic vertebra yellow ligament ossification compound backward moving device is designed with a lifting device, when in use, a transverse connection type lifting rod in the lifting device can penetrate through spinous processes on thoracic vertebrae and is fixed, and then the free thoracic vertebra yellow ligament ossification compound in operation is lifted backward through the spinous processes by an adjusting disc in the lifting device, so that expansion of vertebral canal and full decompression of thoracic spinal cord are realized. Compared with the traditional operation method for the thoracic yellow ligament ossification, the method can avoid the disadvantages of spinal cord injury, dural tear, hemorrhage, infection, obviously prolonged operation time and the like caused by directly cutting and separating the thoracic yellow ligament ossification, greatly improves the safety and operability of the operation, and has great clinical significance especially for patients with the thoracic yellow ligament ossification accompanied with dural adhesion, even the dural ossification.
Drawings
FIG. 1 is a schematic diagram of the structure of the present invention;
FIG. 2 is a cross-sectional view of the internal structure of the pulling device;
FIG. 3 is an exploded view of the structure of the pulling device;
FIG. 4 is a schematic view of the construction of a cross-linked lift rod;
fig. 5 is a schematic view of the structure of a pedicle screw.
In the figure, a 1-pedicle screw connecting rod, a 2-pedicle screw, and a 3-lifting device; 2.1-mounting parts, 2.2-thread grooves, 2.3-second set screws and 2.4-nut caps; 3.1-fixed connecting pieces, 3.2-transverse connection type lifting rods, 3.3-fixed parts, 3.4-adjusting discs and 3.5-transverse connection type lifting rod clamping parts; 3.2.1-positioning grooves; 3.3.1-a first aperture; 3.3.2-first clamping piece, 3.3.3-second clamping piece, 3.3.4-first groove, 3.3.5-second small hole, 3.3.6-first threaded hole, 3.3.7-screw, 3.3.8-screw rod, 3.3.9-spring; 3.4.1-housing, 3.4.2-runner, 3.4.3-connecting disc, 3.4.4-second threaded hole, 3.4.5-scale mark; 3.5.1-clamping pieces, 3.5.2-avoidance holes, 3.5.3-clamping grooves, 3.5.4-third small holes and 3.5.5-third threaded holes; 3.5.6-first set screw.
Detailed Description
The following describes the posterior device for the thoracic ligament ossification complex and the use method thereof in detail with reference to the accompanying drawings.
As shown in fig. 1,2, 3, 4 and 5, a thoracic vertebra yellow ligament ossification compound complex backward moving device comprises two pedicle screw connecting rods 1 arranged on the left side and the right side, wherein a plurality of groups of pedicle screws 2 are detachably connected on the two pedicle screw connecting rods 1; a plurality of lifting devices 3 are detachably connected to the two pedicle screw connecting rods 1; the lifting device 3 comprises two fixed connecting pieces 3.1 with the same specification, and a transverse connection 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 connection 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 part, a first clamping piece 3.3.2 and a second clamping piece 3.3.3 arranged in the lower part, and a first groove 3.3.4 arranged in the upper part; the size of the first small hole 3.3.1 is matched with the size of the pedicle screw connecting rod 1; the first clamping piece 3.3.2 is provided with a second small hole 3.3.5, and the second clamping piece 3.3.3 is provided with a first threaded hole 3.3.6; the second small hole 3.3.5 and the first threaded hole 3.3.6 are detachably connected with a screw 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; the adjusting disc 3.4 is also provided with a second threaded hole 3.4.4 in a penetrating way, 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 is propped against the lower end face of the first groove 3.3.4, and the other end is propped against the upper end face of the housing 3.4.1; the clamping part 3.5 of the transverse connection type lifting rod comprises two clamping pieces 3.5.1 with consistent specification; the lower part of the clamping piece 3.5.1 is provided with a clearance space 3.5.2; the lower end of the clamping piece 3.5.1 is also provided with a clamping groove 3.5.3; a third small hole 3.5.4 is arranged in the middle of the clamping piece 3.5.1; the upper part of the clamping piece 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 connection type lifting rod 3.2; and the transverse connection 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 be pressed against 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 set 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.
The application method of the thoracic yellow ligament ossification compound backward moving device specifically comprises the following steps:
a. The patient firstly carries out reconstruction of X-ray positive lateral position slice, CT axial position slice, disfigurement position and coronal position, nuclear Magnetic Resonance (MRI) detection, and confirms the ossification of the yellow ligament of the thoracic vertebra, the involved section, width and thickness and relevant measurement; wherein, the involved section of the thoracic yellow ligament ossification is used for determining the number of the pedicle screws 2 and the lifting devices 3 and the length of the pedicle screw connecting rod 1 in the operation process; measuring width for determining the position and notice of the slotting of the vertebral plates at the left and right sides; the thickness was measured to determine the height required to pull backward when the thoracic yellow ligament bone complex was free;
b. the operator exposes the operation part of the relevant thoracic vertebral body of the patient, the spinous process, the vertebral lamina and the needle insertion point of the pedicle screw 2; pedicle screws 2 are placed in the corresponding sections, the pedicle screw connecting rods 1 are connected and fixed, and the screw caps 2.5 are fixed at the upper ends of the mounting parts 2.1;
c. The operator opens a slot at the vertebral plates at two sides of the related section of the yellow ligament ossification of the thoracic vertebra and releases the slot with the far and near ends, so that the complex of the yellow ligament ossification of the thoracic vertebra floats;
d. Selecting a hard bone position of the spinous process of the thoracic vertebra by an operator, punching the hard bone position, and enabling a transverse connecting lifting rod 3.2 to pass through the hole on the spinous process; sliding the fixed connecting piece 3.1 on the pedicle screw connecting rod 1 and adjusting to a proper position; two ends of the transverse connection type lifting rod 3.2 penetrate through the third small hole 3.5.4; tightening the screw 3.3.7 to fix the fixed connection 3.1 on the pedicle screw connection rod 1; the first set screw 3.5.6 is tightened to press the lower ground of the first set screw 3.5.6 against the positioning groove 3.2.1, thereby fixing the transverse connection type lifting rod 3.2.
E. According to the height to be lifted measured before operation, the rotating wheels 3.4.2 on the two sides are screwed, at the moment, the second threaded holes 3.4.4 interact with the screw rod 3.3.8, so that the adjusting disc 3.4 moves upwards, the adjusting disc 3.4 drives the transverse lifting rod clamping part 3.5 to move upwards, the transverse lifting rod clamping part 3.5 drives the transverse lifting rod 3.2 to move upwards, and the transverse lifting rod 3.2 lifts and pulls the thoracic yellow ligament ossification compound complex backwards to achieve the procedures of expansion of the thoracic spinal canal and decompression of the thoracic spinal cord; meanwhile, the operator can control the upward moving distance by observing the graduation marks 3.4.5.
The present invention is not limited to the preferred embodiments, and the present invention is described above in any way, but is not limited to the preferred embodiments, and any person skilled in the art will appreciate that the present invention is not limited to the embodiments described above, while the above disclosure is directed to various equivalent embodiments, which are capable of being modified or varied in several ways, it is apparent to those skilled in the art that many modifications, variations and adaptations of the embodiments described above are possible in light of the above teachings.

Claims (1)

1. A thoracic vertebra yellow ligament ossification compound complex posterior device, which is characterized in that: including two pedicle screw connecting rods (1) that set up in left and right sides, two pedicle screw connecting rods (1) on can dismantle and be connected with a plurality of group pedicle screw (2), two pedicle screw connecting rods (1) on can dismantle and be connected with a plurality of lifting device (3), lifting device (3) include two consistent fixed connection spare (3.1) of specification, can dismantle in two fixed connection spare (3.1) and be connected with transverse connection formula lifting rod (3.2), fixed connection spare (3.1) include fixed part (3.3), The fixing 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), and a transverse connection 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), a first threaded hole (3.3.6) is arranged in the second clamping piece (3.3.3), screws (3.3.7) are detachably connected in the second small hole (3.3.5) and the first threaded hole (3.3.6), a screw rod (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 way, the second threaded hole (3.4.4) is matched with the screw rod (3.3.8), and graduation marks (3.4.5) are further arranged on the outer surface of the housing (3.4.1); the screw (3.3.8) is sleeved with a spring (3.3.9), one end of the spring (3.3.9) abuts against the lower end face of the first groove (3.3.4), the other end of the spring 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 pieces (3.5.1) with identical specifications, the lower part of the clamping piece (3.5.1) is provided with a clearance gap (3.5.2), 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 piece (3.5.1) is provided with a third threaded hole (3.5.5), the third threaded hole (3.5.5) is detachably connected with a first set screw (3.5.6), the transverse connecting type lifting rod (3.2) is provided with two positioning grooves (3.2.1) with the same specification, 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 an installation part (2.1) arranged on the upper part, the installation part (2.1) is provided with a thread groove (2.2), The pedicle screw connecting rod (1) is arranged at the bottom of the thread groove (2.2), a second set screw (2.3) is detachably connected in the thread groove (2.2), and a nut (2.4) is further arranged at the upper end of the mounting part (2.1).
CN201911082038.7A 2019-11-07 2019-11-07 Thoracic vertebra yellow ligament ossification compound backward moving device and application method thereof Active CN110680489B (en)

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CN211187491U (en) * 2019-11-07 2020-08-07 张骏 Thoracic vertebra yellow ligament ossification complex backward moving device

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