CN203749544U - Minimally invasive thoracolumbar posterior percutaneous internal fixation system - Google Patents

Abstract

A thoracolumbar posterior percutaneous minimally invasive internal fixation system described in the utility model includes an internal implant and corresponding surgical instruments. The internal implant includes a pedicle screw and a pre-bent connecting rod. The above-mentioned corresponding surgical instruments include extension needles, spreader pressurizers, puncture needles, guide needles, expansion sleeves, long hollow openers, cones, hollow taps, detectors, nailers, rod holders, and pressure sleeves. cylinder, funnel, internal hollow first dilator, second dilator and third dilator, percutaneous pedicle bone graft channel, the utility model can not only fix the pedicle screw well during the operation, Moreover, it can accurately measure the distance of distraction during row brace reset, accurately judge the degree of distraction, prevent overstretching and insufficient distraction, and at the same time ensure the progress of bone grafting surgery.

Description

A thoracolumbar posterior percutaneous minimally invasive internal fixation system

technical field

The utility model relates to the technical field of spinal surgery medical instruments, in particular to a posterior thoracolumbar percutaneous minimally invasive internal fixation system.

Background technique

Segmental instability of the spine, fracture fragments, or displacement of intervertebral disc tissue caused by thoracolumbar fractures can compress the dural sac or nerve roots, causing neurological symptoms. Patients with neurological symptoms or severe fracture compression often require surgical treatment. The purpose of surgical treatment is to stabilize the spine, restore the height of the vertebral body, decompress the spinal canal, and reduce the compression on the nerves. At present, the classic operation method is internal fixation through the posterior transpedicular pedicle using the rod pedicle screw system.

Pedicle screw internal fixation is a very mature technique in spinal surgery and has been widely used. In recent years, the technology of percutaneous minimally invasive pedicle screw system has been applied clinically, with less trauma, less blood loss, and faster recovery, and has achieved certain curative effects. The patent document with the publication number CN 102973314 A discloses a minimally invasive bone cement spinal internal fixation system for the thoracolumbar posterior approach. The internal fixation system provides a percutaneous minimally invasive pedicle screw internal fixation system, including Root screws, pre-bent longitudinal connecting rods, top wires, and the corresponding surgical instruments described above are puncture needles, puncture needle sleeves, pointed guide pins, spherical guide pins, hollow openers, dilators, hollow drills, hollow wire taps, open Screw Extender, Closed Screw Extender, Screw Mounting Base, Screw Mounting Guide, Open Screw Extender Sleeve, Extender Locking Wrench, Hollow Screw Set, Bone Cement Syringe, Rod Measurer, Rod Holder, Rod Lock Tighteners, Rod Pushers, Fascia Separators, Plug Holders, Pressurizers, Crowbars, Torque Wrenches, Final Tightening Wrenches. Wherein, the pedicle screw includes a nail body, a nail seat, two breakable long arms and a screw plug, the nail body is connected to the nail seat, and the two breakable long arms are oppositely fixedly connected to the nail seat to form a U The U-shaped structure is used to embed the pre-bent connecting rod, the two long arms that can be broken extend to the outside of the skin incision, and the screw plug is used to screw into the U-shaped structure of the two long arms that can be broken to compress the longitudinal connecting rod. Although the distraction presser in the prior art can complete the pedicle screw fixation in minimally invasive surgery, it cannot achieve a good fixation effect in actual operation (such as the bone grafting process). The distance to be stretched cannot be accurately judged by stretching the pressurizer and the pressurizing sleeve when the middle row brace is reset.

Contents of the invention

Aiming at the deficiencies of the prior art, the purpose of this utility model is to provide a thoracolumbar posterior percutaneous minimally invasive internal fixation system, which can not only fix the pedicle screws well, but also effectively compress the vertebral body Retraction can be used for reduction, and it can accurately measure the distance of distraction, accurately judge the degree of distraction, prevent overstretching and insufficient distraction, and also ensure the progress of bone grafting surgery.

A thoracolumbar posterior percutaneous minimally invasive internal fixation system, including internal implants and corresponding surgical instruments, the corresponding surgical instruments include puncture needles, guide pins, expansion sleeves, long hollow openers, cones, hollow taps, A detector, a nail setter, a rod holder, a funnel, a first dilator and a second dilator with a hollow interior.

The internal implant includes a pedicle screw and a pre-bent connecting rod, and the pedicle screw is composed of a screw rod, a screw seat connected to the upper end of the screw rod, and a U-shaped arm connected to the upper end of the screw rod, and the screw rod is A plurality of openings are provided, and the upper end of the inner cavity of the nail seat communicates with the inner cavity of the lower part of the U-shaped arm while the lower end communicates with the inner cavity of the screw rod.

The corresponding surgical instrument also includes a distraction pressurizer, a pressurizing sleeve, a percutaneous pedicle bone graft channel, a third dilator and a bone cement injection connector, and the distraction pressurizer is symmetrically arranged The two stretching presser bodies are composed of two stretching presser bodies. The stretching presser body is composed of a handle section, a bending section and a pressurizing section. A measuring ruler is provided on the bending section of the pressurizer; a probe is provided on one side of the pressurizing sleeve; a probe positioning hole is provided at one end of the pre-bent connecting rod; Both the bone channel and the third expander are pipe bodies that penetrate up and down, and the inner diameter of the pipe of the percutaneous pedicle bone grafting channel is consistent with the outer diameter of the pipe of the third expander; the bone cement injection connector is vertically penetrated. pipe body.

The upper end of the percutaneous pedicle bone graft channel is provided with a handle, and the upper end of the channel is provided with an external thread.

The head of the third dilator is provided with a handle, and the lower end of the head of the third dilator is provided with an internal thread, and the internal thread is matched with the external thread on the percutaneous pedicle bone grafting channel.

The inner cavity of the nail seat is an inverted cone-shaped cavity, the inner cavity of the screw rod is a cylindrical cavity, and the inner wall of the U-shaped arm is provided with internal threads.

The length of the nail seat is about 5mm-20mm.

One end of the measuring ruler is fixedly connected to the handle section on the right side of the stretching presser, while the other end passes through the handle section on the left side of the stretching presser and is slidably connected with the stretching presser; The pressurizing section of the pressurizer is provided with a groove consistent with the inner diameter of the pre-bent connecting rod.

One side of the pressurizing sleeve is provided with an upper support and a lower support, the upper end of the probe is provided with a needle cap, and the lower end passes through the upper support and the lower support, and the probe is covered with a spring. The spring is located between the upper support and the lower support, and the other side of the pressure sleeve is fixedly connected with a sleeve handle.

One end of the pre-bent connecting rod is set as a square, and the other end is set as an ellipsoid, and the probe positioning hole is set on the pre-bent connecting rod located on the ellipsoid.

The head of the bone cement injection connector is provided with a handle, the lower end of the head of the bone cement injection connector is provided with external threads, the lower end of the bone cement injection connector is set in a cone shape, and the bone cement injection connector The injection connector is provided with a cylindrical cavity that penetrates up and down; the external thread on the bone cement injection connector matches the internal thread on the inner wall of the U-shaped arm, and the bone cement injection connector has a conical lower end Matching with the conical cavity in the nail seat, the inner diameter of the cylindrical cavity of the bone cement injection connector is consistent with the inner diameter of the screw rod.

The beneficial effects of the utility model are:

1. The expansion presser of the present utility model is provided with a mounting hole consistent with the inner diameter of the pre-bent connecting rod in its pressurizing section, and the mounting hole is connected with the pedicle screw by passing the pre-bending connecting rod. When holding the handle of the expansion presser with both hands and pressing down moderately, the expansion pressure can be directly applied to the screw base of the pedicle screw, so it can achieve openness in minimally invasive surgery Distraction effect of surgery.

2. When performing percutaneous pedicle screw internal fixation for thoracolumbar fractures, the facet joints of the fractured vertebral body will withstand the longitudinal connecting rod, forming a leverage effect, which will lead to the failure of the operation due to the difficulty in pulling out the screws and distracting them. The utility model lengthens the length of the pedicle screw seat to prevent the facet joints of the fractured vertebra from resisting the pre-bent connecting rod, effectively preventing the difficulty of pulling out the screw and propping it apart, thus ensuring the smooth progress of the operation.

3. During minimally invasive surgery, the injection of bone cement can enhance the anti-pullout force of the screw, which can effectively avoid complications such as pedicle screw pullout and loosening. The extender is screwed into the two breakable U-shaped long arms. One end of the needle tip of the extender is connected with the upper end of the inner cavity of the screw to form a channel. Connect the Luer connector of the extender to the bone cement injection device to inject bone cement. After injecting the bone cement, insert the needle core into the extender and pedicle screw, push the bone cement remaining in the extender and pedicle screw into the vertebral body, and unscrew the extender to complete the bone cement push. Note, the utility model has simple structure, few components, easy and safe operation, reliable fixing and good sealing performance.

4. When percutaneous pedicle screw system internal fixation is performed for thoracolumbar compression fracture surgery, the degree of distraction cannot be directly seen when performing distraction reduction. The utility model can be set at the bending section of the distractor press When the stretching scale displayed on the measuring ruler on the pressure gauge and the probe on the pressurizer touch the probe positioning hole at the oval end of the pre-bent connecting rod after the probe is lowered, according to the position of the pre-bent connecting rod in the pedicle screw The outer length is about 3mm standard, which can accurately measure the distance and degree of stretching, and can effectively prevent over-stretching and under-stretching.

5. If the patient's fracture is more compressed, the utility model can ensure the smooth progress of subsequent bone grafting operation.

Description of drawings

Fig. 1 is the structural representation of pedicle screw;

Fig. 2 is the structural representation of stretching pressurizer;

Fig. 3 is the left view of Fig. 2;

Fig. 4 is a schematic diagram of the connection structure between the pedicle screw and the expansion presser;

Fig. 5 is the structural representation of the 3rd dilator;

Fig. 6 is a structural schematic diagram of a percutaneous pedicle bone graft channel;

Fig. 7 is a structural schematic diagram of a pressurized sleeve;

Fig. 8 is the right view of Fig. 7;

Fig. 9 is the structural representation of pre-bent connecting bar;

Fig. 10 is a schematic structural view of the bone cement injection connector.

Detailed ways

Now in conjunction with accompanying drawing, the utility model is described in further detail.

A thoracolumbar posterior percutaneous minimally invasive internal fixation system, including internal implants and corresponding surgical instruments, the corresponding surgical instruments include puncture needles, guide pins, expansion sleeves, long hollow openers, cones, hollow taps, A detector, a nail setter, a rod holder, a funnel, a first dilator and a second dilator with a hollow interior.

As shown in accompanying drawing 1, Fig. 4 and Fig. 9, the internal implant comprises pedicle screw 1 and pre-bent connecting rod 4, and pedicle screw 1 is connected by screw rod 13, the nail base 12 that is connected with the upper end of screw rod and the connection. The U-shaped arm 11 at the upper end of the nail seat is composed of a plurality of openings on the screw rod 13. The upper end of the inner cavity of the nail seat 12 communicates with the inner cavity of the lower part of the U-shaped arm 11 and the lower end communicates with the inner cavity of the screw rod 13. The inner cavity of 12 is an inverted cone-shaped cavity, the inner cavity of the screw rod 13 is a cylindrical cavity, the inner wall of the U-shaped arm 11 is provided with internal threads, and the length of the nail seat 12 is about 5mm-20mm; the pre-bent connecting rod One end is provided with a probe positioning hole, one end of the pre-bent connecting rod 4 is set to a square body 41, the other end is set to an ellipsoid 42, and the probe positioning hole 43 is arranged on the pre-bending connecting rod 4 and is located on the ellipsoid.

The corresponding surgical instrument also includes a distraction pressurizer 2, a pressurizing sleeve 3, a percutaneous pedicle bone graft channel 5, a third dilator 6 and a bone cement injection connector 7, and the distraction pressurizer 2 is composed of It consists of two symmetrically arranged stretching presser bodies.

As shown in accompanying drawing 2, accompanying drawing 3 and accompanying drawing 4, stretching presser body is made up of handle section 24, bending section 22 and pressurizing section 23, two bending sections 22 of stretching pressurizing body Cross movable connection, the bending section 22 of the stretching presser 2 is provided with a measuring ruler 25; one side of the pressurizing sleeve 3 is provided with a probe 33, and one end of the measuring ruler 25 is fixedly connected to the right side of the stretching pressurizer On the handle section of the pressurizer, the other end passes through the handle section on the left side of the pressurizer and is slidably connected with the pressurizer. Corresponding groove 26.

As shown in accompanying drawings 5 and 6, the percutaneous pedicle bone grafting channel 5 and the third expander 6 are all pipe bodies that pass through up and down. The outer diameters of the pipes of 6 are consistent, and the upper end of the pipe of the percutaneous pedicle bone grafting channel 5 is provided with a handle 52, and the upper end of the pipe is provided with an external thread 51, and the head 61 of the third dilator 6 is provided with a handle 62. The lower end of the head 61 of the three dilators 6 is provided with an internal thread 63 , and the internal thread 63 is matched with the external thread 51 on the percutaneous pedicle bone graft channel 5 .

As shown in accompanying drawing 10, the bone cement injection connector 7 is a pipe body that penetrates up and down, the head 72 of the bone cement injection connector 7 is provided with a handle 73, and the lower end of the head 72 of the bone cement injection connector 7 is provided with a There is an external thread 74, the lower end of the bone cement injection connector 7 is set in a conical shape, and the bone cement injection connector 7 is provided with a cylindrical cavity that penetrates up and down; the external thread 74 on the bone cement injection connector 7 and The internal thread of the inner wall of the U-shaped arm 11 is matched, and the conical lower end of the bone cement injection connector 7 is matched with the conical cavity in the nail seat 12. The cylindrical cavity of the bone cement injection connector 7 The inner diameter is consistent with the inner diameter of the screw rod 13 .

As shown in accompanying drawing 7 and accompanying drawing 8, one side of pressurizing sleeve 3 is provided with upper bearing 31 and lower bearing 32, and the upper end of probe 33 is provided with needle cap 35, and its lower end passes through upper bearing 31 and lower bearing 32. The lower support 32 , and the probe 33 is covered with a spring 36 , the spring 36 is located between the upper support 31 and the lower support 32 , and the other side of the pressurizing sleeve 3 is fixedly connected with a sleeve handle 34 .

Example:

Taking the operation of vertebral body compression fracture as an example, the purpose of the operation is to insert 4 pedicle screws in the upper and lower vertebral body of the injured vertebra. The process is as follows:

1. According to the preoperative positioning, the puncture needle is inserted into the needle insertion point between the facet joint and the transverse process under the guidance of the anterior and lateral perspective of the C-arm X-ray machine.

2. After confirming that the needle head of the guide wire is located at the outer edge of the pedicle on the anteroposterior view, screw in the puncture needle until the center of the pedicle, and ensure that the guide wire does not penetrate the pedicle wall through anteroposterior and lateral fluoroscopy.

3. Remove the puncture needle core, place the guide needle, pull out the puncture needle, cut a longitudinal incision about 2 cm centered on the guide needle, put the expansion sleeve inside the dilator over the guide needle and insert it into the bone surface.

4. Cover the outer expansion sleeve with the inner expansion sleeve and place it completely on the needle entry point; after the guide pin and the outer expansion sleeve are locked, remove the inner expansion sleeve and insert the hollow opener along the guide needle into the Flare the cortical bone at the pedicle entry point.

5. Screw a hollow self-drilling tap sleeve of appropriate size into the pedicle at the guide pin. When tapping, pay attention to check the depth mark and vertical mark on the guide pin to avoid excessive screwing and rotation, and do not tap the guide pin In addition; at the same time, the depth mark on the tap can be used to determine the length of the screw.

6. Remove the tap, use the ball probe next to the guide wire to confirm the integrity of the pedicle; screw in the pedicle screw (if you need to inject bone cement, choose a hollow pedicle screw with holes); use the C-arm X After the optical machine is positive and lateral to confirm that the position of the pedicle screw is appropriate, the guide pin is pulled out, and the extender is screwed into the "U"-shaped arm so that the lower end of the extender is closely combined with the inner cone of the screw. The injection device is used to inject bone cement under the supervision of the C-arm X-ray machine. After pushing the bone cement, use the needle core to push the bone cement in the screw into the vertebral body, take out the extender, and insert the pin.

7. Use the rod measuring device to determine the pre-bent connecting rod of appropriate specifications, and use the rod bender to bend the connecting rod into a suitable curvature according to the curvature of the fixed segment; insert the square end of the pre-bent connecting rod into the rod holder and hold Fixed, at this time the positioning space of the pre-bent connecting rod is upward.

8. Put the rod: make the rod holder close to the screw, first screw in the nut on the pedicle screw close to the rod holder to fix and lock it, remove the rod holder, and place the other pedicle screw The cap is screwed into the appropriate depth (the pre-bent rod can move inside the screw), placed in the pressurized sleeve with the probe (so that the side of the probe is on the ellipsoidal side of the pre-bent rod), placed in the Stretch the pressurizer to reset, pay attention to observe the scale on the spreader, and lock the nut when the probe on the pressurization sleeve falls.

9. Use the same method to install the pre-bent connecting rod on the other side and fix the pedicle screw, and finally break off the breakable U-shaped arm and remove it.

10. If the patient’s fracture is more compressed, use a puncture needle to puncture through the pedicle of the injured vertebrae. After the puncture is successful, pull out the needle core, insert the guide needle, and insert the first, second, and third dilators in sequence from small to large. into the vertebral body, drive the third expander with bone graft channel into the vertebral body, take out the expander and guide pin, leave the bone graft channel in the vertebral body, fix the funnel on the upper end of the bone graft channel through threads, and place the broken Put the bone into the funnel and bone graft channel, fix the bone graft channel by hand, push the broken bone into the vertebral body with a needle core that is consistent with the inner diameter of the bone graft channel; if there is a space occupying in the spinal canal, it can be combined with posterior discoscopy (MED) Decompression of the involved segmental laminar resection.

Claims (9)

1. a thoracic and lumbar vertebral posterior minimal invasion internal fixation system, include implant and corresponding operating theater instruments, corresponding operating theater instruments comprises puncture needle, guide pin, expanded casing, vast sky heart open circuit device, cone, hollow screw tap, sounder, upper nail device, the first dilator of holding excellent device, funnel, inner hollow and the second dilator, it is characterized in that:

Described implant includes pedicle screw (1) and pre-bending pitman (4), the nail seat (12) that described pedicle screw (1) connects by screw rod (13), with screw rod upper end and the U-shaped arm (11) that is connected in nail seat upper end form, described screw rod is provided with multiple perforates on (13), the inner chamber UNICOM of the inner chamber upper end of described nail seat (12) and U-shaped arm (11) bottom and lower end and screw rod (13) inner chamber is connected;

Described corresponding operating theater instruments also includes unfolding pressurizing device (2), compressive sleeve (3), percutaneous cone nut bone grafting passage (5), the 3rd dilator (6) and bone cement and injects adapter (7), described unfolding pressurizing device (2) is made up of symmetrically arranged two unfolding pressurizing device bodies, described unfolding pressurizing device body is made up of handle section (24), bending segment (22) and pressurized segment (23), bending segment (22) intersection of two unfolding pressurizing device bodies is flexibly connected, and on the bending segment (22) of unfolding pressurizing device (2), is provided with dip stick (25); Described compressive sleeve (3) one sides are provided with probe (33); One end of described pre-bending pitman is provided with probe positioning hole; Described percutaneous cone nut bone grafting passage (5) and the 3rd dilator (6) are the pipe body of up/down perforation, and the internal diameter of the pipeline of percutaneous cone nut bone grafting passage (5) is consistent with the outer diameter tube of the 3rd dilator (6); Described bone cement is injected the pipe body that adapter (7) is up/down perforation.

2. a kind of thoracic and lumbar vertebral posterior minimal invasion internal fixation system as claimed in claim 1, is characterized in that: described percutaneous cone end, nut bone grafting passage (5) pipeline upper end is provided with handle (52), and its pipeline upper end is provided with external screw thread (51).

3. a kind of thoracic and lumbar vertebral posterior minimal invasion internal fixation system as claimed in claim 1 or 2, it is characterized in that: the head (61) of described the 3rd dilator (6) is provided with handle (62), head (61) lower end of the 3rd dilator (6) is provided with female thread (63), and this female thread (63) matches with the external screw thread (51) on percutaneous cone nut bone grafting passage (5).

4. a kind of thoracic and lumbar vertebral posterior minimal invasion internal fixation system as claimed in claim 1, it is characterized in that: the inner chamber of described nail seat (12) is the cavity that is inverted cone shape, described screw rod (13) inner chamber is cylindrical cavity, and described U-shaped arm (11) inwall is provided with female thread.

5. a kind of thoracic and lumbar vertebral posterior minimal invasion internal fixation system as described in claim 1 or 4, is characterized in that: the length of described nail seat (12) is about 5mm-20mm.

6. a kind of thoracic and lumbar vertebral posterior minimal invasion internal fixation system as claimed in claim 1, it is characterized in that: one end of described dip stick (25) is fixedly connected on the handle section on unfolding pressurizing device right side, and the other end is slidably connected with unfolding pressurizing device through the handle section in unfolding pressurizing device left side; The pressurized segment (23) of described unfolding pressurizing device (2) is provided with the groove (26) consistent with pre-bending pitman (4) internal diameter.

7. a kind of thoracic and lumbar vertebral posterior minimal invasion internal fixation system as claimed in claim 1, it is characterized in that: described compressive sleeve (3) one sides are provided with upper bracket (31) and undersetting (32), the upper end of described probe (33) is provided with pin cap (35), its lower end is through upper bracket (31) and undersetting (32), and the upper cover of probe (33) has spring (36), this spring (36) is positioned between upper bracket (31) and undersetting (32), and the opposite side of described compressive sleeve (3) is fixedly connected with sleeve handle (34).

8. a kind of thoracic and lumbar vertebral posterior minimal invasion internal fixation system as claimed in claim 1, it is characterized in that: one end of described pre-bending pitman (4) is set to square body (41), the other end is set to ellipsoid (42), and described probe positioning hole (43) is arranged on pre-bending pitman (4) and is positioned on ellipsoid.

9. a kind of thoracic and lumbar vertebral posterior minimal invasion internal fixation system as described in claim 1 or 4, it is characterized in that: the head (72) that described bone cement is injected adapter (7) is provided with handle (73), head (72) lower end that bone cement is injected adapter (7) is provided with external screw thread (74), the lower end that described bone cement is injected adapter (7) is set to cone shape, and described bone cement is injected the cylindrical cavity that is provided with up/down perforation in adapter (7); The external screw thread (74) that described bone cement is injected on adapter (7) matches with the female thread of U-shaped arm (11) inwall, described bone cement is injected the lower end that adapter (7) is cone shape and is matched with the cavity that is cone shape in nail seat (12), and it is consistent with described screw rod (13) intracavity diameter that described bone cement is injected the internal diameter of cylindrical cavity of adapter (7).