CN113243967A

CN113243967A - Navigation device for knee-walking total knee joint replacement

Info

Publication number: CN113243967A
Application number: CN202110514362.2A
Authority: CN
Inventors: 黄程军; 郭林; 朱红利; 杨柳
Original assignee: First Affiliated Hospital of PLA Military Medical University
Current assignee: First Affiliated Hospital of PLA Military Medical University
Priority date: 2021-05-11
Filing date: 2021-05-11
Publication date: 2021-08-13
Anticipated expiration: 2041-05-11
Also published as: CN113243967B

Abstract

The invention provides a knee-knee total knee replacement fusion navigation device which comprises a bone cutting guide plate, wherein the bone cutting guide plate is sequentially provided with a femur bone cutting groove, a wedge bone cutting groove and a tibia bone cutting groove which penetrate through the guide plate from top to bottom, the bone cutting guide plate is provided with a verification hole and a verification surface, the verification surface is used for verifying the bone cutting surface in marrow appearance, a metal nail is arranged in the verification hole and used for verifying the bone cutting surface in a perspective view, and fastening through holes are formed in the upper end and the lower end of the bone cutting guide plate and used for fixing with a joint through a screw. According to the invention, whether the guide plate is in a horizontal state or not is observed through the verification surface, so that whether the bone cutting direction is consistent with the actually required bone cutting direction or not is judged; the Kirschner wire is arranged in the verification hole, so that whether the direction of the bone cutting is consistent with the designed bone cutting direction or not can be observed in the operation, the design concept of intramedullary design and extramedullary verification is realized, the guide plate can be accurately placed, navigation is provided for bone cutting operation, and the accuracy of bone cutting is ensured.

Description

Navigation device for knee-walking total knee joint replacement

Technical Field

The invention relates to the technical field of medical instruments, in particular to a knee-walking total knee joint replacement navigation device.

Background

Along with the accelerating aging of population, the prevalence rate of osteoarthritis is on the increasing trend, the prevalence rate in community population over 60 years old can reach 60.1%, and along with the gradual development of OA disease to the terminal stage, Total Knee Arthroplasty (TKA) becomes the most reliable and effective treatment means. However, the conventional TKA surgical tool has problems in various operations such as measuring a force line of a lower limb, selecting an osteotomy angle and an osteotomy amount, selecting a prosthesis size and determining a placement angle, and balancing soft tissues around a joint, such as a joint capsule, a ligament and the like. The surgery effect is not good, the life quality of the patient after the surgery is reduced, even the revision surgery is needed in a short time, the pain is brought to the patient, and meanwhile, the waste of medical resources is caused. The 3D printing technology is in the field of TKA surgery, individuation is really achieved by formulating an individualized surgery osteotomy template, certain matching and accurate prosthesis alignment and alignment are obtained, and therefore a good surgery effect and a prosthesis service life are obtained, surgery time is shortened, bleeding is reduced, and serious complications are effectively prevented. But 3D prints and cuts bone conduction board and easily receive the restriction in operation incision field of vision in clinical application, cuts bone conduction board and bony structure matching face often less, does not have fine face matching, lacks stable support, does not cut bone mark or cut the bone reference when cutting the bone, should cut the bone conduction board and can't place accurately, has the error with actual joint, leads to cutting the bone skew, cuts the bone volume not enough, influences the problem of operation quality.

In view of the above problems, there is a need for an improved guide plate in the prior art to provide a navigation device that can precisely position the knee joint to provide a more precise osteotomy path, which is of great significance to the improvement of the quality of the knee-knee total knee replacement surgery.

Disclosure of Invention

The invention provides a knee-joint-total-knee-joint replacement fusion navigation device, which adopts a comprehensive mode of intramedullary design and extramedullary verification to ensure that the bone cutting is accurate, the operation quality is obviously improved, and the problem that the operation quality is influenced by poor bone cutting accuracy caused by the guide plate guidance and verification capability in the prior art is solved.

In order to solve the technical problems, the invention specifically adopts the following technical scheme:

the fusion knee-walking total knee joint replacement navigation device comprises a bone cutting guide plate which is an arc-shaped plate, the inner surface of the arc-shaped plate is a concave surface which is attached to the knee joint, an intercondylar notch column which extends inwards to the knee joint is arranged on the concave surface, the outer surface of the arc-shaped plate is a convex surface, the convex surface is sequentially provided with a femur osteotomy groove, a wedge-shaped osteotomy groove and a tibia osteotomy groove which penetrate through the guide plate from top to bottom, the osteotomy guide plate is provided with a verification hole which horizontally penetrates through the tibial osteotomy groove, a verification surface is arranged on the lower end edge of the osteotomy guide plate, the verification surface and the verification hole are parallel to the tibia osteotomy groove, the verification surface is used for verifying the osteotomy surface on the marrow appearance, the bone cutting guide plate is characterized in that metal nails are arranged in the verification holes and used for verifying a bone cutting surface in a perspective view, and fastening through holes are formed in the upper end and the lower end of the bone cutting guide plate and used for penetrating screws to be fixed with joints.

Further, be provided with on the convex surface toward outer bellied thighbone osteotomy seat, wedge osteotomy seat and shin bone osteotomy seat, thighbone osteotomy groove sets up in thighbone osteotomy seat, wedge osteotomy groove sets up in wedge osteotomy seat, shin bone osteotomy groove sets up in shin bone osteotomy seat.

Furthermore, the horizontal central plane of the femoral resection groove is a femoral resection surface, and the femoral resection surface is perpendicular to the femoral force axis and is 8-10 mm away from the distal end of the femur.

Furthermore, the horizontal central plane of the tibial osteotomy groove is a tibial osteotomy surface, and the tibial osteotomy surface is perpendicular to the tibial force axis and is 9-11 mm away from the tibial top end.

Furthermore, the horizontal central plane of the wedge-shaped osteotomy groove is a wedge-shaped osteotomy surface, and the wedge-shaped osteotomy surface and the femur osteotomy surface are overlapped by rotating 45 degrees around the intersection line formed by the intersection of the femur osteotomy surface and the tibia osteotomy surface.

Further, the metal nail is a Kirschner wire.

Further, the verification surface protrudes from the cortex by 15-25 mm.

Further, the verification surface is more than 20mm from the tibial osteotomy surface.

Furthermore, the fastening through holes are two at the upper end of the guide plate and two at the lower end of the guide plate.

The invention has the beneficial effects that:

the bone cutting guide plate is fixed with the human body joint by the screws penetrating through the fastening through holes, and the inner surface of the bone cutting guide plate is an arc-shaped concave surface which is attached to the knee joint, so that the bone cutting guide plate is reliably attached to the human body joint, provides a relatively reliable fixing effect and is beneficial to bone cutting. Particularly, the invention can be used for observing whether the guide plate is in a horizontal state or not through the verification surface arranged at the end part of the guide plate so as to judge whether the guide plate is parallel to the actually required osteotomy direction or not, and can also be used for observing whether the guide plate is parallel to the designed osteotomy direction or not in a perspective view in an operation through the arranged verification hole, thereby realizing the design concept of intramedullary design and extramedullary verification, realizing accurate placement, providing navigation for osteotomy operation, ensuring the accuracy of the osteotomy direction and providing help for improving the quality of the fusion knee surgery.

Description of the drawings:

FIG. 1 is a schematic view of a first aspect of the present invention;

FIG. 2 is a schematic view of the second aspect of the present invention;

FIG. 3 is a third schematic view of the present invention;

FIG. 4 is a schematic view of femoral and tibial force axes;

FIG. 5 is a schematic view of femoral resection surface determination;

FIG. 6 is a schematic view of a tibial osteotomy surface and a wedge-shaped osteotomy surface definition;

FIG. 7 is a schematic view of an osteotomy condition;

FIG. 8 is a schematic view of the present invention secured to a knee joint.

In the figure: 1-cutting bone guide plate; 2-a concave surface; 3-convex surface; 4-femoral osteotomy notch; 5-wedge osteotomy groove; 6-tibial osteotomy groove;

7-verifying the hole; 8-verifying the surface; 9-fastening a via hole; 10-a three-dimensional model; 11-femoral force spool; 12-femoral osteotomy face; 13-a tibial force spool; 14-tibial osteotomy face; 15-wedge osteotomy face; 16-intercondylar fossa column; 17-femoral osteotomy seat; 18-wedge osteotomy seat; 19-tibial osteotomy seat.

Detailed Description

In order to make the objects, technical solutions and advantages of the embodiments of the present invention clearer, the technical solutions in the embodiments of the present invention will be clearly and completely described below with reference to the drawings in the embodiments of the present invention, and it is obvious that the described embodiments are some, but not all, embodiments of the present invention. The components of embodiments of the present invention generally described and illustrated in the figures herein may be arranged and designed in a wide variety of different configurations.

Thus, the following detailed description of the embodiments of the present invention, presented in the figures, is not intended to limit the scope of the invention, as claimed, but is merely representative of selected embodiments of the invention. All other embodiments, which can be derived by a person skilled in the art from the embodiments given herein without making any creative effort, shall fall within the protection scope of the present invention.

It should be noted that: like reference numbers and letters refer to like items in the following figures, and thus, once an item is defined in one figure, it need not be further defined and explained in subsequent figures.

In the above description of the present invention, it should be noted that the terms "one side", "the other side" and the like indicate orientations or positional relationships based on the orientations or positional relationships shown in the drawings or orientations or positional relationships that the products of the present invention are conventionally placed in use, and are only used for convenience in describing the present invention and simplifying the description, but do not indicate or imply that the device or the element to which the present invention is directed must have a specific orientation, be constructed in a specific orientation, and be operated, and thus should not be construed as limiting the present invention. Furthermore, the terms "first," "second," and the like are used merely to distinguish one description from another, and are not to be construed as indicating or implying relative importance.

Further, the term "identical" and the like do not mean that the components are absolutely required to be identical, but may have slight differences. The term "perpendicular" merely means that the positional relationship between the components is more perpendicular than "parallel", and does not mean that the structure must be perfectly perpendicular, but may be slightly inclined.

As shown in figures 1-8, the invention provides a knee joint fusion navigation device, which comprises a bone cutting guide plate 1, wherein the bone cutting guide plate is an arc-shaped plate, the inner surface of the arc-shaped plate is a concave surface 2 which is matched with the surface of a knee joint and is jointed with the knee joint, an intercondylar notch column 16 which extends inwards of the joint is arranged on the concave surface, the outer surface of the arc-shaped plate is a convex surface 3, a femur bone cutting groove 4, a wedge-shaped bone cutting groove 5 and a tibia bone cutting groove 6 which penetrate through the guide plate are sequentially arranged on the convex surface from top to bottom, the bone cutting guide plate is provided with a verification hole 7 which horizontally penetrates through the tibia bone cutting groove, the edge of the lower end of the bone cutting guide plate is provided with a verification surface 8, the verification surface and the verification hole are parallel to the tibia bone cutting groove, the verification surface is used for verifying the bone cutting surface in the marrow appearance, a metal nail such as a kirschner pin is arranged in, the fastening through hole is used for passing through a screw to be fixed with the joint.

When the osteotomy guide plate is manufactured, CT scanning is firstly carried out on the knee joint of a patient, then a three-dimensional model 10 of the knee joint is constructed through reverse engineering, as shown in figures 4-6, then a surface curved surface is extracted and stretched to form an equal-thickness plate body, and then characteristics such as a femur osteotomy groove, a wedge-shaped osteotomy groove and a tibia osteotomy groove are constructed:

1) constructing a femur osteotomy groove: determining a femoral force axis 11 in a model through three-dimensional software such as UG, making a plane perpendicular to the femoral force axis, translating the plane to the distal end of the femur by 8-10 mm, wherein the plane is a femoral osteotomy surface 12, as shown in figure 5, and forming an osteotomy groove from the upper end and the lower end in parallel at a certain distance, wherein the certain distance is adaptively designed according to the thickness and the operation space of the osteotomy saw, but is at least more than half of the thickness of the osteotomy saw, and the left width and the right width of the osteotomy groove only need to be adaptively designed according to a focus area.

2) Constructing a tibial osteotomy groove: finding and determining a tibial force axis 13 in the model, making a plane vertical to the tibial force axis, translating the plane to the top of the tibia by 9-11 mm, wherein the plane is a tibial osteotomy surface 14, as shown in fig. 6, and forming an osteotomy groove from the upper end and the lower end in parallel at a certain distance, wherein the certain distance is adaptively designed according to the thickness and the operation space of the osteotomy saw, but is at least more than half of the thickness of the osteotomy saw, and the left width and the right width of the osteotomy groove only need to be adaptively designed according to a focus area.

3) Constructing a wedge-shaped osteotomy groove: the intersection line of the tibial osteotomy surface and the femoral osteotomy surface is found out through three-dimensional software, then the femoral osteotomy surface is rotated by 45 degrees towards the tibial osteotomy surface by taking the intersection line as a rotation center, namely a wedge-shaped osteotomy surface 15 is formed, and as shown in figure 6, a wedge-shaped osteotomy groove is constructed in a manner similar to the femoral osteotomy groove or the tibial osteotomy groove.

The construction method which takes the joint entity of the patient as basic data and adopts reverse engineering as an implementation means constructs more accurate and reasonable femur osteotomy groove, wedge-shaped osteotomy groove and tibia osteotomy groove, and provides conditions for accurate osteotomy.

In the embodiment, when a bone is specifically cut, the intercondylar notch column of the guide plate is firstly arranged in the intercondylar notch, then the guide plate is pressed on the knee joint, the inner surface of the guide plate is attached to the cortical layer on the surface of the joint to form primary fixation, then the intercondylar notch column is rotated to carry out fine adjustment, the verification surface at the lower end of the guide plate is parallel to the horizontal direction, and then the guide plate and the human joint are fixed by penetrating the fastening through hole through the screw to complete final fixation.

Then, the bone cutting is carried out, namely, the bone cutting is carried out on the femur at the femur cutting groove, then the bone cutting is carried out on the tibia cutting groove, finally, the bone cutting is carried out on the wedge-shaped bone cutting groove, and a wedge-shaped space is cut in the focus area, so that the focus area forms two sections, as shown in fig. 7, the two sections can be conveniently taken out respectively.

In the process of osteotomy, an operator can directly observe through the verification plane, and external medical personnel can also monitor the operation through the real-time imaging system in combination with the three-dimensional model, and when the fact that the kirschner wire and the human joint are inclined is observed, a correction instruction can be sent out to guide the operator to correct, so that the operation quality is further guaranteed.

As a modification of this embodiment, a femoral osteotomy seat 17, a wedge-shaped osteotomy seat 18, and a tibial osteotomy seat 19 are provided on the convex surface, the femoral osteotomy groove is provided in the femoral osteotomy seat, the wedge-shaped osteotomy groove is provided in the wedge-shaped osteotomy seat, and the tibial osteotomy groove is provided in the tibial osteotomy seat. Because thighbone cuts bone seat, wedge and cuts bone seat and shin bone and cut bone seat protrusion in the baffle, consequently, have certain degree of depth to make the osteotomy saw have certain guide effect when cutting the bone, stability is better.

As a modification of this embodiment, the verification surface is raised from the cortex by 15-25 mm, and within the allowable range, it is set higher, so that it has stronger visibility.

As a modification of this embodiment, the distance between the verification surface and the tibial osteotomy surface is not limited, but is at least greater than 20mm, as shown in FIG. 8, so that sufficient space is available for the set screw and the fixation seat.

As the improvement of this embodiment, the fastening via hole sets up two in the baffle upper end, sets up two at the baffle lower extreme, respectively sets up two at the upper and lower both ends of baffle promptly, and convenient the fixing prevents that both ends from being single existence and turning on one's side.

Finally, the above embodiments are only for illustrating the technical solutions of the present invention and not for limiting, although the present invention has been described in detail with reference to the preferred embodiments, it should be understood by those skilled in the art that modifications or equivalent substitutions may be made to the technical solutions of the present invention without departing from the spirit and scope of the technical solutions of the present invention, and all of them should be covered in the claims of the present invention.

Claims

1. the navigation device of fused knee row total knee joint replacement, is characterized in that: comprise osteotomy guide plate, described osteotomy guide plate is an arc-shaped plate, and the inner surface of described arc-shaped plate is the concave surface that fits with knee joint, The concave surface is provided with an intercondylar socket column extending into the joint, the outer surface of the arc-shaped plate is a convex surface, and the convex surface is sequentially provided with a femoral osteotomy groove and a wedge-shaped osteotomy groove running through the guide plate from top to bottom. and the tibial osteotomy groove, the osteotomy guide plate is provided with a verification hole that runs through the tibial osteotomy groove horizontally, the osteotomy guide plate is located at the lower edge and is provided with a verification surface, and the verification surface and the verification hole are parallel to the tibial osteotomy groove , the verification surface is used to observe and verify the osteotomy surface in the extramedullary, the verification hole is loaded with metal nails for verifying the osteotomy surface in the perspective view, and the upper and lower ends of the osteotomy guide plate are provided with fastening Holes, the fastening vias are used for fixing with the joint through the screw.

2 . The navigation device for total knee joint replacement for fusion knee according to claim 1 , wherein the convex surface is provided with a femoral osteotomy seat, a wedge-shaped osteotomy seat and a tibial osteotomy seat that protrude outward, and the femoral osteotomy seat is provided. 3 . The osteotomy slot is arranged in the femoral osteotomy seat, the wedge-shaped osteotomy slot is arranged in the wedge-shaped osteotomy seat, and the tibial osteotomy slot is arranged in the tibial osteotomy seat.

3 . The navigation device for total knee joint replacement with fusion knee according to claim 1 , wherein the center plane of the horizontal direction of the femoral osteotomy groove is the femoral osteotomy surface, and the femoral osteotomy surface is perpendicular to the femur. 4 . The axis of force is 8-10mm away from the distal end of the femur.

4. The navigation device for total knee arthroplasty with fusion knee according to claim 3, wherein the horizontal center plane of the tibial osteotomy groove is the tibial osteotomy surface, and the tibial osteotomy surface is perpendicular to the tibia The axis of force is 9-11mm from the top of the tibia.

5 . The navigation device for total knee joint replacement for fusion knee according to claim 4 , wherein the horizontal center plane of the wedge-shaped osteotomy groove is the wedge-shaped osteotomy surface, and the wedge-shaped osteotomy surface is the same as the femoral osteotomy surface. 6 . The bone surface coincides with the intersecting line formed by the intersection of the femoral osteotomy surface and the tibial osteotomy surface and rotated 45° in the direction of the femoral osteotomy surface.

6 . The navigation device for total knee joint replacement with fusion knee according to claim 1 , wherein the metal nails are Kirschner wires. 7 .

7 . The navigation device for total knee joint replacement with fusion knee according to claim 1 , wherein the verification surface protrudes from the cortex by 15-25 mm. 8 .

8 . The navigation device for total knee arthroplasty with a fusion knee according to claim 1 , wherein the distance between the verification surface and the tibial osteotomy surface is greater than 20 mm. 9 .

9 . The navigation device for total knee arthroplasty for fusion knees according to claim 1 , wherein two fastening vias are provided at the upper end of the guide plate and two at the lower end of the guide plate. 10 .