CN107669357A - The horizontal Distraction Apparatus of alveoli dentales mandibulae bone - Google Patents

Abstract

The invention provides a mandibular alveolar bone horizontal distractor, which relates to the field of mandibular alveolar bone defect repair instruments. A mandibular alveolar bone horizontal stretcher, comprising a guide rail made of nickel-titanium memory alloy, at least two fixed titanium plates fixed on the guide rail and at least one movable titanium plate; the long side and wide side of the guide rail are located The side faces are adapted to the shape of the mandibular alveolar bone, a number of holes are uniformly arranged along the length direction of the guide rail, and cross bars are formed between the holes; the moving titanium plate is slidably connected to the guide rail through a sliding mechanism; The sliding mechanism includes a sliding frame and a screw passing through the sliding frame, the guide rail passes through the sliding frame, and the part of the screw rod arranged in the sliding frame is threadedly connected with the cross bar on the guiding rail. The present invention is applicable to a large mandibular alveolar defect, especially when the mandibular alveolar process is involved across the center of the mandible, and can effectively repair moderate to severe mandibular alveolar bone defects.

Description

Mandibular Alveolar Bone Horizontal Distractor

technical field

The invention relates to the field of instruments for repairing mandibular alveolar bone defect, in particular to a horizontal distractor for mandibular alveolar bone.

Background technique

At present, mandibular alveolar bone defect caused by congenital malformation, trauma, or resection of benign and malignant tumors has become one of the more common types of jaw bone defects in clinical practice. Such defects can easily lead to a series of clinical problems such as changes in the appearance of patients, difficulties in denture restoration and retention, and insufficient bone mass to allow implants, which urgently need to be resolved. For small alveolar bone defects, free bone grafting or vascularized bone grafting can be used to repair and reconstruct, but it often leads to insufficient donor site barriers, insufficient soft tissue in the recipient site, and high surgical risks. In addition, for the mandibular alveolar process defect, the vertical maxillary distraction osteogenesis technique can be used, and the local residual alveolar bone can be used to cause local bone and mucosa regeneration under the tension of the distractor to repair the defect. However, when the mandibular alveolar defect has a large range, especially when the mandibular alveolar process is involved across the center of the mandible, vertical distraction ossification is often difficult to achieve smoothly, and the new bone shape formed is also different from the original alveolar process. It is difficult to be consistent, and its effect is difficult to meet clinical needs. How to apply distraction osteogenesis to repair moderate to severe mandibular alveolar bone defects, especially when the defect area crosses the midline, has become the focus of current clinical research.

Contents of the invention

The purpose of the present invention is to provide a mandibular alveolar bone horizontal distractor, which is suitable for mandibular alveolar process defects with a large range, especially when the mandibular alveolar processes are involved across the center of the mandible, and can effectively repair moderate to severe mandibular alveolar processes bone defect.

The object of the present invention adopts following technical scheme to realize.

A mandibular alveolar bone horizontal distractor, comprising a guide rail made of nickel-titanium memory alloy, at least two fixed titanium plates fixed on the guide rail and at least one movable titanium plate; the long side and wide side of the guide rail are located The side faces are adapted to the shape of the mandibular alveolar bone, a number of holes are uniformly arranged along the length direction of the guide rail, and cross bars are formed between the holes; the moving titanium plate is slidably connected to the guide rail through a sliding mechanism; The sliding mechanism includes a sliding frame and a screw passing through the sliding frame, the guide rail passes through the sliding frame, and the part of the screw rod arranged in the sliding frame is threadedly connected with the cross bar on the guiding rail.

In the present invention, the sliding frame includes a U-shaped frame body and a connecting titanium plate, one end of the U-shaped frame body is hinged to the connecting titanium plate, and the other end is connected through a locking mechanism.

In a preferred technical solution, the U-shaped frame body includes first, second and third titanium plates, the first and third titanium plates are parallel to each other and are vertically connected to the second titanium plate.

In a preferred technical solution, the locking mechanism includes a projection provided on the U-shaped frame main body and a limiting part provided on the connecting titanium plate with a U-shaped slot, and the projection is clamped on the limiting part. in the U-shaped slot of the bit part.

In a preferred technical solution, the third titanium plate of the U-shaped frame body is parallel to the first titanium plate and perpendicular to the outwardly facing side of the second titanium plate.

In a preferred technical solution, the corresponding ends of the U-shaped frame body and the connecting titanium plate are respectively provided with hinged ears, and the U-shaped frame body and the connected titanium plate are hinged by passing bolts in the hinged ears.

In a preferred technical solution, the screw includes a main body and end parts respectively connected to two ends of the main body, the diameter of the main body is larger than that of the end parts; The step surface in the sliding frame, the end of the screw rod is exposed outside the sliding frame.

In a preferred technical solution, both ends of the screw are provided with cross-shaped grooves.

In a preferred technical solution, the distances between the two adjacent cross bars are equal.

In the preferred technical solution, the width of the guide rail is 6-8mm, the thickness is 0.5-1.5mm, the distance between the crossbars is 0.5-1.5mm, and the crossbars are cylindrical with a diameter of 0.5-1.5mm .

Beneficial effect

1. The present invention uses the principle of distraction osteogenesis to move the distracted bone block along the guide rail whose shape is consistent with the patient's dental arch through a sliding mechanism composed of a sliding frame and a screw rod. The shape of the new alveolar bone formed is similar to that of the original mandibular teeth The arch shape remains consistent, especially for the formation of new alveolar bone spanning the mandibular midline to repair moderate to severe mandibular alveolar bone defects. The mandibular alveolar bone horizontal stretcher of the present invention has a simple and ingenious structure.

2. The guide rail in the present invention is made of nickel-titanium alloy, which can adapt to the size of different mandibular dental arches, and can be applied to the treatment needs of patients with different dental arch shapes, increasing the clinical versatility of the retractor.

3. The present invention applies distraction osteogenesis technology, which can not only repair moderate to severe mandibular alveolar bone defects, but also promote local mucosal regeneration, and solve the problem of insufficient local soft tissue caused by bone tissue defects for postoperative denture repair.

4. Both ends of the screw used in the present invention are provided with cross-shaped grooves, so it can be rotated from any direction, which is convenient for stretching after crossing the midline.

Description of drawings

Fig. 1 is a schematic structural diagram of the present invention, wherein 1-guide rail, 13-crossbar, 2-sliding mechanism, 3-fixed titanium plate, 4-movable titanium plate.

Fig. 2 is a side view of the sliding frame, wherein 11-sliding frame, 5-U-shaped frame body, 6-connecting titanium plate, 9-lock mechanism, 7-hinge ear, 8-bolt.

Fig. 3 is a schematic diagram of the structure of the U-shaped frame body, wherein 51-the first titanium plate, 52-the second titanium plate, 53-the third titanium plate, 54-bulbs, 7-hinge ears.

Fig. 4 is the connection relationship between the connecting titanium plate and the limiting component, 10-limiting component, 6-connecting titanium plate, 7-hinge ear, 20-U-shaped slot.

Figure 5 is a B-B sectional view of the positional relationship between the sliding frame, guide rail and screw in Figure 1, 11-sliding frame, 12-screw body, 7-hinge ear, 8-bolt, 13-cross bar of guide rail, 9-locking mechanism , 4- Move the titanium plate.

Fig. 6 is the A-A sectional view of sliding frame, guide rail and screw rod positional relationship among Fig. 1, wherein 11-sliding frame, 12-surface is covered with threaded screw main body, 13-the cross bar of guide rail, 22-end.

The left view of Fig. 7 screw rod, 22-end, 14-cruciform groove.

Fig. 8 is the initial state figure that adopts the present invention to treat, and wherein 1-guide rail, 2-sliding mechanism, 3-fixed titanium plate, 4-mobile titanium plate, 15-U-shaped frame, 16-stretched bone block, 17- Mandibular defect site.

Fig. 9 is a middle-term state diagram adopting the present invention to treat, wherein 18-new bone formed after stretching

Fig. 10 is a state diagram when the treatment of the present invention is completed.

detailed description

Embodiment 1 Mandibular alveolar bone horizontal distractor and steps of use

The structure of the present invention is described in conjunction with accompanying drawings 1-7.

A mandibular alveolar bone horizontal distractor, including a guide rail 1 made of nickel-titanium memory alloy, three fixed titanium plates 3 welded on the guide rail 1 and a movable titanium plate 4; the long side and the wide side of the guide rail are located The side is adapted to the shape of the mandibular alveolar bone, and several holes are evenly arranged along the length direction of the guide rail, and cross bars 13 are formed between the holes; the moving titanium plate is slidably connected to the guide rail through the sliding mechanism 2; the sliding mechanism includes Sliding frame 11 and the screw rod that passes sliding frame, guide rail passes sliding frame, and the part that screw rod is located in sliding frame is connected with the cross bar on the guiding rail by screw thread. The external thread on the screw rod is adapted to the cross bar on the guide rail, so that the screw rod and the cross bar on the guide rail are connected through threads. When the screw rod is rotated, the screw rod drives the sliding frame to slide on the guide rail, so that the stretched bone block moves along the direction of the bone defect. In the nickel-titanium memory alloy of the guide rail, nickel accounts for 53-57% and titanium accounts for 43-47%. In addition to its unique shape memory function, it also has the advantages of wear resistance, corrosion resistance, high damping and superelasticity. The holes on the guide rail are arranged at positions corresponding to bone defects.

The sliding frame 11 includes a U-shaped frame main body 5 and a connecting titanium plate 6 , one end of the U-shaped frame main body is hingedly connected with the connecting titanium plate, and the other end is connected through a locking mechanism 9 .

The fixed titanium plate is a three-hole titanium plate routinely used in clinical operations. After the operation, one end is fixed on the mandible with a titanium nail, and the other end is connected to the guide rail through a U-shaped frame or titanium plate. The mobile titanium plate is a clinically used titanium plate selected according to the size of the distracted bone fragment designed for surgery.

The main body of the U-shaped frame includes first, second and third titanium plates 51 , 52 and 53 . The first and third titanium plates 51 and 53 are parallel to each other and are vertically connected to the second titanium plate 52 . The main body of the U-shaped frame is preferably integrally cast, or it can be welded after casting separately.

The locking mechanism includes a bump 54 arranged on the main body of the U-shaped frame and a limiting part 10 arranged on the connecting titanium plate with a U-shaped slot 20. The bump fits into the U-shaped slot and the bump snaps in the U-shaped slot of the limiting part.

The third titanium plate of the U-shaped frame body is parallel to the first titanium plate and is perpendicular to the side of the second titanium plate facing outwards (relative to the inner guide rail of the U-shaped frame body, facing outwards); The positioning part includes three titanium plates: the fourth, fifth and sixth titanium plates, the fourth and sixth titanium plates are opposite and are vertically connected with the fifth titanium plate to form a U shape, the sixth titanium plate is at the top of the opening position of the limiting part and The ends of the connecting titanium plates are connected.

The corresponding ends of the U-shaped frame main body and the connecting titanium plate are respectively provided with hinged ears 7, and the U-shaped frame main body and the connected titanium plate are hinged by passing bolts 8 in the hinged ears.

The method of installing the mobile titanium plate on the guide rail is as follows: pass the guide rail and the screw rod through the main body of the U-shaped frame, the two ends of the screw rod are exposed outside the sliding frame, insert the protrusion into the U-shaped slot of the limiting part, and insert the The hinged ear of the connecting titanium plate and the third titanium plate are hinged with bolts, so that the main body of the U-shaped frame is hingedly connected with one end of the connecting titanium plate, and the other end is connected by a locking mechanism. The sliding frame, the screw and the guide rail are in close contact, and the screw It is connected with the cross bar of the guide rail through threads.

The screw includes a main body 12 and an end 22 respectively connected to the two ends of the main body. The diameter of the main body is larger than that of the end; both sides of the sliding frame are provided with stepped surfaces that limit the axial direction of the screw main body in the sliding frame, and the end is exposed to the sliding frame. outside. The main body of the screw is a cylinder with an external thread, with a diameter of 3mm and a length of 10mm, and the two ends are cylinders with a diameter of 1mm.

There are cross-shaped grooves 14 at both ends of the screw. Supporting rotator: the existing titanium screwdriver, the head end has a cross-shaped protrusion, that is, the male end, which coincides with the cross-shaped grooves at both ends of the screw, that is, the female end. Pass the rotator through the cross groove at the end of the screw rod, and turn the screw rod. Since the screw rod is threadedly connected with the cross bar on the guide rail, the sliding frame is driven to move on the guide rail.

The distance between two adjacent cross bars on the guide rail is equal.

The width of the guide rail is 6-8mm, and the thickness is 0.5-1.5mm. The crossbars are cylinders with a diameter of 0.5-1.5mm, and the distance between the crossbars is 0.5-1.5mm.

The use steps of the mandibular alveolar bone horizontal distractor: first measure the size data of the mandible of the patient, shorten the guide rail appropriately and try it on to ensure that the size is suitable; weld the fixed titanium plate on the guide rail through U-shaped parts outside the mouth, and move the The titanium plate is welded on the main body of the U-shaped frame, the screw rod and the guide rail are passed through the main body of the U-shaped frame, and then the bump and the hinged ear of the main body of the U-shaped frame are respectively installed together with the limiting part and the hinged ear connected to the titanium plate; Fix the guide rail on the outside of the mandible so that it is close to the cervical margin of the teeth; drill holes in the mandible at the site designed before surgery, use titanium nails to fix the fixed titanium plate on the mandible, and fix the mobile titanium plate to the mandible. After confirming that the fixation is good, cut the distracted bone according to the preoperative design; check whether the distracted bone can move, and close the wound after confirming that there is no obstacle; start traction after 7-10 days, and use the rotator every day Rotate the screw for one week to drive the stretched bone block to move 1mm/day in the designed direction; maintain the stretched bone block after reaching the predetermined position, observe the osteogenesis situation, and remove the distractor at a fixed time.

Example 2 Clinical Application of Mandibular Alveolar Bone Horizontal Distractor

The example case is an alveolar bone defect spanning the midline of the mandible, corresponding to the position 33-43 of the mandible, missing teeth at 34 and 35, and the rest of the bone is normal. Utilize the curvature of the remaining mandibular dentition and the plasticity of the guide rail to shape the guide rail close to the cervical margin of the teeth, and fix the two ends of the guide rail to the front edge of the mandibular ramus with fixed titanium plates, and connect the other fixed titanium plate to the end of the mandibular defect . The movable titanium plate can be fixed on the other end of the mandible close to the defect site toward the lower edge of the mandible as needed, and it works together with three fixed titanium plates to fix the entire distractor. The design is located on the left side, which is equivalent to the 34 and 35 alveolar bones, and the reverse "L"-shaped osteotomy is performed to form a distraction bone block. The mobile titanium plate connected with the sliding mechanism is fixed on the distraction bone block with titanium nails. Then use the rotator to rotate the cross groove on the screw rod to drive the sliding frame and distraction bone block to move gradually to the designed direction (healthy side) along the metal guide rail. According to the principle of distraction osteogenesis, new bone is formed in the distraction gap to repair the alveolar bone defect, and the adjacent mucosa is also synchronously regenerated to repair the soft tissue defect. Distraction is terminated when the distracted bone fragment makes contact with the contralateral alveolar bone. The distractor was removed after the new bone calcification stabilized. Figure 8-10 shows the whole process of treatment.

Claims (10)

1. A mandibular alveolar bone horizontal retractor is characterized in that it comprises a guide rail made of nickel-titanium memory alloy, at least two fixed titanium plates fixed on the guide rail and at least one movable titanium plate; the guide rail is long The sides where the sides and wide sides are located are adapted to the shape of the mandibular alveolar bone, and a number of holes are uniformly arranged along the length direction of the guide rail, and cross bars are formed between the holes; the moving titanium plate slides through the sliding mechanism Connected to the guide rail; the sliding mechanism includes a slide frame and a screw passing through the slide frame, the guide rail passes through the slide frame, and the part of the screw rod arranged in the slide frame is threadedly connected with the cross bar on the guide rail. 2. The mandibular alveolar bone horizontal distractor according to claim 1, characterized in that the sliding frame comprises a U-shaped frame main body and a connecting titanium plate, the U-shaped frame main body is hinged with one end of the connecting titanium plate, and the other end is passed through The locking mechanism is connected. 3. according to the said mandibular alveolar bone level distractor of claim 2, it is characterized in that said U-shaped frame main body comprises first, second, third titanium plates, and described first, third titanium plates are parallel and opposite and all with the first The dititanium plates are connected vertically. 4. The mandibular alveolar bone horizontal distractor according to claim 3, characterized in that the locking mechanism includes a projection on the U-shaped frame body and a U-shaped slot on the connecting titanium plate. The limiting part, the protrusion is locked in the U-shaped slot of the limiting part. 5. The mandibular alveolar bone horizontal distractor according to claim 4, characterized in that the third titanium plate of the U-shaped frame body is parallel to the first titanium plate and perpendicular to the outward side of the second titanium plate. bump. 6. According to the described mandibular alveolar bone horizontal distractor according to claim 5, it is characterized in that the corresponding ends of the U-shaped frame main body and the titanium plate are respectively provided with hinged ears, and the U-shaped frame is connected by bolts in the hinged ears. The frame body is hinged with connecting titanium plates. 7. according to the described mandibular alveolar bone level distractor of claim 6, it is characterized in that described screw rod comprises main body, the end that is connected with described main body two ends respectively, and the diameter of described main body is greater than described end; Both sides of the sliding frame are provided with stepped surfaces that axially limit the screw main body in the sliding frame, and the ends of the screw are exposed outside the sliding frame. 8. The mandibular alveolar bone horizontal distractor according to claim 7, characterized in that there are cross-shaped grooves at both ends of the screw rod. 9. The mandibular alveolar bone horizontal distractor according to claim 5, characterized in that the distances between the two adjacent cross bars are equal. 10. The mandibular alveolar bone horizontal distractor according to claim 6, characterized in that the width of the guide rail is 6-8mm, the thickness is 0.5-1.5mm, and the distance between the crossbars is 0.5-1.5mm, so Said cross bar is cylindrical, and its diameter is 0.5-1.5mm.