胸腰椎脊柱内固定手术流程的优化与一次性集约手术器械的研发

Optimization of surgical procedures for thoracolumbar spinal internal fixation and development of disposable integrated surgical instruments

目的优化胸腰椎脊柱内固定手术流程并研制一次性、轻质化、模块化脊柱外科手术器械包,为在特殊条件下完成脊柱外科手术提供必备条件,进而提高脊柱脊髓损伤患者的救治率。方法通过将《新型冠状病毒肺炎疫情期骨科诊疗规范化流程的专家共识》与胸腰椎脊柱内固定手术实际情况相联系,对胸腰椎脊柱内固定手术流程进行优化,同时选择高强度高分子材料代替原有金属材料,减轻器械的质量,实现轻质化;通过优化减少工具数量,使得一物多用,减少工具的数量,实现集成化;通过对植入物的改造,实现单向、万向螺钉的一体化,满足手术中的多种需求。结果优化胸腰椎脊柱内固定手术流程,同时研制出一系列、独立包装的一次性手术器械,一套器械控制在1 kg以内,不超过20件手术器械,可以满足完成一台胸腰椎内固定手术。结论通过优化胸腰椎脊柱内固定手术流程达到有效救治患者、避免交叉感染、保护人员安全的目的。同时,一次性、轻质化、模块化脊柱外科手术器械包可在战争、灾难、疫情等特殊条件下,以及在我国边远医疗条件落后地区开展并完成脊柱手术,解决脊柱脊髓损伤伤员早期救治等问题,提高我国平时、战时的后勤保障能力。

Objective To optimize the thoracolumbar spine internal fixation procedure and develop a disposable, lightweight, and modular spinal surgical instrument kit, which provides the necessary conditions for the completion of spinal surgery under special conditions, thereby improving the treatment rate of patients with spinal and spinal cord injuries.Methods By associating the "Expert consensus on the standardized process of orthopedic diagnosis and treatment during the epidemic of COVID-19" with the actual situation of thoracolumbar spine internal fixation surgery, the process of thoracolumbar spinal internal fixation surgery was optimized, and high-strength polymer materials were selected to replace the original metal material reducing the weight of the instrument;through optimization and reduction of the number of tools, the integration is achieved;through the modification of the implant, unidirectional and universal screws are integrated to meet multiple needs during surgery. Results The surgical procedure of thoracolumbar spine internal fixation was optimized. At the same time, a series of individually packaged disposable surgical instruments were developed. A set of instruments controlled within 1 kg and no more than 20 surgical instruments could complete a spinal surgery. Conclusion By optimizing the procedure of thoracolumbar spine internal fixation, the purpose of effectively treating patients,avoiding cross infection, and protecting personnel safety can be achieved. At the same time, the disposable, lightweight,and modular spinal surgery instrument kit can support surgical needs under special conditions including warfare, disaster and epidemic situation, solve the problems of early treatment of spinal cord injuries, and improve the medical level of the military logistics support capabilities in peacetime and wartime.