CN106580416A - Intertrochanteric fracture intramedullary fixation system - Google Patents
Intertrochanteric fracture intramedullary fixation system Download PDFInfo
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- 206010020100 Hip fracture Diseases 0.000 title claims abstract description 20
- 238000009434 installation Methods 0.000 claims abstract description 15
- 241001227561 Valgus Species 0.000 claims description 5
- 150000001875 compounds Chemical group 0.000 claims 1
- 206010051077 Post procedural haemorrhage Diseases 0.000 abstract description 3
- 206010071229 Procedural haemorrhage Diseases 0.000 abstract description 3
- 206010017076 Fracture Diseases 0.000 description 15
- 208000010392 Bone Fractures Diseases 0.000 description 13
- 238000000034 method Methods 0.000 description 6
- 208000032843 Hemorrhage Diseases 0.000 description 4
- 208000034158 bleeding Diseases 0.000 description 4
- 230000000740 bleeding effect Effects 0.000 description 4
- 210000000988 bone and bone Anatomy 0.000 description 4
- 239000002131 composite material Substances 0.000 description 3
- 230000006835 compression Effects 0.000 description 3
- 238000007906 compression Methods 0.000 description 3
- 238000006073 displacement reaction Methods 0.000 description 3
- 238000001356 surgical procedure Methods 0.000 description 3
- 206010070917 Eccentric fixation Diseases 0.000 description 2
- 206010053206 Fracture displacement Diseases 0.000 description 2
- 239000007943 implant Substances 0.000 description 2
- 238000003780 insertion Methods 0.000 description 2
- 230000037431 insertion Effects 0.000 description 2
- 238000012986 modification Methods 0.000 description 2
- 230000004048 modification Effects 0.000 description 2
- UZUFPBIDKMEQEQ-UHFFFAOYSA-N perfluorononanoic acid Chemical compound OC(=O)C(F)(F)C(F)(F)C(F)(F)C(F)(F)C(F)(F)C(F)(F)C(F)(F)C(F)(F)F UZUFPBIDKMEQEQ-UHFFFAOYSA-N 0.000 description 2
- 238000000926 separation method Methods 0.000 description 2
- 208000002970 Coxa Vara Diseases 0.000 description 1
- 208000020221 Short stature Diseases 0.000 description 1
- 230000032683 aging Effects 0.000 description 1
- 210000003484 anatomy Anatomy 0.000 description 1
- 230000009286 beneficial effect Effects 0.000 description 1
- 230000036770 blood supply Effects 0.000 description 1
- 238000005520 cutting process Methods 0.000 description 1
- 230000007547 defect Effects 0.000 description 1
- 201000010099 disease Diseases 0.000 description 1
- 208000037265 diseases, disorders, signs and symptoms Diseases 0.000 description 1
- 210000002436 femur neck Anatomy 0.000 description 1
- 238000002594 fluoroscopy Methods 0.000 description 1
- 210000000527 greater trochanter Anatomy 0.000 description 1
- 210000001624 hip Anatomy 0.000 description 1
- 238000002513 implantation Methods 0.000 description 1
- 208000015181 infectious disease Diseases 0.000 description 1
- 238000004519 manufacturing process Methods 0.000 description 1
- 230000000399 orthopedic effect Effects 0.000 description 1
- 238000003825 pressing Methods 0.000 description 1
- 230000002035 prolonged effect Effects 0.000 description 1
- 230000001737 promoting effect Effects 0.000 description 1
- 238000004904 shortening Methods 0.000 description 1
- 238000006467 substitution reaction Methods 0.000 description 1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/72—Intramedullary devices, e.g. pins or nails
- A61B17/7233—Intramedullary devices, e.g. pins or nails with special means of locking the nail to the bone
- A61B17/725—Intramedullary devices, e.g. pins or nails with special means of locking the nail to the bone with locking pins or screws of special form
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/74—Devices for the head or neck or trochanter of the femur
- A61B17/742—Devices for the head or neck or trochanter of the femur having one or more longitudinal elements oriented along or parallel to the axis of the neck
- A61B17/744—Devices for the head or neck or trochanter of the femur having one or more longitudinal elements oriented along or parallel to the axis of the neck the longitudinal elements coupled to an intramedullary nail
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Abstract
本发明涉及一种股骨转子间骨折髓内固定系统，包括：髓内钉、近端拉力锁定钉和远端锁定钉，髓内钉包括分别设置第一开孔和第二开孔的近端和远端；近端拉力锁定钉贯穿第一开孔，其前端进入股骨头内，其尾端通过固定件与髓内钉固定；远端锁定钉通过第二开孔与髓内钉固定；近端拉力锁定钉的尾端设置可拆卸的安装工具和加压工具，所述加压工具为一中空结构，其内壁可与所述近端拉力锁定钉螺纹连接。与现有技术相比，本发明所述的股骨转子间骨折髓内固定系统集成了髓内钉与锁定钢板的优点，不需扩髓有效缩短手术时间，且对髓腔干扰明显减少，大幅度减少术中、术后出血，同时不需要防旋钉等辅助结构，进一步减少手术时间，更适合国人使用。
The invention relates to an intramedullary fixation system for intertrochanteric fractures, comprising: an intramedullary nail, a proximal tension locking nail and a distal locking nail, wherein the intramedullary nail includes a proximal end and a first opening and a second opening respectively. The distal end; the proximal tension locking nail goes through the first opening, its front end enters the femoral head, and its tail end is fixed with the intramedullary nail through the fixture; the distal locking nail is fixed with the intramedullary nail through the second opening; the proximal end A detachable installation tool and a pressurizing tool are provided at the tail end of the tension locking nail. The pressure tool is a hollow structure, and its inner wall can be threadedly connected with the proximal tension locking nail. Compared with the prior art, the intertrochanteric fracture intramedullary fixation system of the present invention integrates the advantages of the intramedullary nail and the locking plate, does not require reaming, effectively shortens the operation time, and significantly reduces the interference to the medullary cavity, greatly It reduces intraoperative and postoperative bleeding, and does not require auxiliary structures such as anti-rotation screws, which further reduces operation time and is more suitable for Chinese people.
Description
技术领域technical field
本发明涉及医疗器械技术领域，尤其涉及一种股骨转子间骨折髓内固定系统。The invention relates to the technical field of medical devices, in particular to an intramedullary fixation system for intertrochanteric fractures.
背景技术Background technique
股骨转子间骨折是骨科常见病，90％是由跌倒导致的，人群总体发病率女性63/10万、男性34/10万，30％发生在亚洲，且其中大部分在中国，随着平均寿命延长、老龄化的加深发病率有逐年增多的趋势。Intertrochanteric fracture is a common orthopedic disease, 90% of which are caused by falls. The overall incidence rate of the population is 63/100,000 for women and 34/100,000 for men. 30% of them occur in Asia, and most of them are in China. With the average life expectancy The incidence rate of prolongation and aging is increasing year by year.
目前常规采用手术治疗，其具有促进早期活动，利于康复，防止卧床并发症，降低死亡率等优点，手术固定方式分为：钢板固定(髓外方式)、髓内钉固定(髓内方式)。Surgical treatment is currently routinely used, which has the advantages of promoting early mobilization, facilitating rehabilitation, preventing bed rest complications, and reducing mortality. Surgical fixation methods are divided into: plate fixation (extramedullary), and intramedullary nail fixation (intramedullary).
钢板固定(髓外方式)主要采用DHS(髋动态加压螺钉)，其通过滑动加压达到骨折面最大范围的接触，进而减少内固定承受的负荷，但其具有如下缺点：只适用在稳定骨折；手术暴露较大，增加了出血及感染的风险；偏心性固定，稳定性差，容易发生断钉、断板及切出股骨头等风险；容易发生髋内翻。Plate fixation (extramedullary) mainly adopts DHS (Dynamic Hip Screw), which achieves the maximum contact with the fracture surface through sliding pressure, thereby reducing the load on the internal fixation, but it has the following disadvantages: it is only suitable for stable fractures ; Large surgical exposure increases the risk of bleeding and infection; eccentric fixation, poor stability, prone to breakage of nails, plates, and femoral heads; prone to coxa varus.
髓内钉固定(髓内方式)属于中心性固定，力学性能良好，适用于所有类型骨折，具有各自的固有优点，但目前使用的髓内钉固定(髓内方式)普遍存在如下缺点：需要扩髓，为了固定更稳定、选择更适合的髓内钉等原因大部分髓内钉需要扩髓，导致髓腔血运短暂破坏、术中(后)出血增加、手术时间延长，增加相关手术风险；过于粗大、不适合国人骨骼特征，目前器械多以欧美人骨骼特征设计，普遍粗大，以Intertan双钉设计为例，双钉占用更大的股骨颈空间，导致部分身材矮小人群不能使用或者术中骨折风险加大；加压有限或者不能加压，Gamma-3加压能力有限，PFNA不能加压；易发生术中骨折移位，因解剖不匹配，髓内钉过于粗大等导致髓内钉置入时力量较大甚至粗暴置入，导致骨折移位，且PFNA螺旋刀片敲入时也可导致骨折断端分离移位。Intramedullary nail fixation (intramedullary method) belongs to central fixation with good mechanical properties and is suitable for all types of fractures. For reasons such as more stable fixation and selection of a more suitable intramedullary nail, most intramedullary nails need to be reamed, resulting in temporary damage to the blood supply of the medullary cavity, increased intraoperative (post) bleeding, prolonged operation time, and increased related surgical risks; Too thick and not suitable for the bone characteristics of Chinese people. At present, most of the instruments are designed according to the bone characteristics of European and American people, and they are generally thick. Take the Intertan double nail design as an example. The double nails occupy more space in the femoral neck, which makes it impossible for some people with short stature to use it or during surgery. Increased fracture risk; limited or no compression, Gamma-3 has limited compression capacity, and PFNA cannot pressurize; intraoperative fracture displacement is prone to occur, and intramedullary nails are placed due to anatomical mismatch and too thick intramedullary nails. The insertion force is strong or even rough insertion, resulting in fracture displacement, and the PFNA helical blade can also cause separation and displacement of fracture ends when knocked in.
发明内容Contents of the invention
本发明的目的在于克服现有技术中的缺陷，提供一种股骨转子间骨折髓内固定系统，不需要扩髓，其结合了锁定钢板与髓内钉的优点，能避免常规髓内钉(需要扩髓)及钢板(偏心固定)的固有缺点，具有操作简便、固定可靠、出血少、手术时间短、病人对手术耐受更良好等优点。The purpose of the present invention is to overcome the defects in the prior art, to provide a kind of intertrochanteric fracture intramedullary fixation system, which does not need reaming, which combines the advantages of locking plate and intramedullary nail, and can avoid the conventional intramedullary nail (need Reaming) and plate (eccentric fixation) have inherent disadvantages, but it has the advantages of simple operation, reliable fixation, less bleeding, shorter operation time, and better patient tolerance to the operation.
为实现上述目的，本发明采用如下技术方案：To achieve the above object, the present invention adopts the following technical solutions:
一种股骨转子间骨折髓内固定系统，包括：髓内钉，所述髓内钉包括近端和远端，所述近端上设置倾斜贯通的第一开孔，所述远端上设置贯通的第二开孔；近端拉力锁定钉，所述近端拉力锁定钉贯穿所述第一开孔，所述近端拉力锁定钉的前端进入股骨头内，所述近端拉力锁定钉的尾端通过固定件与所述髓内钉固定；远端锁定钉，所述远端锁定钉通过所述第二开孔与所述髓内钉固定；其中，所述髓内钉和近端拉力锁定钉均为中空结构；其中，所述近端拉力锁定钉的尾端设置可拆卸的安装工具和加压工具，所述加压工具的外径大于所述第一开孔的直径，所述加压工具为一中空结构，其内壁可与所述近端拉力锁定钉螺纹连接。An intramedullary fixation system for intertrochanteric fractures, comprising: an intramedullary nail, the intramedullary nail includes a proximal end and a distal end, the proximal end is provided with a first opening obliquely through it, and the distal end is provided with a through hole The second opening of the proximal end tension locking nail, the proximal tension locking nail passes through the first opening, the front end of the proximal tension locking nail enters the femoral head, and the tail of the proximal tension locking nail The end is fixed with the intramedullary nail through a fixture; the distal locking nail is fixed with the intramedullary nail through the second opening; wherein, the intramedullary nail and the proximal tension locking The nails are all hollow structures; wherein, the tail end of the proximal tension locking nail is provided with a detachable installation tool and a pressure tool, the outer diameter of the pressure tool is greater than the diameter of the first opening, and the pressure tool The pressing tool is a hollow structure, and its inner wall can be threadedly connected with the proximal tension locking nail.
为了进一步优化上述技术方案，本发明所采取的技术措施还包括：In order to further optimize the above-mentioned technical scheme, the technical measures taken by the present invention also include:
优选地，所述固定件为一中空结构，所述固定件的外壁与所述第一开孔为螺纹连接，所述固定件的内壁与所述近端拉力锁定钉为螺纹连接。Preferably, the fixing member is a hollow structure, the outer wall of the fixing member is threadedly connected to the first opening, and the inner wall of the fixing member is threadedly connected to the proximal tension locking nail.
优选地，所述远端锁定钉与所述第二开孔为螺纹连接。Preferably, the distal locking nail is threadedly connected to the second opening.
优选地，所述近端拉力锁定钉的尾端的端部为内六角结构，所述安装工具为内六角扳手。Preferably, the end of the tail end of the proximal tension locking nail is an inner hexagonal structure, and the installation tool is an inner hexagonal wrench.
优选地，所述近端的直径为13～15mm，更优选14mm；所述远端的直径为8.5～10.5mm，更优选9.5mm；所述近端的横截面为圆弧梯形。Preferably, the diameter of the proximal end is 13-15 mm, more preferably 14 mm; the diameter of the distal end is 8.5-10.5 mm, more preferably 9.5 mm; the cross-section of the proximal end is arc-trapezoidal.
优选地，所述髓内钉具有10～14°的前倾角，更优选为12°的的前倾角；所述近端具有3～5°的外翻角，更优选为4°的外翻角。Preferably, the intramedullary nail has an anteversion angle of 10-14°, more preferably an anteversion angle of 12°; the proximal end has a valgus angle of 3-5°, more preferably a valgus angle of 4° .
优选地，所述近端拉力锁定钉的直径为9～11mm，更优选为10mm；所述远端锁定钉的直径4～6mm，更优选为5mm。Preferably, the diameter of the proximal tension locking nail is 9-11 mm, more preferably 10 mm; the diameter of the distal locking nail is 4-6 mm, more preferably 5 mm.
优选地，所述近端拉力锁定钉为一体成型的两端外部均设置螺纹的结构；其中，所述近端拉力锁定钉的前端的直径大于所述近端拉力锁定钉的尾端的直径，所述前端的直径等于或略小于所述第一开孔的直径。Preferably, both ends of the proximal tension locking nail are integrally formed with threaded structures; wherein, the diameter of the front end of the proximal tension locking nail is larger than the diameter of the tail end of the proximal tension locking nail, so The diameter of the front end is equal to or slightly smaller than the diameter of the first opening.
优选地，所述近端拉力锁定钉为由配件一、配件二与配件三组成的复合结构，所述配件一与配件二的外部均设置螺纹，两者通过所述配件三连接；所述配件二可与所述安装工具和加压工具连接，所述配件一可植入股骨头内；其中，所述配件一的直径大于所述配件二，所述配件一的直径等于或略小于所述第一开孔的直径。Preferably, the proximal tension locking nail is a composite structure composed of accessory 1, accessory 2 and accessory 3, and the outside of the accessory 1 and accessory 2 are provided with threads, and the two are connected through the accessory 3; the accessory The second can be connected with the installation tool and the pressurization tool, and the first accessory can be implanted into the femoral head; wherein, the diameter of the first accessory is larger than that of the second accessory, and the diameter of the first accessory is equal to or slightly smaller than the The diameter of the first opening.
优选地，所述远端的底部为缩径的光滑圆锥体，所述圆锥体的底部为光滑的类球形结构。Preferably, the bottom of the distal end is a smooth cone with reduced diameter, and the bottom of the cone is a smooth spherical structure.
与现有技术相比，本发明具有以下有益效果：Compared with the prior art, the present invention has the following beneficial effects:
本发明所述的髓内钉设计采用自锁锁定结构，无需扩髓，且骨折断端可实现加压，更适合于国人骨骼解剖结构；The intramedullary nail of the present invention is designed with a self-locking locking structure, no need for reaming, and the broken end of the fracture can be pressurized, which is more suitable for the anatomical structure of Chinese bones;
本发明采用独特设计的髓内钉结构，髓内钉开孔孔内壁带有螺纹与各螺钉的螺纹相匹配达到自身锁定而完成固定；本发明所述的髓内钉的近端设计一拉力锁定钉，仅需要配套的可拆卸的加压工具即可根据个体的需要实现加压或者不加压；本发明所述的髓内钉根据国人股骨转子间及股骨干近段髓腔解剖数据进行设计，更适合国人，具体表现为器械直径更小巧、髓内钉形态与髓腔更一致，近端圆弧梯形设计，利于抗旋转；The present invention adopts a uniquely designed intramedullary nail structure, and the inner wall of the intramedullary nail hole has threads that match the threads of each screw to achieve self-locking and complete fixation; the proximal end of the intramedullary nail described in the present invention is designed to be locked by tension The nail can be pressurized or not pressurized according to the needs of the individual only by a matching detachable pressurizing tool; the intramedullary nail described in the present invention is designed according to the anatomical data of the femoral intertrochanter and proximal femoral shaft medullary cavity of Chinese people , which is more suitable for Chinese people. The specific performance is that the diameter of the instrument is smaller, the shape of the intramedullary nail is more consistent with the medullary cavity, and the proximal arc trapezoidal design is conducive to anti-rotation;
本发明所述的髓内钉集成了髓内钉与锁定钢板的优点，因不需要扩髓有效缩短手术时间，且对髓腔干扰明显减少，大幅度减少术中、术后出血，同时本发明不需要防旋钉等辅助结构，进一步减少手术时间，更适合国人使用。The intramedullary nail of the present invention integrates the advantages of the intramedullary nail and the locking plate, effectively shortens the operation time because no reaming is required, and significantly reduces interference with the medullary cavity, greatly reducing intraoperative and postoperative bleeding. There is no need for auxiliary structures such as anti-rotation screws, which further reduces operation time and is more suitable for Chinese people.
附图说明Description of drawings
图1是本发明一实施例中的股骨转子间骨折髓内固定系统的结构示意图；Fig. 1 is the structural representation of the intertrochanteric fracture intramedullary fixation system in an embodiment of the present invention;
图2是本发明一实施例中的实施加压过程的结构示意图；Fig. 2 is a schematic structural view of implementing a pressurization process in an embodiment of the present invention;
图中的附图标记为：The reference signs in the figure are:
1、髓内钉；11、近端；12、远端；13、第一开孔；14、第二开孔；2、近端拉力锁定钉；21、前端；22、尾端；3、固定件；4、远端锁定钉；5、加压工具。1. Intramedullary nail; 11. Proximal end; 12. Distal end; 13. First opening; 14. Second opening; 2. Proximal tension locking nail; 21. Front end; 22. Tail end; 3. Fixed 4. The distal locking nail; 5. The press tool.
具体实施方式detailed description
下面结合附图和实施例，对本发明的具体实施方式作进一步描述。以下实施例仅用于更加清楚地说明本发明的技术方案，而不能以此来限制本发明的保护范围。The specific implementation manners of the present invention will be further described below in conjunction with the drawings and examples. The following examples are only used to illustrate the technical solution of the present invention more clearly, but not to limit the protection scope of the present invention.
如图1所示，本发明一实施例所述的股骨转子间骨折髓内固定系统包括髓内钉1、近端拉力锁定钉2和远端锁定钉4。As shown in FIG. 1 , the intramedullary fixation system for intertrochanteric fractures according to an embodiment of the present invention includes an intramedullary nail 1 , a proximal tension locking nail 2 and a distal locking nail 4 .
如图1所示，所述髓内钉1包括近端11和远端12，所述近端11的直径大于所述远端12的直径以更好地与髓腔的结构相匹配，所述近端11上设置倾斜贯通的第一开孔13，所述远端12上设置贯通的第二开孔14，所述髓内钉1安装在髓腔内；所述近端拉力锁定钉2贯穿所述第一开孔13，所述近端拉力锁定钉2的前端21进入股骨头内，所述近端拉力锁定钉2的尾端22通过固定件3与所述髓内钉1固定；所述远端锁定钉4通过所述第二开孔14与所述髓内钉1固定以起到多点支撑的稳固作用；其中，所述髓内钉1和近端拉力锁定钉2均为中空结构，其中间为空心以分别穿过各自的导引针；其中，所述近端拉力锁定钉2的尾端22设置可拆卸的安装工具和加压工具5，所述加压工具5的外径大于所述第一开孔13的直径，所述加压工具5为一中空结构，其内壁可与所述近端拉力锁定钉2螺纹连接，所述安装工具用来将近端拉力锁定钉2植入股骨头内，所述加压工具5用来加压骨折断端以使骨折线闭合；其中，所述髓内钉1的远端12的底部为缩径的光滑圆锥体，所述圆锥体的底部为光滑的类球形结构，可以是球形或椭球形等光滑的形状，以利于髓内钉1植入髓腔的同时不易发生切割。As shown in Figure 1, the intramedullary nail 1 includes a proximal end 11 and a distal end 12, the diameter of the proximal end 11 is greater than the diameter of the distal end 12 to better match the structure of the medullary cavity, the The proximal end 11 is provided with a first opening 13 obliquely through, and the distal end 12 is provided with a second opening 14 through which the intramedullary nail 1 is installed in the medullary cavity; the proximal tension locking nail 2 penetrates The first opening 13, the front end 21 of the proximal tension locking nail 2 enters the femoral head, and the tail end 22 of the proximal tension locking nail 2 is fixed with the intramedullary nail 1 through the fixing member 3; The distal locking nail 4 is fixed to the intramedullary nail 1 through the second opening 14 to stabilize the multi-point support; wherein, the intramedullary nail 1 and the proximal tension locking nail 2 are both hollow structure, which is hollow in the middle to pass through the respective guide needles; wherein, the tail end 22 of the proximal tension locking nail 2 is provided with a detachable installation tool and a pressure tool 5, and the outer surface of the pressure tool 5 The diameter is larger than the diameter of the first opening 13, and the pressure tool 5 is a hollow structure, and its inner wall can be threadedly connected with the proximal tension locking nail 2, and the installation tool is used to close the proximal tension locking nail 2 implanted in the femoral head, the press tool 5 is used to press the broken end of the fracture to close the fracture line; wherein, the bottom of the distal end 12 of the intramedullary nail 1 is a smooth cone with reduced diameter, the The bottom of the cone is a smooth spherical structure, which may be a smooth shape such as a sphere or an ellipsoid, so as to facilitate the implantation of the intramedullary nail 1 into the medullary cavity and prevent cutting.
在一较佳实施例中，所述近端拉力锁定钉2的前端21和尾端22均设置螺纹，其前端21的端部为光滑的类球形结构，可以是球形或椭球形等光滑的形状，以使近端拉力锁定钉2植入股骨头时前端21不会发生切割，进一步地保护了骨骼；所述第一开孔13的内壁设置螺纹，所述固定件3为一中空结构，所述固定件3的外壁设置与所述第一开孔13配套的螺纹，所述固定件3的内壁设置与所述近端拉力锁定钉2的尾端22配套的螺纹，从而完成近端拉力锁定钉2和髓内钉1的自身锁定，防止其发生扭转；所述远端锁定钉4与所述第二开孔14为螺纹连接以起到髓内钉1多点支撑的稳固作用。本发明并不限定髓内钉与近端拉力锁定钉、髓内钉与远端锁定钉的连接方式，也可采用其他可靠的固定连接方式，比如旋转卡接、铆接等。In a preferred embodiment, the front end 21 and the tail end 22 of the proximal tension locking nail 2 are provided with threads, and the end of the front end 21 is a smooth spherical structure, which can be a smooth shape such as a spherical or ellipsoid so that when the proximal tension locking nail 2 is implanted into the femoral head, the front end 21 will not be cut, which further protects the bone; the inner wall of the first opening 13 is provided with threads, and the fixing member 3 is a hollow structure, so The outer wall of the fixing member 3 is provided with threads matching the first opening 13, and the inner wall of the fixing member 3 is provided with threads matching the tail end 22 of the proximal tension locking nail 2, thereby completing the proximal tension locking The self-locking of the nail 2 and the intramedullary nail 1 prevents it from twisting; the distal locking nail 4 is threadedly connected with the second opening 14 to stabilize the multi-point support of the intramedullary nail 1 . The present invention does not limit the connection method between the intramedullary nail and the proximal tension locking nail, or between the intramedullary nail and the distal locking nail, and other reliable fixed connection methods may also be used, such as rotary clamping, riveting and the like.
在一较佳实施例中，所述近端拉力锁定钉2的尾端22的端部为内六角结构，所述安装工具为内六角扳手，所述内六角扳手与所述尾端22的端部配合，以将近端拉力锁定钉2植入股骨头，直至近端拉力锁定钉2的前端21穿过骨折线，此时可移除内六角扳手。本发明并不限定安装工具的形式，也可采用其他的合适的安装工具，如其可为外六角扳手，此时所述近端拉力锁定钉2的尾端22的端部则为外六角结构；其还可为十字螺丝刀，此时所述近端拉力锁定钉2的尾端22的端部则为十字螺丝结构。In a preferred embodiment, the end of the tail end 22 of the proximal tension locking nail 2 is an inner hexagonal structure, the installation tool is an inner hexagonal wrench, and the inner hexagonal wrench is connected to the end of the tail end 22. Cooperate with the part to implant the proximal tension locking nail 2 into the femoral head until the front end 21 of the proximal tension locking nail 2 passes through the fracture line, at which point the Allen wrench can be removed. The present invention does not limit the form of the installation tool, and other suitable installation tools can also be used, such as an external hexagonal wrench, and the end of the tail end 22 of the proximal tension locking nail 2 is an external hexagonal structure; It can also be a Phillips screwdriver. At this time, the end of the tail end 22 of the proximal tension locking nail 2 is a Phillips screw.
在一较佳实施例中，如图2所示，当需要加压操作时，可采用加压工具5进行加压。所述加压工具5的外径大于所述第一开孔13的直径，至少大5～8mm，，当需要加压时，使用此加压工具5顶住所述髓内钉1的外壁，在拧紧的同时实现断面的加压以完成骨折线的闭合。In a preferred embodiment, as shown in FIG. 2 , when pressurization is required, a pressurizing tool 5 can be used for pressurization. The outer diameter of the pressurizing tool 5 is larger than the diameter of the first opening 13, at least 5-8mm larger. When pressurization is required, the pressurizing tool 5 is used to withstand the outer wall of the intramedullary nail 1, Compression of the fracture surface is achieved while tightening to complete closure of the fracture line.
在一较佳实施例中，所述近端11的直径为13～15mm(如14mm)，所述远端12的直径为8.5～10.5mm(如9.5mm))，所述近端11的横截面为圆弧梯形；所述髓内钉1具有10～14°(如12°)的前倾角，所述近端11具有3～5°(如4°)的外翻角；所述近端拉力锁定钉2的直径为9～11mm(如10mm)，所述远端锁定钉(4)的直径4～6mm(如5mm)，上述各尺寸范围均是最适宜国人人体股骨转子间结构的尺寸，这使得整体的器械尺寸更小巧，降低了生产成本及占用空间，采用上述尺寸的髓内钉形态与髓腔的匹配度更一致，而近端采用的圆弧梯形设计更利于髓内钉的抗旋转；相对现有技术中的直线形态的髓内钉，髓内钉的前倾角的设定使得髓内钉更易于植入髓腔，从而减少了术中、术后出血，髓内钉近端的外翻角的设定使得医护人员在手术过程更易于操作，从而缩短了手术时间，同时避免了手术过程中骨折的移位，降低了病人的痛苦。In a preferred embodiment, the diameter of the proximal end 11 is 13-15 mm (such as 14 mm), the diameter of the distal end 12 is 8.5-10.5 mm (such as 9.5 mm)), and the transverse diameter of the proximal end 11 is The section is arc-trapezoidal; the intramedullary nail 1 has an anteversion angle of 10-14° (such as 12°), and the proximal end 11 has a valgus angle of 3-5° (such as 4°); the proximal end The diameter of the tension locking nail 2 is 9 to 11 mm (such as 10 mm), and the diameter of the distal locking nail (4) is 4 to 6 mm (such as 5 mm). The above-mentioned size ranges are the most suitable for the intertrochanteric structure of the Chinese human body. , which makes the overall size of the instrument smaller, reducing the production cost and occupying space. The shape of the intramedullary nail with the above size is more consistent with the matching degree of the medullary cavity, and the arc trapezoidal design of the proximal end is more conducive to the intramedullary nail. Anti-rotation; Compared with the linear intramedullary nail in the prior art, the setting of the forward inclination angle of the intramedullary nail makes it easier to implant the intramedullary nail into the medullary cavity, thereby reducing bleeding during and after the operation. The setting of the valgus angle at the end makes it easier for the medical staff to operate during the operation, thereby shortening the operation time, avoiding the displacement of the fracture during the operation, and reducing the pain of the patient.
在一较佳实施例中，所述近端拉力锁定钉2为一体成型的两端外部均设置螺纹的结构，其中所述近端拉力锁定钉2的前端21的直径大于所述近端拉力锁定钉2的尾端22的直径，所述前端21的直径等于或略小于所述第一开孔11的直径；可选的，所述近端拉力锁定钉2也可由配件一、配件二与配件三组成的复合结构，所述配件一与配件二的外部均设置螺纹，两者通过所述配件三连接；所述配件二可与所述安装工具和加压工具连接，所述配件一可植入股骨头内，所述配件一的直径大于所述配件二，所述配件一的直径等于或略小于所述第一开孔的直径。采用一体成型结构的近端拉力锁定钉需根据各病人的实际情况进行单独制造，其匹配度较高，更易于术后修复；而采用复合结构的近端拉力锁定钉可实现其近端拉力锁定钉长度的控制，可成批生产，成本较低，更易于大范围推广，采用上述型式的近端拉力锁定钉可避免使用螺旋刀片等辅助结构，从而避免了的骨折断端的分离移位。In a preferred embodiment, the proximal tension locking nail 2 is integrally formed with a threaded structure at both ends, wherein the diameter of the front end 21 of the proximal tension locking nail 2 is larger than that of the proximal tension locking nail 2 . The diameter of the tail end 22 of the nail 2, the diameter of the front end 21 is equal to or slightly smaller than the diameter of the first opening 11; Optionally, the proximal tension locking nail 2 can also be composed of accessories one, two accessories and accessories A composite structure composed of three parts, the first part and the second part are provided with threads, and the two are connected through the third part; the second part can be connected with the installation tool and the pressure tool, and the first part can be planted Inserting into the femoral head, the diameter of the first fitting is larger than that of the second fitting, and the diameter of the first fitting is equal to or slightly smaller than the diameter of the first opening. Proximal tension locking nails with one-piece structure need to be individually manufactured according to the actual conditions of each patient, which has a high degree of matching and is easier to repair after surgery; while proximal tension locking nails with a composite structure can achieve proximal tension locking The control of the length of the nail can be mass-produced, the cost is low, and it is easier to promote on a large scale. The use of the above-mentioned type of proximal tension locking nail can avoid the use of auxiliary structures such as helical blades, thereby avoiding the separation and displacement of the fractured ends.
本发明所述的股骨转子间骨折髓内固定系统的操作步骤如下：The operating steps of the intertrochanteric fracture intramedullary fixation system of the present invention are as follows:
骨折复位后，在大粗隆顶点开口，外接瞄准器将髓内钉1的导引针打入髓腔，然后将导向器与髓内钉1连接沿着其导引针将髓内钉1插入髓腔，透视髓内钉1位置良好后，移去导向器；外接瞄准器从髓内钉1的近端11的第一开孔13位置打入拉力锁定钉2的导引针，沿其导引针通过配套的安装工具拧入近端拉力锁定钉2，透视见近端拉力锁定钉2的前端21的螺纹过骨折线后，移去安装工具；使用加压工具5进行断端加压，边拧入边加压，透视骨折线完全闭合后，拆除加压工具5，拧入固定件3使之连接固定髓内钉1与拉力锁定钉2；在髓内钉1的远端12的第二开孔14处拧入远端锁定钉4，手术完成。After the fracture is reduced, an opening is opened at the apex of the greater trochanter, and the guide needle of the intramedullary nail 1 is driven into the medullary cavity with an external aimer, and then the guide is connected with the intramedullary nail 1 and inserted into the intramedullary nail 1 along the guide needle. After seeing the intramedullary nail 1 in a good position in the medullary cavity, remove the guide; the external aimer is driven into the guide needle of the tension locking nail 2 from the position of the first opening 13 of the proximal end 11 of the intramedullary nail 1, and guides along it. The guide pin is screwed into the proximal tension locking nail 2 through the matching installation tool. After the thread of the front end 21 of the proximal tension locking nail 2 passes through the fracture line, remove the installation tool; use the pressure tool 5 to pressurize the broken end, Press while screwing in, and after the fluoroscopy fracture line is completely closed, remove the pressurizing tool 5, and screw in the fixing part 3 to connect and fix the intramedullary nail 1 and the tension locking nail 2; The distal locking nail 4 is screwed into the second opening 14, and the operation is completed.
由上述实施例可知，本发明所述的股骨转子间骨折髓内固定系统，其结构简单，操作便利，其采用了独特设计的髓内钉结构，髓内钉的开孔内壁均带有螺纹且其与各螺钉的螺纹相匹配达到自身锁定而完成固定，不需要防旋钉等辅助结构；本发明所述的髓内钉的近端设计一拉力锁定钉，仅需要配套的可拆卸的加压工具即可根据个体需要实现加压或者不加压；本发明所述的髓内钉根据国人股骨转子间及股骨干近段髓腔解剖数据进行设计，更适合国人，具体表现为器械直径更小巧、髓内钉形态与髓腔更一致，近端圆弧梯形设计，利于抗旋转；本发明所述的髓内钉集成了髓内钉与锁定钢板的优点，因不需要扩髓有效缩短手术时间，且对髓腔干扰明显减少，大幅度减少术中、术后出血，进一步减少手术时间，更适合国人使用。It can be known from the above embodiments that the intertrochanteric fracture intramedullary fixation system of the present invention has a simple structure and is easy to operate. It adopts a uniquely designed intramedullary nail structure. It matches the thread of each screw to achieve self-locking and completes the fixation, without the need for auxiliary structures such as anti-rotation screws; the proximal end of the intramedullary nail according to the present invention is designed as a tension locking nail, which only needs a matching detachable pressurization screw. The tool can be pressurized or not pressurized according to individual needs; the intramedullary nail described in the present invention is designed according to the anatomical data of the femoral intertrochanter and the proximal femoral shaft of Chinese people, which is more suitable for Chinese people, and the specific performance is that the diameter of the instrument is smaller , The shape of the intramedullary nail is more consistent with the medullary cavity, and the proximal arc trapezoidal design is conducive to anti-rotation; the intramedullary nail of the present invention integrates the advantages of the intramedullary nail and the locking plate, and effectively shortens the operation time because no reaming is required , and the interference to the medullary cavity is significantly reduced, the intraoperative and postoperative bleeding is greatly reduced, and the operation time is further reduced, which is more suitable for Chinese people.
以上对本发明的具体实施例进行了详细描述，但其只作为范例，本发明并不限制于以上描述的具体实施例。对于本领域技术人员而言，任何对该实用进行的等同修改和替代也都在本发明的范畴之中。因此，在不脱离本发明的精神和范围下所作的均等变换和修改，都应涵盖在本发明的范围内。The specific embodiments of the present invention have been described in detail above, but they are only examples, and the present invention is not limited to the specific embodiments described above. For those skilled in the art, any equivalent modifications and substitutions to this practice are also within the scope of the present invention. Therefore, equivalent changes and modifications made without departing from the spirit and scope of the present invention shall fall within the scope of the present invention.
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