CN108013926A - 锁骨弹性内固定器 - Google Patents

锁骨弹性内固定器 Download PDF

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CN108013926A
CN108013926A CN201711126836.6A CN201711126836A CN108013926A CN 108013926 A CN108013926 A CN 108013926A CN 201711126836 A CN201711126836 A CN 201711126836A CN 108013926 A CN108013926 A CN 108013926A
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谢志进
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    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
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    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
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    • A61B17/809Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with bone-penetrating elements, e.g. blades or prongs
    • AHUMAN NECESSITIES
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    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B2017/564Methods for bone or joint treatment

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Abstract

本发明公开了一种锁骨弹性内固定器,由钢板主体和弹力臂,以及钢板上附属的弹力片共同组成,当弹力臂钩端插入肩峰下方以后,通过下压钢板主体的近端可使锁骨向下复位,然后根据骨折段短缩情况决定是否通过滑动减压孔来恢复锁骨长度,远近折端的骨块分别通过远端锁定孔和近端锁定孔进行锁定固定,使之成为一个整体,这样,折端的应力通过弹力臂被转移至肩峰处,而弹力片则既能起到控制锁骨远端上抬的作用,又能通过自身的形变吸收应力或将应力分散至弹力臂全段,防止出现应力集中,从而最终实现弹性固定,也能避免传统锁骨钩钢板的各种弊端。

Description

锁骨弹性内固定器
技术领域
本发明涉及医疗器械领域,尤其涉及一种锁骨弹性内固定器。
背景技术
锁骨远端骨折脱位在临床较为常见,其中肩峰端骨折的治疗存在难点,使用锁骨钩钢板治疗时常见肩峰撞击痛、肩关节活动受限、断钩、断板、肩峰下骨质磨损等并发症,而使用锁骨远端锁定钢板治疗时则常见远端小骨块固定不牢,术后折端短缩以及不能早期功能锻炼等弊端;肩锁关节脱位的固定方法较多,如采用锁骨钩钢板、带袢钢板、锚钉系统、喙突螺钉及克氏针钢丝张力带等方法,其中锁骨钩钢板因其技术难度较低、固定牢固等优点最为常用,但仍存在类似并发症问题,而其他治疗方法则存在手术难度偏大,容易造成副损伤,手术过程复杂,学习曲线长,肩锁关节微动功能丢失以及固定失效等问题。
发明内容
针对现有技术容易造成肩峰撞击引起肩痛,肩关节活动受限,断钩、断板,肩峰下骨质磨损,肩锁关节微动功能丢失以及骨折术后折端短缩等缺陷,本发明提供了一种新型的锁骨弹性内固定器,通过弹力臂及弹力片来实现锁骨的弹性固定,避免或减少上述并发症的出现,从而更好地实现肩关节功能康复。
为了解决上述技术问题,本发明采用的技术方案是:一种锁骨弹性内固定器,包括钢板主体和弹力臂,以及钢板上附属的弹力片,钢板主体的远端区域内有多个远端锁定孔,远端锁定孔的近侧依次有拉力螺钉孔、滑动减压孔及近端锁定孔,钢板主体的后侧有两枚弹力片,弹力片通过弹力片固定螺钉与钢板固定,钢板近端通过板臂移行段过渡为弹力臂。
所述的钢板主体其外形符合锁骨中远段解剖形态,其远端膨大并向前侧凸出,数个远端锁定孔均匀分布其内,配合使用直径2.5mm~3mm的锁定螺钉进行远端折块的固定。
所述的拉力螺钉孔位于远端锁定孔的近侧,拉力螺钉钉头可完整沉入孔内。
所述的滑动减压孔位于拉力螺钉孔的近侧,其顶面有滑槽,该处使用直径3.5mm~4mm的普通螺钉进行固定,固定时螺钉钉头可下沉于滑槽内。
所述的近端锁定孔位于滑动减压孔的近侧,有2~3枚,该处使用直径3.5mm~4mm的锁定螺钉进行锁定。
所述的板臂移行段位于钢板主体的近端,呈“C”型,由前向后逐渐变窄变厚,并趋于柱状。
所述的弹力臂由板臂移行段延伸而出,整体位于钢板后侧,弹力臂起始段有既定下沉,远端上抬与钢板平面呈8°~15°夹角,弹力臂的中段呈圆柱状,其远端超出钢板主体的外缘后有两个折弯,似“Z”字形以适配肩峰的骨骼形态,弹力臂的远端逐渐变扁,端头圆润,形成钩端。
所述的弹力片位于钢板主体中远段的后侧,两枚并排设计,均向后方伸出,通过弹力片固定螺钉与钢板固定,弹力片超出钢板上缘部分为弧形下凹,下凹弧度与弹力臂中段弧度匹配。
本发明的有益效果是,首先,由于锁骨远端在发生肩锁关节脱位或者骨折后,锁骨远端或者骨折的近折端在会在斜方肌的作用下上抬,这时,当钩端插入肩峰下并使钢板主体贴服锁骨时,锁骨远端上抬的应力通过弹力臂的初始成角被得到对抗,此时内固定器的应力集中于弹力臂起始段,而在人体内的应力则集中于肩峰下方,若此时初始下压力还不能完全对抗锁骨的上抬应力,剩余的应力可通过弹力片继续施加至钢板而被对抗,此时,弹力片通过自身形变来吸收部分应力,而弹力臂受力后也会引起局部向上的细微弧变,这种变化趋势可使钩端在肩峰的受力点内移,避免了应力集中于肩峰下骨质,也就可避免肩峰下骨质的过度磨损;其次,对于锁骨远端骨折,尤其是粉碎性骨折,可以先通过滑动减压孔的分离作用来避免折端骨块间的压缩趋势,然后采用锁定螺钉技术这种较为牢固的固定方式使骨折段成为一个整体,以保证骨折复位后的稳定性,这样就可避免折端短缩的发生,也可以做到术后的早期功能锻炼;再者,通过滑动减压孔产生的分离力量则通过弹力臂被传导至肩峰,此时内固定器的应力集中于弹力臂“Z”形折弯的近端,通过这种弹性固定机制,使锁骨上抬及短缩的应力被均匀分散至弹力臂的全段,这样就解决了传统钩钢板容易断钩、断板的问题;另外,由于弹力臂及弹力片可通过形变来吸收应力,因此肩锁关节并不会被内固定器完全锁死,肩锁关节的微动功能得以保留,也解决了传统钩钢板术后肩锁关节微动功能丧失的问题;还有,与传统钩钢板相比,由弹力臂延伸出的钩端相对独立于钢板主体,钩端的插入位置可以比传统钩钢板更靠后,可避免占据肩峰下空间,使得术后因肩峰撞击引起肩痛的问题也得到解决。
该发明可适用于锁骨远端的各种类型骨折,具有防止复位丢失以及保留肩锁关节微动功能的效果,也适用于肩锁关节脱位的内固定。
附图说明
下面结合附图和实施例对本发明进一步说明。
图1为本发明的俯视图。
图2为本发明的侧视图。
图3为本发明的斜俯视图。
附图标记说明
1.钢板主体;2.近端锁定孔;3.滑动减压孔;4.拉力螺钉孔;5.弹力臂;6.弹力片;7.弹力臂远端折弯;8.弹力片固定螺钉;9.远端锁定孔;10.弹力臂起始段;11.板臂移行段;12.钩端。
具体实施方式
如附图所示,本实施例为一种锁骨弹性内固定器,材质以弹性模量较高的不锈钢为宜,区分左右设计,包括一体成型的钢板主体1和弹力臂5,以及钢板上附属的弹力片6,钢板主体1外形符合锁骨中远段解剖形态,其远端膨大并向前侧凸出,数个远端锁定孔9均匀分布其内,配合使用直径2.5mm~3mm的锁定螺钉进行远端折块的固定;其近侧设计有拉力螺钉孔4,当存在锁骨远端斜形骨折时在其内可进行垂直于骨折线的拉力螺钉独立固定,拉力螺钉钉头可完整沉入孔内;滑动减压孔3位于拉力螺钉孔4的近侧,其顶面有滑槽,该处使用直径3.5mm~4mm的普通螺钉进行固定,固定时螺钉钉头可下沉于滑槽内,在其近侧进行滑动减压后可恢复并维持锁骨既有长度,减少远端折块间及肩锁关节内的压力;近端锁定孔2位于滑动减压孔3的近侧,有2~3枚,该处使用直径3.5mm~4mm的锁定螺钉进行锁定;板臂移行段11位于钢板主体的近端,呈“C”型,由前向后逐渐变窄变厚,并趋于柱状;弹力臂5由板臂移行段11延伸而出,整体位于钢板后侧,弹力臂起始段10有既定下沉,远端上抬与钢板平面呈8°~15°夹角,弹力臂5的中段呈圆柱状,可减少内植物的软组织刺激,其远端超出钢板主体1外缘后有两个折弯7,似“Z”字形以适配肩峰的骨骼形态,弹力臂5的远端逐渐变扁,端头圆润,形成钩端12;弹力片6位于钢板主体1中远段的后侧,两枚并排设计,均向后方伸出,通过弹力片固定螺钉8与钢板主体1固定,弹力片6超出钢板上缘部分呈弧形下凹,下凹弧度与弹力臂5中段弧度匹配。
使用时先将弹力臂钩端12稍倾斜插入肩峰下方,然后按压钢板近端,通过弹力臂5提供的初始下压力可使锁骨远端向下复位(下压力度可通过不同规格直径的弹力臂5得以实现),锁骨远端的向上移位得到复位后以Allis钳在矢状轴方向进行临时固定,置入后的理想位置以弹力臂5轻贴弹力片6为宜,两枚弹力片6并排设计,可起到限制钢板上抬的趋势,如果有额外的上抬应力时可通过弹力片6的自身形变吸收,又可通过弹方臂5被均匀分散至钢板近端及弹力臂5的远端,避免了应力集中,也实现了弹性固定。如果锁骨远端的骨折断端存在短缩,可通过肩下垫枕以及在滑动减压孔3进行滑动减压来恢复锁骨长度,其后的内固定步骤与传统钩钢板基本一致。
上述实施例仅用来进一步说明本发明的一种锁骨弹性内固定器,但本发明并不局限于实施例,凡是依据本发明的技术实质对以上实施例所作的任何简单修改、等同变化与修饰,均落入本发明技术方案的保护范围内。

Claims (8)

1.一种锁骨弹性内固定器,其特征在于:包括锁骨远端钢板主体(1)和弹力臂(5),以及钢板上附属的弹力片(6),锁骨远端钢板主体(1)的远端区域内有多个远端锁定孔(9),远端锁定孔(9)的近侧依次有拉力螺钉孔(4)、滑动减压孔(3)及近端锁定孔(2),锁骨远端钢板主体(1)的后侧有两枚弹力片(6),弹力片(6)通过弹力片固定螺钉(8)与钢板固定,钢板近端通过板臂移行段(11)过渡为弹力臂(5)。
2.根据权利要求1所述的锁骨弹性内固定器,其特征在于:所述的锁骨远端钢板主体(1)其外形符合锁骨中远段解剖形态,其远端膨大并向前侧凸出,数个远端锁定孔(9)均匀分布其内,配合使用直径2.5mm~3mm的锁定螺钉进行远端折块的固定。
3.根据权利要求1所述的锁骨弹性内固定器,其特征在于:所述的拉力螺钉孔(4)位于远端锁定孔(9)的近侧,拉力螺钉钉头可完整沉入孔内。
4.根据权利要求1所述的锁骨弹性内固定器,其特征在于:所述的滑动减压孔(3)位于拉力螺钉孔(4)的近侧,其顶面有滑槽,该处使用直径3.5mm~4mm的普通螺钉进行固定,固定时螺钉钉头可下沉于滑槽内。
5.根据权利要求1所述的锁骨弹性内固定器,其特征在于:所述的近端锁定孔(2)位于滑动减压孔(3)的近侧,有2~3枚,该处使用直径3.5mm~4mm的锁定螺钉进行锁定。
6.根据权利要求1所述的锁骨弹性内固定器,其特征在于:所述的板臂移行段(11)位于锁骨远端钢板主体(1)的近端,呈“C”型,由前向后逐渐变窄变厚,趋于柱状。
7.根据权利要求1所述的锁骨弹性内固定器,其特征在于:所述的弹力臂(5)由板臂移行段(11)延伸而出,整体位于钢板后侧,弹力臂起始段(10)有既定下沉,远端上抬与钢板平面呈8°~15°夹角,弹力臂(5)的中段呈圆柱状,其远端超出钢板主体的外缘后有两个弹力臂远端折弯(7),似“Z”字形以适配肩峰的骨骼形态,弹力臂的远端逐渐变扁,端头圆润,形成钩端(12)。
8.根据权利要求1所述的锁骨弹性内固定器,其特征在于:所述的弹力片(6)位于锁骨远端钢板主体(1)中远段的后侧,两枚并排设计,均向后方伸出,通过弹力片固定螺钉(8)与钢板固定,弹力片(6)超出钢板上缘部分为弧形下凹,下凹弧度与弹力臂(5)中段弧度匹配。
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