CN111281516A - Anatomical external fixation steel plate and fixation system for femoral neck fracture - Google Patents
Anatomical external fixation steel plate and fixation system for femoral neck fracture Download PDFInfo
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- CN111281516A CN111281516A CN202010124731.2A CN202010124731A CN111281516A CN 111281516 A CN111281516 A CN 111281516A CN 202010124731 A CN202010124731 A CN 202010124731A CN 111281516 A CN111281516 A CN 111281516A
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- 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, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/8061—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates specially adapted for particular bones
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- 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, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/808—Instruments for holding or positioning bone plates, or for adjusting screw-to-plate locking mechanisms
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B2017/564—Methods for bone or joint treatment
Abstract
The embodiment of the invention relates to an external fixation steel plate and a fixation system for anatomic femoral neck fracture, wherein the system comprises a fixation steel plate, a femoral neck fixation nail, a femoral neck lag screw and a locking screw; the external fixation steel plate for the anatomic femoral neck fracture comprises a first fixing part and a second fixing part, wherein the first fixing part is connected with the second fixing part: the first fixing part comprises a first positioning hole, a first oblique bolt hole, a second oblique bolt hole, a third oblique bolt hole, a combined tension bolt hole and a second positioning hole, and is matched with the femoral neck fixing nail and the femoral neck tension bolt for use; the second fixing part comprises a fixing screw hole and is matched with the locking screw for use. The near end of the fixing steel plate can ensure that at least 3 screws are placed into the femoral neck, wherein a tension screw hole is designed to pressurize the fracture end, a positioning screw hole is designed on the far end stem part to avoid nail withdrawing and plate withdrawing, two Kirschner wires are provided with holes to be used for quick positioning and temporary fixing, the operation is quicker, more reliable and more reasonable, and the fracture healing is promoted to the maximum extent.
Description
Technical Field
The invention relates to the field of orthopedic medical instruments, in particular to an external fixation steel plate for an anatomical femoral neck fracture marrow and a fixation system.
Background
Proximal femoral fractures including femoral neck fractures, intertrochanteric fractures and subtrochanteric fractures occur at a rate of about 7.3% of total adult fractures, and in elderly patients with fractures the rate of 23.8%. With the progress of aging of the global population, the incidence of femoral neck fractures increases year by year. After the femoral neck fracture occurs, the intramedullary blood perfusion of the femoral head is destroyed, and the blood supply of the joint capsule is also damaged along with the pressure rise in the joint cavity, so that the femoral neck fracture is not healed after the operation and the femoral head necrosis still occurs. The increasing need for treatment of femoral neck fractures and the high living quality requirements of patients have become a challenge for orthopedists.
With the further research of the theory and the technology of the internal fixation instrument, the internal fixation technology of three hollow compression screws for closed reduction is considered as the gold standard for treating femoral neck fracture. However, the three-nail internal fixation technology still has a plurality of defects. Firstly, the holding force of the three nails on the outer bone block is insufficient, and a considerable part of patients have nail withdrawing phenomenon after operation, so that the neck of the femur is shortened, reset is lost, and the nail withdrawing phenomenon is easier to occur particularly under the conditions of osteoporosis, fracture end crushing and the like; secondly, the process of placing the three nails has higher requirements on the operation experience of an operator and the mastering degree of the femur morphology, the three nails need to be perforated by using a kirschner wire before being placed, and a low-grade surgeon often needs to adjust the placing angle and height of the kirschner wire for multiple times, so that the bone structure is further damaged while a large amount of precious operation time is consumed, and the number of perspective times in the operation is increased; thirdly, even if the screw does not penetrate or cut out of the femoral neck during the intraoperative fluoroscopy and the postoperative radiograph, the actual screw penetration or cutting-out phenomenon occurs sometimes, and particularly, the screw penetrating out of the femoral neck at the upper back is difficult to find under the fluoroscopy due to the existence of the pear-shaped pit. Not only does the screw penetrate or cut out of the femoral neck affect the fixation, but also the severe one causes the fixation failure and seriously affects the prognosis of the patient.
Through retrieval, patent document of application publication No. CN 102551866A discloses a trapezoidal locking steel plate with radian for treating femoral neck fracture, which is provided with 6 parallel locking holes. The locking steel plate has the defects that firstly, the shape design of the locking steel plate does not conform to the anatomical morphology characteristics of the proximal outer edge of the thighbone of Chinese people, so that the matching degree of the steel plate and the outer edge of the thighbone is poor, larger gaps are easy to generate, complications such as extravasated blood, infection and the like are caused, and the operation time is prolonged due to the difficulty in placement; secondly, a well-designed Kirschner wire hole for accurate positioning is lacked, the placing position of the steel plate and the placing boundary of the screw are difficult to be determined quickly and accurately, and the stability of the steel plate is poor during perspective due to the single hole; thirdly, the positions and directions of the holes of the screws are unreasonable, and at least three screws cannot be placed in the femoral neck; fourthly, the screws are fixed in parallel, so that the screws are difficult to be ensured not to withdraw or withdraw together with the steel plate; fifth, the model is single, and steel plates with different widths and lengths are not available, so that better matching with the proximal lateral wall of the male femur and the female femur is difficult to achieve.
Disclosure of Invention
The invention aims to provide an anatomical femur neck fracture extramedullary fixing steel plate and a fixing system aiming at the defects of the prior art, and aims to design a steel plate which accords with the anatomical morphology characteristics of the proximal femur of Chinese population. Through measurement of a large sample Chinese population proximal femur three-dimensional image, a whole set of Chinese population proximal femur three-dimensional morphological parameter system with multiple indexes is finally summarized and summarized, and indexes such as the shape, the length, the width, the middle section radian, the number of related openings, the angle and the like of the steel plate are designed based on the parameter system. In order to further verify the matching performance of the designed steel plate and the real femur, the invention adopts an internal fixation matching virtual matching technology which has independent intellectual property rights and is based on a virtual reality technology, matches the steel plate with the proximal femur of a large sample Chinese population, arranges a screw and a Kirschner wire according to the hole opening direction, and repeatedly adjusts detailed parameters such as the shape of the steel plate, the hole opening direction and the like. By adopting the virtual matching technology, the internal fixed design can be repeatedly adjusted and repeatedly verified with less time consumption and lower cost.
The appearance design of the steel plate of the invention accords with the anatomical morphology characteristics of the proximal lateral wall of the femur, and the steel plate has various types of length and width which can be selected, has extremely high matching degree with the lateral wall, reduces the occurrence of extravasated blood and infection by a small gap, is easy to place, and saves the operation time; according to the invention, the rapid positioning and temporary fixing by placing two Kirschner wires are realized through the hole opening directions of the two Kirschner wires; designing a combined tension oblique bolt hole, wherein a femoral neck tension screw which is matched with the combined tension oblique bolt hole is designed to be half-thread, has the models of threads with different lengths, can be selected according to the difference of the fracture type and the separation form of the femoral neck, and realizes the reduction and the pressurization of the fracture end after being placed; the screw hole opening direction of the proximal part of the steel plate is matched with the shape of the femoral neck, so that at least 3 screws can be arranged in the femoral neck, the requirement of clinical internal fixation operation is met, the screw hole opening directions are different, the angle of the arranged femoral neck fixing nail can be stable, the effectiveness and the stability of internal fixation are ensured, the femoral neck fixing nail is designed into a full-thread hollow locking screw, the hollow design can be matched with a Kirschner wire for use, the holding force of the screw can be enhanced through the full-thread design, and the reliability and the effectiveness of screw fixation are ensured; the distal end of the invention is properly extended and provided with a single opening, and the steel plate can be connected with the femoral shaft by inserting the locking screw, so that the femoral neck screw and the steel plate are prevented from backing off the nail and backing off the plate together. The advantages can make the operation more simple, the time consumption less, and the fixation reliable, reduce the recovery time of the patient, and have better prognosis function.
In a first aspect, an embodiment of the present invention provides an anatomical external fixation steel plate for femoral neck fracture, which is a plate-shaped structure and includes a first fixation portion and a second fixation portion, and the first fixation portion is connected with the second fixation portion;
the inner surface of the first fixing part is an arc-shaped surface and is used for being matched with the outer curved surface of the proximal end of the femur; the first fixing portion includes:
the first positioning hole is positioned at the upper part of the first fixing part and used for fixing a first Kirschner wire, the first Kirschner wire penetrates through the first positioning hole, and the inclination angle of the plane where the first Kirschner wire and the second fixing part are positioned is a first horizontal inclination angle;
the first oblique inserting screw hole is positioned below the first positioning hole, after the first femoral neck fixing nail penetrates through the first oblique inserting screw hole, a first upper screwing part of the first femoral neck fixing nail is in screwed connection with the first oblique inserting screw hole, and the inclination angle of the plane where the first femoral neck fixing nail and the second fixing part are positioned is a second horizontal inclination angle;
the second oblique bolt hole is positioned in the middle of the first fixing part, after the second femoral neck fixing nail penetrates through the second oblique bolt hole, a second upper screw part of the second femoral neck fixing nail is in screw connection with the second oblique bolt hole, and the inclination angle of the plane where the second femoral neck fixing nail and the second fixing part are positioned is a third horizontal inclination angle;
the third oblique bolt hole is positioned in the middle of the first fixing part, when a third femoral neck fixing nail penetrates through the third oblique bolt hole, a third upper screw part of the third femoral neck fixing nail is in screw connection with the third oblique bolt hole, and the inclination angle of the plane where the third femoral neck fixing nail and the second fixing part are positioned is a fourth horizontal inclination angle;
the combined tension screw hole is positioned at the lower part of the third inclined insertion hole and is used for inserting a femoral neck tension screw;
the second positioning hole is positioned at the lower part of the first fixing part and used for fixing a second Kirschner wire, the second Kirschner wire penetrates through the second positioning hole, and the inclination angle of the plane where the second Kirschner wire and the second fixing part are positioned is a fifth horizontal inclination angle;
the second fixing portion includes:
and the fixing screw hole is positioned on the surface of the second fixing part and used for fixing the locking screw.
Preferably, the ranges of the first horizontal inclination angle and the second horizontal inclination angle are both 95-110 degrees;
the third horizontal inclination angle, the fourth horizontal inclination angle and the fifth horizontal inclination angle are all in the range of 110-135 degrees.
Preferably, an inclination angle of the plane where the locking screw and the second fixing portion are located is a sixth horizontal inclination angle, and the sixth horizontal inclination angle is 90 °.
Preferably, the curvature radius of the arc-shaped lower surface between the first positioning hole and the combined tension screw hole is R1, and the range of R1 is 10mm-30 mm;
the curvature radius of the arc-shaped lower surface between the joint tension screw hole and the second positioning hole is R2, and the range of R2 is 30-100 mm.
Further preferably, the R1 shows a trend, and the R2 shows a trend.
Preferably, the width range of the anatomical femoral neck fracture extramedullary fixing steel plate is 20-40 mm; the length range of the anatomical femoral neck fracture extramedullary fixing steel plate is 50 mm-110 mm.
Preferably, a normal vertical direction inclination angle of a plane where the first kirschner wire and the second fixing part are located is a first vertical inclination angle;
the normal vertical direction inclination angle of the first femoral neck fixing nail and the plane of the second fixing part is a second vertical inclination angle;
the normal vertical direction inclination angle of the second femoral neck fixing nail and the plane of the second fixing part is a third vertical inclination angle;
the normal vertical direction inclination angle of the third femoral neck fixing nail and the plane of the second fixing part is a fourth vertical inclination angle;
the normal vertical direction inclination angle of the plane where the second Kirschner wire and the second fixing part are located is a fifth vertical inclination angle;
the first vertical inclination angle and the second vertical inclination angle range from 5 degrees to 20 degrees;
the third vertical inclination angle and the fourth vertical inclination angle range from 5 degrees to 15 degrees;
the range of the fifth vertical inclination angle is 5-30 degrees.
Preferably, the first fixing portion and the second fixing portion are of an integrally formed structure.
In a second aspect, an embodiment of the present invention further provides an anatomical femoral neck fracture intramedullary fixation system, including the anatomical femoral neck fracture intramedullary fixation steel plate, the first femoral neck fixation nail, the second femoral neck fixation nail, the third femoral neck fixation nail, the femoral neck tension screw, and the locking screw described in the first aspect.
Preferably, the first femoral neck fixing nail, the second femoral neck fixing nail and the third femoral neck fixing nail are of full-thread hollow structures, and the femoral neck lag screw is of a half-thread hollow structure.
The anatomical external fixation steel plate and the fixation system for femoral neck fracture at least have the following beneficial effects:
through deep research and exploration on the anatomical morphological characteristics of the proximal femur of a large sample Chinese population, the shape of the steel plate has extremely high matching degree with the outer side wall of the proximal femur, the small gap reduces the occurrence of extravasated blood and infection, and the steel plate is easy to place and saves the operation time;
the screw is simulated to be placed into the steel plate to form the hole through the virtual reality technology, the hole is matched with the proximal femur end of a large sample Chinese population and is repeatedly adjusted, the cross section of the femoral neck is small, and in order to enable more screws to be placed into the hole without mutual influence, the hole opening direction of the screw at the proximal end part of the invention is matched with the shape of the femoral neck, at least 3 screws can be placed into the femoral neck, the clinical requirement is met, the hole opening directions of the screws are different, the angle formed by the placed screws is stable, and the effectiveness and the stability of internal fixation are guaranteed. In addition, the femoral neck fixing nail is designed into a full-thread hollow locking screw, the hollow design can be matched with a Kirschner wire for use, the full-thread design can enhance the holding force of the screw, and the reliability and effectiveness of screw fixation are further ensured;
thirdly, designing a combined tension screw hole, placing forward or backward femoral neck tension screws with threads of different lengths through the combined screw hole according to different shapes and types of femoral neck fractures, resetting fracture lines under the action of tension and pressurizing fracture ends;
fourthly, the far end of the steel plate extends to the femoral shaft and is provided with a single opening, so that the steel plate can be connected with the femoral shaft through a locking screw, and the bone at the femoral shaft part is more compact, so that the fixation is firmer and the operation incision is prevented from being enlarged as much as possible;
fifthly, the rapid positioning and temporary fixing through the two Kirschner wires are realized through the holes formed in the two Kirschner wires, and the nail placing boundary can be rapidly determined according to the two Kirschner wires;
and sixthly, according to the anatomical morphological parameters of the proximal femur of Chinese population of the large sample, a plurality of steel plates with different types of width and length are designed, the steel plates can be maximally adapted to the outer side edge of the proximal femur of an individual, and the steel plates can be wrapped as far as possible but not exceed the front edge and the rear edge of the femur and can be matched with the individual difference of the proximal femur length.
Drawings
FIG. 1 is a top view of an external fixation plate for an anatomic femoral neck fracture according to an embodiment of the present invention;
fig. 2 is a top view of a first fixing portion according to an embodiment of the present invention;
FIG. 3 is a side view of an external fixation plate for an anatomic femoral neck fracture according to an embodiment of the present invention;
FIG. 4 is a second side view of an external fixation plate for an anatomic femoral neck fracture according to an embodiment of the present invention;
FIG. 5 is a schematic structural view of a femoral neck fixing nail according to an embodiment of the present invention;
FIG. 6 is an enlarged view of a portion I of a femoral neck fixation nail according to an embodiment of the present invention;
FIG. 7 is an enlarged view of a second portion of a femoral neck fixation nail according to an embodiment of the present invention;
FIG. 8 is a schematic structural view of a femoral neck lag screw according to an embodiment of the present invention;
FIG. 9 is an enlarged view of a portion I of a femoral neck lag screw according to an embodiment of the present invention;
FIG. 10 is a schematic structural diagram of a locking screw according to an embodiment of the present invention;
FIG. 11 is a left side view of a locking screw provided in accordance with an embodiment of the present invention;
FIG. 12 is a right side view of a locking screw provided in accordance with an embodiment of the present invention;
FIG. 13 is an enlarged view of a portion of a locking screw I according to an embodiment of the present invention;
fig. 14 is a partially enlarged view of part ii of a locking screw according to an embodiment of the present invention.
Detailed Description
The technical solution of the present invention is further described in detail by the accompanying drawings and embodiments.
The embodiment of the invention provides an anatomical external fixation steel plate for femoral neck fracture, which is applied to fixation of fracture parts in femoral neck fracture surgery. Referring to fig. 1 to 4, the anatomical external fixation plate for femoral neck fracture has a plate-shaped structure, and specifically includes a first fixation portion 1 and a second fixation portion 2, where the first fixation portion 1 is connected with the second fixation portion 2, and preferably, the first fixation portion 1 and the second fixation portion 2 are integrally formed.
The outer surface of the first fixing part 1 is an arc-shaped curved surface with a certain radian, a plurality of screw holes and round holes are sequentially formed in the arc-shaped curved surface from the top to the bottom, the inner surface of the first fixing part 1 is an arc-shaped surface and is matched with the curved surface at the upper end of a femur, and the first fixing part 1 is fixed to the top end of the femur through a locking screw. The first fixing portion 1 includes a first positioning hole 11, a first inclined bolt hole 12, a second inclined bolt hole 13, a third inclined bolt hole 14, a combined tension bolt hole 15 and a second positioning hole 16. The first positioning hole 11 and the second positioning hole 16 are used for realizing rapid positioning and temporary fixing of the steel plate through the Kirschner wires, and the nail placing boundary can be rapidly determined according to two inserted Kirschner wires; the joint tension screw hole 15 is used for placing a femoral neck tension screw along the joint tension screw hole 15 according to the separation and displacement conditions of femoral neck fracture under intraoperative fluoroscopy so as to achieve the purpose of resetting and pressurizing the femoral neck fracture end; the first oblique bolt hole 12, the second oblique bolt hole 13 and the third oblique bolt hole 14 are used for attaching and fixing the inner surface of the first fixing part 1 and the bone surface of the outer side of the proximal femur through the femoral neck fixing nail, the screw is simulated to be placed into the hole of the steel plate through the virtual reality technology, the screw is matched with the proximal femur of a large sample Chinese population and is adjusted repeatedly, the cross section of the femoral neck is small, in order to enable more screws to be placed into the bone without mutual influence, the screw hole opening direction of the proximal part of the invention is matched with the shape of the femoral neck, at least 3 screws can be placed into the femoral neck, clinical requirements are met, the screw hole opening directions are different, the placed screws can form an angle stably, and effectiveness and stability of internal fixation are guaranteed.
The first positioning hole 11 is located at the upper part of the first fixing part 1, and is used for fixing a first kirschner wire, and the first kirschner wire penetrates through the first positioning hole 11, and here, the first positioning hole 11 refers to a hole for fixing the kirschner wire, and the first kirschner wire refers to a kirschner wire inserted into the first positioning hole 11. The inclination angle of the plane where the first kirschner wire and the second fixing part 2 are located is a first horizontal inclination angle, and the inclination angle of the normal direction of the plane where the first kirschner wire and the second fixing part 2 are located is a first vertical inclination angle.
The first oblique bolt hole 12 is located below the first positioning hole 11, and after the first femoral neck fixing nail penetrates through the first oblique bolt hole 12, a first upper screwing part of the first femoral neck fixing nail is in screw connection with the first oblique bolt hole 12. In a specific example, after the first femoral neck fixing nail is inserted into the first oblique tapped hole 12, the first upper screw portion of the first femoral neck fixing nail is screwed into the first oblique tapped hole 12, and as the first upper screw portion is screwed into the fastening screw of the first oblique tapped hole 12 and is engaged, the screw cap portion of the first femoral neck fixing nail stays in the upper edge portion of the first oblique tapped hole 12, the screw portion and the head portion of the first femoral neck fixing nail are inserted into the bone after passing through the first oblique tapped hole 12, during the insertion process, the inclination angle formed by the first femoral neck fixing nail and the plane of the second fixing portion 2 is referred to as a second horizontal inclination angle, and the vertical inclination angle formed by the normal direction of the plane of the first femoral neck fixing nail and the plane of the second fixing portion 2 is referred to as a second vertical inclination angle.
And the second inclined bolt hole 13 is positioned in the middle of the first fixing part 1, and after the second femoral neck fixing nail penetrates through the second inclined bolt hole 13, the second upper screw-connection part of the second femoral neck fixing nail is in screw connection with the second inclined bolt hole 13. In a specific example, after the second femoral neck fixing nail is inserted into the second oblique bolt hole 13, the second upper screw part of the second femoral neck fixing nail is screwed into the second oblique bolt hole 13, and as the second upper screw part is screwed into the fastening screw of the second oblique bolt hole 13 and is engaged, the screw cap part of the second femoral neck fixing nail stays in the upper edge part of the second oblique bolt hole 13, the screw part and the head part of the second femoral neck fixing nail are inserted into the bone after passing through the second oblique bolt hole 13, and during the insertion process, the inclination angle formed by the plane where the second femoral neck fixing nail and the second fixing part 2 are located is referred to as a third horizontal inclination angle, and the inclination angle formed by the normal direction of the plane where the second femoral neck fixing nail and the second fixing part 2 are located is referred to as a third vertical inclination angle.
And the third inclined bolt hole 14 is positioned in the middle of the first fixing part 1 and is close to the second inclined bolt hole 13, and after the third femoral neck fixing nail penetrates through the third inclined bolt hole 14, the third upper screwing part of the third femoral neck fixing nail is screwed with the third inclined bolt hole 14. In a specific example, after the third femoral neck fixing nail is inserted into the third oblique tapped hole 14, the third upper screw portion of the third femoral neck fixing nail is screwed with the third oblique tapped hole 14, and as the third upper screw portion is screwed and bitten with the fastening screw of the third oblique tapped hole 14, the screw cap portion of the third femoral neck fixing nail stays in the upper edge portion of the third oblique tapped hole 14, the screw portion and the head portion of the third femoral neck fixing nail pass through the third oblique tapped hole 14 and are implanted into the bone, during the implantation, the inclination angle formed by the third femoral neck fixing nail and the plane where the third fixing portion is located is referred to as a fourth horizontal inclination angle, and the vertical inclination angle formed by the normal direction of the plane where the third femoral neck fixing nail and the second fixing portion 2 are located is referred to as a fourth vertical inclination angle.
The combined tension screw hole 15 is composed of two adjacent screw holes, and when the combined tension screw hole is used, one of the two adjacent screw holes is located at the lower part of the third inclined inserting screw hole 14, tension screws can be placed at a proper angle according to actual requirements, and the number of the tension screws is one. The lag screw has different thread lengths, and aims to ensure that all threads can pass through the fracture end so as to realize reduction and pressurization of the fracture end, and meanwhile, the lag screw with longer threads is selected as much as possible so as to realize the stability and effectiveness of reduction of the fracture end. In a specific example, if the femoral neck fracture is of a underhead type, a half-thread lag screw with a shorter thread is selected for implantation; if the femoral neck fracture is of a transcervical type, a half-thread lag screw with a slightly longer thread is selected for implantation; if the femoral neck fracture is basal type, a half-thread lag screw with longer thread is selected for implantation. The direction of the tension screw needs to be adjusted according to actual reduction or fixation requirements and the experience of a clinician, and the reduction of the femoral neck fracture end can be realized after the screw thread passes through the fracture end and is further screwed down. In a specific example, if the fracture end separation part is arranged in the front, the tension screw insertion direction needs to be deviated to the front; if the fracture end separation part is close to the rear part, the insertion direction of the lag screw needs to be deviated to the rear part. The combined tension screw hole 15 is used for placing a tension screw along the front side or the rear side of the combined tension screw hole 15 according to the separation and displacement conditions of femoral neck fracture under intraoperative perspective, the fracture line is reset through the tension action after the screw thread passes through the fracture line, the fracture end is pressurized, and the placing angle can be adjusted according to actual requirements, so that the aims of resetting and pressurizing the femoral neck fracture end are fulfilled.
The second positioning hole 16 is located below the first fixing portion 1, and is used for fixing a second k-wire, and the second k-wire is inserted into the second positioning hole 16, where the second positioning hole 16 is a hole for fixing the k-wire, and the second k-wire is a k-wire inserted into the second positioning hole 16. The inclination angle formed by the plane of the second kirschner wire and the second fixing part 2 is referred to as a fifth horizontal inclination angle, and the vertical direction inclination angle formed by the normal direction of the plane of the second kirschner wire and the second fixing part 2 is referred to as a fifth vertical inclination angle.
In order to enable the steel plate to accord with the anatomical morphology characteristics of the proximal outer edge of the femur of Chinese people, the matching degree of the steel plate and the proximal outer edge of the femur is high, and the ranges of the first horizontal inclination angle and the second horizontal inclination angle are preferably 95-110 degrees; the ranges of the third horizontal inclination angle, the fourth horizontal inclination angle and the fifth horizontal inclination angle are preferably 110-135 degrees; the ranges of the first vertical inclination angle and the second vertical inclination angle are preferably 5-20 °; the third vertical inclination angle and the fourth vertical inclination angle range from 5 degrees to 15 degrees; the range of the fifth vertical inclination angle is 5-30 degrees. In a preferred embodiment, the first and second horizontal inclination angles are 101 °, the third, fourth and fifth horizontal inclination angles are 121 °, the first and second vertical inclination angles are preferably 13 °, the third vertical inclination angle is preferably 11 °, the fourth vertical inclination angle is preferably 8 ° and the fifth vertical inclination angle is preferably 22 °.
It should be noted that the first horizontal inclination angle and the second horizontal inclination angle may be the same or different; the third horizontal inclination angle, the fourth horizontal inclination angle and the fifth horizontal inclination angle can be the same or different; the first vertical inclination angle and the second vertical inclination angle can be the same or different; the first vertical tilt angle and the second vertical tilt angle may be the same or different.
The curvature radius of the arc-shaped lower surface between the first positioning hole 11 and the joint tension screw hole 15 is R1, and the value range of R1 is 10mm-30 mm; the radius of curvature of the arc-shaped lower surface between the joint tension screw hole 15 and the second positioning hole 16 is R2, and the value range of R2 is 30 mm-100 mm. In the preferred embodiment, R1 has a trend, R2 has a trend, and more preferably, R1 has a trend of 20mm-10mm-30mm from front to back, and R2 has a trend of 30mm-60mm-100mm from front to back.
The structure of the first fixing portion 1 is described in detail above, and the structure of the second fixing portion 2 is described below with reference to fig. 1 to 4, and the second fixing portion 2 includes a fixing screw hole 21.
The fixing screw hole 21 is positioned on the surface of the second fixing part 2, specifically, the inside of the fixing screw hole 21 is specifically composed of an upper edge part and a lower edge part, the surface of the upper edge part is a smooth curved surface and is matched with an upper screwed part of the locking screw, and the surface of the lower edge part is provided with a fastening thread; the inclination of the locking screw to the plane of the second fixing part 2 is a seventh horizontal inclination, preferably 90 °. The inner surface of the second fixing part 2 is also provided with an arc-shaped curved surface with a certain radian on one side which is jointed with the femoral shaft, and the radian of the arc-shaped curved surface of the inner surface of the second fixing part 2 can be adapted according to different patients and different fracture parts, so that the anatomical femoral neck fracture intramedullary fixing steel plate is more jointed with the surface of the femur.
The fixing screw hole 21 is matched with a locking screw for use, a fourth upper screwing part of the locking screw is screwed with the lower edge part of the fixing screw hole 21, a screw cap part of the locking screw stays in the upper edge part of the fixing screw hole 21, and a screw rod part and a screw head part of the locking screw penetrate through the fixing screw hole 21 respectively and are implanted into a bone. The steel plate and the femoral shaft can be connected and fixed through the locking screw by extending the far end of the steel plate to the fixing screw hole 21 designed on the femoral shaft, and the bone at the femoral shaft part is more compact, so that the fixation is firmer and the operation incision is prevented from being enlarged as much as possible.
In a preferred embodiment, the width of the anatomical femoral neck fracture intramedullary fixation steel plate ranges from 20mm to 40mm, that is, the width of the widest part ranges from 20mm to 40mm, so as to conform to the shape of the proximal lateral wall of the femur of different individuals, and the steel plate is wrapped as much as possible but not beyond the anterior-posterior edge of the femur. The length range of the anatomic femoral neck fracture extramedullary fixing steel plate is 50 mm-110 mm so as to match the individual difference of the length of the femoral shaft. According to the invention, a plurality of steel plates with different types of width and length are designed according to the anatomical morphological parameters of the proximal femur of Chinese population of a large sample, the adaptation of the steel plates and the outer edge of the proximal femur of an individual can be realized to the maximum extent, and the steel plates can wrap the proximal femur and the rear femur as much as possible without exceeding the front and rear edges and can be matched with the individual difference of the proximal femur length.
In a more preferred embodiment, the first femoral neck fixing nail, the second femoral neck fixing nail and the third femoral neck fixing nail are of full-thread hollow structures, specifically, as shown in fig. 5, 6 and 7, the hollow design can be used in cooperation with a kirschner wire, the full-thread design can enhance the holding force of the screw, and further ensure the reliability and effectiveness of screw fixation, and a person skilled in the art can set the specifications of the threads on the femoral neck fixing nail according to needs.
Further, the femoral neck lag screw has a half-thread hollow structure, and particularly, as shown in fig. 8 and 9, the femoral neck lag screw has different thread types with different lengths, and a user can select the type and the separation form of the femoral neck fracture.
Further, the locking screw has a full thread structure, the head has a self-tapping blade, and the upper thread and the lower thread are different, as shown in fig. 10 to 14, and those skilled in the art can set the specification of the thread on the locking screw and the length of the locking screw as needed.
The above is an introduction of the components of the anatomical external fixation plate for femoral neck fracture and the connection relationship between the components, and the following is a detailed description of the usage of the anatomical external fixation plate for femoral neck fracture with reference to fig. 1 to 4.
After a doctor selects a proper anatomic femoral neck fracture intramedullary fixing steel plate in a femoral neck fracture operation, when the anatomic femoral neck fracture intramedullary fixing steel plate is used for fixing a fracture part, a kirschner wire, a femoral neck fixing nail, a femoral neck tension screw and a locking screw are used in a matched mode. The process used in conjunction is described in detail below.
In a specific femoral neck fracture operation process, a doctor aligns and fits a first fixing part 1 of the anatomical femoral neck fracture extramedullary fixing steel plate with a bone surface at the top end of a femur, and places a first Kirschner wire and a second Kirschner wire through a first positioning hole 11 and a second positioning hole 16, so that the quick positioning and temporary fixing effects can be achieved. After the two Kirschner wires are placed, the steel plate cannot shift or rotate during perspective, and the ideal position of the second Kirschner wire placed along the second positioning hole 16 is above the lower edge of the femoral neck and clings to the lower edge of the femoral neck, so that the height can be determined through perspective; the first Kirschner wire placed in the direction of the first positioning hole 11 is positioned in the center of the femoral neck, so that the rotation can be determined through perspective, therefore, the rapid positioning and temporary fixing through placing two Kirschner wires are realized through the two Kirschner wire holes, and the nail placing boundary can be determined rapidly according to the placed two Kirschner wires.
After the position of the steel plate is determined, according to the actual situation or the preference of a doctor and according to the difference of the fracture forms of the neck of femur, a forward or backward tension screw is placed in the joint tension screw hole 15, the fracture line is reset under the action of tension, and the fracture end is pressurized.
After that, screws are sequentially inserted in the screw hole opening direction. Specifically, the femur neck fixing nail is respectively arranged in a first oblique bolt hole 12, a second oblique bolt hole 13 and a third oblique bolt hole 14 in a penetrating manner, the screw part and the nail head part of the femur neck fixing nail are respectively implanted into the bone after penetrating through the bolt holes, and finally the first fixing part 1 of the anatomical femur neck fracture extramedullary fixing steel plate is fixed on the bone surface at the top end of the femur. The screw opening direction of the proximal part of the invention is matched with the shape of the femoral neck, so that at least 3 screws can be ensured to be arranged in the femoral neck, the clinical requirement is met, and the screw opening directions are different, so that the angle formed by the arranged femoral neck fixing nail is stable, and the effectiveness and the stability of internal fixation are ensured.
Finally, a locking screw is inserted along the fixing screw hole 21, an upper screwing part of the locking screw is screwed with a lower edge part of the fixing screw hole 21, a screw cap part of the locking screw stays in an upper edge part of the fixing screw hole 21, and a screw rod part and a screw head part of the locking screw are respectively inserted into the bone after passing through the fixing screw hole 21. The steel plate is connected with the femoral shaft through the locking screw by a single opening (a fixing screw hole 21) which is designed by extending the far end of the steel plate to the femoral shaft, and the bone at the femoral shaft part is more compact, so the fixation is firmer and the operation incision is prevented from being enlarged as much as possible.
Accordingly, on the basis of understanding the structure and the using method of the anatomical external fixation steel plate for femoral neck fracture provided in the embodiment of the present invention, an anatomical external fixation system for femoral neck fracture is further provided in the embodiment of the present invention, which includes the anatomical external fixation steel plate for femoral neck fracture, the first femoral neck fixation nail, the second femoral neck fixation nail, the third femoral neck fixation nail, the lag screw and the locking screw described in the above embodiment.
The embodiment of the invention provides an anatomical external fixation steel plate and a fixation system for femoral neck fracture, the shape design has high matching degree with the outer side wall of the proximal end of a femur, steel plates with various lengths and width models can be selected, the proximal end can ensure that at least 3 screws are placed into the femoral neck, a tension screw hole is designed for pressurizing a fracture end, a locking screw hole is designed at the distal end part to avoid screw withdrawing and plate withdrawing, two kirschner wires are provided with holes for quick positioning and temporary fixation, the operation is quicker, more convenient, more reliable and more reasonable, the perspective and bleeding during the operation are reduced, the fracture healing is promoted to the maximum extent, the curative effect of a patient is improved, and the occurrence of complications is reduced.
In the present invention, the term "plurality" means two or more unless explicitly defined otherwise. The terms "mounted," "connected," "fixed," and the like are to be construed broadly, and for example, "connected" may be a fixed connection, a removable connection, or an integral connection; "coupled" may be direct or indirect through an intermediary. The specific meanings of the above terms in the present invention can be understood by those skilled in the art according to specific situations.
In the description of the present invention, it is to be understood that the terms "upper", "lower", "left", "right", "front", "rear", and the like indicate orientations or positional relationships based on those shown in the drawings, and are only for convenience of description and simplification of description, but do not indicate or imply that the referred device or unit must have a specific direction, be constructed in a specific orientation, and be operated, and thus, should not be construed as limiting the present invention.
In the description herein, the description of the terms "a particular embodiment," "some embodiments," "an embodiment," etc., means that a particular feature, structure, material, or characteristic described in connection with the embodiment or example is included in at least one embodiment or example of the invention. In this specification, the schematic representations of the terms used above do not necessarily refer to the same embodiment or example. Furthermore, the particular features, structures, materials, or characteristics described may be combined in any suitable manner in any one or more embodiments or examples.
The above-mentioned embodiments are intended to illustrate the objects, technical solutions and advantages of the present invention in further detail, and it should be understood that the above-mentioned embodiments are merely exemplary embodiments of the present invention, and are not intended to limit the scope of the present invention, and any modifications, equivalent substitutions, improvements and the like made within the spirit and principle of the present invention should be included in the scope of the present invention.
Claims (10)
1. The anatomical femur and neck fracture external fixation steel plate is characterized in that the anatomical femur and neck fracture external fixation steel plate is of a plate-shaped structure and comprises a first fixing part and a second fixing part, and the first fixing part is connected with the second fixing part;
the inner surface of the first fixing part is an arc-shaped surface and is used for being matched with the outer curved surface of the proximal end of the femur; the first fixing portion includes:
the first positioning hole is positioned at the upper part of the first fixing part and used for fixing a first Kirschner wire, the first Kirschner wire penetrates through the first positioning hole, and the inclination angle of the plane where the first Kirschner wire and the second fixing part are positioned is a first horizontal inclination angle;
the first oblique inserting screw hole is positioned below the first positioning hole, after the first femoral neck fixing nail penetrates through the first oblique inserting screw hole, a first upper screwing part of the first femoral neck fixing nail is in screwed connection with the first oblique inserting screw hole, and the inclination angle of the plane where the first femoral neck fixing nail and the second fixing part are positioned is a second horizontal inclination angle;
the second oblique bolt hole is positioned in the middle of the first fixing part, after the second femoral neck fixing nail penetrates through the second oblique bolt hole, a second upper screw part of the second femoral neck fixing nail is in screw connection with the second oblique bolt hole, and the inclination angle of the plane where the second femoral neck fixing nail and the second fixing part are positioned is a third horizontal inclination angle;
the third oblique bolt hole is positioned in the middle of the first fixing part, when a third femoral neck fixing nail penetrates through the third oblique bolt hole, a third upper screw part of the third femoral neck fixing nail is in screw connection with the third oblique bolt hole, and the inclination angle of the plane where the third femoral neck fixing nail and the second fixing part are positioned is a fourth horizontal inclination angle;
the combined tension screw hole is positioned at the lower part of the third inclined insertion hole and is used for inserting a femoral neck tension screw;
the second positioning hole is positioned at the lower part of the first fixing part and used for fixing a second Kirschner wire, the second Kirschner wire penetrates through the second positioning hole, and the inclination angle of the plane where the second Kirschner wire and the second fixing part are positioned is a fifth horizontal inclination angle;
the second fixing portion includes:
and the fixing screw hole is positioned on the surface of the second fixing part and used for fixing the locking screw.
2. The anatomical femur neck fracture intramedullary fixation plate of claim 1, wherein the first horizontal inclination angle and the second horizontal inclination angle are both in the range of 95 ° to 110 °;
the third horizontal inclination angle, the fourth horizontal inclination angle and the fifth horizontal inclination angle are all in the range of 110-135 degrees.
3. The anatomical intramedullary fixation plate for femoral neck fractures according to claim 1, wherein the locking screw has a sixth horizontal inclination angle with respect to the plane of the second fixation portion, the sixth horizontal inclination angle being 90 °.
4. The anatomical extra-medullary fixation steel plate for femoral neck fracture according to claim 1, wherein the radius of curvature of the arc-shaped lower surface between the first positioning hole and the joint tension screw hole is R1, and the range of R1 is 10mm to 30 mm;
the curvature radius of the arc-shaped lower surface between the joint tension screw hole and the second positioning hole is R2, and the range of R2 is 30-100 mm.
5. The anatomical extra-medullary fixation steel plate for femoral neck fracture according to claim 4, wherein the R1 has a trend change and the R2 has a trend change.
6. The anatomical external fixation plate for femoral neck fracture according to claim 1, wherein the width of the anatomical external fixation plate for femoral neck fracture ranges from 20mm to 40 mm; the length range of the anatomical femoral neck fracture extramedullary fixing steel plate is 50 mm-110 mm.
7. The anatomical femur neck fracture intramedullary fixation plate of claim 1, wherein a vertical direction inclination angle normal to a plane in which the first k-wire and the second fixation portion are located is a first vertical inclination angle;
the normal vertical direction inclination angle of the first femoral neck fixing nail and the plane of the second fixing part is a second vertical inclination angle;
the normal vertical direction inclination angle of the second femoral neck fixing nail and the plane of the second fixing part is a third vertical inclination angle;
the normal vertical direction inclination angle of the third femoral neck fixing nail and the plane of the second fixing part is a fourth vertical inclination angle;
the normal vertical direction inclination angle of the plane where the second Kirschner wire and the second fixing part are located is a fifth vertical inclination angle;
the first vertical inclination angle and the second vertical inclination angle range from 5 degrees to 20 degrees;
the third vertical inclination angle and the fourth vertical inclination angle range from 5 degrees to 15 degrees;
the range of the fifth vertical inclination angle is 5-30 degrees.
8. The anatomical extra-medullary fixation steel plate for femoral neck fracture according to claim 1, wherein the first and second fixation portions are of an integrally formed structure.
9. An anatomical femoral neck fracture intramedullary fixation system comprising the anatomical femoral neck fracture extramedullary fixation plate of any one of claims 1 to 8, a first femoral neck fixation nail, a second femoral neck fixation nail, a third femoral neck fixation nail, a femoral neck lag screw and a locking screw.
10. The anatomical femoral neck fracture intramedullary fixation system of claim 9, wherein the first femoral neck fixation nail, the second femoral neck fixation nail, and the third femoral neck fixation nail are full-threaded cannulations and the femoral neck lag screw is a half-threaded cannulation.
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| Application Number | Priority Date | Filing Date | Title |
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| CN202010124731.2A CN111281516A (en) | 2020-02-27 | 2020-02-27 | Anatomical external fixation steel plate and fixation system for femoral neck fracture |
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| Application Number | Priority Date | Filing Date | Title |
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| CN202010124731.2A CN111281516A (en) | 2020-02-27 | 2020-02-27 | Anatomical external fixation steel plate and fixation system for femoral neck fracture |
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| CN111281516A true CN111281516A (en) | 2020-06-16 |
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| CN202010124731.2A Pending CN111281516A (en) | 2020-02-27 | 2020-02-27 | Anatomical external fixation steel plate and fixation system for femoral neck fracture |
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| CN112006768A (en) * | 2020-09-23 | 2020-12-01 | 杨润松 | Combined fixing device for femoral intramedullary nail steel plate |
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Application publication date: 20200616 |