CN113730049A

CN113730049A - Pressing bone grafting supporting device for femoral head necrosis

Info

Publication number: CN113730049A
Application number: CN202111096822.0A
Authority: CN
Inventors: 沈锦涛; 华茂奇; 李强; 武圣超; 李基威; 王上增
Original assignee: Henan Hospital Traditional Chinese Medicine Second Affiliated Hospital of Henan University of Traditional Chinese Medicine TCM
Current assignee: Henan Hospital Traditional Chinese Medicine Second Affiliated Hospital of Henan University of Traditional Chinese Medicine TCM
Priority date: 2021-09-18
Filing date: 2021-09-18
Publication date: 2021-12-03
Anticipated expiration: 2041-09-18
Also published as: CN113730049B

Abstract

The invention relates to a striking and pressing bone grafting supporting device for femoral head necrosis, which comprises a supporting steel plate, a positioning steel plate, a striking device and a traction device, wherein a center hole is formed in the center of the supporting steel plate, the section of the center hole is conical, tapered holes are symmetrically formed in two ends of the diameter direction of the center hole, the center hole can be in threaded connection with a sealing plug, counter bores are further formed in two sides of the tapered hole in the supporting steel plate, internal threads are formed in the counter bores, the counter bores are used for being in threaded connection with traction bolts, a guide pipe is arranged in the center of the positioning steel plate, through holes are formed in the positioning steel plate, the number of the through holes is not less than four, the through holes are used for accommodating the traction bolts, the traction bolts can penetrate through the through holes to splice and fix the supporting steel plate and the positioning steel plate, and external threads are formed in the end part of the guide pipe. The invention can solve the problems that the existing pressing bone grafting method for treating femoral head necrosis can not position the femoral head during pressing bone grafting, so that the cartilage cap is extruded and damaged and the pressed and implanted cancellous bone particles are not pressed firmly.

Description

Pressing bone grafting supporting device for femoral head necrosis

Technical Field

The invention relates to the technical field of orthopedic surgery repair, in particular to a pressing bone grafting supporting device for femoral head necrosis, which is used for repairing early femoral head necrosis.

Background

Ischemic necrosis of femoral head is better in young and strong people of 30-50 years old, and is one of important reasons for hip joint disability. If the patient is not treated effectively, 80% of patients will have femoral head deformation and collapse within 1-4 years, the joint surface of the femoral head is not smooth after collapse, cartilage abrasion is accelerated, hip joint loses stability, the patient can quickly enter into the osteoarthritis stage, irreversible pathological and structural changes occur, and finally, only artificial joint replacement treatment can be selected. Therefore, the femoral head collapse is an important disease course node, and clinical near-term follow-up results show that hip protection type intervention before femoral head collapse can effectively delay the femoral head necrosis course. The method for treating the femoral neck internal transplantation of the allogenic fibula can effectively delay the femoral head necrosis course, has high bone structure reconstruction quality, can restore the strength of the femoral head while reducing pressure, has better mechanical support for the later period of the femoral head, and is necessary for pressing cancellous bone between the hard fibula and the cartilage cap to implant bone, thereby not only avoiding stress concentration under cartilage, but also providing a support for new bone reconstruction.

In the existing pressing bone grafting method, because the bone is pressed and implanted between the opened femoral neck decompression channel and the transplanted fibula and the cartilage cap in a layered manner, the implanted cancellous bone particles need to be compacted in the pressing bone grafting process, frequent movement of the femoral head in the acetabulum is inevitably caused in the pressing and compacting process of the cancellous bone particles, the cartilage cap is also squeezed after the femoral head is subjected to pressing vibration, and is particularly damaged by the squeezing of necrotic and hardened bone structures in the cancellous bone, the damage of the cartilage cap is extremely unfavorable for the repair of the femoral head, and the femoral head moves due to ineffective fixation when the bone is pressed and implanted, the movement of the femoral head along with the pressing bone grafting can cause the incompact of the cancellous bone particles in the decompression femoral neck channel to be compacted, while the uncompacted cancellous bone particles can seriously delay the reconstruction of the bone structure, and further influence the repair of the femoral head dead zone, the existing pressing bone grafting method uses no tool which can position and support the femoral head.

Disclosure of Invention

In order to solve the problems in the background art, the invention provides a pressing bone grafting support device for femoral head necrosis, which comprises a support steel plate, a positioning steel plate, a pressing device and a traction device, wherein the support steel plate is used for relieving pressure of a medullary core to press a bone graft and a support after a fibula is implanted, the positioning steel plate is used for positioning and guiding the pressing device when the medullary core presses the bone graft, the pressing device can be connected with a conduit in the positioning steel plate and used for fixing and guiding the pressing bone grafting device, and the traction device is used for drawing the support steel plate and the positioning steel plate after combination, so that a cartilage cap of a femoral head is prevented from being extruded by a necrotic and hardened bone structure in the femoral head when the bone graft is pressed.

The invention can solve the problems that the existing pressing bone grafting method for treating femoral head necrosis can not position the femoral head during pressing bone grafting, so that the cartilage cap is extruded and damaged and the pressed and implanted cancellous bone particles are not pressed firmly.

In order to achieve the purpose, the invention provides the following technical scheme: the utility model provides a beat and press bone grafting strutting arrangement for femoral head necrosis, includes supporting steel plate, location steel plate, beats and presses device and tractive device, supporting steel plate center department sets up the centre bore, the centre bore cross-section is the toper, and further centre bore surface diameter size is less than the internal surface diameter size, and the toper design of centre bore has realized that the centre bore marginal region can not cause the hindrance to the guide pin when using the guide pin location necrosis region.

Furthermore, taper holes are symmetrically formed in two ends of the diameter direction of the central hole, the number of the taper holes is not less than two, the taper holes are used for accommodating first bolts, the supporting steel plate is fixed on a femur through the first bolts, a small-diameter opening of the central hole is provided with a spiral line, the spiral line at the small-diameter opening can be in threaded connection with the sealing plug, the spiral line arranged at the small-diameter opening of the central hole can effectively fix the sealing plug when the sealing plug is installed on the taper holes, so that the sealing plug can be ensured to abut against the opening of the femur to seal fibula and cancellous bone particles implanted in the pressure reducing core, the fibula is prevented from moving in the pressure reducing core, counter holes are further formed in two sides of the taper holes in the supporting steel plate, the number of the counter holes is not less than four, internal threads are formed in the counter holes, the counter holes are used for being in threaded connection with traction bolts, and a guide pipe is arranged in the center position of the positioning steel plate, the pipe axis becomes the contained angle design with location steel sheet place plane, the pipe is at 50-55 degrees scopes with location steel sheet place plane contained angle, it has the through-hole to open on the location steel sheet, through-hole quantity is no less than four, the through-hole is used for holding draw bolt, draw bolt can pass the through-hole and will support the steel sheet and fix a position the steel sheet concatenation fixed, the location steel sheet still includes the pterygoid lamina, the pterygoid lamina branch is in location steel sheet both sides, the draw bolt is also installed on the pterygoid lamina surface, the pipe end is opened there is the external screw thread.

Furthermore, the wing plate in the positioning steel plate realizes that the interval between the expanded steel wires in the bone grafting process vacates an operation space for the pressing device to press the bone graft in the pressure reducing core, and the guide pipe on the positioning steel plate realizes the guiding effect on the pressing device when the bone graft is pressed, so that the phenomenon that spongy bone particles pressed by pressing cannot reach the lower part of the cartilage cap along the channel of the pressure reducing core to cause the untimely pressing of the lower part of the cartilage cap is avoided.

Further, the device of suppressing includes the conveying pipeline, conveying pipeline one end is equipped with the adapter pipe, it has the internal thread to open in the adapter pipe, the adapter pipe can with the pipe spiro union on the location steel sheet, the conveying pipeline inside is equipped with the piston, open on the piston surface has the bleeder vent, four is no less than to bleeder vent quantity, the bleeder vent can avoid sealing up the air between piston and the spongy bone granule, the resistance that the piston received when avoiding suppressing the bone grafting, guide rod is connected to the piston terminal surface, guide rod outwards extends from the stand pipe of the conveying pipeline other end, it has the wide range screw thread to open the one end of keeping away from the piston on the guide rod, the spiro union weight on the wide range screw thread, the one end of keeping away from the adapter pipe on the conveying pipeline is equipped with the funnel, the funnel link up with the conveying pipeline, wide range screw thread bearing capacity is strong, and the wide range screw thread can be effectual with the inertia power of weight pass through guide rod to the piston when the weight is reciprocal suppressing, so as to carry out compact pressing on the spongy particles in the decompression core.

Furthermore, the traction device comprises a first base, the first base is connected with a sliding rail at the edge of the operating table, a locking rod is arranged on the first base, the locking rod is in threaded connection with the first base, the locking rod is used for locking the first base after adjustment, the first base further comprises an extension part, a sliding rod and a screw rod are arranged between the first base and the extension part, a rotating handle is arranged at one end of the screw rod, which is far away from the first base, a second base is in threaded connection with the screw rod, the second base is connected with the sliding rod, the sliding rod is used for guiding the second base, the upper part of the second base is connected with a first supporting rod, the first supporting rod is cylindrical, a sliding block is arranged on the first supporting rod, the locking rod is arranged on the sliding block, the sliding block is locked on the first supporting rod through the locking rod, and a second supporting rod is arranged on the sliding block, the second support rod is also cylindrical, a disc is arranged at one end, far away from the sliding block, of the second support rod, the center of the disc is connected with the end portion of the second support rod, pull rings are mounted at the center of the disc and the quartering position of the end face of the disc and used for connecting steel wires, and the other end of each steel wire pull wire can be connected with a traction bolt.

A method of percussive grafting of a femoral head using a percussive graft support device according to any of claims 1 to 3, comprising the steps of:

firstly, punching a femoral head by using a trepan with the aid of X-ray imaging equipment, reserving a circular bone fragment formed after punching, advancing a guide pin from the femoral head punching hole to a femoral head necrosis area, and stopping after the guide pin advances to a cartilage cap position;

secondly, a decompression core channel is formed in the axis direction of the guide pin by using bone taking equipment, the decompression core channel needs to extend inwards to a femoral head necrosis area, and after bone in the femoral head necrosis area is dug out by using a scraper tool, the decompression core is washed to clean bone particles remained in the decompression core;

thirdly, centering a central hole of the support steel plate with a round hole formed in the femoral head, and fixing the support steel plate to the femoral head by using a first bolt;

fourthly, connecting the positioning steel plate with the supporting steel plate by using a traction bolt;

fifthly, after the traction bolt is connected with a pull ring in the traction device by using a steel wire, adjusting the positions and angles of a first base, a second base, a first support rod and a second support rod in the traction device, locking the base on a slide rail through a locking rod after the steel wire is tensioned, locking the second support rod on the first support rod by using a slide block and the locking rod, and rotating a rotating handle adjusting screw rod to enable the steel wire between the disc and the positioning steel plate to be tensioned and draw the femur;

taking out the guide pin, connecting an adaptive pipe of the pressing device to an external thread of the guide pipe, pulling the heavy hammer outwards, then feeding cancellous bone particles into the funnel, driving the guide rod to push the piston inwards by the handheld heavy hammer to press the cancellous bone particles into the pressure reducing core, driving the piston to reciprocate by the handheld heavy hammer through the guide rod to press and compact the cancellous bone particles in the pressure reducing core for multiple times, and implanting the fibula into the pressure reducing core after the cavity below the cartilage cap is filled with the cancellous bone particles;

seventhly, after the fibula is implanted, removing the traction device and the positioning steel plate, and putting the round bone slices formed by punching in the first step back to the positions of the punched round holes of the thighbone through the center holes of the supporting steel plate;

eighthly, screwing the sealing plug into the central hole in the supporting steel plate to support the round bone plate

The invention has the beneficial effects that: the invention can solve the problems that the cartilage cap is extruded and damaged and the impacted and implanted cancellous bone particles are not compacted due to the fact that the femoral head cannot be positioned when the bone is impacted and implanted in the operation of treating femoral head necrosis by the existing impacting and bone grafting method through the matching of the supporting steel plate, the positioning steel plate and the traction device, and the impacting device can be used for impacting the cancellous bone particles in the pressure reducing core by using the inertia of the heavy hammer without assisting personnel to use the impacting hammer for impacting, so that the impacting operation is simplified, and the bone grafting efficiency is improved.

Drawings

In order to more clearly explain the technical solutions in the embodiments, the drawings in the embodiments will be briefly described below.

FIG. 1 is a perspective view of a support steel plate and a positioning steel plate according to the present invention.

Fig. 2 is a perspective view of the pressing device of the present invention.

Fig. 3 is a structural view of the pulling device of the present invention.

In the figure: 1. a support steel plate; 2. positioning a steel plate; 3. a pressing device; 4. a pulling device; 5. a central bore; 6. a taper hole; 7. a first bolt; 8. a helical line; 9. a sealing plug; 10. a counter bore; 11. a draw bolt; 12. a conduit; 13. a through hole; 14. a wing plate; 15. a delivery pipe; 16. a fitting pipe; 17. a piston; 18. air holes are formed; 19. a guide rod; 20. a guide tube; 21. wide pitch threads; 22. a weight; 23. a funnel; 24. a first base; 25. a locking lever; 26. an extension portion; 27. a slide bar; 28. a screw; 29. rotating the handle; 30. a second base; 31. a first support bar; 32. a second support bar; 33. a disc; 34. a pull ring; 35. a steel wire; 36. a slide block.

Detailed Description

The technical solution in the embodiments of the present invention is clearly and completely described below with reference to the drawings in the embodiments of the present invention. The detailed structure of the present invention will be apparent from the following detailed description of the structure with reference to fig. 1 to 3, and the structural contents mentioned in the following embodiments are all referred to in the attached drawings of the specification.

As shown in fig. 1 to 3, the support device for bone grafting by striking and pressing for femoral head necrosis of the present embodiment includes a support steel plate 1, a positioning steel plate 2, a striking device 3 and a drawing device 4, wherein a center hole 5 is formed at the center of the support steel plate 1, the cross section of the center hole 5 is tapered, two ends of the center hole 5 in the diameter direction are symmetrically provided with taper holes 6, the number of the taper holes 6 is not less than two, the taper holes 6 are used for accommodating a first bolt 7 and fixing the support steel plate 1 on the femur through the first bolt 7, a small-diameter opening of the center hole 5 is provided with a spiral line 8, the spiral line 8 at the small-diameter opening can be screwed with a sealing plug 9, two sides of the taper hole 6 on the support steel plate 1 are further provided with counter bores 10, the number of the counter bores 10 is not less than four, an internal thread is formed in the counter bores 10, the counter bores 10 are used for being screwed with a drawing bolt 11, a guide tube 12 is arranged at the center position of the positioning steel plate 2, and the guide tube 12 and the plane where the central axis positioning steel plate 2 is located form an included angle, the plane included angle that pipe 12 and location steel sheet 2 are located is in 50-55 degrees scopes, it has through-hole 13 to open on the location steel sheet 2, through-hole 13 quantity is no less than four, through-hole 13 is used for holding draw bolt 11, draw bolt 11 can pass through-hole 13 with supporting steel sheet 1 with the location steel sheet concatenation fixed, location steel sheet 2 still includes pterygoid lamina 14, pterygoid lamina 14 divides to live in 2 both sides in the location steel sheet, draw bolt 11 is also installed on pterygoid lamina 14 surface, pipe 12 tip is opened there is the external screw thread.

More specifically, the pressing device 3 can be connected with the conduit 12 in the positioning steel plate 2 for fixing and guiding the pressing bone grafting device, and the pulling device 4 is used for pulling the supporting steel plate 1 and the positioning steel plate 2 after being combined, so as to prevent the cartilage cap of the femoral head from being damaged when being pressed by the necrotic and hardened bone structure in the femoral head when being positioned on the acetabulum during pressing bone grafting

More specifically, the wing plate 14 in the positioning steel plate 2 realizes that the space between the expanded steel wires 35 vacates an operating space for the pressing device 3 to press the bone grafting into the pressure reducing core in the bone grafting process, and the guide pipe 12 on the positioning steel plate 2 realizes the guiding effect on the pressing device 3 when pressing the bone grafting, thereby avoiding the phenomenon that spongy bone particles pressed by pressing cannot reach the lower part of the cartilage cap along the channel of the pressure reducing core and the lower part of the cartilage cap is not pressed firmly.

Specifically, the pressurizing device 3 comprises a conveying pipe 15, one end of the conveying pipe 15 is provided with an adapting pipe 16, an internal thread is formed in the adapting pipe 16, the adapting pipe 16 can be in threaded connection with a guide pipe 12 on a positioning steel plate 2, a piston 17 is arranged inside the conveying pipe 15, air holes 18 are formed in the surface of the piston 17, the number of the air holes 18 is not less than four, a guide rod 19 is connected to the end face of the piston 17, the guide rod 19 extends outwards from a guide pipe 20 at the other end of the conveying pipe 15, one end, far away from the piston 17, of the guide rod 19 is provided with a wide-distance thread 21, a heavy hammer 22 is in threaded connection with the wide-distance thread 21, one end, far away from the adapting pipe 16, of the conveying pipe 15 is provided with a funnel 23, and the funnel 23 is communicated with the conveying pipe 15.

More specifically, wide range screw 21 bearing capacity is strong, and wide range screw 21 can be effectual transmits the inertial force of weight 22 to piston 17 through guide rod 19 when weight 22 is suppressed reciprocal, and then carries out closely knit the suppression to the spongy of bone granule in the decompression core, wherein guide rod 19 need adopt stainless steel.

Specifically, the traction device 4 includes a first base 24, the first base 24 is connected with a slide rail at the edge of the operating table, a locking rod 25 is arranged on the first base 24, the locking rod 25 is screwed with the first base 24, the locking rod 25 is used for locking the first base 24 after adjustment, the first base 24 further includes an extension portion 26, a sliding bar 27 and a screw 28 are arranged between the first base 24 and the extension portion 26, a rotating handle 29 is arranged at one end of the screw 28 far away from the first base 24, a second base 30 is screwed on the screw 28, the second base 30 is connected with the sliding bar 27, the sliding bar 27 is used for guiding the second base 30, the first support bar 31 is connected with the upper portion of the second base 30, the first support bar 31 is cylindrical, a sliding block 36 is arranged on the first support bar 31, the locking rod 25 is arranged on the sliding block 36, the sliding block 36 is locked on the first support bar 31 through the locking rod 25, a second support bar 32 is further arranged on the sliding block 36, the second support rod 32 is also cylindrical, a disc 33 is arranged at one end, far away from the sliding block, of the second support rod 32, the center of the disc 33 is connected with the end portion of the second support rod 32, pull rings 34 are arranged at the center of the disc 33 and on the end face of the disc 33 in a quartering mode, pull rings 34 are used for being connected with a steel wire 35, and the other end of the pull wire of the steel wire 35 can be connected with the traction bolt 11.

Based on the above-mentioned support device for the impact bone grafting of femoral head necrosis, the present invention also provides a method for the impact bone grafting of the femoral head by using the support device for the impact bone grafting, which comprises the following steps:

thirdly, centering a central hole 5 of the support steel plate 1 with a round hole formed in the femoral head, and fixing the support steel plate 1 to the femoral head by using a first bolt 7;

fourthly, connecting the positioning steel plate 2 with the supporting steel plate 1 by using a traction bolt 11;

fifthly, after the traction bolt 11 and a pull ring 34 in the traction device 4 are connected by using a steel wire 35, adjusting the positions and angles of a first base 24, a second base 30, a first support rod 31 and a second support rod 32 in the traction device 4, locking the bases on a slide rail through a locking rod after the steel wire 35 is ensured to be tensioned, locking the second support rod 32 on the first support rod 31 by using a slide block and a locking rod 25, and rotating a rotating handle 29 to adjust a screw 28 so that the steel wire 35 between a disc 33 and a positioning steel plate 2 is tensioned and a femur is pulled;

sixthly, taking out the guide pin, connecting an adaptive pipe 16 of the pressing device 3 to an external thread of the guide pipe 12, pulling a heavy hammer 22 outwards, then feeding spongy bone particles into a funnel 23, driving a guide rod 19 to push a piston 17 inwards by the handheld heavy hammer 22 to press the spongy bone particles into the pressure reducing core, driving the piston 17 to reciprocate by the handheld heavy hammer 22 through the guide rod 19 for multiple times to press and compact the spongy bone particles in the pressure reducing core, and then implanting fibulas into the pressure reducing core after the cavity below the cartilage cap is filled with the spongy bone particles;

seventhly, after the fibula is implanted, the traction device 4 and the positioning steel plate 2 are removed, and the round bone slices formed by punching in the first step are placed back to the round hole positions of the femoral punching through the central hole 5 of the supporting steel plate 1;

and eighthly, screwing the sealing plug 9 into the central hole 5 in the support steel plate 1 to support the round bone fragments.

The foregoing description is further illustrative of the present invention and is not to be construed as limiting thereof, the scope of which is defined in the appended claims, and the invention may be modified in any manner without departing from the essential structure thereof.

Claims

1. The utility model provides a beat and press bone grafting strutting arrangement for femoral head necrosis, includes supporting steel plate, location steel sheet, beats and presses device and draw-off gear, its characterized in that, supporting steel plate center department sets up the centre bore, the centre bore cross-section is the toper, the both ends symmetry of centre bore diameter direction is opened there is the taper hole, taper hole quantity is no less than two, the taper hole is used for holding first bolt to be fixed in the thighbone through first bolt with supporting steel plate on, the path mouth of centre bore is equipped with the helix, the helix of path mouth department can the spiro union sealing plug, still opened the counter bore in the taper hole both sides on the supporting steel plate, four are no less than to counter bore quantity, open the internal thread in the counter bore, the counter bore is used for spiro union traction bolt, location steel sheet central point puts and is equipped with the pipe, the pipe axis becomes the contained angle design with location steel sheet place plane, the pipe is in 50-55 degrees scopes with location steel sheet place plane contained angle, it has the through-hole to open on the location steel sheet, through-hole quantity is no less than four, the through-hole is used for holding draw bolt, draw bolt can pass the through-hole and will support the steel sheet with the location steel sheet concatenation is fixed, the location steel sheet still includes the pterygoid lamina, the pterygoid lamina split is in location steel sheet both sides, the pterygoid lamina surface is also installed draw bolt, pipe end portion is opened there is the external screw thread.

2. The bone grafting supporting device with beating pressure for femoral head necrosis as claimed in claim 1, wherein the beating pressure device comprises a material conveying pipe, one end of the material conveying pipe is provided with an adapter pipe, the adapter pipe is internally provided with an internal thread, the adapter pipe can be in threaded connection with a guide pipe on a positioning steel plate, a piston is arranged inside the material conveying pipe, the surface of the piston is provided with air holes, the number of the air holes is not less than four, the end surface of the piston is connected with a guide rod, the guide rod extends outwards from a guide pipe at the other end of the material conveying pipe, one end of the guide rod, far away from the piston, is provided with a wide-distance thread, a heavy hammer is in threaded connection with the wide-distance thread, one end of the material conveying pipe, far away from the adapter pipe, is provided with a funnel, and the funnel is communicated with the material conveying pipe.

3. The support device for bone grafting under impact for femoral head necrosis according to claim 1, wherein the traction device comprises a first base, the first base is connected with a slide rail at the edge of the operating table, a locking rod is arranged on the first base, the locking rod is in threaded connection with the first base, the locking rod is used for locking the first base after adjustment, the first base further comprises an extension part, a slide bar and a screw rod are arranged between the first base and the extension part, a rotating handle is arranged at one end of the screw rod far away from the first base, a second base is in threaded connection with the screw rod, the second base is connected with the slide bar, the slide bar is used for guiding the second base, the first support bar is connected with the upper part of the second base, the first support bar is cylindrical, a slide block is arranged on the first support bar, and a locking rod is arranged on the slide block, the slider passes through the locking lever locking on first bracing piece, be equipped with the second bracing piece on the slider, the second bracing piece also is cylindrical the one end of keeping away from the slider on the second bracing piece is equipped with the disc, disc center and second bracing piece end connection, disc central point puts and disc terminal surface quartering position installation pull ring the pull ring is used for connecting the steel wire, the other end of acting as go-between of steel wire can connect traction bolt.

4. A method of percussive grafting of a femoral head using a percussive graft support device according to any of claims 1 to 3, comprising the steps of:

and eighthly, screwing the sealing plug into the central hole in the support steel plate to support the round bone piece.