CN1424892A - 接骨板 - Google Patents

接骨板 Download PDF

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CN1424892A
CN1424892A CN00818648A CN00818648A CN1424892A CN 1424892 A CN1424892 A CN 1424892A CN 00818648 A CN00818648 A CN 00818648A CN 00818648 A CN00818648 A CN 00818648A CN 1424892 A CN1424892 A CN 1424892A
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罗伯特·弗里格
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Abstract

一种接骨板，所述接骨板带有一个顶表面(1)、一个用于接触骨头的底表面(2)和一组孔(4)，所述孔(4)位于所述板的纵轴(3)之上并且连接所述顶表面和所述底表面(1；2)，以便接受骨螺钉(11)。所述孔(4)中的至少一个包括一个组合，所述组合包括一个直径为d对称中心为(SK)的圆孔(14)和一个对称中心为SL的长孔(24)，所述长孔具有一个在所述板的纵轴方向上延伸的长轴a和一个与其垂直的短轴b，对称中心(SK和SL)之间的距离(A)小于d/2+a/2，并且两个对称中心都位于所述板的纵轴(3)所在的区域上。所发明的接骨板可以非折衷地作为一个压板和作为一个所谓的内部固定器使用。

Description

接骨板
技术领域
本发明涉及一种如权利要求1的前序部分所请求保护的接骨板和一种如权利要求20的前序部分所请求保护的包括所述接骨板的固定装置。
背景技术
通常已知两种类型应用接骨板的骨缝合术。
第一类型的骨缝合术被称为“刚性骨缝合术”。刚性骨缝合术被用于关节骨折、骨干的简单骨折的固定(在此处不能实行插钉术)以及骨切开术的场合。除了解剖学上复位的可能性之外，骨头本身支持刚性骨缝合术的稳定性，这使得患者可以方便地使用受伤的肢体，并且在使该肢体承受重量时感觉到较少的疼痛。在因为外伤而使骨头中的血液循环大大减小的情况下，对骨折的稳定固定的优势也是十分明显的。对于“非联合”的固定或在感染的情况下，骨折的骨头必须稳定，以便能够使其复位并且避免由骨折裂缝的不稳定而可能引起的其它任何刺激。
第二类型被称为“柔性骨缝合术”。柔性(生物)骨缝合术的最大优点可以从发生在长骨骨干部分的粉碎性骨折的情况下看到。对于这些骨折的处理，目的是保持骨头的长度不变并且保持骨头的端部(关节)相互处在正确的位置上。骨折区域本身不被直接固定或处理，这样在该区域通过骨头的血液流量将不会进一步减少。接骨板的功能可以比得上仅固定在干骺端的骨髓内钉的功能。
考虑这两个依靠装接骨板的骨缝合术的极端例子，很容易会注意到它们是如何的不同。由于骨折，一旦考虑到其固定方式时，通常不能够清晰地划分为适合于上述这种或那种类型的骨缝合术，所以外科医生通常不得不进行折衷，因为还没有植入物使得他可以有效地结合所述的这两种方法。这两种方法的结合将会是有用的，例如，在当整个关节部分通过一个内部固定器并且借助于角度稳定螺钉被固定在骨干上的同时，骨折的关节可以在穿过接骨板的拉力螺钉的帮助下承受压力。另一个应用将是在骨质疏松的骨头的场合，在此通过轴向和角度稳定螺钉，接骨板可以被固定到干骺端的碎块中，这样在骨干区域可以以一种稳定的方式放置接骨板，该接骨板组件由一个在骨折区域穿过该接骨板的拉力螺钉支承。这种方法可以实现骨折骨头的基本稳定性。
这种局面下的一个结果就是，分别适应于这两种类型骨缝合术的骨头植入物都被发展并且被推向市场。两种类型的植入物都最优地适应于其设计所针对的特定方法。然而，其缺点是这两个系统不能相互结合。
US 5 709 686 TALOS ET AL.揭示了这样一种组合板，该板带有形成在长孔的中心部分的圆柱形螺纹。该已知的板有以下缺点：
1)由于处在该板的长孔中心的螺纹的位置所限，所以该螺纹的范围被限制在60°到179°的角度之间。
2)由于处在该板的长孔(固定螺钉孔)中心的螺纹的位置所限，存在这样的危险，即该长孔的横向凸缘可能会扩大。
3)由于螺纹为圆柱形，所以必须使用具有特殊形状的螺钉头，当该螺钉被推入到骨头中时，该螺钉头才能够被该板的表面支承。
发明内容
本发明旨在克服这些缺点。本发明所要解决的问题在于，提供一种接骨板，所述接骨板可以结合两种骨缝合术而不会对这两种传统的安装接骨板的方法产生任何限制。这样，本发明的目的是允许将该接骨板作为一个受压板并且作为一个内部固定器而有效和不受限制地加有利用。
通过提供具有权利要求1所述特征的接骨板，本发明解决了该问题。
本发明的长孔可以定义为这样一个孔，即其在接骨板的纵轴方向的直径大于其垂直于该接骨板纵轴方向上的直径。这样所述孔可为卵形、椭圆形或矩形、或者是这些形状的结合体；被该定义唯一排除的形式是圆孔。
在一个优选实施例中，该组联合孔中的圆孔配置了一个三维构造部分，其形式最好为一段内螺纹或一个圆周凹沟或凸缘。该三维构造部分可以配置在平行于接骨板顶表面的一个平面内，或配置在平行于所述顶表面的一组平面内。
圆孔的直径d最好小于该组联合孔中长孔的短轴b。典型地，d小于b约5到25％。
将所述板用作为内部固定器会使板-螺钉接触面所受的机械应力大大增加，因为所述板不压靠着骨头，而骨折是借助于该板与骨头之间的摩擦力来固定的。在一个优选实施例中，所述长孔中的螺纹延伸了至少180°的角度，包括螺钉头的螺纹也至少延伸了这一范围，这个事实已经考虑到了这种增加的机械应力。在使用薄接骨板的地方，这个特征尤其重要。
根据本发明的一个优选实施例，在这组联合孔中形成的三维构造部分，例如以一段内螺纹形式出现的三维构造部分，具有一个—最好为圆锥形的—形状，向着接骨板的底表面逐渐变小。这一改进的优点是：配置在接骨板上的孔的圆锥螺纹与螺钉头上相应的圆锥螺纹相结合将使得该螺钉得到固定。在使用自钻孔螺钉时这种类型的固定特别重要。由于在所述螺钉的头部有圆锥螺纹，所以当所述螺钉被推入骨头中时不需要考虑所述板的位置。仅仅当螺钉头上带螺纹的圆锥与所述板上的长孔的内部螺纹相啮合时，才产生对螺钉的阻挡。虽然在所述板的圆锥孔中以及在骨头中螺纹啮合的开始发生在不同的点上，但螺钉头的圆锥形螺纹将自动地进入到所述板的带螺纹圆锥的中心位置上。
在拧紧所述圆锥形螺纹的过程中，在所述板的孔中将产生径向力。为了有效地吸收这些力，所述板的圆锥孔必须有足够的强度。
在一个优选实施例中，向着骨折底表面逐渐变小的圆锥内螺纹适合具有的圆锥角度在5-20°之间，典型为10°。
在本发明的一个优选实施例中，从所述板的纵轴的方向上来考虑，所述内螺纹形成于所述长孔的两个端部的其中之一处。按照设计，这个端部位置可以增加带螺纹的部分，该螺纹所形成的几何体可以延伸例如到190°到280°的角度范围内，最好延伸到200°到250°的角度范围内。
如果长孔为圆锥形状，在所述板的底表面和顶表面对内螺纹进行的测量将会产生不同的结果。在顶表面进行测量，螺纹部分最好延伸到180°到230°的角度范围；在底表面进行测量，螺纹部分最好延伸到200°到270°的角度范围。
在另一个优选实施例中，在长孔(固定螺钉孔)的端部形成的圆锥螺纹是形成在靠近所述板的中心的那一端。这种配置的优点在于：所述板的固定螺钉孔的固定能力没有受到负面的影响。
在另一个优选实施例中，这组联合孔在其面向顶表面的上部具有一个凹槽，该凹槽最好是一个球形扩大部分，以便接受一个具有球形螺钉头的骨螺钉。该凹槽、球形扩大部分最优地成形，以便与传统骨螺钉的球形螺钉头相配。如果骨螺钉是偏心地插入，需要实现骨折处承受压力的技术时，上述这一点就特别有用。
在另一个优选实施例中，所述底表面凹陷地成形。所述板的该凹陷底表面可以更好地适应胫骨、股骨、肱骨和前臂骨头的圆形横截面。在所述板底表面上的孔的凹陷的实施例使传统的骨螺钉可以被推着倾斜地穿过所述板的孔。这一点对于捕获必须拉到所述板附近的骨头小碎块来说是特别重要的。
在另一个优选实施例中，所述内螺纹延伸过所述接骨板的整个厚度，从底表面到顶表面，以便提供最大的强度。
在另一个优选实施例中，这组联合孔被扩大到对着所述板底面形成在所述联合孔下部的非构造部分，以便使所述骨螺钉精确定向。
在另一个实施例中，除了本发明的接骨板之外，还包括至少一个骨螺钉；所述骨螺钉具有形成在其螺钉头上的例如为一段外螺纹的构造部分，该外螺纹与所述的三维构造部分相对应，并且最好是自攻丝和/或自钻孔的螺纹。如果所述接骨板被用作为一个压板，所述板的孔的几何形状不会受到形成在其端部的圆锥螺纹孔的不利影响。所述螺纹孔的圆锥形设计具有这样的优点，即当螺钉被推入骨头时，不需要考虑所述板的位置，因为所述螺钉与所述板之间的固定啮合仅仅发生在当圆锥形的带螺纹的螺钉头被推入到所述板的相应的内螺纹中之时。在使用自钻孔、自攻丝的螺钉时这一点特别重要。
附图说明
下面，将参考几个实施例的局部示意图对本发明及本发明的进一步进行详细的说明。
其中：
图1是一组由一个圆孔和一个长孔组成的联合孔的示意图；
图2是本发明的接骨板的俯视图，显示了带有一个三维构造部分的一组联合孔；
图3是图2所示的一组联合孔中的圆孔的纵向截面；
图4是一个透视图，显示了本发明的接骨板，该接骨板带有一个插入在其与联合孔组成为一体的螺纹中的骨螺钉。
具体实施方式
如图2所示，本发明的接骨板具有一个顶表面1、一个与骨头接触的底表面2和两个位于该接骨板纵轴3上的孔4，所述孔4连接所述顶表面1和所述底表面2，以便接受骨螺钉11。箭头7表示的方向向着所述接骨板的一端而箭头8表示的方向向着所述接骨板的中心。
离所述接骨板中心更近的孔4在所述接骨板的纵轴3的方向上的直径大于所述孔在垂直于所述接骨板的纵轴3方向上的直径。
如图1示意性所示，所述孔4包括两个交迭的孔，即一个直径为d并且对称中心为SK的圆孔14，和一个对称中心为SL的长孔24。
长孔24有一个沿所述接骨板的纵轴3方向延伸的长轴a和一个与其垂直的短轴b，对称中心SK与SL之间的距离A小于和d/2+a/2。所述两个对称中心都位于接骨板的纵轴3上。
长孔24对着顶表面1在其上部有一个最好为球形扩展的凹槽6，以便接受一个球头骨螺钉。
如图3所示，三维构造部分5延伸过所述接骨板的整个厚度，从顶表面1延伸到底表面2，其中该三维构造部分5为靠近接骨板端部的孔4中的一段内螺纹5。
在图2和3所示的本发明的优选实施例中，所述内螺纹形成于长孔的靠近所述接骨板中心的端部。在底表面2上来测量，如圆弧9所示，该内螺纹延伸了256°的角度，而在顶表面1上来测量，如圆弧10所示，它延伸了223°的角度。
根据该内螺纹5的直径，可获得以下优选参数：
螺纹直径             2.4mm         3.5mm         5.0mm
双头螺纹             是            是            是
螺距                 0.6           0.8           1.0
螺纹深度(＝内外      0.175         0.2295        0.2810
径之差的一半)
角度(在顶表面处)     200°         200°         190°
角度(在底表面处)     260°         240°         250°
图4显示了一个包含了根据图2的接骨板的固定装置，该装置包括一个骨螺钉11，该骨螺钉11带一段形成在螺钉头13上的外螺纹12，该外螺纹12对应于所述接骨板的内螺纹。
适宜地，骨螺钉11是一个自钻孔和/或自攻丝螺钉。

Claims (22)

1.一种接骨板，所述接骨板带有一个顶表面(1)、一个用于接触骨头的底表面(2)和一组孔(4)，所述孔(4)位于所述板的纵轴(3)之上并且连接所述顶表面(1)和所述底表面(2)，以便接受骨螺钉(11)，其特征在于：
所述孔(4)中的至少一个包括以下构成的组合：
a)一个直径为d对称中心为SK的圆孔(14)和
b)一个对称中心为SL的长孔(24)，所述长孔具有一个在所述板的纵轴方向上延伸的长轴a和一个与其垂直的短轴b，
对称中心SK和SL之间的距离A小于d/2+a/2，并且两个对称中心都位于所述板的纵轴(3)上。
2.根据权利要求1的接骨板，其特征在于：所述圆孔(14)配置了一个三维构造部分(5)，其形式最好为一段内螺纹或一个圆周凹沟或凸缘。
3.根据权利要求2的接骨板，其特征在于：所述三维构造部分(5)被配置在一个平行于所述顶表面(1)的平面上。
4.根据权利要求2的接骨板，其特征在于：所述三维构造部分(5)被配置在一组平行于顶所述表面(1)的平面上。
5.根据权利要求1到4任意之一的接骨板，其特征在于：所述圆孔(14)的直径d小于所述长孔(24)的所述短轴b，最好小于5％到25％。
6.根据权利要求1到5任意之一的接骨板，其特征在于：所述三维构造部分(5)在圆孔(14)中至少延伸180°。
7.根据权利要求6的接骨板，其特征在于：所述三维构造部分(5)在圆孔(14)中延伸的角度范围为190°和280°，最好的角度范围为200°和250°。
8.根据权利要求6或7的接骨板，其特征在于：所述三维构造部分(5)-在所述顶表面(1)上测量-延伸到180°和230°的角度范围-在所述底表面上测量-延伸到200°和270°的角度范围。
9.根据权利要求1到8任意之一的接骨板，其特征在于：所述联合孔(14，24)具有一个从所述顶表面(1)到所述底表面(2)逐渐变小的形状。
10.根据权利要求1到9任意之一的接骨板，其特征在于：所述三维构造部分(5)-在所述板的纵轴(3)的方向来考虑-形成于所述联合孔(14，24)的靠近所述板的中心(8)的端部。
11.根据权利要求1到10任意之一的接骨板，其特征在于：在所述长孔(24)面对所述顶表面(1)的上部，具有一个凹槽，所述凹槽最好是一个球形扩大部分(6)，以便接受一个具有球形螺钉头(13)的骨螺钉(11)。
12.根据权利要求1到11任意之一的接骨板，其特征在于：所述底表面(1)具有一个凹槽或平面的形状。
13.根据权利要求1到12任意之一的接骨板，其特征在于：所述三维构造部分(5)延伸过所述接骨板的整个厚度，从所述顶表面(1)延伸到所述底表面(2)。
14.根据权利要求1到13任意之一的接骨板，其特征在于：所述联合孔(14，24)在其对着所述板底面(2)形成在所述联合孔下部的非构造部分中具有一个扩大部分。
15.根据权利要求1到4任意之一的接骨板，其特征在于：对称中心SK和SL之间的距离A满足以下条件：
             0.5(d/2+a/2)＜A＜1.0(d/2+a/2)。
16.根据权利要求1到15任意之一的接骨板，其特征在于：孔(4)中的至少一个孔的轴相对于平行于所述顶表面(1)的平面的角度在70°到110°之间的范围内。
17.根据权利要求1到16任意之一的接骨板，其特征在于：所述板包括一组最好导致所述板为L形或T形的区段，板的各区段的纵轴(3)之间相互形成一个锐角或一个钝角。
18.根据权利要求17的接骨板，其特征在于：接骨板的至少两个区段被配置在不同的平面内。
19.根据权利要求17或18的接骨板，其特征在于：所述接骨板的最长区段的三维构造部分(5)-从该最长区段的纵轴方向上考虑-形成于所述联合孔(14，24)的靠近相邻的、所述接骨板的较短区段的端部。
20.一种包括根据权利要求1到19任意之一的接骨板的固定装置，其特征在于：所述板还至少包括一个骨螺钉(11)。
21.根据权利要求20的固定装置，其特征在于：所述骨螺钉(11)包括一个形成在所述螺钉头(13)上的三维构造部分(12)-所述三维构造部分(12)最好为外螺纹的形式-所述的三维构造部分(12)与所述的三维构造部分(5)相对应。
22.根据权利要求20或21的固定装置，其特征在于：所述骨螺钉(11)是一个自攻丝和/或自钻孔的骨螺钉。
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AU775910B2 (en) 2004-08-19
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US20080132955A1 (en) 2008-06-05
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ES2253202T3 (es) 2006-06-01
WO2001054601A1 (de) 2001-08-02
CA2398372C (en) 2007-01-09
US20040236332A1 (en) 2004-11-25
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US9161791B2 (en) 2015-10-20
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AR031369A1 (es) 2003-09-24
KR100706291B1 (ko) 2007-04-11
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US7354441B2 (en) 2008-04-08
CA2398372A1 (en) 2001-08-02
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US20020183752A1 (en) 2002-12-05
CN100415182C (zh) 2008-09-03

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