A kind of easy-lock intramedullary nail
Technical field
This utility model relates to a kind of bone fracture internal fixing device material, is specifically related to a kind of easy-lock intramedullary nail.
Background technology
Since the eighties in last century, interlocking intramedullary nail destroys little, biological flexible fastening, few, the union of fracture rate advantages of higher of stress shielding owing to have blood circulation, becomes one of prefered method of treatment long bone shaft fracture gradually.In developed countries such as America and Europes, its utility ratio reaches more than 80% at present.But there is an outstanding shortcoming in it: the pinning difficulty, especially distal locking nail more the difficulty (Anastopoulos G, Ntagiopoulos PG, Chissas D, et al.Distal locking of tibial nails:a new device toreduce radiation exposure.Clin Orthop Relat Res.2008Jan; 466 (1): 216-20.; Malek S, Phillips R, Mohsen A, et al Computer assistedorthopaedic surgical system for insertion of distal locking screws inintra-medullary nails:a valid and reliable navigation system.IntJ Med Robot.2005Dec; 1 (4): 34-44.; Khoury A, Liebergall M, Weil Y, etal.Computerized fluoroscopic-based navigation-assistedintramedullary nailing.Am J Orthop.2007Nov; 36 (11): 582-5.; Li Ying, Wu Jiming, Yang Guangxin etc. the design of femur self-locking intramedullary nail and biomechanics characteristic. Chinese orthopaedic trauma magazine, 2005; 935-938.), it shows as: 1) pinning mortality height: the near-end pinning can be up to 10%, distal locking nail up to more than 20% (Luo Xianzheng, Qiu Guimin. the intramedullary pin internal fixation. the 1st edition, People's Health Publisher, 1997; Preface-5.); 2) complex operation, difficulty; 3) need expensive device such as the other fluoroscopic machine of bed, special operation table and aiming navigation system, be difficult to extensively carry out at basic hospital; 4) often make doctor's long term exposure (Anastopoulos G under roentgen radiation x, Ntagiopoulos PG, Chissas D, et al.Distal locking of tibial nails:a new device to reduce radiationexposure.Clin Orthop Relat Res.2008Jan; 466 (1): 216-20.; Malek S, Phillips R, Mohsen A, et al Computer assisted orthopaedic surgicalsystem for insertion of distal locking screws in intra-medullary nails:a valid and reliable navigation system.Int J Med Robot.2005Dec; 1 (4): 34-44.; Khoury A, Liebergall M, Weil Y, et al.Computerizedfluoroscopic-based navigation-assisted intramedullary nailing.Am JOrthop.2007Nov; 36 (11): 582-5.; Li Ying, Wu Jiming, Yang Guangxin etc. the design of femur self-locking intramedullary nail and biomechanics characteristic. Chinese orthopaedic trauma magazine, 2005; 935-938.), influence its clinical practice.To this both at home and abroad some scholars once to its improvement, carry out the development of far-end self-locking nail, developed far-end wing bracing type self-locking nail (Blumbery KD as Brooker-Wills (1985), Foster WC, Blumberg JF, et al.A comparison of the Brooker-Wills andRussell-Taylor nails for treatment of patients who have fracture ofthe femoral shaft.J Bone Joint Surg (Am), 2000; 72:1019-1024.), Xu Shaoting (1998) developed far-end sword bracing type self-locking nail (Li Jianmin, Xu Shaoting, Zou Dewei etc. the construction features of IESN and mechanical behavior. Chinese journal of orthopedics, 1998; 18 (12): 728-731.).But there are a lot of problems in these existing far-end self-locking nails: 1) the far-end self-lock mechanism also mainly is to rely on to strut the wing or sword simple barrier effect in the metaphysis spongy bone, and its resistance to compression, the anti-ability of revolving are very weak, are difficult to play good fixation; 2) mechanical performance instability, rate of breakdown it is reported can be up to 50% (Maher SA, Meyers K, Borens O, et al.Biomechanicalevaluation of an expandable nail for the fixation of midshaft fractures.J Trauma.2007Jul; 63 (1): 103-7.; Blum J, Karag ü l G, Sternstein W, etal.Bending and torsional stiffness in cadaver humeri fixed with aself-locking expandable or interlocking nail system:a mechanicalstudy.J Orthop Trauma.2005Sep; 19 (8): 535-42.); 3) near-end still prolongs with traditional non-locking pinning mode.Therefore, these far-end self-locking nails are not generally accepted always, still prolong with traditional interlocking intramedullary nail clinically both at home and abroad at present always.Therefore develop a kind of easy and simple to handle, have strong resistance to compression, the anti-easy-lock intramedullary nail that revolves performance becomes an orthopaedics field difficult problem anxious to be solved and this technical field development trend.
Summary of the invention
It is a kind of easy and simple to handle that the purpose of this utility model is to provide, and has strong resistance to compression, the anti-performance of revolving, need not far away, the traditional direct laying of fire pinning of near-end, avoid an incident pinning difficulty and the high difficult problem of mortality in traditional pinning process, can treat the easy-lock intramedullary nail of long bone fracture such as femur, tibia, humerus more convenient, effectively.The far-end of this easy-lock intramedullary nail by bore the direct-view of bone hole be screwed into the locking pinning or by the self-locking of tube wall expansion support bone wall fix, near-end is screwed into the locking pinning by direct-view and fixes.
For achieving the above object, the easy-lock intramedullary nail that this utility model is first type comprises: dissection determines that the main body nail and the proximal lock lock of length and external diameter are followed closely, the far-end locking pinning according to patient's long bone, the near-end and the far-end of main body nail offer the horizontal or oblique nail hole of follow closely body of running through, and each inwall of following closely the hole offers with the head of a nail external screw thread of near, far-end locking pinning or follows closely the female thread that the body external screw thread is complementary; Said main body nail is hollow nail pipe or solid nail rod; The quantity in main body nail near-end and far-end nail hole is respectively one or more.
For achieving the above object, the easy-lock intramedullary nail of another type of the present utility model comprises: dissection determines that hollow the main body nail and the proximal lock lock of length and external diameter are followed closely, the far-end expansion gear according to patient's long bone, the near-end of main body nail offers the horizontal or oblique nail hole of running through the bilateral tube wall, and the inwall in this nail hole offers the head of a nail external screw thread of following closely with the proximal lock lock or follows closely the female thread that the body external screw thread is complementary; Offer 2-3 symmetric longitudinal slot on the far-end tube wall of main body nail, be provided with at the distal tube intracavity and can make the expansible far-end expansion gear of far-end band crack tube wall; The quantity in near-end nail hole is one or more.
The long and band external screw thread of the head of a nail of locking pinning of the present utility model, the female thread of its head of a nail external screw thread and main body ailing hole inwall is complementary; Or the head of a nail of pinning is big and be with external screw thread, but the screw thread that the bone hole that head of a nail screw thread and this side seam wall leave is attacked is complementary, and female thread of the nail hole inwall that its nail body external screw thread and main body are followed closely is complementary; The nail point of pinning is plain edition, self-taped type or self-drilling self-tapping type.
The central sections of far-end expansion gear of the present utility model is a solid screw, the outer wall of this solid screw is provided with the external screw thread that the female thread with main body nail distal tube cavity wall is complementary, the near-end of solid screw is outer six prisms, far-end be from the close-by examples to those far off gradually taper expand until the ailhead that forms the bullet type.
Main body nail of the present utility model, proximal lock lock nail, far-end locking pinning and far-end expansion gear adopt medical stainless steel or titanium metal material to make.
The fixing means of first type easy-lock intramedullary nail: this side seam wall in long bone far-end and main body nail far-end nail corresponding position, hole, bore the bone hole of suitable size, down the far-end locking pinning is screwed into far-end nail hole and penetrates offside monolayer cortical bone wall by the direct-view of bone hole, finish fixedly securing of the similar locking steel plate of intra medullary nail far-end; This side seam wall in long bone near-end and main body nail near-end nail corresponding position, hole, bore the bone hole of suitable size, when if near-end nail hole is opened in main body nail proximal top, then need not to bore the bone hole, direct-view locks near-end pinning down and is screwed into near-end nail hole and penetrates offside monolayer cortical bone wall, finishes fixedly securing of the similar locking steel plate of intramedullary pin near-end.
The easy-lock intramedullary nail fixing means of another kind of type: with far-end is that the cutter aid of separating of interior six rib pipes inserts in the main body nail tube chamber from main body nail near-end, and be socketed on outer six prisms that are positioned at the intraluminal far-end expansion gear near-end of main body nail section far away and be rotated, the solid screw of far-end expansion gear is moved to main body nail tube chamber nearside along main body nail lumen wall female thread, the far-end that drives the far-end expansion gear expands ailhead and pushes the tube wall that main body nail far-end has 2-3 vertical symmetrical crack and expand, and support fixedly secures intra medullary nail far-end on the cortical bone inwall of long bone far-end pulp cavity; This side seam wall in long bone near-end and main body nail near-end nail corresponding position, hole, bore the bone hole of suitable size, when if near-end nail hole is opened in main body nail proximal top, then need not to bore the bone hole, direct-view locks near-end pinning down and is screwed into near-end nail hole and penetrates offside monolayer cortical bone wall, finishes fixedly securing of the similar locking steel plate of intramedullary pin near-end.
" two ends locking " formula easy-lock intramedullary nail of first type: this intramedullary pin two ends pinning fixed form breaks through traditional pinning fixed form, and uses the locking steel plate principle, all adopts the locking pinning to fix.Different with traditional nail hole is: the inwall in each nail hole offers and locks the head of a nail external screw thread of pinning or the female thread that nail body external screw thread is complementary.The locking pinning is also different with traditional pinning: the long and band external screw thread of the head of a nail of locking pinning, and the female thread of its head of a nail external screw thread and main body ailing hole inwall is complementary; Or the head of a nail of locking pinning is big and be with external screw thread, but the screw thread that the bone hole that head of a nail screw thread and this side seam wall leave is attacked is complementary, and its female thread of following closely body external screw thread and main body ailing hole inwall is complementary; The nail point of pinning is plain edition, self-taped type or self-drilling self-tapping type.
" end locks an end and expands " formula easy-lock intramedullary nail of another type: this intramedullary pin near-end adopts locking pinning fixed form, and far-end adopts the fixed form of far-end tube wall expansion support pulp cavity cortical bone bone wall.The near-end setting of main body nail is identical with " two ends locking " formula easy-lock intramedullary nail near-end with fixing means.
Far away, the near-end fixed form of easy-lock intramedullary nail of the present utility model two types, replace far away, the nearly two ends of traditional interlocking intramedullary nail and run through traditional direct laying of fire pinning fixing means of double-deck bone wall, operation is greatly simplified, need not an other fluoroscopic machine, reducing X ray shines the doctor, overcome a difficulty and the high difficult problem of mortality easily take place in traditional pinning process, and have stronger anti-rotation and incompressible effect equally, fracture is fixedly secured.
Description of drawings
Fig. 1,2 is structural principle and the fundamental diagram and the diagram of traditional pinning fixed form of traditional interlocking intramedullary nail;
Fig. 3 is the sketch map of this utility model locking pinning fixed form one;
Fig. 4 is the sketch map of this utility model locking pinning fixed form two;
Fig. 5 is the sketch map of this utility model locking pinning fixed form three;
Fig. 6 is structural principle and the fundamental diagram of this utility model embodiment 1;
Fig. 7 is structural principle and the fundamental diagram of this utility model embodiment 2;
Fig. 8 is structural principle and the fundamental diagram of this utility model embodiment 3.
The specific embodiment
Below in conjunction with accompanying drawing this utility model is described in further detail.
Referring to Fig. 1,2, structural principle and fundamental diagram and traditional pinning localized immobilization schematic diagram of tradition interlocking intramedullary nail: the main body nail is far away, near-end nail hole inwall does not have screw thread, pinning and main body nail does not closely connect as one, and pinning must run through that bilateral bone wall just can play far, near-end fixedly secures effect.If this side seam wall bores one than the DAGU hole, it is relatively poor to only depend on pinning to pass the fixation of offside monolayer bone wall, can not play the effect of fixedly securing.
Referring to Fig. 3, this utility model locking pinning fixed form one is: offer and lock the female thread that pinning head of a nail external screw thread is complementary at main body nail 1 nail hole inwall; The long and band external screw thread of the head of a nail of this locking pinning, the female thread of the nail hole inwall of its head of a nail external screw thread and main body nail 1 is complementary.When boring one in corresponding position, the nail hole of main body nail 1 at this side seam wall during than the DAGU hole, when down this pinning being screwed into the nail hole of main body nail 1 and penetrating offside monolayer cortical bone wall by the direct-view of bone hole, the mutual interlock of female thread in the nail hole of the external screw thread of the pinning head of a nail and main body nail 1, making pinning and main body follow closely 1 strong bonded is one, has increased the pinning fixation; Simultaneously since the threaded engagement between the nail hole of the head of a nail of pinning and main body nail 1 follow closely body with pinning and the threaded engagement between the side seam hole existed the gap of diameter and pitch, therefore can enlarge markedly the hold of pinning to the one-sided bone wall of offside, significantly increased fixation, and realized the self-locking locking action of pinning, prevent that effectively pinning from getting loose in main body ailing hole, this constant intensity to the similar locking steel plate fixed form of one-sided bone wall far surpasses the fixed constant intensity of traditional pinning that runs through two side seam walls.This is to open than the DAGU hole at this side seam wall brill of the relevant position, nail hole of main body nail 1, down this pinning is screwed into main body by the direct-view of bone hole and follows closely 1 nail hole and penetrate offside monolayer cortical bone wall, realizes fixedly securing acting on providing mechanics basis.In addition, the design of the longer nut of self-locking locking pinning is that pinning head of a nail tail end is exposed at outside this side seam wall bone hole, in case bone hole healing when getting pinning, can not find the pinning head of a nail and causes getting the pinning difficulty.
Referring to Fig. 4, this utility model locking pinning fixed form two is: the nail hole inwall at main body nail 1 offers and locks the female thread that pinning nail body external screw thread is complementary; The head of a nail of this locking pinning is big and be with external screw thread, but the screw thread that the bone hole that pinning head of a nail screw thread and this side seam wall are opened is attacked is complementary, and the female thread that pinning nail body external screw thread and main body are followed closely 1 nail hole inwall is complementary.When boring one than the DAGU hole in the corresponding position, nail hole of main body nail 1 at this side seam wall, when direct-view is screwed into this pinning the nail hole of main body nail 1 down and penetrates offside monolayer cortical bone wall, the mutual interlock of female thread in the external screw thread of the pinning head of a nail and this side seam hole, the female thread in the nail hole of the external screw thread of pinning nail body and main body nail 1 and to the mutual interlock of the female thread in side seam hole, not only making pinning and main body follow closely 1 strong bonded is one, has increased the pinning fixation; And since the threaded engagement between the pinning head of a nail and this side seam hole and pinning nail body and main body follow closely 1 nail hole and and the threaded engagement between the side seam hole is existed the gap of diameter and pitch, therefore can increase the reverse hold of pinning to the one-sided bone wall of this side, increased fixation more, realized the reverse self-locking locking action of pinning simultaneously, prevent that effectively pinning from getting loose in main body ailing hole, the constant intensity of the reverse fixed form of this similar locking steel plate far surpasses the fixed constant intensity of traditional pinning.
Referring to Fig. 5, this utility model locking pinning fixed form three is: both followed closely with main body in bone hole that this side seam wall bores just that 1 nail hole para-position is not good enough has to enlarge this bone hole, so that the threaded engagement between the pinning head of a nail and this side seam hole was lost efficacy, but the mutual interlock of female thread because of the nail hole of the external screw thread of pinning nail body and main body nail 1, make pinning and the main body stickfast is fixed is integrated, increased the pinning fixation, though because the threaded engagement between pinning nail body and main body ailing hole is followed closely body with pinning and the threaded engagement between the side seam hole is not existed the gap of diameter and pitch, pinning is not so good as fixed form one to the hold and the self-locking locking action of the one-sided bone wall of offside, two, but it is better than the fixed form of traditional pinning far away.
Below in conjunction with attached 6,7,8 and embodiment structural principle of the present utility model and operation principle are described in further detail.Present embodiment is that 260-420mm, external diameter are that the femur self-locking locking of intramedullary nails of 8.0-12mm is an example with length.
Embodiment 1, and referring to Fig. 6, present embodiment comprises according to patient's long bone dissects main body nail 1, proximal lock lock nail 2, the far-end locking pinning 3 of determining length and external diameter.The near-end traditional location of main body nail 1 or proximal top offer the horizontal or oblique near-end nail hole 4 of following closely body of running through, and can be screwed into proximal lock lock nail 2 in this near-end nail hole 4; The far-end of main body nail 1 offers the horizontal or oblique far-end nail hole 5 of following closely body of running through, and can be screwed into far-end locking pinning 3 in this far-end nail hole 5.Near, far- end nail hole 4,5 inwalls of main body nail 1 are provided with and lock the female thread that the external screw thread of the head of a nail of pinning 2,3 is complementary.Closely, the head of a nail of far- end locking pinning 2,3 is long and have external screw thread, its head of a nail external screw thread is complementary with main body nail 1 female thread near, that far-end is followed closely hole 4,5 inwalls; Its nail point is plain edition, self-taped type or self-drilling self-tapping type.
Embodiment 2, and referring to Fig. 7, near, far- end nail hole 4,5 inwalls of the main body of present embodiment nail 1 are provided with and lock the female thread that the external screw thread of the nail body of pinning 2,3 is complementary.Far, the head of a nail of proximal lock lock nail 2,3 is big and be with external screw thread, but the screw thread that the bone hole that this head of a nail screw thread and this side seam wall are opened is attacked is complementary, its nail body external screw thread and main body nail 1 are closely, the far-end female thread of following closely hole 4,5 inwalls is complementary.Other structure is with embodiment 1.
Referring to Fig. 6,7, its fixing means is: the bone hole of boring suitable size at this side seam wall of following closely 1 far-end nail, 5 corresponding positions, hole with main body of long bone far-end, down far-end locking pinning 3 is screwed into far-end nail hole 6 and penetrates offside monolayer cortical bone wall by the direct-view of bone hole, finish fixedly securing of the similar locking steel plate of intra medullary nail far-end; This side seam wall in the near-end nail long bone near-end and main body nail 14 corresponding positions, hole bores the bone hole when if being arranged on the top (near-end nail hole 5 need not bore the bone hole) of suitable size, down near-end is locked pinning 2 by the direct-view of bone hole and be screwed into near-end nail hole 4 and penetrate offside monolayer cortical bone wall, finish fixedly securing of the similar locking steel plate of intramedullary pin near-end.
Embodiment 3, and referring to Fig. 8, present embodiment comprises according to patient's long bone dissects hollow body nail 1, proximal lock lock nail 2, the far-end expansion gear 6 of determining length and external diameter.The near-end traditional location of main body nail 1 or proximal top offer the horizontal or oblique near-end nail hole 4 of follow closely body of running through, and these near-end nail hole 4 inwalls are provided with and lock the head of a nail of pinning 2 or follow closely the female thread that the external screw thread of body is complementary.Main body is followed closely and is offered 2-3 symmetric longitudinal slot on the 1 far-end tube wall, main body is followed closely 1 distal tube cavity wall and is provided with female thread, the distal tube intracavity of main body nail 1 is provided with and can makes the expansible far-end expansion gear 6 of this longitudinal slot, the central sections of far-end expansion gear 6 is a solid screw 7, the outer wall of this solid screw 7 is provided with main body and follows closely the external screw thread that 1 distal tube cavity wall female thread is complementary, the near-end of solid screw 7 is outer six prisms 8, the far-end of solid screw 7 be from the close-by examples to those far off gradually taper expand until the ailhead 9 that forms the bullet type.
Referring to Fig. 8, its fixation procedure is as follows, the tail medicated cap of the intramedullary pin proximal tip of at first back-outing, with far-end is that the cutter aid of separating of interior six rib pipes is followed closely in the tube chamber that 1 proximal tip inserts main body nail 1 from main body, and be socketed in rotation on outer six prisms 8 that are positioned at intraluminal far-end expansion gear 6 near-ends of main body nail 1 section far away, the solid screw 7 that makes far-end expansion gear 6 is followed closely 1 lumen wall female thread along main body and is followed closely 1 tube chamber nearside to main body and move, the ailhead 9 that drive far-end expansion gear 6 far-ends expand is pushed the tube wall expansion that main body nail pipe 1 far-end has 2-3 vertical symmetrical crack, and support fixedly secures intra medullary nail far-end on the cortical bone inwall of long bone far-end pulp cavity; This side seam wall in the near-end nail long bone near-end and main body nail 14 corresponding positions, hole bores the bone hole when if being arranged on the top (near-end nail hole 4 need not bore the bone hole) of suitable size, down near-end is locked pinning 2 by the direct-view of bone hole and be screwed into near-end nail hole 4 and penetrate offside monolayer cortical bone wall, finish fixedly securing of the similar locking steel plate of intramedullary pin near-end.
This utility model innovation is given birth to: use advanced locking steel plate principle, be provided with and lock the pinning head of a nail or follow closely body external screw thread interlock female thread mutually at main body ailing hole inwall, realize the locking action of the strong bonded of locking pinning and main body nail, this constant intensity to the similar locking steel plate fixed form of one-sided bone wall far surpasses the fixed constant intensity of traditional pinning that runs through two side seam walls.This opens than the DAGU hole for this side seam wall in relevant position, main body ailing hole bores, and by under the direct-view of bone hole this pinning being screwed into main body ailing hole and penetrating offside monolayer cortical bone wall, realizes that the effect of fixedly securing provides mechanics basis.Therefore this utility model is fixed by adopt direct-view to be screwed into the locking pinning at near-end, adopt direct-view to be screwed into the locking pinning or by tube wall expansion support bone wall fixed form at far-end, replace far away, the nearly two ends of interlocking intramedullary nail and run through the traditional direct laying of fire pinning fixing means of double-deck bone wall, operation is greatly simplified, need not an other fluoroscopic machine, reducing X ray shines the doctor, overcome a difficulty and the high difficult problem of mortality easily take place in traditional pinning process, and have stronger anti-rotation and incompressible effect equally, fracture is fixedly secured.