CN205379353U - Be used for damaged bone handling device of big section bone of fine and close patient's shin bone of sclerotin - Google Patents

Abstract

The utility model discloses a bone-handling device for a large section of tibial defect in a patient with dense bone, which comprises an intramedullary main nail for axially driving into the bone, and the intramedullary main nail has a structure corresponding to the anatomical structure of the tibia of a human body. The width of the anastomosis, the two ends are provided with locking holes for matching with ordinary fixing screws; the two ends of the main intramedullary nail are provided with fixing screw holes; a fixing bracket and several fixing screws are also included; the rear end of the fixing screw is connected with the fixing screw. The front end is connected with the fixing screw hole on the main intramedullary nail; it also includes a number of delivery needles that can move axially along the main intramedullary nail, and one end of the delivery needle is radially implanted into the bone block that needs to slide Reach the intramedullary main nail, and the other end is connected to the fixed bracket.

Description

A bone handling device for large segmental bone defect of tibia in patients with dense bone

technical field

The utility model relates to a device for treating large-section bone defects of long bones by using bone transport, in particular to a device for large-section bone defects of the tibia of patients with relatively dense bone.

Background technique

Large-segment long bone defect refers to a bone defect in which the fracture cannot heal itself or can only regenerate 10%, generally 2-3 times the diameter of the involved long bone. Large-segment bone defects are usually caused by high-energy trauma, infection, tumors, etc., often accompanied by limb shortening, deformity, osteomyelitis, muscle atrophy, and stiffness of adjacent joints. Its repair treatment has always been one of the biggest problems in the field of orthopedics. According to statistics, in Germany, bone graft surgery is one of the top 50 treatments that patients receive most frequently; in the United States, about 800,000 patients need bone graft surgery every year; 3 million cases; large bone defects have brought huge physical and mental injuries and economic burdens to patients, so how to solve this problem has become an important issue in the field of orthopedics.

At present, the main methods for the clinical treatment of large segmental bone defects of long bones include autologous bone grafting, Masquelet technique and Ilizarov technique. Autologous bone graft has the best osteoconduction, osteoinduction and osteogenesis effects, and is the standard for the treatment of bone defects. However, the limited amount of autologous bone and poor bone strength make it difficult to meet the needs of large bone defects. Although anastomotic bone grafting (such as fibula, iliac crest, ribs, etc.) is also an effective method for the treatment of large bone defects, the operation involves large trauma, many complications at the donor site, and it takes a long time for the grafted bone to complete shaping and thickening. Moreover, patients cannot bear weight in the early stage, and are prone to stress fractures and muscle atrophy in the later stage. In addition, this technology has a long learning curve and relatively high requirements for the operator, and it cannot be widely used clinically, so it is not a mainstream method for the treatment of large bone defects. The emergence of Masquelet technology provides a new way for the treatment of large bone defects. This technique uses membrane-assisted autologous bone grafting to treat segmental bone defects. This technique is specifically divided into two stages. The first stage: PMMA bone cement spacer is implanted after thorough cleansing, fixed with internal or external fixation, the wound is closed, and an induction membrane is formed. The second stage: after 6-8w, the induction membrane is cut, the bone cement placer is removed, the medullary cavity is opened, autologous cancellous bone is filled in the membrane, and then the induction membrane and the incision are closed. The inductive membrane not only has the functions of avoiding graft bone resorption, maintaining the position of graft bone, and preventing soft tissue invasion, but also can secrete growth factors and osteoinductive factors to promote bone growth, such as vascular endothelial factor, TGF-β1, BMP-2, etc.[ 12]. Although a number of clinical studies have proved that Masquelet technology can achieve certain clinical effects in the treatment of bone defects, it also has great limitations. The biggest defect of this technique is that a large amount of autologous bone graft is required in the process of repairing bone defects, which increases surgical trauma and complications at the donor site; moreover, this technique cannot effectively correct limb shortening and line of force. A combination of micro-flap techniques is required. In addition, postoperative patients cannot carry out early weight-bearing exercises, and complications such as stress fractures, bone resorption, and bone nonunion are prone to occur. Moreover, this method requires two or even multiple operations, and the patient's hospital stay is long and expensive.

The emergence of bone-handling technology is considered a milestone in orthopedic surgery in the 20th century, ushering in a new era for the treatment of bone defects. Originally created by Russian orthopedic surgeon Ilizarov, the bone transport technology follows the tension-stress law of tissue regeneration and conforms to the concept of "natural bone reconstruction". It is currently the gold standard for clinical treatment of large segmental bone defects. The core of bone handling technology lies in the distraction osteogenesis of the Ilizarov scaffold, which is divided into three steps: 1. Use the Ilizarov scaffold to fix the affected limb to provide stability, maintain the length of the limb and the line of force; Perform low-energy cortical osteotomy on the epiphysis; 3. Adjust the Ilizarov scaffold to slide and close the active bone segment to the stump of the bone defect at an appropriate speed and frequency, and complete the repair of the bone defect under the fixation of the Ilizarov scaffold. Compared with autologous bone grafting and Masquelet technology, bone transport technology has the following advantages: 1) The length of bone defect repair is not limited, autologous bone grafting is not required, and the defect of "repairing trauma with trauma" of autologous bone grafting and Masquelet technology is avoided ; 2) This technology can stretch soft tissue regeneration at the same time, without the need for skin flap transplantation to repair skin and soft tissue defects; 3) Various complex limb deformities can be corrected at the same time through external stents. 4) It belongs to minimally invasive surgery with reliable curative effect and low cost.

Although the bone transport technique is effective in treating various complex bone defects, there are many complications, which are closely related to the use of the Ilizarov stent. Currently, the Ilizarov brackets used in bone handling techniques are mainly ring-type external fixation brackets and single-rod external fixation brackets. The ring-type external fixation bracket is a three-dimensional space configuration, which is firm in fixation and uniform in stress distribution. The bracket needs to drive several steel needles into the metaphysis at both ends of the long bone and the sliding bone fragments to provide stability, maintain the length of the limb and the line of force. However, piercing multiple steel needles in multiple planes will cause bone cutting, weaken the local bone strength, and may cause iatrogenic fractures; moreover, piercing steel needles in multiple planes requires high operational skills and may damage important neurovascular risky. Ilizarov stents have a long fixation period and difficult clinical care, so needle tract infection, needle tract loosening, fracture and soft tissue cutting complications often occur. Moreover, some patients have poor tolerance and are prone to mental problems such as anxiety, depression, and even paranoia. Some patients refuse to go to the ground for weight-bearing training due to discomfort such as limb pain and swelling. Complications such as delayed healing or even non-union. The single-rod external fixation bracket has the advantages of simple operation, convenient portability, less needle tract infection, and easy tolerance of patients, and is suitable for bone defects with small lengths. However, the mechanical stability of the single-rod external fixator is poor, the line of force cannot be adjusted, and the affected limb cannot bear weight in the early stage. In the later stage, complications such as poor line of force, disuse osteoporosis, refracture, delayed bone union or even nonunion may occur.

Utility model content

In view of the above-mentioned technical problems, the utility model provides a bone handling device for patients with dense tibial bone defect, which has less bone needle insertion and good stability.

In order to solve the above-mentioned technical problems, the technical solution adopted by the utility model is: a bone handling device for large tibial bone defects in patients with dense bone, including an intramedullary main nail for axially driving into the bone, the medullary The main intramedullary nail has a width consistent with the anatomical structure of the human tibia, and there are locking holes at both ends for matching with ordinary fixing screws; the two ends of the main intramedullary nail are provided with fixing screw holes; it also includes a fixing bracket and several fixing screws. screw; the rear end of the fixing screw is connected with the fixing bracket, and the front end is matched with the fixing screw hole on the main intramedullary nail; it also includes a number of transfer needles that can move axially along the main intramedullary nail, and one end of the transfer needle is radially The bone fragment that needs to be slid is implanted and the main intramedullary nail is not reached, and the other end is connected to the fixed bracket.

As an improvement, the fixed frame is a three-section type, including two fixed sections used to connect with fixing screws and a middle section used to connect with the delivery needle; Connect to the knot. Due to the slight difference in the external anatomical structure of the bone, the existing straight rod-shaped support does not fit well with it. The fixing bracket is set as three sections, and the sections are connected by universal joints, so that the radian of the fixing bracket can be adjusted through the universal joints to suit.

As an improvement, the fixing section is provided with a hole through which the fixing screw passes; the rear end of the fixing screw passes through the hole and is fastened by a bolt. Firstly, the fixing screw is passed through the hole on the fixing segment, then the needle is screwed into the fixing screw hole on the main intramedullary nail, and finally the bolt is tightened for fastening. It has good stability and is convenient to adjust. Of course, there are also other connection and fastening methods, such as directly providing screw holes on the fixed section. When in use, the fixing screws are first screwed into the screw holes on the fixed section, and then screwed into the fixed screw holes on the main intramedullary nail. Both ends of the fixing screw are threaded, which not only plays the role of a fixed intramedullary main nail, but also locks itself with the fixing bracket, which has a locking effect.

As an improvement, the conveying section is made up of several sleeves nested together; adjacent sleeves are provided with slotted holes corresponding to the positions, and are fixed by bolts penetrating the slotted holes. The length of human long bones is different, and the length of the same bone is different among different individuals. The length of the transport section on the fixed bracket is set to be adjustable, which is suitable for long bones of different lengths, making the whole device widely adaptable.

As a further improvement, scales are provided on the sleeve. The sleeve length is indicated for precise adjustment.

As an improvement, it also includes a needle seat that can slide up and down along the fixed bracket, and the transfer needle is fixed on the needle seat. The front end of the transport needle is implanted into the bone block to be transported, and its rear end is fixed on the needle seat. When the bone block needs to be moved, the position of the needle seat on the fixed support can be adjusted.

As a further improvement, the fixed bracket has a scale indicating the moving distance of the needle seat. It is convenient to precisely adjust the position of the needle seat, and can also record the distance of the bone block transported.

As an improvement, the fixed bracket is provided with a rack in the axial direction, a gear cooperating with the rack is provided inside the needle seat, and an adjusting bolt for driving the gear to rotate is provided outside the needle seat. Since the long bone is axially driven into the intramedullary main nail for fixation, the force required to move the bone block is relatively large, and it is difficult to move. Utilizing rack and pinion cooperation, only need to rotate the adjustment bolt, the needle base can be moved axially along the fixed bracket, and at the same time, the transfer needle can be driven to carry the bone block.

As a preference, two ends of the main intramedullary nail are provided with locking holes for matching with common fixing screws. Two locking holes are preferably arranged at each end, and are arranged outside the fixing screw holes. After the bone transport is completed, the fixing bracket can be removed, and the main intramedullary nail can be fixed by ordinary fixing screws, reducing the burden on the patient.

As a preference, two fixing screws are provided at both ends of the main intramedullary nail; there are two delivery needles. Two fixing screws are provided at each end to make the whole system more stable. Similarly, the two transport pins can also ensure the stability of the bone transport. However, if multiple steel pins are used to fix the same bone plane, it will cause local bone cutting, which will weaken the local bone strength and cause the risk of iatrogenic fracture. Moreover, there are many neurovascular vessels in the metaphysis, which are easy to be damaged during operation.

The advantages of the utility model are: 1. The device can maintain the backbone force line and length throughout the whole process, avoiding bad force line, shortening deformity and lateral displacement in the process of bone transportation; 2. The device is fixed reliably, and the patient can After that, joint function exercise and weight-bearing exercise can be performed to reduce the incidence of refracture after disuse osteoporosis and joint stiffness; 3. The number of steel needles implanted in this device is small, which reduces needle tract infection and iatrogenic The incidence of fractures and soft tissue cuts; 4. The operation technique of this device is relatively simple, the learning curve is short, and it is suitable for extensive use in hospitals at all levels; 5. The device is light, convenient for clinical care, and does not affect the daily life of patients, and the patient's compliance is good. Reduce anxiety, depression and other mental symptoms of patients; 6. There is no limit to the handling of needles, and it can be made thicker to increase its strength.

Description of drawings

Fig. 1 is the structural representation of the utility model.

Fig. 2 is a schematic diagram of the structure of the main intramedullary nail.

Marks in the figure: 1 main intramedullary nail, 11 fixing screw hole, 13 locking hole, 2 fixing screw, 3 handling pin, 4 fixing bracket, 41 fixing section, 42 handling section, 43 bolt, 44 long hole, 45 adjusting bolt, 46 pins, 47 universal joints.

detailed description

Below in conjunction with accompanying drawing, the utility model is described in detail.

In order to make the purpose, technical solution and advantages of the utility model clearer, the utility model will be further described in detail below in conjunction with the accompanying drawings and embodiments. It should be understood that the specific embodiments described here are only used to explain the utility model, and are not intended to limit the utility model.

As shown in Figures 1 and 2, the utility model includes an intramedullary main nail 1 for driving axially into the bone. The locking hole 13 that cooperates with ordinary fixing screws; the two ends of the main intramedullary nail 1 have fixing screw holes 11; it also includes a fixing bracket 4 and several fixing screws 2; the rear end of the fixing screw 2 is connected with the fixing bracket 4 The front end is connected with the fixed screw hole 11 on the main intramedullary nail 1; it also includes a number of delivery needles 3 that can move axially along the main intramedullary nail 1, and one end of the delivery needle 3 is radially implanted into the The bone block does not reach the intramedullary main nail 1 , and the other end is connected to the fixing bracket 4 . Two fixing screws 2 are arranged at both ends of the main intramedullary nail 1; there are two carrying needles 3 .

The fixed bracket 4 is a three-section type, including two fixed sections 41 for connecting with the fixing screws 2 and a middle transportation section 42 for connecting with the transportation needle 3; Connect 47 to the joint. The fixing section 42 is provided with a hole for the fixing screw 2 to pass through; the rear end of the fixing screw passes through the hole and is fastened by a bolt. The conveying section 42 is formed by a plurality of sleeves nested together; adjacent sleeves are provided with slotted holes 44 in corresponding positions, and are fixed by bolts 43 penetrating the slots 44 . Scales are arranged on the sleeve. The sleeve length is indicated for precise adjustment.

It includes a needle seat 46 that can slide up and down along the fixed bracket 4 , and the transfer needle 3 is fixed on the needle seat 46 . The fixed bracket 4 is provided with a rack in the axial direction, and the needle seat 46 is provided with a gear cooperating with the rack; the needle seat 46 is provided with an adjusting bolt 45 to drive the gear to rotate. The fixed bracket 4 has a scale indicating the moving distance of the needle base 46 . It is convenient to precisely adjust the position of the needle seat 46 and can record the distance of the bone block transported.

Both ends of the main intramedullary nail 1 are provided with locking holes 13 for matching with common fixing screws. Each end of the locking 13 holes is preferably provided with two, and is arranged on the outside of the fixing screw hole 11.

The steps are as follows: 1. Implant the main intramedullary nail 1 first and lock it to restore the length and line of force of the backbone;

2. To install the fixing bracket 4, first pass the fixing screw 2 through the hole on the fixing section 41, then insert the needle into the fixing screw hole 11 on the main intramedullary nail 1, and finally tighten the bolt for fastening.

3. Osteotomy at the target site of the metaphysis, and then insert the transfer needle 3 through the transfer slot 12 into the bone block to be slid;

4. Rotate the adjusting bolt 45 to slide the needle seat 46 on the fixed bracket 4 to drive the transport needle 3 to slide the fracture fragment, and perform precise sliding according to the scale on the fixed bracket until it slides to the parking position, and finally take out the fixed bracket 4, The main intramedullary nail 1 is kept until the fracture is completely healed.

The above descriptions are only preferred embodiments of the present utility model, and are not intended to limit the present utility model. Any modifications, equivalent replacements and improvements made within the spirit and principles of the present utility model shall be included in this utility model. within the scope of protection of utility models.

Claims (10)

1. A bone handling device for large segmental bone defects of the tibial bone in patients with dense bone, comprising an intramedullary main nail for axially driving into the bone, the intramedullary main nail has a width that matches the anatomical structure of the human tibia , both ends are provided with locking holes for matching with ordinary fixing screws; it is characterized in that: the two ends of the main intramedullary nail are provided with fixing screw holes; it also includes a fixing bracket and several fixing screws; the rear end of the fixing screw is connected with the The fixed bracket is connected, and the front end is matched with the fixing screw hole on the main intramedullary nail; it also includes a number of delivery needles that can move axially along the main intramedullary nail, and one end of the delivery needle is radially implanted into the bone block that needs to be slid. If the main intramedullary nail is not reached, the other end is connected to the fixed bracket. 2. A bone handling device for patients with dense tibial bone defect according to claim 1, characterized in that: the fixation frame is a three-section type, including two sections for fixing with fixation screws segment and the intermediate transport segment for connecting with the transport needle; the fixed segment and the transport segment are connected by a universal joint. 3. A bone handling device for large tibial bone defects in patients with dense bone according to claim 2, characterized in that: the fixation section is provided with a hole for the passage of the fixation screw; the rear end of the fixation screw runs through the holes and fastened with bolts. 4. A bone handling device for patients with dense tibial bone defect according to claim 2, characterized in that: the handling section is formed by a plurality of joint sleeves; Long holes corresponding to positions are provided, and are fixed by bolts passing through the long holes. 5 . The bone handling device for large tibial bone defects in patients with dense bone according to claim 4 , wherein the sleeve is provided with a scale. 6 . 6. A bone handling device for patients with dense tibial bone defect according to claim 1, characterized in that: it also includes a needle seat that can slide up and down along the fixing bracket, and the handling needle is fixed on the needle seat. 7. A bone handling device for patients with dense tibial bone defect according to claim 6, characterized in that: the fixed bracket has a scale indicating the moving distance of the needle seat. 8. A bone handling device for patients with dense tibial bone defect according to claim 6, characterized in that: the fixed bracket is axially provided with a rack, and the needle seat is provided with a toothed There are matching gears; the outside of the needle seat is provided with an adjusting bolt that drives the gears to rotate. 9. A bone handling device for patients with dense tibial bone defect according to claim 1, characterized in that: the two ends of the main intramedullary nail are provided with locking holes for matching with common fixing screws. 10. A bone handling device for patients with dense tibial bone defect according to claim 1, characterized in that: two fixation screws are arranged at both ends of the main intramedullary nail; for two.