CN217408943U

CN217408943U - Proximal humerus reconstruction system

Info

Publication number: CN217408943U
Application number: CN202123180027.8U
Authority: CN
Inventors: 张伟; 吴显宗; 常祖豪; 聂少波; 孟令慧; 蒋超; 张炜鹏; 苗志明
Original assignee: Tianjin Zhengtian Medical Instrument Co Ltd; Beijing Naton Medical Technology Holdings Co Ltd
Current assignee: Tianjin Zhengtian Medical Instrument Co Ltd; Beijing Naton Medical Technology Holdings Co Ltd
Priority date: 2021-12-17
Filing date: 2021-12-17
Publication date: 2022-09-13
Anticipated expiration: 2031-12-17

Abstract

The utility model provides a proximal humerus reconstruction system, which comprises a bone fracture plate and screws, wherein the bone fracture plate is of an anatomical symmetrical structure and is used for coating a greater tuberosity of the humerus with the area approximately same as that of the proximal humerus; the bone fracture plate is provided with a plurality of screw holes and a plurality of suture holes, the screws are arranged in the screw holes in a penetrating mode, at least one screw is used for extending to an epiphyseal region, at least one screw is used for extending to a humeral distance, and the suture holes are used for arranging sutures for suturing the rotator cuff in a penetrating mode. The utility model discloses humerus near-end system of rebuilding can enough fix the big tubercle of humerus through coaptation board and screw, can also sew up the rotator cuff through sewing up hole and suture, in addition, because the bony structure of epiphyseal district and humerus apart from does not appear obviously loose and sparsely along with age growth, therefore the coaptation board passes through the fix with screw to epiphyseal district and humerus apart from, can realize the stable fixed to the big tubercle fracture of humerus.

Description

Proximal humerus reconstruction system

Technical Field

The utility model belongs to the technical field of orthopedic implant, especially, relate to a system is rebuild to humerus near-end.

Background

Proximal humeral fractures are one of the most common osteoporotic fractures, most common in the elderly, often accompanied by displaced greater tuberosity fractures. The greater tubercle, the most important anatomical structure of the proximal humerus, is the main attachment site of the rotator cuff, and is involved in the functions of shoulder lift, abduction, and rotation. When the greater tubercle of the humerus is fractured, the rotator cuff tissue is pulled to cause the rotator cuff tissue to shift towards the near end and the back, so that the rotator cuff can be impacted and the glenoid can be impacted, the function of the shoulder joint on the affected side is obviously limited, and the life quality of a patient is seriously influenced.

At present, the treatment principle for the fracture of the greater tuberosity of the humerus is to stably fix the greater tuberosity of the fracture and simultaneously realize the functional reconstruction of the rotator cuff. Common surgical treatment indications include: (1) a purely displaced greater tuberosity fracture; (2) rebuilding the functions of humeral greater tuberosity fracture and rotator cuff after the intramedullary nail fixation of the comminuted proximal humerus fracture; (3) and rebuilding the fracture of greater tuberosity of humerus and the function of rotator cuff after the replacement of comminuted proximal humeral fractured joint (including half-shoulder joint replacement, total-shoulder joint replacement and reverse-shoulder joint replacement).

Aiming at the disease, the main clinical treatment modes comprise simple rotator cuff suture, Kirschner wire tension band fixation, cancellous bone screw fixation and proximal humerus dissection locking steel plates. The first three methods can not effectively fix the fracture and can not realize the effective reconstruction of the function of the rotator cuff, which often causes the failure of the fracture treatment and the loss of the function of the affected shoulder joint. In addition, there are physicians who use proximal humeral locking plates (most commonly used as philis plates) to fix the greater humeral tuberosity. Although this method can achieve effective fixation of the fracture, it also presents major clinical problems: (1) the surgical injury and tissue stripping range is large, and even the axillary nerve is injured, so that shoulder joints cannot be abducted and lifted; (2) although the steel plate is also provided with a suture hole for rotator cuff suture reconstruction, the suture hole is designed to be a single small round hole, the passing of a suture and a suture needle is difficult, and the suture is easy to cut and break, which finally results in rotator cuff function reconstruction failure; (3) the steel plate cannot be used for reconstruction of greater nodules and rotator cuff after shoulder joint replacement; (4) when the angulation fixing steel plate system is used for fixing proximal humerus comminuted fracture, the incidence rate of postoperative screw resection, fracture displacement and internal fixture failure is as high as 30%.

Currently, effective greater tuberosity fixation and functional reconstruction of the rotator cuff are independent factors in post-operative function and clinical prognosis of all proximal humeral fractures. Along with the increasing of the aging population, the incidence of proximal humerus fracture involving the greater tuberosity is increased, and the wide application of minimally invasive surgery is realized, for the proximal humerus fracture involving the greater tuberosity, a proximal humerus reconstruction system applied to reconstruction of the greater tuberosity and the rotator cuff is urgently needed in the clinical practice process to realize strengthening and fixing the greater tuberosity of the humerus and effectively fixing the rotator cuff in various common surgical scenes, so that the improvement of the treatment effect and the postoperative functional requirements of patients on the disease is met, and the requirements on the operative effectiveness and the minimally invasive surgery are increased in the medical practice.

SUMMERY OF THE UTILITY MODEL

In view of the above, the present invention is directed to a proximal humerus reconstruction system for fixing the greater tuberosity of the humerus and reconstructing the rotator cuff.

In order to achieve the above purpose, the technical scheme of the utility model is realized as follows:

the proximal humerus reconstruction system comprises a bone fracture plate and screws, wherein the bone fracture plate is of an anatomical symmetrical structure and is used for coating a greater tuberosity of a humerus with the area approximately same as that of the greater tuberosity of the humerus; the bone fracture plate is provided with a plurality of screw holes and a plurality of suture holes, the screws are arranged in the screw holes in a penetrating mode, at least one screw is used for extending to an epiphyseal region, at least one screw is used for extending to a humeral distance, and the suture holes are used for penetrating and sewing sutures of the rotator cuff.

As a preferable scheme of the proximal humerus reconstruction system, the bone fracture plate has a symmetrical structure, a symmetrical plane of the bone fracture plate is parallel to a length direction of the bone fracture plate, and the screw holes and the suture holes are symmetrically arranged relative to the symmetrical plane.

As a preferable scheme of the proximal humerus reconstruction system, the bone plate is provided with five screw holes, two screw holes are located at the proximal end of the bone plate, two screw holes are located in the middle of the bone plate, and one screw hole is located at the distal end of the bone plate.

As a preferred version of the above proximal humerus reconstruction system, the screw is provided through a screw hole at the proximal end of the bone plate, the screw being adapted to extend to the epiphyseal region; when the screw is arranged in the screw hole in the middle of the bone fracture plate in a penetrating way, the screw is used for extending to the humerus distance; when the screw is arranged in the screw hole at the far end of the bone fracture plate, the screw is used for inclining the far end of the humerus and is arranged on the cortical bone at the opposite side of the bone fracture plate in a penetrating way.

In a preferred embodiment of the proximal humerus reconstruction system, the screws are diverged toward the outer side of the bone plate after penetrating the screw holes.

As a preferable solution of the proximal humerus reconstruction system, the bone plate is provided with seven suture holes, seven suture holes are located at edges of the bone plate, three suture holes are located at a proximal end of the bone plate, two suture holes are located at a middle portion of the bone plate, and two suture holes are located at a distal end of the bone plate.

As a preferable scheme of the proximal humerus reconstruction system, the suture hole includes a wire accommodating hole and a wire inlet, and the wire inlet is in a tapered structure along a wire inlet direction.

As a preferable scheme of the humerus proximal reconstruction system, the wire accommodating hole is a long circular hole, the inner wall of a plane at one side of the wire accommodating hole is close to the outer side face of the bone fracture plate, and the wire inlet is formed in a blocking wall between the inner wall of the plane of the wire accommodating hole and the outer side face of the bone fracture plate.

As a preferable scheme of the proximal humerus reconstruction system, an obstacle avoidance opening is arranged below the barrier wall.

As a preferable proposal of the proximal humerus reconstruction system, the bone fracture plate has the length ranging from 25mm to 35mm, the width ranging from 6mm to 13mm and the thickness ranging from 3.2mm to 3.8 mm.

Compared with the prior art, the utility model discloses a proximal humerus rebuilds system has following advantage:

the utility model discloses a humerus near-end reconstruction system can enough fix the big tubercle of humerus through coaptation board and screw, can also sew up the rotator cuff through sewing up hole and suture, in addition, because the bony structure of epiphyseal district and humerus apart from does not appear obviously loose and sparsely along with the age growth, therefore the coaptation board passes through the fix with screw to epiphyseal district and humerus apart from, can realize the stable fixed to the big tubercle fracture of humerus.

Drawings

The accompanying drawings, which form a part hereof, are included to provide a further understanding of the invention, and are incorporated in and constitute a part of this specification, illustrate embodiments of the invention and together with the description serve to explain the invention without undue limitation. In the drawings:

fig. 1 is a schematic view of a bone plate of the proximal humerus reconstruction system of the present invention fixed to a humerus;

fig. 2 is a front view of a bone plate of the proximal humerus reconstruction system of the present invention;

fig. 3 is a schematic structural view of another angle of the bone fracture plate of the proximal humerus reconstruction system of the present invention;

fig. 4 is a schematic view of the position of the screws in the humerus of the proximal humerus reconstruction system of the present invention;

fig. 5 is a top view of the present invention shown in fig. 4;

fig. 6 is a schematic structural view of the proximal humerus reconstruction system of the present invention when a screw at the distal end of the bone plate is not inserted;

fig. 7 is a side view of a bone plate of the proximal humerus reconstruction system of the present invention.

Description of the reference numerals:

1. a bone plate; 2. a screw;

11. screw holes; 12. sewing the hole;

121. a wire accommodating hole; 122. a wire inlet; 123. a retaining wall; 124. an obstacle avoidance opening;

001. an epiphyseal region; 002. humeral distance.

Detailed Description

It should be noted that, in the present invention, the embodiments and features of the embodiments may be combined with each other without conflict.

The present invention will be described in detail below with reference to the accompanying drawings in conjunction with embodiments.

The present embodiment provides a proximal humerus reconstruction system, as shown in fig. 1, the proximal humerus reconstruction system includes a bone plate 1 and screws 2, the bone plate 1 is an anatomical symmetric structure and is used for covering a greater tuberosity of a humerus with an area approximately the same as that of the greater tuberosity of the humerus; the bone plate 1 is provided with a plurality of screw holes 11 and a plurality of suture holes 12, the screws 2 are arranged in the screw holes 11 in a penetrating way, at least one screw 2 is used for extending to the epiphyseal region 001, at least one screw 2 is used for extending to the humeral distance 002, and the suture holes 12 are used for arranging the suture lines for suturing the rotator cuff in a penetrating way.

The proximal humeral reconstruction system in this embodiment can fix a greater tuberosity of a humerus by the bone plate 1 and the screws 2, and can suture a rotator cuff by the suture holes 12 and the suture lines, and in addition, since the bone structures of the epiphyseal region 001 and the humeral distance 002 are not significantly loosened and sparse with age, the bone plate 1 is fixed to the epiphyseal region 001 and the humeral distance 002 by the screws 2, and stable fixation of fracture of the greater tuberosity of the humerus can be realized.

In this embodiment, as shown in fig. 1 and 2, the bone plate 1 has a symmetrical structure, the symmetrical plane of the bone plate 1 is parallel to the length direction of the bone plate 1, and the plurality of screw holes 11 and the plurality of suture holes 12 are symmetrically arranged with respect to the symmetrical plane. In clinical use, the bone fracture plate 1 does not need to distinguish between a left bone fracture plate and a right bone fracture plate, so that the universality is better, and the complexity and confusion of clinical selection are reduced.

In this embodiment, the bone plate 1 covers the greater tuberosity of the humerus, with the bone plate 1 having a length in the range of 25mm to 35mm, a width in the range of 6mm to 13mm and a thickness in the range of 3.2mm to 3.8 mm. The bone fracture plate 1 is short in length and does not extend to the humeral shaft in a large range, so that surgical injury can be reduced to the maximum extent, and minimally invasive surgery is realized. Specifically, the bone plate 1 has a length of 30mm, a width of 6mm-13mm and a thickness of 3.5 mm. Preferably, the bone plate 1 is placed 5mm to 10mm below the proximal end of the greater tuberosity of the humerus and 5mm to 10mm behind the anterior edge of the greater tuberosity. The bone plate 1 is 35mm-40mm away from the greater tuberosity of the humerus at the most far end. The distance can prevent the axillary nerve from being exposed and interfered by the surgeon during the operation, so that the axillary nerve is not damaged.

This coaptation board 1 is for dissecting the adhesion with the big tubercle of humerus, can not produce the irritation to surrounding tissue to can guarantee that the big tubercle of humerus can accurately reset.

In this embodiment, as shown in fig. 1-5, the bone plate 1 is provided with five screw holes 11, two screw holes 11 are located at the proximal end of the bone plate 1, two screw holes 11 are located at the middle portion of the bone plate 1, and one screw hole 11 is located at the distal end of the bone plate 1. When the screw 2 is arranged in the screw hole 11 at the near end of the bone fracture plate 1 in a penetrating manner, the included angle between the screw 2 and the sagittal plane is 15 degrees, the included angle between the screw 2 and the coronal plane is 15 degrees, and the screw 2 can extend to the epiphyseal region 001 to hold the epiphyseal region 001; when the screw 2 is arranged in the screw hole 11 in the middle of the bone fracture plate 1 in a penetrating manner, the included angle between the screw 2 and the sagittal plane is 15 degrees, the included angle between the screw 2 and the coronal plane is 15 degrees, and the screw 2 can extend to the humeral distance 002 to hold the humeral distance 002; when the screw 2 is arranged in the screw hole 11 at the far end of the bone fracture plate 1 in a penetrating manner, the included angle between the screw 2 and the coronal plane is 15 degrees, the screw 2 is inclined to the far end of the humerus and arranged on the cortical bone at the opposite side of the bone fracture plate 1 in a penetrating manner, so that the double-cortical fixation of the screw 2 is realized, and the stable fixation of the bone fracture plate 1 is realized. In other embodiments, the screw 2 may point in other directions in the screw hole 11.

In the present embodiment, the screws 2 are diverged toward the outer side of the bone plate 1 after being inserted into the screw holes 11. In this embodiment, it is determined whether the screw 2 needs to be inserted into the screw hole 11 at the distal end of the bone plate 1 according to the needs of a particular operation. Referring to fig. 6, the proximal humeral reconstruction system can be used with an intramedullary nail or a shoulder replacement prosthesis when no screws 2 are provided in the screw holes 11 at the distal end of the bone plate 1 or when screws 2 are provided so as to avoid the middle region of the humeral medullary cavity, i.e., a space can be formed between the diverging screws 2 to allow the intramedullary nail or shoulder replacement prosthesis to be implanted in the humeral medullary cavity.

In the present embodiment, as shown in fig. 2 and 3, the screw holes 11 are all universal holes, and an insertion angle of 15 ° is allowed to be added to each direction on the basis of the original direction of the set screw 2. The universal hole keeps the integration of the bone fracture plate 1 and the screws 2 on the one hand, and increases the distribution angles of the screws 2 on the other hand, so that an embedding space is reserved for intramedullary nails or shoulder joint replacement prostheses and the like, the interference among different implants is reduced, the universal hole is suitable for reconstruction of greater humeral tuberosities under various application scenes, the strength of fracture fixation is increased, and the risk of internal fixation failure is reduced.

In this embodiment, the screw hole 11 is a countersunk hole capable of receiving the nut of the screw 2, and the nut is prevented from being higher than the surface of the bone plate 1, so as to reduce irritation of the nut of the screw 2 to soft tissue.

In this embodiment, as shown in fig. 2, bone plate 1 is provided with seven suture holes 12, seven suture holes 12 are located at the edge of bone plate 1, three suture holes 12 are located at the proximal end of bone plate 1, two suture holes 12 are located at the middle of bone plate 1, and two suture holes 12 are located at the distal end of bone plate 1. Two suture holes 12 at the distal end of the bone plate 1 are used for initial preset sutures of the supraspinatus, infraspinatus, teres minor and subscapularis.

The suture holes 12 in the proximal end of the bone plate 1 and the suture holes 12 in the middle of the bone plate 1 are used after all the screws 2 have been placed. Three suture holes 12 at the proximal end of the bone plate 1 are used for suture fixation of supraspinatus. The three suture holes 12 on the same side edge of the bone plate 1, which are respectively positioned at the near end of the bone plate 1, the middle part of the bone plate 1 and the far end of the bone plate 1, are suitable for suture fixation of the infraspinatus and the small deltoid muscle, and the three suture holes 12 on the other same side edge of the bone plate 1, which are respectively positioned at the near end of the bone plate 1, the middle part of the bone plate 1 and the far end of the bone plate 1, are used for suture fixation of the infrascapular muscle.

As shown in fig. 7, the suture hole 12 includes a thread accommodating hole 121 and a thread inlet 122, and since the suture hole 12 is provided with the thread inlet 122, a suture needle is not needed when the rotator cuff is sutured, so that the use of a medical sharp instrument is reduced, and the medical cost, the iatrogenic injury and the risk of occupational exposure of a medical care team are reduced.

The wire inlet 122 is a tapered structure along the wire inlet direction, and is specifically in a shape like a Chinese character 'ba', the outer opening of the wire inlet 122 is large, the wire inlet 122 is aligned conveniently during threading, the operation is fast, the inner opening of the wire inlet 122 is small, the thread penetrating into the thread accommodating hole 121 can be prevented from being separated, and the effect of sewing the rotator cuff is ensured. The wire accommodating hole 121 is an oblong hole, and the length of the wire accommodating hole 121 is 2mm, and the width of the wire accommodating hole is 1 mm. The planar inner wall of one side of the wire accommodating hole 121 is arranged close to the outer side face of the bone fracture plate 1, and the wire inlet 122 is arranged on the blocking wall 122 between the planar inner wall of the wire accommodating hole 121 and the outer side face of the bone fracture plate 1. The barrier opening 124 is arranged below the barrier wall 122, so that a certain space can be formed between the bone fracture plate 1 and a bone substance, and the operation of threading a suture is convenient. The thickness and width of the blocking wall 122 are both 0.6 mm.

In other embodiments, the size of the wire receiving hole 121 and the size of the blocking wall 122 may be selected according to specific situations.

The edges of the suture holes 12 are processed with low incisional marks to avoid suture cutting and breaking.

The above description is only a preferred embodiment of the present invention, and should not be taken as limiting the invention, and any modifications, equivalent replacements, improvements, etc. made within the spirit and principle of the present invention should be included in the protection scope of the present invention.

Claims

1. A proximal humeral reconstruction system, comprising: the bone fracture plate comprises a bone fracture plate (1) and screws (2), wherein the bone fracture plate (1) is of an anatomical symmetrical structure and is used for coating a greater humeral tubercle with the area approximately the same as that of the bone fracture plate; the bone fracture plate (1) is provided with a plurality of screw holes (11) and a plurality of suture holes (12), the screws (2) penetrate through the screw holes (11), at least one screw (2) is used for extending to an epiphyseal region (001), at least one screw (2) is used for extending to a humeral distance (002), and the suture holes (12) are used for penetrating and sewing sutures of a rotator cuff.

2. The proximal humerus reconstruction system according to claim 1, characterized in that the bone plate (1) has a symmetrical structure, a symmetrical plane of the bone plate (1) is parallel to a longitudinal direction of the bone plate (1), and the screw holes (11) and the suture holes (12) are symmetrically arranged with respect to the symmetrical plane.

3. The proximal humerus reconstruction system according to claim 2, characterized in that five screw holes (11) are provided in the bone plate (1), two screw holes (11) being located at the proximal end of the bone plate (1), two screw holes (11) being located in the middle of the bone plate (1), one screw hole (11) being located at the distal end of the bone plate (1).

4. Proximal humeral reconstruction system according to claim 3, characterized in that the screw (2) is intended to extend to the epiphyseal region (001) when the screw (2) is inserted through a screw hole (11) located at the proximal end of the bone plate (1); when the screw (2) is arranged in a screw hole (11) in the middle of the bone plate (1) in a penetrating way, the screw (2) is used for extending to a humerus distance (002); when the screw (2) is arranged in the screw hole (11) at the far end of the bone fracture plate (1) in a penetrating way, the screw (2) is used for inclining to the far end of the humerus and is arranged on the cortical bone at the opposite side of the bone fracture plate (1) in a penetrating way.

5. The proximal humeral reconstruction system according to claim 4, characterized in that the screws (2) after passing through the screw holes (11) each diverge towards the outside of the bone plate (1).

6. The proximal humerus reconstruction system according to claim 2, characterized in that the bone plate (1) is provided with seven suture holes (12), seven suture holes (12) being located at the edge of the bone plate (1), three suture holes (12) being located at the proximal end of the bone plate (1), two suture holes (12) being located in the middle of the bone plate (1), two suture holes (12) being located at the distal end of the bone plate (1).

7. The proximal humeral reconstruction system according to claim 6, characterized in that the suture hole (12) includes a thread receiving hole (121) and a thread inlet (122), and the thread inlet (122) is of a tapered structure in a thread inlet direction.

8. The proximal humeral reconstruction system according to claim 7, characterized in that the wire receiving hole (121) is an oblong hole, a planar inner wall of one side of the wire receiving hole (121) is disposed near the lateral surface of the bone plate (1), and the wire inlet (122) opens on a barrier wall (123) between the planar inner wall of the wire receiving hole (121) and the lateral surface of the bone plate (1).

9. Proximal humerus reconstruction system according to claim 8, characterized in that an obstacle avoidance opening (124) is provided underneath the barrier wall (123).

10. Proximal humerus reconstruction system according to claim 1, characterized in that the bone plate (1) has a length in the range 25mm to 35mm, a width in the range 6mm to 13mm and a thickness in the range 3.2mm to 3.8 mm.