JP2008068011A - Fixing appliance for bone fracture of proximal part of femur - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a fixing appliance for the bone fracture of the proximal part of a femur capable of corresponding to various lug screw attaching angles required corresponding to the situation of operation and eliminating not only a restriction having to prepare many intramedullary rods corresponding to the different lug screw attaching angles but also the occurrence of the re-insertion work of the intramedullary rods during operation. <P>SOLUTION: Each of the intramedullary rods 11 is formed into a rod shape inserted in the pulp of the part 100b on the distal part side of the femur and has a first through-hole 18 piercing its side surface. A sleeve 12 is formed as a cylindrical member to be inserted in the first through-hole 18 and provided with the second through hole 23 piercing along the longitudinal direction of the cylindrical member. Each of the lug screws 13 is formed into a rod shape so as to be inserted in the second through-hole 23 and has the screw part 24 threaded with the part 100a on the primal part side of the femur installed on its leading end side. An angle adjusting means is formed in the first through-hole 18 and the sleeve 12 to change the angle of inclination of each of the lug screws 13 with respect to each of the intramedullary rod 11. <P>COPYRIGHT: (C)2008,JPO&INPIT

Description

  The present invention relates to a proximal femoral fracture for fixing a proximal portion to a distal portion from a fracture position in the femur when a fracture occurs in the proximal femur. It relates to a fixture.

  Conventionally, when a fracture occurs in the proximal part of the femur, fixation for the fracture of the proximal part of the femur to fix the proximal part to the distal part from the fracture position in the femur An instrument is known (see Patent Documents 1 and 2). A therapeutic device for a femoral fracture described in Patent Document 1 includes a rack screw having means for engaging with a femoral head, a hollow sleeve that slidably receives the rack screw, and a marrow that is inserted into the marrow of the femur. And an inner rod. The intramedullary rod is provided with a passage therethrough, and the sleeve is received in this passage. Further, an intertrochanteric fracture fixing device described in Patent Document 2 includes an intramedullary rod having a cornered opening for receiving a screw for a femoral neck having a threaded portion, and a wall portion of the neck screw and the cornered opening. And locking means for preventing relative rotation of the cervical screw and the intramedullary rod. And this locking means is comprised as a sleeve which can be slid within the angled opening.

Japanese Patent Laid-Open No. 4-215551 Japanese Patent Laid-Open No. 5-176842

  However, in the femoral fracture treatment device described in Patent Document 1, the angle of attachment of the rack screw engaged with the femoral head to the intramedullary rod remains constant. Similarly, in the intertrochanteric fracture fixing device described in Patent Document 2, the attachment angle of the femoral neck screw to the intramedullary rod remains constant. As described above, in the femoral proximal fracture fixing device configured as described in Patent Literatures 1 and 2, the lag screw provided with the screw portion that is screwed into the proximal portion from the fracture position in the femur. However, it will be attached to the intramedullary stick inserted along the inside of the medulla at a fixed fixed angle. For this reason, many types of intramedullary are designed so that the lag screw can be attached to the intramedullary bar at different attachment angles to accommodate the various lag screw attachment angles required depending on the surgical situation. A stick must be prepared. During the operation, after inserting the intramedullary rod, the angle of attachment of the lag screw is such that the lag screw cannot be inserted at the optimum insertion position intended by the operator performing the operation. In such a case, it is necessary to remove the intramedullary bar once inserted and reinsert the intramedullary bar having a different attachment angle.

  In view of the above circumstances, the present invention can cope with various lag screw mounting angles required according to the situation of surgery, and many intramedullary rods corresponding to different lag screw mounting angles must be prepared for surgery. It is an object of the present invention to provide a fixation device for fractures of the proximal femur that can eliminate the above-described problems and eliminate the occurrence of the operation of reinserting the intramedullary rod during surgery.

  Further, in the femoral proximal fracture fixing device described in Patent Documents 1 and 2, the proximal end portion of the intramedullary rod has a shape in which the cross-sectional area is larger than the distal end portion. It has become. For this reason, when the intramedullary stick is inserted into the femur, the part of the femur proximal to the fracture position is likely to interfere with the proximal end of the intramedullary stick. There is a risk that the varus, which is a phenomenon in which a gap is generated between the proximal portion side portion and the distal portion side portion, becomes large. Therefore, in the present invention, when the intramedullary stick is inserted into the femur, the interference between the proximal part of the femur and the end of the proximal part of the intramedullary stick is suppressed, and the varus Another object of the present invention is to provide a proximal femoral fracture fixation device that can reduce the above-mentioned problem.

Means and effects for solving the problems

The present invention relates to a proximal femoral fracture for fixing a proximal portion to a distal portion from a fracture position in the femur when a fracture occurs in the proximal femur. It relates to a fixture.
In order to achieve the above object, the proximal femoral fracture fixation device of the present invention has several features as follows. That is, the present invention comprises the following features alone or in appropriate combination.

  In order to achieve the above object, the first feature of the proximal femoral fracture fixation device according to the present invention is formed in a rod shape inserted along the medulla of the distal portion side portion, and An intramedullary rod provided with a first through-hole penetrating on the side surface, and a second formed as a cylindrical body and inserted through the first through-hole along the longitudinal direction of the cylindrical body A sleeve provided with a through-hole, a lug screw formed in a rod shape that is inserted into the second through-hole, and a screw portion that is screwed into a portion on the proximal portion side, and provided on the distal end side, Angle adjusting means that is formed in at least one of the first through hole and the sleeve and makes the inclination angle of the lug screw with respect to the intramedullary rod variable.

  According to this configuration, the intramedullary rod is inserted into the medulla at the distal portion side, the sleeve is inserted into the first through hole of the intramedullary rod, and the lug screw is inserted into the second through hole of the sleeve Is done. Then, by adjusting the angle adjusting means formed in at least one of the first through hole and the sleeve, the operator during the operation adjusts the inclination angle of the lag screw with respect to the intramedullary rod, that is, the lag screw mounting angle. The angle is set so as to be an angle intended by the operator. Furthermore, the screw part of the lug screw set to the operator's desired mounting angle is screwed into the proximal part, so that the proximal part is fixed to the distal part from the fracture position. Will be. In this way, by adjusting the angle adjusting means by the surgeon during the operation, it is possible to cope with various lag screw mounting angles required according to the situation of the operation. Therefore, according to the configuration of the present invention, it is possible to eliminate the restriction that many intramedullary bars corresponding to different lag screw mounting angles have to be prepared for the operation, and to eliminate the operation of reinserting the intramedullary bar during the operation. A femoral proximal fracture fixation device can be provided.

  A second feature of the proximal femoral fracture fixation device according to the present invention is that the angle adjusting means is formed in the first through-hole formed so as to extend while being curved, and the first through-hole. And the sleeve formed in an outer shape having a curved shape.

  According to this configuration, the orientation direction of the sleeve is changed by displacing the sleeve having a curved shape inserted through the first through hole formed to be slid along the first through hole. The orientation direction of the lug screw inserted through the second through hole of the sleeve is also changed at the same time. That is, the lag screw mounting angle can be easily adjusted by displacing the sleeve along the first through hole.

  A third feature of the proximal femoral fracture fixation device according to the present invention is that the tilt angle of the first through-hole changes in a direction of warping from the distal portion side toward the proximal portion side. That is, it is curved.

  According to this configuration, the first through-hole is curved so that the angle of inclination changes in a direction in which the first through-hole warps from the distal portion side toward the proximal portion side. For this reason, the surgeon can adjust the displacement of the sleeve along the first through-hole while displacing the sleeve gradually toward the proximal portion side until the desired angle of the lug screw is reached. The angle adjustment operation can be performed more easily.

  A fourth feature of the proximal femoral fracture fixation device according to the present invention is that the angle adjusting means includes the first through-hole formed as a hole having a circular cross section, and the cross-sectional outer shape of the first penetration. The second through-hole is formed in a circular shape corresponding to the circular cross section of the hole and is formed so as to penetrate obliquely with respect to the longitudinal direction of the sleeve.

  According to this configuration, the sleeve formed in the circular cross section corresponding to the circular cross section of the first through hole is rotated by an appropriate angle in the first through hole having the circular cross section so as to be inclined with respect to the longitudinal direction of the sleeve. The inclination of the second through hole formed so as to penetrate the first through hole changes by a predetermined angle. Therefore, the lug screw mounting angle can be easily adjusted by turning the sleeve at an appropriate angle within the first through hole.

  A fifth feature of the proximal femoral fracture fixation device according to the present invention is that the lug screw is formed such that the maximum diameter of the screw portion is larger than the diameter of the central portion of the shaft. Is provided with a flange projecting in a range allowing passage of the central portion of the shaft at least at a part of the inner circumferential edge of the portion oriented toward the proximal portion of the second through-hole, The two through holes allow passage of the screw portion and the shaft center portion, and the flange portion is provided so that the opening diameter on the proximal portion side of the second through hole is larger than the maximum diameter of the screw portion. The lug screw is further formed on the rear end side opposite to the front end side where the screw portion is provided. Toward the proximal side in the through-hole of It is that the collar portion and capable of abutting against a stepped portion is formed when the sliding.

  According to this configuration, first, the screw portion and the shaft center portion of the lug screw can be inserted into the second through hole of the sleeve. And since the sleeve is formed so that the opening diameter on the proximal portion side of the second through hole is smaller than the maximum diameter of the screw portion and larger than the minimum diameter by providing the flange portion, By inserting into the second through hole while rotating, the screw part of the lug screw can pass through the opening part of the second through hole narrowed by the flange part. For this reason, after passing the screw part of a lag screw through the opening part of a 2nd through-hole, the maximum diameter of a screw part is larger than the opening diameter of the proximal part side of a 2nd through-hole, and a screw part and a collar part And the lug screw from the sleeve is prevented from falling off when placed in the femur. Furthermore, since the step part which can contact | abut with the collar part of a sleeve is provided in the rear-end side of the lag screw, it can also prevent that a lag screw penetrates a 2nd through-hole.

  The sixth feature of the femoral proximal fracture fixing device according to the present invention is that the angle adjusting means is formed as a tapered hole whose cross-sectional area decreases from the distal side toward the proximal side. A plurality of the sleeves, each of which is formed as a tapered surface having a side peripheral surface along the first through-hole, and a center line connecting the cross-sectional centers of the second through-holes And the plurality of sleeves in which the second through holes are respectively formed so that the angles formed by the center lines connecting the cross-sectional centers of the first through holes are different from each other.

  According to this configuration, when sleeves having different inclinations of the second through hole with respect to the first through hole are used, the lug screw mounting angle is also different. Therefore, by appropriately selecting a sleeve corresponding to a desired lag screw mounting angle from a plurality of sleeves having different inclinations of the second through-hole with respect to the first through-hole, a common intramedullary rod can be used. The lug screw mounting angle can be easily adjusted by simply replacing the sleeve.

  A seventh feature of the femoral proximal fracture fixation device according to the present invention is that the intramedullary rod is a through hole different from the first through hole, and penetrates from the side and has a cross-sectional shape. Is further provided with a second screw that is inserted into the third through hole and screwed into the proximal portion side portion. It is that you are.

  According to this structure, the second screw is inserted into the third through hole provided in the intramedullary rod and screwed into the proximal portion of the femur, thereby preventing the second screw from rotating. The function can be achieved and the proximal portion can be prevented from rotating. Further, the cross-sectional shape of the third through hole is formed to be a long hole shape, and the degree of freedom of the mounting angle of the second screw can be increased. For this reason, the second screw can be easily attached at a desired angle to the proximal portion of the femur while preventing interference with the lug screw attachment angle.

  An eighth feature of the femoral proximal fracture fixing device according to the present invention is that a distal end portion of the proximal portion of the intramedullary stick is provided with a cut-out portion formed in a tapered surface shape. It is.

  According to this configuration, the tip portion on the proximal portion side of the intramedullary rod is provided with the tapered surface cut portion. For this reason, when an intramedullary stick is inserted into the femur of the femur, interference occurs between the proximal part of the femur and the end of the intramedullary stick in the proximal part of the fracture. Therefore, it is possible to provide a femoral proximal fracture fixation device that can suppress the varus and reduce the varus.

  In addition, a proximal femur fracture fixing device according to another aspect of the present invention for achieving the above-described other object is provided so that a fracture occurs in the femur when the fracture occurs in the proximal femur. A proximal femoral fracture fixation device for fixing a proximal portion with respect to a distal portion, the rod being inserted along the medulla of the distal portion An intramedullary rod formed with a first through-hole penetrating on the side surface and formed as a cylindrical body and inserted through the first through-hole, along the longitudinal direction of the cylindrical body A sleeve provided with a second through-hole penetrating through and a screw portion formed in a rod shape that is inserted into the second through-hole and screwed into a portion on the proximal portion side is provided on the distal end side. A lug screw, and a tip formed on the proximal side of the intramedullary rod is formed into a tapered surface. Wherein the parts are provided.

  According to this configuration, the tip portion on the proximal portion side of the intramedullary rod is provided with the tapered surface cut portion. For this reason, when an intramedullary stick is inserted into the femur of the femur, interference occurs between the proximal part of the femur and the end of the intramedullary stick in the proximal part of the fracture. Therefore, it is possible to provide a femoral proximal fracture fixation device that can suppress the varus and reduce the varus.

  Hereinafter, embodiments for carrying out the present invention will be described with reference to the drawings. In the present invention, the proximal part of the femur for fixing the proximal part to the distal part from the fracture position in the femur when a fracture occurs in the proximal part of the femur It can be widely applied as a fracture fixation device.

(First embodiment)
FIG. 1 is a perspective view of a femoral proximal fracture fixing device 1 (hereinafter simply referred to as a fixing device 1) according to a first embodiment of the present invention, and FIG. 2 is opposite to the front side of FIG. The perspective view of the fixing device 1 seen from the back side is shown. As shown in FIGS. 1 and 2, the fixing device 1 includes an intramedullary rod 11, a sleeve 12, a lug screw 13, an anti-rotation screw 14, a sleeve pressing member 15, a sleeve pressing lock screw 16, and an auxiliary screw. 17. Note that the sleeve pressing member 15 and the sleeve pressing lock screw 16 are arranged inside the intramedullary rod 11 in FIG. 1, and are shown in an exploded perspective view in FIG.

  FIG. 3 shows a front view of the fixation device 1 and shows a part of the intramedullary rod 11 and the sleeve 12 in cross section. FIG. 4 is a front view including a partial cross section of the intramedullary rod 11. In FIG. 3, illustration of the sleeve pressing lock screw 16 and the auxiliary screw 17 is omitted. As shown in FIGS. 1 to 4, the intramedullary rod 11 is formed in a rod shape, and is provided with a through hole 18 (a first through hole in the present embodiment) penetrating on the side surface. Further, the intramedullary rod 11 has a hollow hole 19 formed along the axial direction (longitudinal direction extending in a rod shape).

  FIG. 6 is a front view showing a state in which the fixing device 1 is disposed on the femur 100. As shown in FIG. 6, the fixing device 1 has a fracture at the proximal portion of the femur 100. At this time, it is used to fix the proximal portion 100a to the distal portion 100b from the fracture position in the femur 100 (the position indicated by the two-dot chain line in the figure). Then, as shown in FIG. 6, the intramedullary rod 11 formed in a rod shape is inserted along the intramedullary region of the distal portion 100b. In addition, in FIG. 6, the case where it applies to a left leg femur is illustrated and the part arrange | positioned in the femur 100 in the fixing device 1 is shown with the dotted line.

  Further, the through-hole 18 provided so as to penetrate the intramedullary rod 11 on the side surface thereof extends while curving so as to indicate a direction along the contour line and the center line by a one-dot chain line A in FIG. Is formed. And this through-hole 18 is curvedly formed so that the angle of inclination changes in the direction which curves toward the proximal part side from the distal part side (refer the dashed-dotted line A in FIG. 4).

  Further, the intramedullary rod 11 is a through hole different from the through hole 18 and penetrates through the side surface of the intramedullary rod 11 similarly to the through hole 18 (third through hole in the present embodiment). Is formed. As shown in FIGS. 1 to 4, the through hole 20 is formed so that the cross-sectional shape is a long hole (a long hole extending in the axial direction of the intramedullary rod 11). The through-hole 20 is formed as a straight through-hole as indicated by a one-dot chain line B in FIG. In addition, the intramedullary rod 11 is provided with a cutting edge portion 22 having a tapered surface 21 which is a portion formed in a tapered surface shape, as shown in FIGS. ing.

  FIG. 5 shows a sectional view of the sleeve 12 (FIG. 5A) and a side view thereof (FIG. 5B). As shown in FIGS. 1 to 3 and 5, the sleeve 12 is formed as a cylindrical body, and is inserted into a through hole 18 provided in the intramedullary rod 11. The sleeve 12 is provided with a through hole 23 (second through hole in the present embodiment) penetrating straight along the longitudinal direction of the cylindrical body. The outer shape of the sleeve 12 is formed in a curved shape along the through hole 18 of the intramedullary rod 11. Since it is formed in this way, the position of the sleeve 12 can be slid along the through hole 18 in a state where the sleeve 12 is inserted into the through hole 18 of the intramedullary rod 11.

  The lug screw 13 shown in FIGS. 1 to 3 is formed in a rod shape that is inserted into the through hole 23 of the sleeve 12, and a screw portion 24 that is screwed into the proximal portion side portion 100 a of the femur 100 is on the distal end side. Is provided. The lug screw 13 may be configured such that the end opposite to the screw portion 24 is fixed with a screw in a state where the shaft portion 25 is inserted into the through hole 23 of the sleeve 12. The lug screw 13 has a maximum diameter of the shaft portion 25 and the screw portion 24 (the diameter at the top of the mountain of the screw portion 24, that is, the top of the top of the mountain with respect to a plane perpendicular to the axial direction of the screw portion 24). (Diameter) and the same size. The lug screw 13 is formed so that the maximum diameter of the screw portion 24 is larger than that of the shaft portion 25, and the maximum diameter of the screw portion 24 is larger than the diameter of the through hole 23 of the sleeve 12. It may be formed as follows. As described above, when the screw portion 24 having a diameter larger than that of the shaft portion 25 is provided in the lug screw 13 and the screw portion 24 is formed to be larger than the diameter of the through hole 23, the screw portion 24 is inserted into the through hole 23. The lag screw 13 is in contact with the edge portion of the through-hole 23 at the screw portion 24, and the lag screw 13 can be reliably prevented from falling off from the sleeve 12 when placed in the femur 100. Become.

  The anti-rotation screw 14 (second screw in the present embodiment) shown in FIGS. 1 to 3 is inserted into a through-hole 20 having a long hole cross section provided in the intramedullary rod 11. The anti-rotation screw 14 is provided with a screw portion 27 that is screwed into the proximal portion 100a of the femur 100 on the distal end side. When the anti-rotation screw 14 is screwed into the proximal portion 100a of the femur 100, the displacement in the rotational direction relative to the distal portion 100b of the proximal portion 100a is restricted and prevented. Will be.

  The sleeve pressing member 15 shown in FIG. 2 and FIG. 3 is formed in a bifurcated shape at the distal end side so that the distal end side is inserted into the hollow hole 19 of the intramedullary rod 11 from the cut end portion 22 side. It has become. Thereby, the sleeve pressing member 15 is inserted into the hollow hole 19 of the intramedullary rod 11 and arranged on the distal side thereof. Then, in this state, the sleeve pressing member C15 is further extended at its distal end such that the bifurcated portion on the distal end side straddles the shaft portion 29 of the anti-rotation screw 14 inserted through the through hole 20 of the intramedullary rod 11. The sleeve 12 located on the side is brought into contact with and can be pressed down. The sleeve pressing lock screw 16 is fitted into the hollow hole 19 of the intramedullary rod 11 from the cut end 22 side in a state where the sleeve pressing member 15 presses the sleeve 12 as described above. A male screw portion is formed on the outer periphery of the sleeve presser lock screw 16, and this male screw portion is screwed with a female screw portion formed at the end of the hollow hole 19 on the cut end portion 22 side. Yes. As a result, the sleeve pressing lock screw 16 is screwed into the female screw portion of the hollow hole 19 and fixed in a state where the sleeve pressing member 15 is in contact with the sleeve 12, so that the sleeve 12 can be positioned.

  The auxiliary screw 17 shown in FIGS. 1 and 6 is inserted into a through-hole 28 having a long hole-like cross section provided in the middle of the shaft portion of the intramedullary rod 11, and a thigh is provided at the distal end side. A screw portion that is screwed into the bone 100 is formed. By providing the auxiliary screw 17, the rotation of the intramedullary rod 11 within the medulla of the femur 100 is reliably prevented.

  In addition, the fixing device 1 is provided with angle adjusting means that is formed in the through hole 18 and the sleeve 12 so that the inclination angle of the lug screw 12 with respect to the intramedullary rod 11 is variable. In the present embodiment, the angle adjusting means is formed by a curved through hole 18 and a curved outer sleeve 12 along the through hole 18.

  When the above-described fixing device 1 causes a fracture at the proximal femur, as shown in FIG. 6, the proximal portion 100a is fixed to the distal portion 100b from the fracture position. To be used. When such an operation is performed on a fractured portion on the proximal side of the femur, the surgeon inserts the intramedullary rod 11 into the medullary portion of the distal portion 100b, and then the sleeve 12 is intramedullary. The rod 11 is inserted into the through hole 18. The lug screw 13 is inserted through the through hole 23 of the sleeve 12 at the shaft portion 25. Moreover, a screw can also be attached to the edge part on the opposite side to the front end side of the lug screw 13. FIG.

  From the state described above in which the sleeve 12 is disposed in the through hole 18 of the intramedullary rod 11 and the lug screw 13 is disposed in the through hole 23 of the sleeve 12, the surgeon moves the sleeve 12 within the through hole 18 of the intramedullary rod 11. Displace to slide. That is, the operator adjusts the angle adjusting means formed by the through hole 18 and the sleeve 12. By the adjustment by the angle adjusting means, the inclination angle of the lag screw 13 with respect to the intramedullary rod 11, that is, the lag screw attachment angle is set to be an angle intended by the operator. And the screw part 24 of the lag screw 13 set to the operator's desired attachment angle is screwed into the proximal part 100a, so that the proximal part 100a is distant from the fracture position. It will be fixed to the part 100b.

  Further, the anti-rotation screw 14 is also inserted into the through hole 20, and the screw portion 27 of the anti-rotation screw 14 is further screwed into the proximal portion 100b. Then, the sleeve pressing member 15 is inserted into the hollow hole 19 until the sleeve pressing member 15 straddles the anti-rotation screw 14 and comes into contact with the sleeve 12, and the sleeve pressing lock screw 16 is a female screw provided at the end portion 22 side of the hollow hole 19. The sleeve 12 is positioned by being screwed to the portion. The auxiliary screw 17 is also inserted through the through hole 28, and a screw portion provided on the distal end side thereof is screwed to the femur 100. Accordingly, the state shown in FIG. 6 is obtained, and the operation of fixing the proximal portion 100a to the distal portion 100b of the femur 100 by the fixing device 1 is completed.

  The fixation device 1 can be used for various forms of femoral fractures as illustrated in FIG. Although the bone is broken, the proximal portion 100a and the distal portion 100b have almost no relative displacement between the proximal portion 100a and the distal portion 100b (FIG. 7A). Bone defect unlike the case of FIG. 7 (b), in a form in which relative displacement has occurred between the distal part 100b but no bone defect has occurred (FIG. 7 (b)). As shown in FIGS. 7 (a) to 7 (d), those having a form in which a fracture occurs (FIG. 7 (c)), those having a complicated fracture (FIG. 7 (d)), and FIGS. The fixing device 1 is applied to various forms of femoral fractures such as a form in which the fracture position becomes higher toward the inner side of the human body (FIG. 7 (e)) instead of the form in which the fracture position becomes higher. be able to.

  Here, the function of the fixation device 1 that can suppress the occurrence of a varus that causes a gap between the proximal portion 100a and the distal portion 100b of the femur 100 will be described. FIG. 8 is a diagram for explaining a case where the proximal portion 100a is fixed to the distal portion 100b with a general fixing device according to the prior art. As shown in FIG. 8A, first, in the fractured femur 100, the lag screw 102 according to the prior art is inserted when the proximal portion 100a is fixed to the distal portion 100b. A planned position X1 (shown by a one-dot chain line) is determined. Next, as shown in FIG. 8B, the intramedullary rod 101 according to the prior art is inserted into the medulla of the distal portion 100b. The proximal end 101a of the intramedullary rod 101 has a shape with a large cross-sectional area. For this reason, when the intramedullary rod 101 is inserted into the distal portion side portion 100b, the proximal portion portion 100a is likely to interfere with the end portion 101a of the intramedullary rod 101. The gap Y1 generated between the portion 100a and the distal portion 100b becomes large. That is, a large varus will occur. As a result, the insertable position X2 (indicated by the alternate long and short dash line) of the lug screw 102 is shifted from the planned insert position X1. Then, from the state of FIG. 8B, the lag screw 102 is inserted along the insertable position X2 as shown in FIG. 8C, and the position of the lag screw 102 was planned at the start of the operation. It will be inserted in a position higher than the planned insertion position X1.

  On the other hand, the case where the proximal part 100a is fixed to the distal part 100b by the fixing device 1 of the present embodiment will be described with reference to FIG. FIG. 9A is a diagram for explaining the estimated insertion position X1 as in FIG. 8A. When the estimated insertion position X1 is determined, as shown in FIG. 9B, the intramedullary rod 11 is inserted into the medulla of the portion 100b on the distal side. A tip 22 having a tapered surface 21 is provided at the distal end of the intramedullary rod 11 on the proximal side. For this reason, when the intramedullary stick 11 is inserted into the distal part 100b, interference between the proximal part 100a and the end of the intramedullary stick 11 (cutting part 22) is suppressed. The gap Y2 generated between the proximal portion 100a and the distal portion 100b is reduced. In other words, the varus can be reduced. As a result, it is possible to reduce the deviation between the piercable position X3 (indicated by the alternate long and short dash line) of the lag screw 13 and the planned piercing position X1. Then, as shown in FIG. 9C from the state of FIG. 9B, the lag screw 13 is inserted along the insertion possible position X3, and the lag screw 13 is scheduled to be inserted at the start of the operation. It is possible to stab at a position that does not deviate much from the position X1. Although FIG. 9 illustrates the case where the anti-rotation screw 14 is not used, the anti-rotation screw 14 can also be used.

  According to the fixing device 1 described above, various adjustments are required depending on the situation of the operation by adjusting the angle adjusting means constituted by the through hole 18 of the intramedullary rod 11 and the sleeve 12 by the operator during the operation. It will be possible to correspond to the lag screw mounting angle. Therefore, according to the fixing device 1, it is possible to eliminate the restriction that many intramedullary rods corresponding to different lag screw mounting angles must be prepared for the operation, and to eliminate the operation of reinserting the intramedullary rod during the operation. Can do.

  Further, according to the fixing device 1, the orientation direction of the sleeve 12 is changed by displacing the curved outer sleeve 12 inserted through the curved through hole 18 so as to slide along the through hole 18. Then, the orientation direction of the lug screw 13 inserted through the through hole 23 of the sleeve 12 is also changed at the same time. That is, the lag screw mounting angle can be easily adjusted by displacing the sleeve 12 along the through hole 18 of the intramedullary rod 11.

  Moreover, according to the fixing device 1, the through-hole 18 of the intramedullary stick 11 is curved so that the angle of inclination changes in a direction in which the through hole 18 warps from the distal side toward the proximal side. For this reason, the surgeon can adjust the lag screw mounting angle while displacing the sleeve 12 toward the proximal portion side along the through hole 18 until the desired lag screw mounting angle is pushed. Can be adjusted more easily.

  Further, according to the fixing device 1, the anti-rotation screw is inserted by inserting the anti-rotation screw 14 into the through hole 20 provided in the intramedullary rod 11 and screwing the anti-rotation screw 14 into the proximal portion 100 a of the femur 100. 14 fulfills the anti-rotation function and can prevent the proximal portion 100a from rotating. Further, the through hole 20 is formed so that the cross-sectional shape thereof is a long hole shape, and the degree of freedom of the attachment angle of the anti-rotation screw 14 can be increased. Therefore, it is possible to easily attach the anti-rotation screw 14 to the proximal portion 100a of the femur 100 at a desired angle while preventing interference with the lug screw attachment angle.

  In addition, according to the fixing device 1, the taper-shaped cutting edge portion 22 is provided at the distal end portion of the proximal portion of the intramedullary rod 11. For this reason, when the intramedullary stick 11 is inserted into the medullary bone of the femur 100, the portion 100 a proximal to the fracture position in the femur 100 and the end of the intramedullary stick 11 on the proximal side. It is possible to suppress the occurrence of interference between them and reduce the varus.

  In addition, in the fixing device 1 of 1st Embodiment, the form of the sleeve 12 and the lug screw 13a can also be changed and implemented like the sleeve 12a and the lug screw 13a shown in FIG. FIG. 10 is a view showing a sleeve 12a and a lug screw 13a according to a modification, in which the sleeve 12a is a sectional view, and the lug screw 13a is a partially cutaway sectional view.

  The sleeve 12a and the lug screw 13a according to the modification shown in FIG. 10 can be used in place of the sleeve 12 and the lug screw 13 in the fixing device 1 of the first embodiment, and are similar to the sleeve 12 and the lug screw 13. Although it is formed with a configuration, it is configured with some forms different from the first embodiment.

  First, as shown in FIG. 10 (a), the lug screw 13a has a maximum diameter of the screw portion 24a (diameter indicated by a double-headed arrow in the drawing). It is formed so that the diameter of the diameter dimension B indicated by a double-ended arrow is larger (that is, B> A). The sleeve 12a has an inner edge of the second through hole 23a within a range that allows passage of the central portion of the shaft 25a to the inner peripheral edge of the portion oriented to the proximal portion of the second through hole 23a. The collar part 40 which protrudes toward is provided. In addition, in FIG. 10, although the case where the collar part 40 is provided over the perimeter of the edge part of the inner peripheral side of the part orientated to the proximal part side of the 2nd through-hole 23a is illustrated, The collar part 40 may be provided in at least one part of the edge part. In addition, the sleeve 12a has a second through-hole 23a formed to have a dimension that allows passage of the threaded portion 24a and the shaft central portion of the shaft 25a, and is provided with the flange portion 40 so that the second through-hole is formed. The opening diameter on the proximal side of the hole 23a is smaller than the maximum diameter (dimension B) of the screw portion 24a and larger than the minimum diameter of the screw portion 24a (diameter at the valley portion of the screw portion 24a). ing. Further, when the lag screw 13a slides toward the proximal side in the second through hole 24a on the rear end side opposite to the tip side where the screw portion 24a is provided, the lag screw 13a A step portion 41 that can contact the portion 40 is formed.

  According to this modification, first, the threaded portion 24a of the lug screw 13a and the shaft central portion of the shaft portion 25a can be inserted into the second through hole 23a of the sleeve 12a (see FIG. 10A). The sleeve 12a is provided with the flange 40 so that the opening diameter on the proximal side of the second through hole 23a is smaller than the maximum diameter of the screw portion 24a and larger than the minimum diameter. Therefore, by inserting the lug screw 13a into the second through hole 23a while rotating the lug screw 13a, the screw portion 24a of the lug screw 13a passes through the opening of the second through hole 23a narrowed by the flange portion 40. (That is, the state shown in FIG. 10A can be shifted to the state shown in FIG. 10B). For this reason, after passing the screw part 24a of the lug screw 13a through the opening part of the 2nd through-hole 23a, the maximum diameter of the screw part 24a is larger than the opening diameter by the side of the proximal part of the 2nd through-hole 23a. The screw portion 24a and the heel portion 40 come into contact with each other, so that the lug screw 13a can be prevented from coming off from the sleeve 12a when placed in the femur 100. Further, since the rear end side of the lug screw 13a is provided with a step portion 41 that can come into contact with the flange portion 40 of the sleeve 12a, the step portion 41 contacts the flange portion 40 as shown in FIG. Therefore, the lag screw 13a can be prevented from penetrating through the second through hole 23a.

(Second Embodiment)
FIG. 11 is a perspective view of the femoral proximal fracture fixing device 2 (hereinafter simply referred to as the fixing device 2) according to the second embodiment of the present invention. FIG. 12 shows a front view of the fixing device 2 and shows a part of the intramedullary rod 11 and the sleeve 30 in a cross-sectional view. The fixing device 2 shown in FIG. 11 and FIG. 12 is similar to the fixing device 1 of the first embodiment. The intramedullary bar 11, the sleeve 30, the lug screw 13, the anti-rotation screw 14, the sleeve pressing member 15 and the like. A sleeve holding lock screw 16 (not shown) and an auxiliary screw 17 are provided. However, the configuration of the angle adjusting means is different from that in the first embodiment. In the description of the second embodiment, the same elements as those in the first embodiment are denoted by the same reference numerals in the drawings, and the description thereof is omitted.

  In the fixing device 2, angle adjusting means for adjusting the lag screw mounting angle is formed by the through hole 32 (first through hole in the second embodiment) of the intramedullary rod 11 and the plurality of sleeves 30. FIG. 13 is a front view including a partial cross section of the intramedullary rod 11 of the fixation device 2. As shown in FIGS. 11 to 13, the through-hole 32 penetrating on the side surface of the intramedullary rod 11 of the fixation device 2 is formed as a tapered hole whose cross-sectional area decreases from the distal portion side toward the proximal portion side. Has been.

  Further, the fixing device 2 is provided with a plurality of sleeves 30 each having a different way of forming the through hole 31 (second through hole in the second embodiment). FIG. 14 shows a cross-sectional view and a side view of a plurality of sleeves 30 (30a, 30b, 30c, 30d). The outer shapes of the plurality of sleeves 30 are formed in the same shape, and each side peripheral surface 33 is formed as a tapered surface along the through hole 32 of the intramedullary rod 11. And the through-hole 31 (31a, 31b, 31c, 31d) is each formed in each sleeve 30 as a straight through-hole. However, as shown in FIG. 14, the inclination angle of each through hole 31 is different in each sleeve 30.

  In the sleeve 30a shown in FIG. 14A, a through hole which is a center line connecting the cross-sectional center of the through-hole 31a with respect to the external cross-sectional center line C1 which is a center line connecting the cross-sectional centers of the external shapes formed by the side peripheral surfaces 33 A through hole 31a is formed through the sleeve 30a so that the center line C2 is inclined by 3 °. The outer cross-sectional center line C <b> 1 coincides with the center line connecting the cross-sectional centers of the through-holes 32 when the sleeve 30 is inserted into the through-holes 32 of the intramedullary rod 11. The sleeve 30 is formed with a shape of a side peripheral surface 33 so that the sleeve 30 can be inserted into the through-hole 32 of the intramedullary rod 11 even when rotated 180 degrees about the outer cross-sectional center line C1. For this reason, in the sleeve 30a shown in FIG. 14A, the through-hole center line C2 is inclined by + 3 ° or −3 ° with respect to the center line of the through-hole 32 of the intramedullary rod 11 that overlaps the outer cross-sectional center line C1. It will be inserted into the through hole 32 so as to be in a state.

  In the sleeve 30b shown in FIG. 14B, the through hole 31b is formed to penetrate the sleeve 30b so that the through hole center line C2 is inclined by 2 ° with respect to the outer cross-sectional center line C1. . Therefore, the sleeve 30b is inserted into the through-hole 32 so that the through-hole center line C2 is inclined + 2 ° or −2 ° with respect to the center line of the through-hole 32 of the intramedullary rod 11. Become. In the sleeve 30c shown in FIG. 14C, the through-hole 31c is formed to penetrate the sleeve 30c so that the through-hole center line C2 is inclined by 1 ° with respect to the outer cross-sectional center line C1. . Therefore, the sleeve 30c is inserted into the through hole 32 so that the through hole center line C2 is inclined by + 1 ° or −1 ° with respect to the center line of the through hole 32 of the intramedullary rod 11. Become. In the sleeve 30d shown in FIG. 14 (d), the through hole 31d is formed through the sleeve 30b so that the outer cross-sectional center line C1 and the through hole center line C2 coincide (so that the inclination becomes 0 °). Has been.

  As described above, the plurality of sleeves 30 (30a, 30b, 30c, 30d) include the through-hole center line C2 connecting the cross-sectional centers of the through-holes 31 (31a, 31b, 31c, 31d) and the through-holes 32 of the intramedullary rod 11. The through holes 31 are formed so that the angles formed by connecting the center of the cross section and the center line overlapping the outer cross section center line C1 are different from each other. When the lug screw 13 is inserted into the through hole 31, if the sleeve 30 is different, the lug screw 13 is also inclined with respect to the intramedullary rod 11 at different angles according to the angles of the different through holes 31. .

  According to the fixing device 2 according to the second embodiment described above, when the sleeve 30 having a different inclination of the through-hole 31 with respect to the through-hole 32 of the intramedullary rod 11 is used, the lag screw mounting angle is also different. Accordingly, the sleeve 30 corresponding to the desired lug screw mounting angle is appropriately selected from the plurality of sleeves 30 having different through-holes 31 with respect to the through-holes 32, so that the same intramedullary rod 11 remains used. The lug screw mounting angle can be easily adjusted by simply replacing 30.

(Third embodiment)
FIG. 15 is a perspective view of a femoral proximal fracture fixing device 3 (hereinafter simply referred to as a fixing device 3) according to a third embodiment of the present invention. FIG. 16 is a front view of the fixing device 3, and shows a part of the intramedullary rod 11 and the sleeve 34 in a cross-sectional view. The fixing device 3 shown in FIGS. 15 and 16 is similar to the fixing device 1 of the first embodiment. The intramedullary bar 11, the sleeve 34, the lug screw 13, the anti-rotation screw 14, the sleeve pressing member 15 and the like. A sleeve holding lock screw 16 (not shown) and an auxiliary screw 17 are provided. However, the configuration of the angle adjusting means is different from that in the first embodiment. In the description of the third embodiment, the same elements as those in the first embodiment are denoted by the same reference numerals in the drawings, and description thereof is omitted.

  In the fixing device 3, angle adjusting means for adjusting the lag screw mounting angle is formed by the through hole 36 (first through hole in the third embodiment) of the intramedullary rod 11 and the sleeve 34. FIG. 17 is a front view including a partial cross section of the intramedullary rod 11 of the fixation device 3. As shown in FIGS. 15 to 17, the through-hole 36 (the first through-hole in the third embodiment) penetrating on the side surface of the intramedullary rod 11 of the fixing device 3 is a through-hole that extends straight as a hole having a circular cross section. It is formed as.

  FIG. 18 shows a sectional view of the sleeve 34 (FIG. 18A) and a side view thereof (FIG. 18B). As shown in FIGS. 15, 16, and 18, the sleeve 34 has a circular cross-sectional outer shape so as to correspond to the circular cross section of the through hole 36 of the intramedullary rod 11. And in the sleeve 34, the through-hole 35 (2nd through-hole in 3rd Embodiment) is formed so that it may penetrate diagonally straight with respect to a sleeve longitudinal direction. That is, as shown in FIG. 18, the sleeve 34 is a center line that connects the cross-sectional center of the through-hole 35 with respect to the external cross-sectional center line C <b> 3 that is the central line that connects the cross-sectional center of the external shape formed by the side peripheral surface 37. A through hole 35 is formed through the sleeve 34 so that a certain through hole center line C4 is inclined.

  According to the fixing device 3 according to the third embodiment described above, the sleeve 34 formed in a circular cross section corresponding to the circular cross section of the through hole 36 in the through hole 36 having the circular cross section is rotated by an appropriate angle. The inclination of the through hole 35 formed obliquely with respect to the longitudinal direction with respect to the through hole 36 changes by a predetermined angle. Therefore, the lag screw mounting angle can be easily adjusted by rotating the sleeve 34 at an appropriate angle within the through hole 35.

  In addition, in the fixing device 3 which concerns on 3rd Embodiment, the modification similar to the modification of 1st Embodiment regarding the sleeve 34 and the lug screw 13 can also be implemented. That is, with respect to the sleeve 34 of the fixing device 3, a flange 40 similar to the sleeve 12a of the modified example of the first embodiment is provided, and the lug screw 13 of the fixing device 3 is changed to the lag screw 13a of the modified example of the first embodiment. May be.

  The first to third embodiments of the present invention have been described above. However, the present invention is not limited to the above-described embodiments, and various modifications can be made as long as they are described in the claims. .

  The present invention relates to a proximal femoral fracture for fixing a proximal portion to a distal portion from a fracture position in the femur when a fracture occurs in the proximal femur. It can be widely applied as a fixing device.

1 is a perspective view of a femoral proximal fracture fixing device according to a first embodiment of the present invention. FIG. It is the perspective view which looked at the fixing tool shown in FIG. 1 from the back side opposite to the front side of FIG. It is a front view including the partial cross section of the fixing device shown in FIG. It is a front view including the partial cross section of the intramedullary stick in the fixing device shown in FIG. It is sectional drawing and the side view of the sleeve in the fixing device shown in FIG. It is a front view which shows the state by which the fixing device shown in FIG. 1 was arrange | positioned at the femur. It is a figure which illustrates and demonstrates the various forms of a femur fracture. It is a figure explaining the case where the part by the side of the proximal part of a femur is fixed with respect to the part by the side of a distal part with the fixing device concerning a prior art. It is a figure explaining the case where the part by the side of the proximal part of a femur is fixed with respect to the part by the side of a distal part with the fixing device shown in FIG. It is a figure which shows the sleeve and lug screw which concern on the modification of 1st Embodiment. It is a perspective view of the femoral proximal fracture fixing device according to the second embodiment of the present invention. It is a front view including the partial cross section of the fixing device shown in FIG. It is a front view including the partial cross section of the intramedullary stick in the fixing device shown in FIG. FIG. 12 is a cross-sectional view and a side view of a plurality of sleeves used in the fixing device shown in FIG. 11. It is a perspective view of the femoral proximal fracture fixing device according to the third embodiment of the present invention. It is a front view containing the partial cross section of the fixing device shown in FIG. It is a front view including the partial cross section of the intramedullary stick in the fixing device shown in FIG. FIG. 16 is a sectional view and a side view of a sleeve in the fixing device shown in FIG. 15.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Femoral proximal fracture fixation device 11 Intramedullary stick 12 Sleeve, angle adjusting means 13 Lug screw 18 Through hole (first through hole), Angle adjusting means 23 Through hole (second through hole)
24 Screw part 100 Femur 100a Proximal part 100b Distal part

Claims (9)

This is a proximal femoral fracture fixation device for fixing a proximal portion to a distal portion from a fracture position in the femur when a fracture occurs in the proximal femur. And
An intramedullary rod formed in a rod shape inserted along the intramedullary portion of the distal portion side portion and provided with a first through hole penetrating on the side surface;
A sleeve formed as a cylindrical body and inserted into the first through hole, and provided with a second through hole penetrating along the longitudinal direction of the cylindrical body;
A lug screw formed in a rod shape that is inserted into the second through hole, and provided with a screw portion that is screwed into a portion on the proximal portion side, on the distal end side;
An angle adjusting means formed in at least one of the first through-hole and the sleeve, wherein the angle of inclination of the lug screw with respect to the intramedullary rod is variable;
A femoral proximal fracture fixation device comprising:   The angle adjusting means is formed by the first through-hole formed so as to extend while being curved, and the sleeve formed in a curved outer shape along the first through-hole. The femoral proximal fracture fixing device according to claim 1, wherein the femoral proximal fracture fixing device is provided.   The femoral vicinity according to claim 2, wherein the first through hole is curved so that an inclination angle changes in a direction of warping from the distal portion side toward the proximal portion side. Fixation device for distal fracture.   The angle adjusting means includes the first through-hole formed as a hole having a circular cross section, and a cross-sectional outer shape formed in a circle corresponding to the circular cross-section of the first through-hole, and the second through-hole The femoral proximal fracture fixing device according to claim 1, characterized in that it is formed by the sleeve formed so as to penetrate obliquely with respect to the longitudinal direction of the sleeve. The lug screw is formed such that the maximum diameter of the screw portion is larger than the diameter of the central portion of the shaft,
The sleeve is provided with a flange projecting in a range that allows passage of the shaft central portion at least at a part of the inner peripheral side edge of the portion oriented to the proximal portion side of the second through-hole, The second through hole allows passage of the screw portion and the shaft center portion, and the flange portion is provided so that the opening diameter on the proximal portion side of the second through hole is the maximum of the screw portion. Formed to be smaller than the diameter and larger than the minimum diameter of the screw portion,
The lag screw is further moved to the rear end side opposite to the front end side where the screw portion is provided, when the lag screw slides toward the proximal portion side in the second through hole. The femoral proximal fracture fixing device according to any one of claims 1 to 4, wherein a stepped portion capable of coming into contact with the buttocks is formed. The angle adjusting means is
The first through-hole formed as a tapered hole with a cross-sectional area decreasing from the distal side toward the proximal side;
A plurality of sleeves each having a side circumferential surface formed as a tapered surface along the first through-hole, wherein a center line connecting a cross-sectional center of the second through-hole and the first through-hole; A plurality of the sleeves in which the second through holes are formed so that angles formed by a center line connecting the center of the cross section are different from each other;
The femoral proximal fracture fixing device according to claim 1, wherein the femoral proximal fracture fixing device is formed by: The intramedullary rod is provided with a third through hole which is a through hole different from the first through hole and which is formed so as to penetrate the side surface and have a cross-sectional shape of a long hole,
The second screw according to any one of claims 1 to 6, further comprising a second screw that is inserted through the third through hole and is screwed into a portion on the proximal portion side. Fixator for fracture of proximal femur.   The tip portion on the proximal portion side of the intramedullary rod is provided with a cutting edge portion having a portion formed in a tapered surface shape, according to any one of claims 1 to 7. The femoral proximal fracture fixation device as described. This is a proximal femoral fracture fixation device for fixing a proximal portion to a distal portion from a fracture position in the femur when a fracture occurs in the proximal femur. And
An intramedullary rod formed in a rod shape inserted along the intramedullary portion of the distal portion side portion and provided with a first through hole penetrating on the side surface;
A sleeve formed as a cylindrical body and inserted into the first through hole, and provided with a second through hole penetrating along the longitudinal direction of the cylindrical body;
A lug screw formed in a rod shape that is inserted into the second through hole, and provided with a screw portion that is screwed into a portion on the proximal portion side, on the distal end side;
With
A proximal femur fracture fixing device, wherein a distal end portion of the intramedullary rod on the proximal portion side is provided with a cutting edge portion having a tapered portion.

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