JP2014036746A - Plate for fracture treatment - Google Patents

Abstract

PROBLEM TO BE SOLVED: To prevent a bone pin or a bone screw for fixating a plate for a fracture treatment on a radius from being loosened.SOLUTION: A plate for a fracture treatment includes a diaphysis plate part applied to a diaphysis portion of a radius (6) and a head plate part (5a) applied to a distal end portion (6a) of the radius and has a plurality of through-holes formed respectively on the diaphysis plate part and the head plate part for inserting a bone pin or a bone screw. In the plate for a fracture treatment, the through-holes (9,10) on a head plate part side are provided in two rows in a manner to follow a subchondral bone (6c) of the distal end portion of the radius. A female screw where a male screw formed on a head part (7a) of the bone screw or the bone pin (7) of a single-axis type is screwed is formed on the through-hole (9) in the row on the distal side. Fixing means for fixing the bone screw or the bone pin (8) of a multiple-axis type in a desired direction is provided on the through-hole (10) in the row on the proximal side. The bone screw or the bone pin of the multiple-axis type is fixed by the fixing means while the bone screw or the bone pin of the single-axis type that is inserted into the desired through-hole in the row on the distal side abuts on the subchondral bone, and the bone screw or the bone pin of the multiple-axis type that is inserted into the desired through-hole in the row on the proximal side abuts on the subchondral bone.

Description

  The present invention relates to a fracture treatment plate for treating a fracture occurring at a distal end portion of a radius.

  Conventionally, a fracture treatment plate is used to treat a fracture at the distal end of the radius. This fracture treatment plate includes a stem plate portion applied to the trunk portion of the radius and a head plate portion applied to the distal end portion of the radius, and a bone screw or bone is provided on each of the stem plate portion and the head plate portion. A through hole for inserting a pin is formed.

  For example, when treating a fracture at the distal end of the rib, the head plate portion and stem plate portion of the fracture treatment plate are respectively applied to the distal end portion and trunk portion of the rib so as to straddle the fracture line. A bone screw or a bone pin is passed through and is embedded in the rib, whereby the bone fragment at the distal end is fixed to the trunk via the fracture treatment plate (see, for example, Patent Documents 1, 2, and 3). ).

Special Table 2000-512186 Special table 2010-536427 gazette JP 2011-514196 A

  If the through hole of the fracture treatment plate is a simple round hole, the bone screw can be used as a multi-axis type. However, after inserting the bone screw or bone pin into the bone through the through hole and fixing it, it is impossible for the bone. When a strong force is applied, there is a risk that the bone screw or the bone pin may be loosened or displaced (see, for example, Patent Document 1).

  In addition, when the through hole of the fracture treatment plate and the head of the bone screw or bone pin are formed into a spherical shape and the screw is formed on this spherical surface, the bone screw or bone pin can be used as a multi-axis type. Since the binding force of the parts is relatively weak, there is a possibility that the bone screw or the bone pin may be loosened or tilted when an excessive force is applied to the bone (see, for example, Patent Document 2).

  Furthermore, when a spherical seating surface is formed in the through hole of the fracture treatment plate, a spherical nut is inserted into the seating surface, and the screw shaft of the head of the bone screw or bone pin is screwed into the nut. A bone screw or bone pin can be used as a multi-axis type. However, when this coupling means is used for all bone screws or bone pins, the bone screw or bone pin may loosen if excessive force is applied to the bone. There is a risk of tilting (for example, see Patent Document 3).

  That is, if the bone pins 3 and 4 or the bone screw are loosened or displaced after the fracture treatment plate 1 is attached to the distal end side fracture portion of the radius 2 as shown in FIG. Since the external force F due to muscle strength or the like is acting in the direction indicated by the arrow, the bone fragments 2a and 2b at the fracture portion may fall to the side of the trunk 2c of the radius, and the fracture may not be healed normally.

  In order to solve the above problems, the present invention employs the following configuration.

  In order to facilitate understanding of the present invention, reference numerals in the drawings are given in parentheses, but the present invention is not limited thereto.

  That is, the invention according to claim 1 includes a stem plate portion (5b) applied to the trunk portion (6b) of the rib (6) and a head plate portion (5a) applied to the distal end portion (6a) of the rib (6). A fracture treatment plate in which a plurality of through holes for inserting bone screws or bone pins are formed in each of the stem plate portion (5b) and the head plate portion (5a). The through holes (9, 10) on the side of the plate portion (5a) are provided in two rows along the subchondral bone (6c) of the distal end portion (6a) of the rib (6), of which the distal side row In the through hole (9), a single screw bone screw or a female screw (9a) into which a male screw formed on the head (7a) of the bone pin (7) is screwed is formed. The through hole (10) is provided with a fixing means for fixing the multiaxial bone screw or the bone pin (8) in a desired direction, and the desired penetration of the distal side row is provided. A uniaxial bone screw or bone pin (7) inserted into the hole (9) abuts the subchondral bone (6c) and is inserted into the desired through hole (10) in the proximal side row A fracture in which a multiaxial bone screw or bone pin (8) is fixed by the fixing means in a state where the multiaxial bone screw or bone pin (8) is in contact with the subchondral bone (6c). The treatment plate (5) is adopted.

  As described in claim 2, in the fracture treatment plate (5) according to claim 1, the fixing means is a spherical surface provided at the base end of a multi-axial bone screw or bone pin (8). A body (8a), a concave seating surface (10a) formed in the through hole (10) for receiving the spherical body (8a), and pressing the spherical body (8a) toward the concave seating surface (10a) And a fixing tool (13) to be fixed.

  As described in claim 3, in the fracture treatment plate (5) according to claim 1, the fixing means includes a concave seating surface (10a) formed in the through hole (10), A spherical body (8a) inserted into the concave seating surface (10a) and having a female screw hole (15) formed in the central axis, and provided at the proximal end (8) of a multiaxial bone screw or bone pin; It has a male screw shaft (21) that is screwed into the female screw of the female screw hole (15) to expand the diameter of the spherical body (8a) and to be in close contact with the concave seating surface (10a). it can.

  Bone pins (7, 8) or bone screws connected to the fracture treatment plate (5) are difficult to loosen and are uniaxial bone pins (7) inserted into desired through holes (9) in the distal side row Or the bone screw is in contact with the subchondral bone (6c) of the rib (6) and the multiaxial bone pin (8) or bone screw inserted into the desired through hole (10) in the proximal side row is the cartilage. A state in which the uniaxial bone pin (7) of the lower bone (6c) or a position different from the position where the bone screw contacts is maintained for a long period after the operation. Therefore, it is possible to surely prevent the bone fragment from falling to the trunk (6b) side at the distal end (6a) of the radius (6), and to appropriately treat the fracture of the distal end (6a) of the radius (6). Will be done.

It is a top view which shows the state which attached the fracture treatment plate which concerns on Embodiment 1 of this invention to the fracture part of the radius. It is an II-II line arrow directional view in FIG. FIG. 3 is a view taken along the line III-III in FIG. 1. (A) is a top view of the plate for fracture treatment, (B) is a bottom view. FIG. 3 is an enlarged view of a V portion in FIG. 2. FIG. 3 is an enlarged view of a VI part in FIG. 2. It is a partial notch figure of the plate for fracture treatment which concerns on Embodiment 2 of this invention. It is explanatory drawing which shows the state in which the bone piece in the distal end side fracture part of a radius fell to the trunk side of the skull by the shift | offset | difference, loosening, etc. of a bone screw or a bone pin.

  Embodiments of the present invention will be described below with reference to the drawings.

<Embodiment 1>
As shown in FIG. 1, the fracture treatment plate 5 is used to treat a fracture of the distal end portion 6 a in the rib 6 of the left hand.

  In addition, in FIG. 1, the code | symbol 11 shows an ulna.

  As shown in FIGS. 1 and 4 (A) and 4 (B), the fracture treatment plate 5 includes a head plate portion 5a applied to the distal end portion 6a of the rib 6 and a trunk portion 6b of the rib 6 from the palm side. A trunk plate portion 5b to be applied.

  The fracture treatment plate 5 is formed of a single thin metal plate as a whole, and the head plate portion 5a and the trunk plate portion 5b are connected so as to have a substantially T-shape. As the metal material, for example, pure titanium or a titanium alloy close to the elastic modulus of bone is used.

  As shown in FIG. 1, the fracture treatment plate 5 is applied to the rib 6 so as to straddle the fracture line A, and is fixed to the rib 6 by bone pins 7 and 8 as shown in FIGS. 5 and 6. The bone pins 7 and 8 may be replaced with bone screws (not shown) depending on the location and state of the fracture. The bone pins 7 and 8 and the bone screw are appropriately selected and used depending on the location and state of the fracture. In this way, the fracture treatment plate 5 is fixed to the rib 6 by the bone pins 7 and 8 and the bone screw, so that the broken bone pieces at the distal end portion 6a of the rib 6 are joined together, and these bone pieces are connected. Is connected to the trunk 6 b of the rib 6.

  As shown in FIGS. 1 and 4 (A) and 4 (B), the head plate portion 5a has through-holes 9 and 10 through which the bone pins 7 and 8 or bone screws are passed. Two rows are provided along the side. As shown in FIG. 1, the tip side of the head plate portion 5 a extends along the subchondral bone 6 c of the distal end portion 6 a of the rib 6. Therefore, as shown in FIG. 2, the bone pins 7 and 8 or bone screws inserted into the through holes 9 and 10 also extend along the subchondral bone 6c.

  As shown in FIG. 5, a female screw 9 a is formed in the through hole 9 in the distal side row of the through holes 9 and 10. As shown in FIG. 2, the axial center of the spiral of the female screw 9 a extends so as to come into contact with the curved surface of the subchondral bone 6 c when the fracture treatment plate 5 is applied to the rib 6.

  The bone pin 7 is of a single axis type and includes a head portion 7a and a shaft portion 7b, and those having shaft portions 7b of various lengths are prepared. Each head 7a of the uniaxial bone pin 7 is formed with a male screw that is screwed with the female screw 9a, and the surface of each shaft portion 7b is a smooth surface. Depending on the through hole 9, a single-axis type bone screw (not shown) may be used instead of the single-axis type bone pin 7, but a tapping male screw is provided on the surface of the shaft portion of this single-axis type bone screw. A screw is formed.

  When the bone pin 7 or the bone screw is inserted into the through hole 9 and the male screw of the head 7a is screwed with the female screw 9a in the through hole 9, the surface of the shaft portion 7b is smoothed as shown in FIG. The face or male screw contacts the subchondral bone 6c. Since the head 7a of this uniaxial bone pin 7 or bone screw is firmly screwed with the through hole 9 of the fracture treatment plate 5, it does not loosen or shift after the operation. Therefore, the drop of the bone pieces 2a and 2b as shown in FIG. 8 is prevented.

  Of the two rows of through-holes 9 and 10, the proximal-side row of through-holes 10 is provided with a fixing means for fixing the multiaxial bone screw 8 or bone pin in a desired direction.

  As shown in FIG. 6, the fixing means includes a spherical body 8a provided at the base end of a multi-axis bone pin 8 or a bone screw, and a concave shape formed in the through hole 10 for receiving the spherical body 8a. The seat surface 10a and the fixture 13 that presses and fixes the spherical body 8a to the concave seat surface 10a side are provided.

  The spherical body 8a is provided integrally with the bone pin 8 or the shaft portion 8b of the bone screw. A locking groove 14 for locking a tool (not shown) is formed on the top of the spherical body 8a when the bone pin 8 or the bone screw is rotated. The locking groove 14 is formed as a square hole such as a hexagonal hole, an octagonal hole, or a star hole.

  The concave seating surface 10 a is provided at a location near the back surface side of the fracture treatment plate 5 in the through hole 10. The concave seating surface 10a preferably has a spherical surface that matches the spherical body 8a, but may also be a mortar-shaped slope. A female screw hole 15 in which the fixing tool 13 is embedded is provided at a location on the plate surface side adjacent to the concave seating surface 10 a in the through hole 10.

  The fixture 13 is formed as a nut having an external thread on the outer peripheral surface. On the inner end surface of the fixture 13, a spherical concave surface 13a that matches the spherical body 8a is formed. A locking groove 16 similar to the locking groove 14 is formed on the opposite end surface of the fixture 13.

  The multiaxial bone pin 8 or the shaft portion 8b of the bone screw is passed through the through hole 10, the spherical body 8a is in contact with the concave seating surface 10a, and the shaft portion 8b is in contact with the subchondral bone 6c as shown in FIG. Is set, the fixture 13 is screwed into the female screw hole 15 in the through hole 10. When the male screw of the fixing tool 13 is firmly screwed into the female screw of the female screw hole 15 by this screwing and the spherical concave surface 13a of the fixing tool 13 is in close contact with the spherical body 8a, the multiaxial bone pin 8 or bone The screw is firmly fixed in place.

  Thus, the single-axis type bone pin 7 or bone screw and the multi-axis type bone pin 8 or bone screw are arranged as shown in FIGS. 2 and 3, and the subchondral bone 6c in the distal end portion 6a of the radius 6 is provided. The bone pieces 2a and 2b as shown in FIG. 8 are prevented from falling.

  In addition, as shown in FIGS. 1 and 4A and 4B, a plurality of temporary fixing holes 17 are provided in the vicinity of the through holes 9 in the distal side row in the head plate portion 5a as necessary. . A temporary fixing pin (not shown) is inserted into the temporary fixing hole 17 and pushed against the distal end 6 a of the rib 6, whereby the fracture treatment plate 5 is temporarily fixed to the distal end 6 a of the rib 6.

  By using the temporary fixing hole 17, the bone piece 7, 8 or the bone fragment of the distal end portion 6 a can be temporarily fixed to the fracture treatment plate 5 prior to the attachment of the bone screw. Or a bone screw can be attached simply and accurately. The temporary fixing pin is a nail-like elongated bar that can be inserted into the temporary fixing hole 17.

  Moreover, as shown in FIG.1 and FIG.4 (A) (B), the through-holes 18 and 19 are provided also in the trunk plate part 5b of the plate 5 for fracture treatment. When the bone screw 20 or the bone pin is inserted into the trunk portion 6 b of the rib 6 through these through holes 18 and 19, the trunk plate portion 5 b of the fracture treatment plate 5 is fixed to the rib 6. Since these through-holes 18 and 19 and the bone pins or bone screws passed through these through-holes 18 and 19 have the same configuration as the conventional one, detailed description thereof will be omitted.

  Next, an example of the action of the fracture treatment plate having the above configuration will be described.

  As shown in FIG. 1, it is assumed that the rib 6 of the left hand is broken, the distal end portion 6a is divided from the trunk portion 6b, and further divided into bone fragments.

  First, the surgeon makes an incision in the vicinity of the wrist with the palm of the left hand up, and the fracture treatment plate 5 shown in FIGS. 4 (A) and 4 (B) is inserted into the exposed ribs 6. The head plate portion 5a is applied to the distal end portion 6a so as to straddle the fracture line A of the rib 6, and the trunk plate portion 5b is applied to the trunk portion 6b.

  Next, a pilot hole is drilled in the trunk 6b of the radius 6 with a drilling tool (not shown) such as a drill, and the bone screw 20 or the bone pin is loosely screwed into the pilot hole through the through holes 18 and 19. Thereby, the fracture treatment plate 5 is temporarily fixed to the trunk 6 b of the rib 6.

  Subsequently, a cylindrical guide (not shown) is screwed and fixed to the female screw 9a of the through hole 9 in the distal side row of the head plate portion 5a of the fracture treatment plate 5, and a drill or the like is drilled from this guide. A tool (not shown) is passed, and a pilot hole is formed in the distal end portion 6a of the rib 6 in the penetration direction of the through hole 9. This pilot hole is formed so as to contact the subchondral bone 6c shown in FIG.

  A single-axis type bone pin 7 or a bone screw is appropriately selected, and the single-axis type bone pin 7 or the bone screw is pushed into the prepared hole through the through-hole 9 to the distal end portion 6a. Then, as shown in FIG. 5, the male screws of the heads 7 a are screwed into the female screws 9 a of the through holes 9.

  As a result, the distal end 6 a of the rib 6 is fixed to the fracture treatment plate 5. Further, a single-axis type bone pin 7 or bone screw fixed to the fracture treatment plate 5 through screwing of the male screw of the bone pin 7 or the head 7a of the bone screw and the female screw 9a of the through hole 9 is used. Since the surface of the shaft portion 7b contacts the subchondral bone 6c in the distal end portion 6a, the bone pin 7 or the bone screw is not loosened or tilted after the operation, and the contact state is maintained. . Therefore, the drop of the bone pieces 2a and 2b as shown in FIG. 8 is prevented.

  Further, a drilling tool (not shown) such as a drill is passed through the through hole 10 in the proximal side row of the head plate portion 5a of the fracture treatment plate 5 in a desired direction to the bone fragment of the distal end portion 6a. A pilot hole is formed. As shown in FIG. 2, the pilot hole is formed so as to contact the subchondral bone 2c from a different direction from the pilot hole.

  The multi-axis type bone pin 8 or the bone screw is appropriately selected, and the multi-axis type bone pin 8 or the bone screw is thrust into the prepared hole through the through hole 10 at the distal end portion 6a. Then, as shown in FIG. 6, the fixture 13 is screwed into the through hole 10, and the spherical body 8a at the base end of the bone pin 8 or bone screw is pressed against the concave seat surface 10a.

  As a result, the distal end portion 6a is fixed to the fracture treatment plate 5, and at the same time, the surface of the shaft portion 8b of the multiaxial bone pin 8 or bone screw fixed to the fracture treatment plate 5 is subchondral bone. 6c is contacted as shown in FIG. This multi-axis type bone pin 8 or bone screw has its spherical body 8a fixed by being strongly pressed and fixed by the concave seating surface 10a in the through hole 10 and the spherical concave surface 13a of the fixture 13. Therefore, the bone pieces 2a and 2b as shown in FIG. 8 are prevented from falling.

  Thereafter, the bone screw 20 or the bone pin temporarily fixed to the trunk 6b side of the rib 6 is tightened.

  Thus, as shown in FIG. 1, the distal end portion 6a and the trunk portion 6b of the rib 6 are integrally fixed via the fracture treatment plate 5 and inserted into a desired through hole 9 in the distal side row. A single-axis type bone pin 7 or bone screw abuts against the subchondral bone 6c, and a multi-axis type bone pin 8 or bone screw inserted into the desired through hole 10 in the proximal side row is the subchondral bone 6c. The state where the uniaxial bone pin 7 or the bone screw is in contact with a location different from the location where the bone screw abuts is maintained.

<Embodiment 2>
As shown in FIG. 7, in the second embodiment, a polyaxial bone pin or bone screw fixing means different from that in the first embodiment is used.

  That is, the fixing means of the second embodiment includes a concave seat surface 10a formed in the through hole 10, and a spherical body 8a inserted into the concave seat surface 10a and having a female screw hole 15 formed in the central axis. And a male screw shaft 21 provided at the base end of the multi-axial bone pin 8 or bone screw and screwed into the female screw of the female screw hole 15 to expand the diameter of the spherical body 8a and closely contact the concave seating surface 10a. It has.

  The concave surface of the concave seating surface 10a is formed into a spherical surface as in the illustrated example.

  The spherical body 8a is made of a relatively soft material such as synthetic resin, for example, and is fitted into the concave seating surface 10a by its elastic deformation.

  The male screw of the male screw shaft 21 is formed so that its outer diameter is slightly larger than the outer diameter of the female screw of the female screw hole 15. A locking groove 21a for locking a tool (not shown) is formed on the top of the male screw shaft 21 when the bone pin 8 or the bone screw is rotated. The locking groove 21a is formed as a square hole such as a hexagonal hole, an octagonal hole, or a star hole.

  The operation of this fixing means is as follows.

  A drilling tool (not shown) such as a drill is passed in a desired direction from the through hole 10 in the proximal side row of the head plate portion 5a of the fracture treatment plate 5, and a pilot hole is passed to the bone fragment of the distal end portion 6a. Is formed. As shown in FIG. 2, the pilot hole is formed so as to contact the subchondral bone 6 c from a direction different from the pilot hole in the through hole 9.

  The multi-axis type bone pin 8 or the bone screw is appropriately selected, and the multi-axis type bone pin 8 or the bone screw is thrust into the prepared hole through the through hole 10 at the distal end portion 6a. Then, a tool (not shown) is inserted into the locking groove 21a of the male screw shaft 21, the bone pin 8 or the bone screw is rotated, and the male screw shaft 21 is screwed into the female screw hole 15 of the spherical body 8a. Since the male screw shaft 21 is slightly larger in diameter than the female screw hole 15 as described above, the spherical body 8a is expanded in diameter within the concave seat surface 10a by the screwing of the male screw shaft 21, and is in close contact with the concave seat surface 10a. To do.

  As a result, the distal end portion 6a is fixed to the fracture treatment plate 5, and at the same time, the surface of the shaft portion of the multiaxial bone pin 8 or bone screw contacts the subchondral bone 6c as shown in FIG. This multi-axis type bone pin 8 or bone screw has its shaft portion 8b firmly fixed by the close contact between the spherical body 8a in the through hole 10 and the concave seating surface 10a. Therefore, the fall of the bone fragment as shown in FIG. 8 is prevented.

  In addition, in the second embodiment, the same parts as those in the first embodiment are illustrated using the same reference numerals, and detailed description thereof is omitted.

  In each of the above embodiments, the rib treatment plate for the left-hand rib has been described as an example. However, the present invention can also be applied to the rib treatment plate for the right-hand rib. In addition, the fracture treatment plate applied to the rib from the palm side has been described as an example, but the present invention can also be applied to the fracture treatment plate applied from the instep side.

DESCRIPTION OF SYMBOLS 5 ... Plate for fracture treatment 5a ... Head board part 5b ... Stem board part 6 ... Rib 6a ... Distal end part 6b ... Stem part 6c ... Subchondral bone 7 ... Single axis type bone pin 7a ... Head 8 ... Multiaxial type Bone pin 8a ... spherical body 9,10 ... through hole 9a ... female screw 10a ... concave seat 13 ... fixing tool 15 ... female screw hole 21 ... male screw shaft

Claims (3)

  A plurality of members for inserting a bone screw or a bone pin into each of the stem plate portion and the head plate portion, comprising a stem plate portion applied to the trunk portion of the rib and a head plate portion applied to the distal end portion of the rib In the fracture treatment plate in which a single through hole is formed, the through hole on the head plate side is provided in two rows along the subchondral bone at the distal end of the radius, of which the distal side row The through-hole is formed with a single-axis type bone screw or a female screw with which a male screw formed on the head of the bone pin is screwed, and the through-hole in the proximal side row has a multi-axis type bone screw or A fixing means for fixing the bone pin in a desired direction is provided, and a uniaxial bone screw or a bone pin inserted into a desired through hole in the distal side row contacts the subchondral bone, and the near In the state where a multiaxial bone screw or bone pin inserted into a desired through hole in the distal side row is in contact with the subchondral bone, the fixing means For fracture treatment plate bone screw or bone pins multiaxial type is characterized in that so as to be fixed Te.   2. The fracture treatment plate according to claim 1, wherein the fixing means includes a spherical body provided at a proximal end of a multiaxial bone screw or a bone pin, and a concave shape formed in the through hole for receiving the spherical body. A fracture treatment plate comprising: a seat surface; and a fixture that presses and fixes the spherical body to the concave seat surface side.   2. The fracture treatment plate according to claim 1, wherein the fixing means includes a concave seat surface formed in the through hole, and a spherical body inserted into the concave seat surface and having a female screw hole formed in the central axis. And a male screw shaft provided at the base end of a multi-axial bone screw or bone pin and screwed into the female screw in the female screw hole to expand the diameter of the spherical body and closely contact the concave seating surface. A fracture treatment plate characterized by the above.

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