JP2023092893A - Intramedullary nail aid and osteosynthesis tool using the same - Google Patents

Abstract

To provide an intramedullary nail aid selectively attachable to an intramedullary nail, improving flexibility of a procedure and enabling appropriate fixing according to affected parts.SOLUTION: An intramedullary nail aid 10 comprises: a body part attachable to an intramedullary nail 101 including a shaft hole 105 and a lateral hole 104 extending in a direction crossing the shaft hole, facing an outer peripheral wall 700 of the intramedullary nail, disposed at an interval from the outer peripheral wall and extending in a direction of an axis AX1; a joint part, a part of which faces an upper end T of the intramedullary nail by extending, continuously from the body part, in a radial direction of the intramedullary nail; a position adjusting mechanism interposed between the joint part and the upper end T of the intramedullary nail; and a fixture capable of fixing the joint part to the upper end T of the intramedullary nail, The position adjusting mechanism includes: a radially sliding mechanism for guiding the intramedullary nail and the joint part in the radial direction so as to freely move relative to each other; and a circumferential engagement mechanism for engaging the intramedullary nail and the joint part along a circumferential direction of the intramedullary nail.SELECTED DRAWING: Figure 1

Description

TECHNICAL FIELD The present invention relates to an intramedullary nail assisting device that can be selectively attached to an intramedullary nail used for treatment of bone fractures, and a bone connector using the same.

Conventionally, as a method for treating fractures near the head of a bone having a head such as a femur and a humerus, an intramedullary nail is inserted into the bone along the axial direction, and the intramedullary nail is used. A surgical instrument (osteosynthesis device) with an osteosynthesis member (lag screw) that is inserted through the bone may be used. In such a surgical instrument, at the end of the bone on the femoral head side, the bone can smoothly fuse in the region where the posterior wall or the side wall has partially delaminated, and the fracture site near the femoral head can be firmly fixed. Surgical instruments have also been developed. (See Patent Document 1, for example).

The technique described in Patent Literature 1 includes an abutment plate that can be subsequently attached to the intramedullary nail. By being fixed to the intramedullary nail, the abutment plate is abutted against the area where a portion of the posterior wall or side wall has been ablated at the end of the femoral head, thereby causing the ablation located in this area. It is intended to reposition the delaminated bone to the position it was in prior to detachment. The abutment plate is configured to be rotatable about the axis of the intramedullary nail before the abutment plate is fixed to the intramedullary nail by a fixture. With such a configuration, the abutment plate can be fixed to the intramedullary nail at a position suitable for the patient to whom the bone connector is applied.

Japanese Patent No. 6426482

However, there are a wide variety of patient physiques and conditions of affected areas, and the conventional techniques have limitations in terms of enabling effective treatment and reduction in accordance with them. For example, the abutment plate described in Patent Document 1 is rotatable about the axis of the intramedullary nail. You may not be able to place it in the proper position before

More specifically, when a fractured part is fixed using an osteosynthesis tool (intramedullary nail or osteosynthesis member), the femur tends to be twisted toward the front side or the back side of the human body compared to the bone before the fracture. In addition, the twisted state is also various. In such a case, if the abutment plate is only allowed to rotate with respect to the intramedullary nail, it may not be possible to set an appropriate position for the abutment plate depending on the state of the fracture.

On the other hand, there are cases where it is desirable to fix the abutment plate by rotating it with respect to the intramedullary nail. , diversity is desirable. In addition, there is also a demand for increasing the degree of freedom of the procedure for the operator.

Further, for example, the specifications of intramedullary nails are often standardized, and if the method of use differs for each bone connector, the burden on the operator is increased. For this reason, multiple highly convenient functions can be provided without changing or replacing the overall specifications of the bone connector (especially the intramedullary nail), and can be selectively added as appropriate depending on the situation. was desired.

In view of such circumstances, the present invention is capable of being selectively attached to an intramedullary nail, increases the degree of freedom in manipulation, and enables appropriate fixation according to the affected area, thereby aiding effective reduction. The purpose of the present invention is to provide an intramedullary nail assisting tool and a bone connector using the same.

The present invention is an intramedullary nail assisting device that can be attached to an intramedullary nail having an axial hole and a lateral hole extending in a direction intersecting the axial hole, the auxiliary tool for intramedullary nail facing the outer peripheral wall of the intramedullary nail, and a body portion which is spaced apart from the outer peripheral wall and extends in the axial direction of the intramedullary nail; and a body portion which is continuous with the body portion and extends in the radial direction of the intramedullary nail. a connecting portion partially facing the upper end of the intramedullary nail; a position adjusting mechanism interposed between the connecting portion and the upper end of the intramedullary nail; a fixture that can be fixed to the upper end, wherein the position adjustment mechanism includes a radial slide mechanism that guides the intramedullary nail and the connecting portion so as to be relatively movable in the radial direction; and the intramedullary nail. and a circumferential engaging mechanism that engages the connecting portion along the circumferential direction of the intramedullary nail.

The present invention also relates to an osteosynthesis tool comprising an intramedullary nail, an osteosynthesis member to be inserted through the intramedullary nail, and the intramedullary nail assisting tool.

According to the present invention, a spinal cord that can be selectively attached to an intramedullary nail, increases the degree of freedom in manipulation, and enables appropriate fixation according to the affected area to assist effective reduction. A superior effect can be obtained in that it is possible to provide an internal nail assisting device and a bone connecting device using the same.

BRIEF DESCRIPTION OF THE DRAWINGS It is a figure explaining the osteosynthesis tool of this embodiment, (A) is a perspective view of the external appearance which shows one part see-through, (B) is a longitudinal cross-sectional view which shows a part of osteosynthesis tool. BRIEF DESCRIPTION OF THE DRAWINGS It is a figure explaining the intramedullary nail assistance tool of this embodiment, (A) Appearance perspective view, (B) exploded perspective view, (C) top view. FIG. 2 is a plan view for explaining the osteosynthesis device of the present embodiment, (A) a partially transparent plan view showing the vicinity of the femur when the patient to which the osteosynthesis device is attached is standing, (B) (A) is shown in FIG. It is a top view shown typically. FIG. 2 is a view showing the plate member of the present embodiment, (A) an external perspective view of the plate member for the left foot, (B) an external perspective view of the plate member for the right foot, (C) a plan view showing the connecting portion for the left foot; (D) A plan view showing the connecting portion for the right foot, (E) a front view showing the main body for the left foot, and (F) a front view showing the main body for the right foot. (A) Appearance perspective view of the spacer, (B) Front view explaining the engagement state between the spacer and the intramedullary nail, (C) Front view of the spacer, (D) Side view of the spacer, (E) Bottom of the spacer Figure, (F) Plane (top) view of the spacer, (G) Appearance perspective view of the fixture, (H) Front view of the fixture, (I) Front view showing a state in which the fixture is inserted into the spacer. It is a plane schematic diagram explaining a relative movement direction. BRIEF DESCRIPTION OF THE DRAWINGS It is a figure explaining the plate member of this embodiment, (A) Side view, (B) It is a schematic diagram which shows a usage example. It is a figure explaining the plate member of this embodiment. It is a figure which shows an example of the surgical operation method using the osteosynthesis tool of this embodiment. It is a figure showing the plate member for the left foot of the present embodiment, (A) plan view seen from above (top view), (B) plan view seen from below (bottom view), (C) left side view, (D) A front view seen from the rear, (E) a rear view seen from the front, and (F) a right side view. If the present invention is to be separately registered as a partial design, that part is indicated by a solid line here, and the other parts are indicated by a broken line. (A) It is an external perspective view which shows the use condition of the plate member of this embodiment. (B) is an external perspective view showing the plate member of the present embodiment. It is a figure which shows the spacer of this embodiment, (A) front view, (B) left side view, (C) bottom view, (D) plane (top) view, (E) right side view, (F) back. Figure. FIG. 3 is a diagram showing the intramedullary nail assisting device of the present embodiment, (A) an external perspective view of the spacer, (B) an external perspective view of the intramedullary nail assisting device, and (C) a plan view of a state in which the spacer and the plate member are combined. Figure.

BEST MODE FOR CARRYING OUT THE INVENTION Hereinafter, embodiments of the present invention will be described with reference to the accompanying drawings. In each figure below, the parts with the same reference numerals represent the same parts. In addition, in each drawing, a part of the configuration is appropriately omitted to simplify the drawing, and the size, shape, thickness, etc. of the members are appropriately exaggerated.

<Bone connector>
First, referring to FIG. 1, the overall configuration of the bone connector 100 of this embodiment will be described. 1A and 1B are schematic diagrams showing a state in which a bone fracture site of a patient's femur 500 is fixed by an osteosynthesis device 100, and FIG. (B) is a longitudinal sectional view showing a part of the bone connector 100. FIG. In the following description, unless otherwise specified, the direction is specified based on the state in which the bone fracture site of the patient's femur 500 is fixed with the bone connector 100 . That is, the patient's ventral side is called "front", the dorsal side is called "posterior", the patient's head side is called "upper", and the patient's leg side is called "lower". FIG. 1 shows a left leg femur 500 as an example.

As shown in FIG. 1A, the bone connector 100 of this embodiment includes, for example, an intramedullary nail (nail) 101, a bone connector (lag screw) 201, and an intramedullary nail assisting device 10. As shown in FIG. The intramedullary nail assisting device 10 of this embodiment can be selectively attached to, for example, a conventionally known intramedullary nail 101 . That is, in this embodiment, known intramedullary nail 101 and bone-synthesis member 201 can be employed. The intramedullary nail assisting tool 10 is attached to one end (upper end T (base end) side) of an intramedullary nail 101, which is a rod-like member whose overall shape is shaft-shaped, in the direction of the axis AX1. In FIG. 1, the direction of the axis AX1 of the intramedullary nail 101 is the vertical direction in the drawing.

The intramedullary nail 101 and the osteosynthesis member 201 will be briefly described with reference to FIG. 1(B). In addition, illustration of the intramedullary nail assisting device 10 is omitted in FIG. 1(B).

The intramedullary nail 101 is used by being inserted into the medullary cavity (lumen) of the femur 500 . The intramedullary nail 101 has a proximal portion 102 on the base end (upper end T) side in the direction of the axis AX1 and a distal portion 103 located on the tip (lower end) side. The intramedullary nail 101 has a shaft hole 105 that communicates with the proximal portion 102 and the distal portion 103, extends in the direction of the axis AX1, and is open at both ends. A female thread 106 is formed on the inner wall (inner surface) near the opening of the shaft hole 105 on the side of the proximal portion 102 (upper end T). Note that the shaft hole 105 may be provided only on the proximal portion 102 side of the intramedullary nail 101 and may not communicate with the distal portion 103 . That is, distal portion 103 may be solid.

The intramedullary nail 101 has a lateral hole 104 extending in a direction intersecting the axial hole 105 . The lateral hole 104 is a hole through which a bone joint member (lag screw) 201 is inserted. The axial hole 105 opens into the horizontal hole 104 in the middle of opening at both upper and lower ends of the intramedullary nail 101, and at this position, the axial hole 105 and the horizontal hole 104 communicate with each other. A set screw 451 , which is a fixture for the osteosynthetic member 201 , is inserted into this connecting portion, more specifically, into the axial hole 105 above the lateral hole 104 .

In the cross-sectional view shown in FIG. 1B, the lateral hole 104 obliquely penetrates the intramedullary nail 101 so as to have an axis AX2 inclined with respect to the direction of the axis AX1 of the intramedullary nail 101 . Hereinafter, the direction of the axis AX2 of the lateral hole 104 is also referred to as the lateral hole axial direction.

The inclination angle of the lateral hole 104 (its axis AX2) in FIG. The fracture site near the femoral head 502 of the femur 500 can be fixed by the osteosynthesis member 201 when the femoral bone 500 is inserted into the bone. In this embodiment, as an example, the inclination angle is set to substantially match the angle formed by the axial direction of the femur 500 (vertical direction in the drawing) and the direction in which the femoral head 502 protrudes from the femur 500 .

Also, in this example, the intramedullary nail 101 has a fastener insertion hole 108 which penetrates the distal portion 103 and whose both ends are open on both outer peripheral surfaces of the distal portion 103 . In addition, the fixture insertion hole 108 is formed through the distal portion 103 in a direction substantially perpendicular to the direction of the axis AX1. A screw 601 or the like is inserted through the fastener insertion hole 108 , thereby fixing the intramedullary nail 101 and the femur 500 also at the distal portion 103 .

The osteosynthesis member (lag screw) 201 is also a rod-shaped member whose overall shape is shaft-shaped, and is inserted through the lateral hole 104 of the intramedullary nail 101 . That is, the direction of the axis AX2 of the osteosynthesis member 201 coincides with the direction of the axis AX2 of the lateral hole 104 (horizontal hole axial direction). The osteosynthesis member 201 has an engaging portion (screw portion) 211 located on its distal end side and formed with a screw groove, and a shaft portion extending from the engaging portion 211 toward the proximal end side and inserted through the horizontal hole 104. 221 , and by screwing the engaging portion 211 into the femoral head 502 , the fracture site in the vicinity of the femoral head 502 is fixed. A plurality of osteosynthesis members 201 may be inserted, or an additional rod-shaped member generally used together with the osteosynthesis member 201 for preventing rotation may be used together.

The osteosynthesis member 201 is also fixed to the intramedullary nail 101 by a set screw 451 . The set screw 451 has a screw shape consisting of a head portion and a threaded portion having a male thread. The threaded portion of the set screw 451 is configured to be screwed into. In the osteosynthesis member 201, a plurality of groove portions 222 extending in the direction of the axis AX2 are formed on the outer peripheral surface of the shaft portion 221 at equal intervals around the shaft. By engaging, the osteosynthesis member 201 is prevented from rotating and fixed to the intramedullary nail 101 while being inserted into the lateral hole 104 .

<Intramedullary nail aid>
The intramedullary nail assisting device 10 according to the present embodiment will be described in detail with reference to FIGS. 2 to 9. FIG. 2A and 2B are views showing an outline of the intramedullary nail assisting device 10, FIG. 2A is an external perspective view of the intramedullary nail assisting device 10, and FIG. It is a perspective view, and FIG. 2(C) is a plan view showing a part of the intramedullary nail assisting device 10 extracted from above the axis AX1.

3A and 3B are plan views of the femur 500 and the osteosynthesis tool 100 (intramedullary nail auxiliary tool 10) viewed from the direction T of the upper end (top) of the intramedullary nail 101, and FIG. Fig. 10 is a partially perspective plan view showing the vicinity of the femur 500 of the left leg viewed from above (the patient's head) when the patient to which the intramedullary nail assisting device 10 is attached is standing on his own. FIG. 3B is a plan view schematically showing FIG. 3A.

As shown in FIGS. 2(A) and 2(B), the intramedullary nail assisting device 10 includes a plate member 13 having a body portion 11 and a connecting portion 12, and an upper end T (top portion) of the intramedullary nail 101. It has a detachably fixed spacer 14 and a fixture 16 capable of fixing the connecting part 12 to the upper end T of the intramedullary nail 101 . Further, the intramedullary nail assisting device 10 has a position adjusting mechanism 15 interposed between the connecting portion 12 and the upper end T of the intramedullary nail 101, as shown in FIG. 2(C). As will be described later, in a preferred embodiment of the present invention, the position adjustment mechanism 15 is configured by at least part of the long hole 121 of the connecting portion 12 and the spacer 14 . The position adjusting mechanism 15 includes a radial slide mechanism 151 that guides the connecting portion 12 and the intramedullary nail 101 so that the intramedullary nail 101 and the connecting portion 12 can freely move relative to each other in the radial direction of the intramedullary nail 101 . , the connecting portion 12 and the intramedullary nail are engaged so that relative rotation (rotation) between the intramedullary nail 101 and the connecting portion 12 along the circumferential direction R (the direction around the axis AX1) of the intramedullary nail 101 is impossible. and a mating circumferential engagement feature 152 .

Referring to FIG. 3(A), the neck axis BX2 of the femur 500 is antetorsion with respect to the lateral axis BX1 of the femoral condyle at the distal end (knee joint portion). The anteversion angle (anteversion angle θ) in plan view of A) is generally about 10° to 15° in a normal case. The osteosynthesis member 201 is often implanted so that its axis AX2 is generally aligned with the neck axis BX2 of the femur 500, but it depends on the shape of the bone, the value of the anteversion angle θ, and the state of the fracture. However, the axis AX2 of the osteosynthesis member 201 and the neck axis BX2 of the femur 500 do not necessarily match.

This embodiment will be described with reference to the axis AX2 of the osteosynthesis member 201 embedded at a desired position in the femur 500, based on the schematic diagram shown in FIG. 3(B). FIG. 3B schematically shows the femur 500 of the left leg, the osteosynthesis device 100 for the left leg, and the intramedullary nail assisting device 10, with the upper side of the drawing being the front and the lower side of the drawing being the rear. is. The left side of the drawing is the base end side of the bone joint member 201, and the right side of the drawing is the distal end (engagement portion 211) side of the bone joint member 201 and the direction of the femoral head 502 (hip joint). The bone connector 100 for the right leg and the intramedullary nail assisting device 10 are the same as the above except that they are arranged line-symmetrically with respect to a line segment perpendicular to the axis AX2, so description thereof will be omitted.

3B and 2C, the radial slide mechanism 151 of the position adjustment mechanism 15 allows the intramedullary nail 101 and the connecting portion 12 to move relative to each other in the radial direction of the intramedullary nail 101. It guides the intramedullary nail 101 and the connecting part 12 freely. The direction of relative movement between the intramedullary nail 101 and the connecting portion 12 (hereinafter referred to as "relative movement direction D") is defined as follows when the intramedullary nail 101 is viewed from its axis AX1 direction (upper end T side). It is a direction intersecting with the axis AX2 direction (horizontal hole axial direction) of the osteosynthesis member 201 (horizontal hole 104). Specifically, the direction of relative movement D is a direction substantially orthogonal to the axial direction of the lateral hole. More specifically, the direction of relative movement D is a direction orthogonal to the axial direction of the lateral hole It is a direction including an allowable angle within ±α° centered on the hole orthogonal direction PX2”. "A direction including an allowable angle within ±α° centered on the direction perpendicular to the lateral hole PX2" means "a direction of α° (+α°) clockwise with the direction perpendicular to the lateral hole PX2 as a reference (12 o'clock position). "in the direction of α° (-α°) in the counterclockwise direction from For example, the allowable angle α is 30° (a direction within ±30° centering on the lateral hole orthogonal direction PX2), more preferably 20°, and even more preferably 15°.

Note that one relative movement direction D is set for one intramedullary nail assisting device 10 (not intended to be set multiple within the range of the allowable angle α). Specifically, for example, the relative movement direction D of a certain intramedullary nail assisting device 10 is +5° around the transverse hole orthogonal direction PX2, and the relative movement direction of the other intramedullary nail assisting device 10. D is the lateral hole orthogonal direction PX2 (the direction coinciding with it). In the following description, as an example, the case where the relative movement direction D coincides with the lateral hole orthogonal direction PX2 will be described.

Referring to FIG. 2(C), the position adjusting mechanism 15 of the present embodiment includes a first slide surface 153 provided in the connecting portion 12 and extending in the relative movement direction D, and an upper end of the intramedullary nail 101. It has a first slide surface 153 provided on the T side and a slidable second slide surface 154 . The first slide surface 153 and the second slide surface 154 function as the radial slide mechanism 151 .

More specifically, the position adjusting mechanism 15 includes a long hole 121 provided in the connecting portion 12 and having a longitudinal direction Ld in the relative movement direction D (horizontal hole orthogonal direction PX2), and a long hole 121 provided on the upper end T side. and a longitudinally slidable protrusion 142 therein. In this case, the first slide surface 153 is part of the slot 121 and the second slide surface 154 is part of the protrusion 142 . Moreover, as shown in FIG. 2B, the projecting portion 142 is a part of the spacer 14, for example.

In addition, the projecting portion 142 and a part of the long hole 121 of the connecting portion 12 are arranged so that when the connecting portion 12 is about to turn (rotate) along the circumferential direction R of the intramedullary nail 101 (around the axis AX1). Engageably configured, these function as a circumferential engagement mechanism 152 .

As described above, the position adjustment mechanism 15 (the radial slide mechanism 151 and the circumferential engagement mechanism 152) of the present embodiment is configured by at least part of the long hole 121 of the connecting portion 12 and the spacer 14, and will be described below. A more detailed description will be given.

FIG. 4 is a diagram illustrating the plate member 13. FIG. For example, the intramedullary nail assisting device 10 can be fixed to each of the left and right femurs 500, and the plate members 13 are prepared for the left foot and the right foot. FIG. 4 shows the left and right plate members 13 side by side. 4(A), 4(C), and 4(E) show the plate member 13 for the left femur 500, and FIGS. 4(B), 4(D), and 4(F) show the right side. is a plate member 13 for the femur 500 of . 4(A) and 4(B) are external perspective views of the plate member 13; ), and FIG. 4F is a front view of the main body 11 as seen from the rear. The left and right plate members 13 are symmetrical with respect to the vertical centerline of the human body.

By being fixed to the intramedullary nail 101, the plate member 13 is brought into contact with a region where a part of the rear wall or side wall is peeled off near the end of the femur 500 opposite to the femoral head 502. This is for repositioning the delaminated bone (posterior wall bone fragment, third bone fragment, etc.) located in this region to the position before delaminating (see FIGS. 1 and 3).

As shown in FIGS. 4(A) and 4(B), the plate member 13 includes a body portion 11 that abuts against the delaminated bone, and an upper end of the body portion 11 (the upper end of the intramedullary nail 101 in the direction of the axis AX1). ) and a connecting portion 12 provided in connection with the . The main body 11 faces an outer peripheral wall 700 (see FIG. 1B) of the intramedullary nail 101 and is spaced apart from the outer peripheral wall 700 so as to extend in the direction of the axis AX1 of the intramedullary nail 101. It is a part that extends to The main body portion 11 has a generally flat plate (strip) shape as a whole, and in this embodiment, it is made of, for example, one plate. Further, here, as an example, the outer shape of the body portion 11 presents a substantially rectangular shape whose longitudinal direction is along the direction of the axis AX1 when viewed from the front (FIGS. 4(E) and 4(F)).

The connecting portion 12 extends in the radial direction of the intramedullary nail 101 continuously from the body portion 11 so that a part of the connecting portion 12 faces the upper end T (top portion) of the intramedullary nail 101 (FIG. 1). (A)). As shown in FIGS. 4(C) and 4(D), the connecting portion 12 has, for example, a U shape (in a plan view) when the intramedullary nail 101 is viewed from its axis AX1 direction (upper end T side). It has an outer shape, and an elongated hole 121 is provided near its center. The long hole 121 is provided at a position corresponding to the axial hole 105 of the intramedullary nail 101 , and the fastener 16 is fixed to the axial hole 105 of the intramedullary nail 101 through the long hole 121 (Fig. 2(A)), the articulating part 12 (plate 13) is fixed to the intramedullary nail 101; As a result, the body portion 11 is brought into contact with the delaminated bone.

As shown in FIGS. 4A and 4C, the long hole 121 of the connecting portion 12 is provided so as to penetrate the connecting portion 12 in the plate thickness d1 direction and the longitudinal direction Ld is along the relative movement direction D. . That is, as shown in FIG. 3B, the longitudinal direction Ld of the long hole 121 corresponds to the direction of the axis AX2 of the lateral hole 104 (lateral hole axis) when viewed from the direction of the axis AX1 of the intramedullary nail 101 (upper end T side) direction) and substantially perpendicular to the axial direction of the lateral hole. More specifically, the longitudinal direction Ld of the long hole 121 is, for example, within ±30° around the horizontal hole orthogonal direction PX2, preferably within ±20° around the horizontal hole orthogonal direction PX2. A direction, more preferably a direction within ±15° centering on the horizontal hole orthogonal direction PX2.

As already described, the neck axes BX2 of the left and right femurs 500 are anterotorted with respect to the lateral axes BX1 of the femoral condyles at the distal ends (knee joints) (Fig. 3(A)). , the anteversion angle .theta. is bilaterally symmetrical about a line segment orthogonal to the horizontal axis BX1 of the femoral condyle shown in FIG. 3(A).

The longitudinal direction Ld of the elongated hole 121 in the plate member 13 of the present embodiment is set, for example, in a direction orthogonal to the axis AX2 of the corresponding bone joint member 201 (horizontal hole orthogonal direction PX2) in both the left and right cases. there is That is, the longitudinal direction Ld of the elongated hole 121 of the plate member 13 for the left leg is, for example, a direction orthogonal to the axis AX2 of the lateral hole 104 (or the bone junction member 201) of the intramedullary nail 101 to be implanted in the left leg (horizontal hole orthogonal direction). PX2) (FIG. 4(C)), and the longitudinal direction Ld of the long hole 121 of the plate member 13 for the right leg is the lateral hole 104 of the intramedullary nail 101 (or the osteosynthesis member 201) to be implanted in the left leg. ), for example, in a direction orthogonal to the axis AX2 (horizontal hole orthogonal direction PX2) (FIG. 4(D)). The longitudinal direction Ld of the long hole 121 is the direction D of relative movement.

4A and 4B, long hole 121 has first slide surface 153 extending in relative movement direction D. Referring to FIGS. The outer peripheral shape of the long hole 121 of the present embodiment is not a continuous curve, but a shape formed by connecting a straight portion 121S facing each other and a curved portion 121C facing each other in plan view shown in FIGS. 4(C) and 4(D). is. The extending direction of the straight portion 121S coincides with the longitudinal direction Ld, and the inner wall portion (side surface 1211) of the elongated hole 121 that becomes the straight portion 121S serves as the first slide surface 153. As shown in FIG.

Next, the spacer 14, fixture 16 and position adjusting mechanism 15 of this embodiment will be described with reference to FIG. Spacers 14 and fixtures 16 are common for left and right feet. 5A to 5F are external views of the spacer 14, and FIGS. 5G and 5H are external views of the fixture 16. FIG. 5(A) is an external perspective view, FIG. 5(B) is a front view for explaining the state of engagement with the intramedullary nail 101, FIG. 5(C) is a front view of the spacer 14, and FIG. 5(D) is a left side view. 5(E) is a bottom view, and FIG. 5(F) is a plane (top) view. 5(G) is an external perspective view of the fixture 16, and FIG. 5(H) is a front view. 5(I) is a front view showing a state in which the fixture 16 is inserted through the spacer 14. FIG.

The spacer 14 is interposed between the plate member 13 when the plate member 13 is attached to the upper end T (top) of the intramedullary nail 101, and prevents looseness and reduces the clearance between the members. Since the plate member 13 is attached to the intramedullary nail 101 embedded in the femur 500 (see FIG. 1B), it is difficult to bring the upper end T and the plate member 13 into close contact with each other. Therefore, the spacer 14 fills the gap between them to prevent rattling and fix them securely. A part of the spacer 14 functions as the position adjusting mechanism 15 together with the long hole 121 of the connecting portion 12 .

As shown in FIGS. 5(A), 5(E), and 5(F), the spacer 14 is a substantially cylindrical body with a hollow inside, and the inside thereof is shown in FIGS. A fixture 16 shown in H) can be inserted. The spacer 14 has a cylindrical body portion 140 , a locking piece 141 provided at the bottom of the cylindrical body portion 140 , and a projecting portion 142 provided at the upper portion of the body portion 140 . The locking piece 141 is formed by protruding part of the peripheral surface of the trunk portion 140 at an acute angle downward in the direction of the axis AX1 at the bottom portion of the spacer 14, for example. As shown in FIG. 5(B), the locking piece 141 is configured to be lockable with a notch portion 1012 provided at the upper end T of the intramedullary nail 101 (see FIG. 1(A)).

The protruding portion 142 is a portion of the upper portion of the spacer 14 (body portion 140) formed by protruding a part of the peripheral surface of the body portion 140 upward in the direction of the axis AX1 in a substantially rectangular shape when viewed from the front (FIG. 5(C)). and are provided at two locations so as to face each other in the radial direction of the trunk portion 140 (FIG. 5(F)). As shown in FIG. 2(C), the diameter L1 of the trunk portion 140 is larger than the length L2 of the long hole 121 in the short side direction, and when assembled as the intramedullary nail assisting device 10, the length from the short side direction of the long hole 121 is large. A portion of the peripheral surface of the trunk portion 140 is exposed radially outward. It can also be said that the projecting portion 142 is configured by cutting out a portion of the exposed peripheral surface of the trunk portion 140 . The shape of the protruding portion 142 in plan view is a substantially circular arc formed by a part of the circumferential surface of the body portion 140, and the chord length thereof is slightly smaller than the length L2 of the elongated hole 121 in the lateral direction (see FIG. 2). (C), FIG. 5(F)). Also, the height H1 of the projecting portion 142 is smaller than the thickness d1 of the connecting portion 12 (FIG. 2(B)).

5(G) to 5(I), 2(A) and 2(B), fixture (end cap) 16 is inserted through long hole 121 of connecting portion 12 and spacer 14 . , the connecting portion 12 (plate member 13) is fixed to the intramedullary nail 101 and the shaft hole 105 is sealed at the proximal end ( FIG. 1(A)). The fixture 16 has a head portion 161 positioned on the base end side, a threaded portion 162 positioned on the distal end side, and a cylindrical portion 163 positioned between the head portion 161 and the threaded portion 162 .

The outer peripheral surface of the threaded portion 162 has a thread groove (male thread), and the threaded portion 162 is threaded at the proximal end of the shaft hole 105 so that the axis AX1 of the intramedullary nail 101 and the axis of the threaded portion 162 are aligned. The fixture 16 is fixed to the shaft hole 105 of the intramedullary nail 101 by screwing it into the female thread 106 formed in the inner wall of the shaft hole 105 .

The head portion 161 has a diameter larger than that of the cylindrical portion 163 and has a collar shape. The diameter of the head portion 161 is equal to the diameter of the trunk portion 140 of the spacer 14 (the diameter of a circle with the projecting portion 142 as an arc) and the length L2 of the elongated hole 121 of the plate member 13 in the lateral direction (FIG. 2(C)). , and the outer diameter of the cylindrical portion 163 is set smaller than the inner diameter of the body portion 140 of the spacer 14 . As shown in FIG. 5I, the fixture 16 can be inserted through the body 140 of the spacer 14, but the head 161 rests on the projection 142 of the spacer 14. As shown in FIG. Also, the length of the cylindrical portion 163 (the length in the direction of the axis AX1) is based on the height of the spacer 14, and is greater than the overall height H2 of the spacer 14 (the length from the projecting portion 142 to the tip of the locking piece 141). set long. Specifically, when the fixture 16 is inserted through the trunk portion 140 of the spacer 14 , the entire threaded portion 162 is exposed downward from the spacer 14 . The fixture 16 is inserted through the axial hole 105 of the intramedullary nail 101 through the elongated hole 121 of the plate member 13 . At this time, the locking piece 141 of the spacer 14 is locked with the notch portion 1012 of the intramedullary nail 101 , and the threaded portion 162 of the fixture 16 exposed from the spacer 14 is securely screwed into the shaft hole 105 .

With such a configuration, as shown in FIG. 2A, when the plate member 13 (the connecting portion 12 thereof) is attached to the upper portion of the spacer 14, the protruding portion 142 protrudes upward into the long hole 121. As shown in FIG. The connecting portion 12 around the long hole 121 is placed on the upper surface of the body portion 140 of the spacer 14 (the upper surface exposed between the projecting portions 142). The protruding portion 142 does not protrude upward from the elongated hole 121 . Also, the head 161 of the fixture 16 is engaged with the upper surface of the long hole 121 .

Then, as shown in FIG. 2A, the protruding portion 142 is slidable in the long hole 121 in the longitudinal direction Ld. At this time, the side surface 1211 of the elongated hole 121 becomes the first slide surface 153, and the side surface (notch surface) 1421 of the projecting portion 142 becomes the second slide surface 154 and slides. That is, the elongated hole 121 (first slide surface 153 ) and the spacer 14 (the protrusion 142 and the second slide surface 154 ) function as a radial slide mechanism 151 .

5B, the locking piece 141 of the spacer 14 is locked to the notch portion 1012 of the upper end T of the intramedullary nail 101 and attached (fixed) to the upper end T of the intramedullary nail 101. As shown in FIG. That is, by locking the locking piece 141 to the notch portion 1012, the relative position of the projecting portion 142 with respect to the intramedullary nail 101 is determined. When (the connecting portion 12 of) the plate member 13 is attached to the upper portion of the spacer 14, the protruding portion 142 becomes slidable in the long hole 121 in the longitudinal direction Ld. That is, by sliding the first slide surface 153 and the second slide surface 154, the intramedullary nail 101 and the connecting portion 12 (and the main body portion 11) can be relatively moved in the relative movement direction D.

Further, as shown in FIGS. 2(C) and 5(A), the linear portions 121S of the elongated holes 121 are arranged outside the both side surfaces 1421 of the projecting portion 142. As shown in FIG. The clearance between the straight portion 121S and the projecting portion 142 is small, and when the connecting portion 12 is to be rotated in the circumferential direction R of the intramedullary nail 101 (around the axis AX1 of the intramedullary nail 101), (Side surface (notched surface) 1421 of the protrusion 142) abuts and engages with the side surface 1211 of the straight portion 121S of the long hole 121, and relative rotation (relative rotation) is regulated. That is, in this case, the elongated hole 121 and the spacer 14 (the projecting portion 142 thereof) function as a circumferential engagement mechanism 152 .

As described above, in the present embodiment, the radial slide mechanism 151 and at least part of the circumferential engagement mechanism 152 (long hole 121) are formed in the connecting portion 12, and the radial slide mechanism 151 and the radial slide mechanism 151 are formed in the upper portion of the spacer . At least part of the circumferential engagement mechanism 152 (projection 142) is formed. The elongated hole 121 and the spacer 14 (the protrusion 142 thereof) cooperate to provide a position adjustment mechanism 15 (a radial sliding mechanism 151 and a circumferential engaging mechanism) interposed between the connecting portion 12 and the upper end T of the intramedullary nail 101. It functions as a joining mechanism 152). The position adjustment mechanism 15 guides the intramedullary nail 101 and the connecting portion 12 (the plate member 13) so as to be relatively movable in the radial direction of the intramedullary nail 101, while the intramedullary nail 101 and the connecting portion 12 (the plate member 13) can be rendered relatively unrotatable along the circumferential direction R of the intramedullary nail 101 .

Although the detailed procedure will be described later, in this embodiment, the plate member 13 is adjusted to an appropriate position along the radial direction of the intramedullary nail 101 before being completely fixed by the fixture 16 . Thereafter, by screwing the fixture 16 into the shaft hole 105 , the plate member 13 is also fixed to the intramedullary nail 101 as the fixture 16 and the intramedullary nail 101 are fixed.

As described above, the relative movement direction D between the intramedullary nail 101 and the plate member 13 is determined by the longitudinal direction Ld of the slot 121 , which is also the relative position of the projection 142 with respect to the intramedullary nail 101 . That is, as shown in FIGS. 2(D) and 5(C), the direction of the line segment (protrusion center line 142L) connecting the centers 142C of the opposing protrusions 142 in the circumferential direction (arc portions) is the long hole. 121 and these are the directions of relative movement D.

In this embodiment, as an example, the direction of the protrusion center line 142L (longitudinal direction Ld of the long hole 121) is set to the horizontal hole orthogonal direction PX2, and as a result, the relative movement direction D becomes the horizontal hole orthogonal direction PX2. ing.

Also, the relative movement direction D may be a direction within ±30° around the lateral hole orthogonal direction PX2. The longitudinal direction Ld of the long hole 121 is set so as to be inclined with respect to the horizontal hole orthogonal direction PX2 (rotated around the intersection of the line segment of the horizontal hole orthogonal direction PX2 (horizontal hole orthogonal line) and the axis AX2).

An example in which the relative movement direction D is set in a direction that is inclined with respect to the lateral hole orthogonal direction PX2 will be described with reference to FIG. First, FIG. 6A is a schematic plan view showing from above the intramedullary nail assisting device 10 for the left foot when the lateral hole orthogonal direction PX2 and the relative movement direction D match. FIG. 6B is a schematic plan view when the direction of relative movement D is inclined (rotated) clockwise with respect to the direction perpendicular to the horizontal hole PX2. In FIG. 6, the connecting portion 12 exists on the same plane as the elongated hole 121, and the body portion 11 is bent in the direction perpendicular to the plane of the paper at the bent portion 13L indicated by the thick line.

Although the allowable amount (allowable angle) of inclination (rotation) from the transverse hole orthogonal direction PX2 can be selected as appropriate, in particular, as shown in FIG. It is desirable that the amount of inclination of 201 toward the engagement portion 211 (the tip of axis AX2) side (the amount of clockwise rotation +α° in the figure) be small. When the protrusion center line 142L is inclined as shown in FIG. 6(B), as the plate member 13 moves forward along the relative movement direction D, the engaging portion 211 of the main body 11 is displaced as indicated by the dashed line. The side portion 113 closer to the head moves toward the head 502 . However, since there are ligaments, nerves, blood vessels, etc. on the femoral head 502 (inner leg) side, movement of the plate member 13 should avoid inhibiting these functions and causing tissue damage.

In the present embodiment, the direction of relative movement D is most preferably the direction orthogonal to the lateral hole PX2, but if it deviates (is tilted) from the direction orthogonal to the lateral hole PX2, the plate member 13 (body portion 11) The direction is set so as to reduce the effects of movement on function inhibition and tissue damage. As an example, the relative movement direction D is, for example, a direction within ±30° centered on the lateral hole orthogonal direction PX2, more preferably a direction within ±20° centered on the lateral hole orthogonal direction PX2, more preferably is a direction within, for example, ±15° from the lateral hole orthogonal direction PX2. On the other hand, regarding the amount of tilt in the illustrated counterclockwise direction of the direction of relative movement D, it can be said that movement of the plate member 13 has almost no effect on function inhibition or tissue damage. It may be set to (rotate).

The bent portion 13L, which is the boundary between the connecting portion 12 and the main body portion 11 in plan view shown in FIG. Although they are inclined away from each other (the body portion 11 is provided in such a manner), the positional relationship between the body portion 11 and the axis AX2 can be selected as appropriate. Here, as an example, the main body portion 11 is provided so as to be inclined with respect to the axis AX2 so that the base end side of the osteosynthesis member 201 can easily come into contact with the femur 500 (point contact may be used).

Each part of the bone connector 100 (the intramedullary nail 101, the bone connector 201, the plate member 13, the spacer 14, the fixture 16, etc.) is preferably made mainly of a metal material or a polymer material. Since metal materials and polymer materials have excellent strength and elasticity, the bone fracture site can be firmly fixed by the osteosynthesis device 100 .

As the metal material, various materials can be used, but titanium or a titanium alloy is particularly preferable. Titanium or a titanium alloy is preferably used as a constituent material of each part because of its high biocompatibility and excellent strength. Although the titanium alloy is not particularly limited, for example, Ti-6Al-4V and Ti-29Nb-13Ta-4.6Zr are mainly composed of Ti, and Al, Sn, Cr, Zr, Mo, Ni , Pd, Ta, Nb, V, Pt and the like are added.

As the polymer material, there are various kinds of materials, but polyether ether ketone is particularly preferable. In addition, polyethylene, polyethylene terephthalate, polymethyl methacrylate, and the like, which are used clinically, can be used.

In addition, those portions of the osteosynthesis device 100 that are exposed from the femur 500 have rounded corners (R-marked) as in the present embodiment. It is preferable that the With such a configuration, it is possible to prevent damage to surrounding tissues when fixing the osteosynthesis device 100 to the fracture site of the femur 500 .

<Other Forms of Main Body/Wire Engaging Portion and Proximal Inflection Region>
The configuration of the body portion 11 will be further described with reference to FIGS. 7 and 8. FIG. 7A and 7B are diagrams for explaining the body portion 11 of the present embodiment, FIG. 7A is a side view of the plate member 13, and FIG. It is a schematic diagram.

As shown in FIGS. 7A and 4, the main body 11 may have a wire locking portion 112 capable of locking a wire (fixing metal (Ti) wire) W. As shown in FIG. The wire locking portions 112 are provided on both side portions 113 (left and right side portions in a front view such as FIG. 4(E) and FIG. 4(F)) along the circumferential direction R of the intramedullary nail 101 in the body portion 11, Each has a recess 114 . A plurality of recesses 114 (4 to 5 in this example) are provided along the longitudinal direction of one side portion 113, for example. As shown in FIG. 7B, a wire W can be engaged with each of the recesses 114, and the detached bone can be fixed together with the main body portion 11. As shown in FIG. Depending on the state of the fracture, the bone fragments may be divided into a large number of bone fragments, such as three or more, and it may be difficult to fix all the divided bone fragments by the main body 11 alone. Moreover, even if the number of bone fragments to be fixed is small, the plate member 13 is made of a thin and slippery material, and when it is inserted into the body, it becomes more slippery due to body fluid, cerebrospinal fluid, fat, or the like.

In such a case, the wire W can be hung around at a desired position and locked in the recess 114 to fix the bone fragment and the main body 11 . Further, a plurality of recesses 114 are provided in the longitudinal direction of the side portion 113 of the main body 11 as the wire locking portion 112, and any recesses 114 can be used depending on the state of the fractured part or the femur 500, so that the wire W can be flexibly secured. can be locked, and the detached bone fragment can be fixed to an area wider than the area of the main body 11 .

In addition, as shown in FIG. 7A, the body portion 11 bends toward the intramedullary nail 101 toward the lower end in the direction of the axis AX1 (the extending direction of the body portion 11 is from the upper end to the lower end). A proximate inflection region that bends from a predetermined direction moving away from the intramedullary nail 101 to a direction that makes the degree of moving away from the intramedullary nail 101 smaller than the predetermined direction or a direction that approaches the intramedullary nail 101) 111 at least in part. In this example, the body portion 11 is a substantially rectangular flat plate member, and has a proximal inflection region 111 at one location near the center of the long side (longitudinal direction). That is, the main body portion 11 of this example includes a first region 11A in which the main body portion 11 is displaced slightly away from the intramedullary nail 101 as it goes from its upper side (upper end in the direction of the axis AX1) toward the proximal inflection region 111; The main body 11 has a second region 11B that displaces toward the intramedullary nail 101 from the inflection region 111 downward (lower end in the direction of the axis AX1) of the main body 11 .

The proximal inflection region 111 is a region having a vertex 111P farthest from the intramedullary nail 101 in the main body portion 11, and an imaginary line (indicated by a dashed dotted line) in the axial direction AX1 that contacts the vertex 111P portion of the proximal inflection region 111. ), the second region 11B is inclined at a predetermined angle γ with respect to the virtual line and approaches the intramedullary nail 101 . This tilting angle (the angle formed by the virtual line and the surface S2 of the second region 11B) is referred to as the proximity angle γ here, and the proximity angle γ is, for example, 1° to 30°, preferably 3° to 20°, or more. It is preferably 5° to 15°.

By adopting such a configuration, the body portion 11 can be brought closer to the shape of the femur 500 . The main body part 11 may be in point contact with the femoral part 500, but by approximating the shape of the femur 500, it becomes easier to secure contact points with the detached bone. In addition, the area greatly separated from the femur 500 can be minimized, and space can be saved.

As shown in FIG. 7A, the first region 11A side may also be provided with the proximity angle γ', and the first region 11A side proximity angle γ' may be the proximity angle γ of the second region 11B. may be equal to or different from Also, the approach angle γ' may be 0 (the surface S1 of the first region 11A may have a shape along the axis AX1). Also, a plurality of proximity inflection regions 111 may be provided.

In addition, the plate member 13 is provided at the boundary between the connecting portion 12 and the main body portion 11 (near the upper end (base end) of the main body portion 11 in the direction of the axis AX1) at another portion (for example, thicker than the lower tip portion 11T of the main body portion 11). The plate member 13 has a thick portion 11 D. The thick portion 11 D is the largest portion of the plate member 13 when compared with the overall thickness (the size in the plate thickness direction). Specifically, the thickness d1 of the connecting portion 12, the thickness d2 of the thick portion 11D, the thickness d3 of the first region 11A, the thickness d4 of the proximal inflection region 111, and the thickness d5 of the second region 11B. , the thickness d2 of the thick portion 11D is set larger than the other thicknesses d1 and d3-d5. 11 can increase the strength when fixing the bone fragment.

<Other Forms of Main Body / Circumferential Displacement Area>
8A and 8B are front views of the main body 11 as seen from the rear. FIG. 8A shows the plate member 13 for the left leg, and FIG. 8B shows the plate member 13 for the right leg. FIG. 8(C) is a schematic diagram showing an example of the state of use of the intramedullary nail assisting device 10 for the left foot.

The body portion 11 may have, at least in part, a circumferential displacement region 115 that is displaced in the circumferential direction R of the intramedullary nail 101 toward the lower end (lower tip portion 11T) in the direction of the axis AX1. The circumferential displacement region 115 is, for example, a region where a line (reference line) 11C that serves as a reference for the body portion 11 is displaced in the circumferential direction R of the intramedullary nail 10. The reference line 11C is, for example, the circumferential direction R of the body portion 11 is the center line at

Specifically, the body portion 11 has a circumferential non-displacement region 116 and a circumferential displacement region 115 where the amount of displacement in the circumferential direction R of the intramedullary nail 101 is 0 toward the lower end in the direction of the axis AX1. Circumferential direction non-displacement region 116 is a region extending from the base end of body portion 11 to a certain length along axis AX1, and reference line 11C of body portion 11 extends along axis AX1 and extends below axis AX1. does not displace toward On the other hand, in the circumferentially displaced region 115, the reference line 11C' is displaced away from the reference line 11C of the circumferentially non-displaced region 116 toward the lower side of the axis AX1. The angle (circumferential twist angle (lead angle)) η between the reference line 11C and the reference line 11C′ is the direction toward the distal end (engagement portion 211) of the osteosynthesis member 201 (axis AX2) with reference to the direction of the axis AX1. For example, 1° to 30°, preferably 3° to 25°, more preferably 5° to 20°. That is, in the case of the left leg plate member 13 shown in FIG. Head to the part 211 and curve to the right in the figure. In the case of the plate member 13 for the right leg shown in FIG. 8B, the lower distal end portion 11T of the body portion 11 engages the osteosynthesis member 201 (for the right leg) more than the center of the base end side of the body portion 11. Head to part 211 and curve to the left in the drawing.

Note that FIG. 8 shows an example in which the circumferentially displaced region 115 is circumferentially displaced around the axis AX1 so as to approach the femoral head 502 in general. Considering the general shape of the femur 500, the fixation of the detached bone by the plate member 13 (main body portion 11) proceeds toward the tip (engagement) of the inner side (bone joint member 201 (axis AX2)) toward the toe. This is because it may be easier to hold down by curving in the direction of approaching the joining portion 211). By providing the circumferential displacement region 115, it is possible to expand the supporting range of the exfoliated bone in the circumferential direction.

In addition, the generation of detached bones varies depending on the situation, such as the case of a single sheet or the case of a plurality of sheets. When the detached bone is split into a plurality of pieces, if the split is on the femoral head 502 side away from the longitudinal direction of the main body 11, the bone fragments from the femoral head 502 may not be held down by the straight main body 11. be.

In such a case, the circumferential displacement region 115 displaces in the circumferential direction about the axis AX1 toward the distal end of the bone junction member 201 toward the lower end of the main body 11 (the lower end in the AX1 axis direction). should be provided. While the bone fragments from the head 502 are held down by the circumferentially displaced region 115 , the (straight) body portion 11 of the circumferentially non-displaced region 116 can hold down the upper bone fragments.

In this case, by inclining the reference line 11C with respect to the axis AX1 while maintaining the straight shape of the main body 11 as a whole, it is possible to hold down the bone fragment from the femoral head 502 near the lower end of the main body 11 . However, in this case, the upper end (base end) side of the body portion 11 may protrude too far toward the base end side of the bone junction member 201, or the lower end side of the body portion 11 may come too close to the femoral head 502 side. difficult to get in.

On the other hand, by providing the circumferential displacement region 115 and forming a shape that curves toward the lower tip portion 11T of the body portion 11, it is possible to cope with various conditions of delaminated bones while saving space. .

For example, a plurality of types of plate members 13 having different lengths and shapes in the longitudinal direction (direction along the axis AX1) of the main body 11 are prepared. In addition, there are a plurality of types that differ in the presence or absence of the proximal inflection region 111 and its approach angle γ (γ′), the presence or absence of the wire locking portion 112 and the number of recesses 114, the presence or absence of the circumferential displacement region 115 and its torsion angle η. be prepared.

A plurality of spacers 14 having different heights (lengths in the direction along the axis AX1) of the body portion 140 are prepared, and a plurality of fixtures 16 are also prepared according to the height of the spacers 14 . The spacers 14 and fixtures 16 are prepared in pairs for each height.

The plurality of types of plate members 13 and the plurality of types of spacers 14 all have the same position adjustment mechanism 15 (the shape and inclination of the elongated holes 121 and the shape of the projecting portion 142). The length of the long hole 121 in the longitudinal direction Ld, that is, the relative movement distance in the relative movement direction D between the plate member 13 and the intramedullary nail 101 may differ between the plate members 13 .

Accordingly, the optimal intramedullary nail assisting tool 10 can be selected according to the shape of the femur 500 and the state of the fracture. In addition, each of the plurality of intramedullary nail assisting devices 10 selected from these and configured by combining them has a position adjusting mechanism 15 and can be attached to the corresponding intramedullary nail 101 . For example, for one corresponding intramedullary nail 101, a plurality of intramedullary nail assisting devices 10 configured by selecting and combining from the following can be attached to each.

<Surgical method using osteosynthesis tool>
The osteosynthesis device 100 of the present embodiment is applied, for example, to treat fractures near the head of the femur (femoral neck fractures). An example of a surgical method (procedure) using the osteosynthesis device 100 will be described below with reference to FIG. 9 and previous figures.

First, referring to FIG. 1(B), an entry hole is formed using an awl or the like in the upper end portion 501 of the femur 500 on the femoral head 502 side. A hole is drilled to open the cortical bone. As a result, an opening is formed at the end 501 . The opening in the cortical bone communicates with the medullary canal of the femur 500 .

Next, the intramedullary nail 101 is inserted into the internal medullary cavity along the axis of the femur 500 by introducing the distal end of the intramedullary nail 101 through the opening formed in the end portion 501 .

Next, an intramedullary nail attachment device (target device) (not shown) is connected to the upper end T (top, proximal end) of the intramedullary nail 101 exposed from the femur 500 . After engaging the tip (holding portion) of the intramedullary nail attaching device with the notch portion 1012 provided at the upper end T of the intramedullary nail 101, a fixing bolt (not shown) is screwed into the female screw 106, The intramedullary nail anchoring device and the intramedullary nail 101 are connected. Then, a guide pin (not shown) is inserted from outside the body along the axis of the lateral hole 104 according to a guide provided in advance in the intramedullary nail attaching device. The guide pin tip traverses the fracture line 505 until the tip reaches the cortical bone of the head 502 .

The guide pin is then used to guide a drilling tool such as a drill and reamer. The punch creates a bone hole 503 in the femur 500 along the axis of the transverse hole 104 .

Next, after removing the punch, the guide pin is used to guide the bone joining member (lag screw) 201 . As a result, the osteosynthesis member 201 passes through the lateral hole 104 and is screwed into the bone hole 503 formed in the femur 500 . At this time, the engaging portion 211 of the osteosynthesis member 201 crosses the fracture line 505 and reaches the cortical bone of the head 502 .

As a result, the osteosynthesis member 201 is fixed to the femoral head 502, and the osteosynthesis member 201 is pulled toward the intramedullary nail 101 side. At 505, the abutting fracture sites on both sides are reduced so that they are in close contact with each other.

Next, in this state, the set screw 451 is screwed into the axial hole 105 from the proximal end of the intramedullary nail 101 so that the distal end of the set screw 451 abuts the bone junction member 201 . Thereby, the osteosynthesis member 201 is fixed to the intramedullary nail 101 .

Next, as shown in FIG. 9A, the inserted intramedullary nail 101 and the femur 500 (rear wall) are combined in order to select the plate member 13 suitable for the affected area (fracture state and bone shape). The positional relationship is templated with a dedicated template 50. - 特許庁Depending on the templating results, the appropriate shape and size of plate member 13, spacers 14 and fixtures 16 are selected and assembled on an implant caddy (not shown).

The combined plate member 13 , spacer 14 and fixture 16 are integrally attached to the intramedullary nail 101 as the intramedullary nail assisting device 10 . That is, as shown in FIG. 9(B), for example, the intramedullary nail assisting tool 10 is grasped with a dedicated insertion forceps 51, and a driver 52 is attached to the fixing tool 16 to insert the end of the proximal portion 102 of the intramedullary nail 101. insert into the part. Then, the plate member 13 is inserted near the affected area (rear wall side) while avoiding tissues such as muscles. After that, the threaded portion 162 of the fixture 16 is aligned with the female screw 106 formed in the inner wall of the shaft hole 105 of the intramedullary nail 101 (see FIG. 1B), and the insertion forceps 51 are loosened. At the same time, the screw portion 162 is lightly screwed into the female screw 106 with the screwdriver 52 (temporary fixation).

In this state, the intramedullary nail assisting device 10 is lightly fixed (screwed) to the shaft hole 105 of the intramedullary nail 101 by the spacer 14 and the fixture 16, but the plate member 13 (connecting portion 12) is , and the head 161 of the fixture 16 (temporarily fixed in that way), so that the spacer 14 is slidable. That is, as shown in FIGS. 9(C) and 9(D), the side surface (notch surface) 1421 of the projecting portion 142 and the inner wall portion (side surface 1211) of the long hole 121 are slidable, and the relative movement direction It becomes free to move relative to D. On the other hand, (the notch surface 1421 of) the projecting portion 142 abuts and engages with the side surface 1211 of the straight portion 121S of the long hole 121, and the connecting portion 12 and the intramedullary nail 101 are rotated relative to each other in the circumferential direction R (relative rotation). ) is regulated.

Then, as shown in FIG. 9(E), a portion of the body portion 11 of the plate member 13 is brought into contact with a portion of the delaminated bone, and the body portion 11 is moved so that the delaminated bone is properly returned to its original position. move manually. After the plate member 13 is moved to an appropriate position, the screw portion 162 and the female screw 106 are fastened by the screwdriver 52 (final fixation). By this fastening, (the head 161 of) the fixing tool 16 and the connecting part 12 are abutted and pressed to fix the plate member 13 to the intramedullary nail 101 .

After that, the intramedullary nail 101 is fixed to the femur 500 by screwing a screw (distal screw) 601 into the fixture insertion hole 108 provided in the intramedullary nail 101 . As described above, the fracture site near the femoral head 502 of the femur 500 is fixed using the osteosynthesis device 100 .

Thus, in this embodiment, the plate member 13 can be moved (slid) with respect to the intramedullary nail 101 (femoral bone 500) after the intramedullary nail 101 (and the osteosynthesis member 201) is inserted. Accordingly, even if the femur 500 is twisted due to the insertion of the intramedullary nail 101 (and the osteosynthesis member 201), the plate member 13 can be moved to an appropriate position according to the state of the femur 500 at that time. and hold the delaminated bone.

Further, by setting the moving direction of the plate member 13 (approximately) in the horizontal hole orthogonal direction PX2, it is possible to press in the direction toward the bone axis (the direction intersecting the bone axis). When the femur 500 is fragile due to osteoporosis or the like, when inserting the intramedullary nail into the medullary canal along the axial direction of the femur 500 from the end 501 on the side of the femoral head 502, this end 501 is , along the axial direction of the femur 500 in the posterior or lateral wall. Due to this crack, part of the side wall or rear wall may be delaminated at the end 501, and as a result, there may be a problem that the bone does not fuse smoothly in the delaminated region.

In this embodiment, the plate member 13 (main body portion 11) is brought into contact with the delaminated bone, and the plate member 13 can be manually slid in the lateral hole orthogonal direction PX2, so that the delaminated bone can be returned to its original position. While returning, it can be fixed by pressing in the direction of restoring (filling the gap) the crack along the axial direction of the femur 500 . Then, in a state in which the body portion 11 can support the detached bone at an appropriate position, the fixture 16 is fastened with the driver 52 . The plate member 13 is thereby fixed to the intramedullary nail 101 . In this way, the delaminated bone can be pressed and fixed at a more appropriate position and from a direction appropriate for restoration, thereby improving bone cohesion.

In addition, by allowing the slide in a predetermined direction, it is possible to increase the degree of freedom of manipulation within the range assumed by the operator. On the other hand, by making the intramedullary nail 101 and the connecting portion 12 (plate member 13) relatively unrotatable along the circumferential direction R of the intramedullary nail 101, unintended movement of the plate member 13 can be prevented. movement can be regulated. Therefore, the osteosynthesis device 100 with high operability can be provided along with the operator.

In addition, the locking piece 141 of the spacer 14 is locked with a notch portion 1012 provided at the upper end T (top portion) of the intramedullary nail 101. It is originally provided in the intramedullary nail 101 for retention. Therefore, the existing intramedullary nail 101 (and osteosynthesis member 201) can be used as it is without changing or replacing the specifications of the intramedullary nail 101 (and osteosynthesis member 201). A material suitable for the bone condition can be appropriately selected from the above.

In the above example, the case where the intramedullary nail assisting tool 10 is gripped by the insertion forceps 51 and the fixing tool 16 is fastened by the driver 52 has been described. The procedure may be performed with a screwdriver with an insertion guide that

An example of the present embodiment has been described above. The position adjustment mechanism 15 includes a radial slide mechanism 151 that guides the intramedullary nail 101 and the connecting portion 12 so as to be relatively movable in the radial direction; 12 along the circumferential direction R of the intramedullary nail 101 .

In addition, the position adjusting mechanism 15 includes a first slide surface 153 that is provided on the connecting portion 12 and extends in the direction of relative movement D, and a first slide surface 153 that is provided on the upper end T side of the intramedullary nail 101 . and a slidable second slide surface 154 .

Further, the position adjusting mechanism 15 includes a long hole 121 provided in the connecting portion 12 and a projecting portion 142 provided on the upper end T side of the intramedullary nail 101 and slidable in the longitudinal direction Ld in the long hole 121. You just have to.

Further, the spacer 14 may be provided integrally with the plate member 13, for example, as long as the protruding portion 142 is configured to be slidable in the long hole 121 in the longitudinal direction Ld.

Further, the main body portion 11 may have at least one of the wire locking portion 112, the proximal inflection region 111, and the circumferential displacement region 115, or may have at least one of these in combination. There may be, or the configuration may not have them.

In addition, the structure of the intramedullary nail 101 is an example, and the proximal portion 102 and the distal portion 103 may be integrally formed, or may be provided separately. The distal end of the portion 102 and the proximal end of the distal portion 103 may be joined by fitting, screwing, or the like.

It should be noted that the present invention is not limited to the above-described embodiments, and it goes without saying that various modifications can be made without departing from the gist of the present invention.

10 Intramedullary Nail Auxiliary Tool 11 Body Part 11 Plate Member 13
11A first region 11B second region 11C reference line 11D thick portion 11T lower tip portion 12 connecting portion 13 plate member 14 spacer 15 position adjusting mechanism 16 fixture (end cap)
50 dedicated template 51 insertion forceps 52 driver 100 bone connector 101 intramedullary nail
102 Proximal portion 103 Distal portion 104 Lateral hole 105 Axial hole 111 Proximal bending region 112 Wire locking portion 114 Recessed portion 115 Circumferential direction displacement region 121 Long hole 140 Body portion 141 Locking piece 142 Protruding portion 142L Protruding portion center line 151 Radial direction slide mechanism 152 Circumferential direction engagement mechanism 153 First slide surface 154 Second slide surface 161 Head 162 Threaded portion 163 Cylindrical portion 201 Osteotomy member (lag screw)
211 engagement portion (screw portion)
451 set screw 500 femur 500 femur 502 femoral head 700 outer peripheral wall 1012 notch 1211 side 1421 side (notched surface)
AX1 Axis AX2 Axis D Relative movement direction PX2 Horizontal hole orthogonal direction γ Approach angle η Lead angle

Claims (16)

An intramedullary nail assisting device attachable to an intramedullary nail having an axial hole and a lateral hole extending in a direction intersecting the axial hole,
a main body facing and spaced apart from the outer peripheral wall of the intramedullary nail and extending in the axial direction of the intramedullary nail;
a connecting portion extending in the radial direction of the intramedullary nail so as to be continuous with the main body portion such that a portion of the connecting portion faces the upper end of the intramedullary nail;
a position adjustment mechanism interposed between the connecting portion and the upper end of the intramedullary nail;
a fixture capable of fixing the connecting portion to the upper end of the intramedullary nail;
has
The position adjustment mechanism includes a radial slide mechanism that guides the intramedullary nail and the connecting portion so as to be relatively movable in the radial direction, and a radial sliding mechanism that guides the intramedullary nail and the connecting portion in the circumferential direction of the intramedullary nail. a circumferential engagement mechanism that engages along
An intramedullary nail assisting device characterized by: When the intramedullary nail is viewed from the axial direction, the direction of the relative movement (hereinafter referred to as "relative movement direction") is the axial direction of the lateral hole (hereinafter referred to as "lateral hole axial direction"). is the direction transverse to
The intramedullary nail assisting device according to claim 1, characterized in that: The direction of relative movement is a direction substantially orthogonal to the axial direction of the lateral hole,
The intramedullary nail assisting device according to claim 2, characterized in that: The direction of relative movement is a direction within ±30° centering on a direction orthogonal to the axial direction of the lateral hole.
The intramedullary nail assisting device according to claim 2, characterized in that: The position adjustment mechanism includes a first slide surface provided at the connecting portion and extending in the direction of the relative movement, and a second slide surface provided at the upper end side and slidable on the first slide surface. a sliding surface;
The intramedullary nail assisting device according to any one of claims 1 to 4, characterized in that: The position adjustment mechanism has a long hole provided in the connecting portion, and a protruding portion provided on the upper end side and slidable in the longitudinal direction in the long hole.
The intramedullary nail assisting device according to any one of claims 1 to 5, characterized in that: the position adjustment mechanism has a spacer detachably fixed to the upper end of the intramedullary nail;
The intramedullary nail assisting tool according to any one of claims 1 to 6, characterized in that: The spacer is
A substantially tubular body into which the fixture can be inserted,
The bottom part has a locking piece that can be locked with a notch formed at the upper end of the intramedullary nail,
At least part of the radial slide mechanism and the circumferential engagement mechanism are formed on the upper part,
The intramedullary nail assisting device according to claim 7, characterized in that: At least a portion of the main body portion has a proximal inflection region that displaces a portion of the main body portion toward the lower end in the axial direction so as to be closer to the intramedullary nail,
The intramedullary nail assisting tool according to any one of claims 1 to 8, characterized in that: The approach angle of the main body displaced so as to approach the intramedullary nail is 5 degrees to 30 degrees with respect to the axial direction.
The intramedullary nail assisting device according to claim 9, characterized in that: The body portion has a wire locking portion capable of locking a wire,
The intramedullary nail assisting tool according to any one of claims 1 to 10, characterized in that: The wire locking portion has a recess formed in the circumferential side edge of the main body,
The intramedullary nail assisting device according to claim 11, characterized in that: At least a part of the body portion has a circumferentially displaced region that displaces in the circumferential direction toward the lower end in the axial direction,
The intramedullary nail assisting tool according to any one of claims 1 to 12, characterized in that: With respect to the axial direction, the circumferential twist angle of the circumferential displacement region is 5 degrees to 20 degrees.
The intramedullary nail assisting device according to claim 13, characterized in that: The body portion has a thick portion near the connecting portion that is thicker than the tip portion of the body portion,
The intramedullary nail assisting device according to any one of claims 1 to 14, characterized in that: an intramedullary nail;
an osteosynthesis member inserted through the intramedullary nail;
an intramedullary nail assisting device according to any one of claims 1 to 15;
An osteosynthesis device characterized by:

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