JP4644606B2 - Radial distal end dorsal reduction device - Google Patents

Description

  The present invention guides the direction of insertion of the plate lock screw into the bone by installing it on the dorsal plate attached to the fracture from the dorsal side of the distal radius, the dorsal plate attached from the palm side, the dorsal side, and the domed plate. Dorsal side, palm side guide block, dorsal side, plate lock screw that fixes the palm side plate and fractured part, drill guide that attaches to the dorsal side, palm side plate and drills a drill hole in the bone, drill guide A steel wire guide that guides a perforated steel wire that is inserted into a bone to drill a steel wire hole, a blunt rod that is inserted into a steel wire guide to search for a position where a bone perforated steel wire is inserted, and a rib that combines the above tools The present invention relates to a distal end dorsal reduction device and a distal radius palmar reduction device.

  As a conventional bone plate, a stem plate portion applied to a bone stem portion and a head plate portion applied to a distal end portion or a proximal end portion of a bone are provided, and a bone screw is provided to each of the stem plate portion and the head plate portion. Alternatively, in a bone plate in which at least one through hole for inserting a bone pin is formed, a concave seating surface is formed on the entrance side of the through hole in the trunk plate portion, and the entrance side and the exit side of the through hole in the head plate portion If the bone screw or bone pin shaft formed on the lower surface of the head is loosely inserted into the through hole, the spherical convex surface of the head is the concave seat. If the male screw is inserted into the through hole in the head plate part, the female screw on the head is There is one that is screwed into a female screw (for example, see Patent Document 1).

JP 2004-313514 A

  However, according to the above conventional technique, the skin and muscles are largely incised, the periosteum is exfoliated, the bone is expanded, the bone plate is directly applied to the bone, and the fracture portion is fixed to the bone plate by the bone screw. There has been a problem that the muscles to be incised and expanded are greatly damaged, and it takes time to recover the muscles after the fracture portion is reduced and the bone plate is removed.

  The present invention has been made in view of the above, and the incision of a muscle or the like is suppressed to a minimum, the mechanical stability of fracture fixation is excellent, and the muscular periosteum damage at the time of reduction of the fracture is small (minimum) It is an object of the present invention to obtain a reduction device for a fractured portion of the distal radius that allows rapid recovery of muscles and the like, and can also provide early bone fusion.

To solve the above problems and achieve the object, radial distal dorsal repositioning device of the invention, a multiple screw holes, located on Lister nodules radial distal end dorsal portion A dorsal plate that is installed on the extensor strut on the dorsal side of the distal end of the radius to fix the fractured portion from the dorsal side, and a lock screw that is locked to the screw hole. It is characterized by comprising a plate lock screw having a formed head, a columnar intermediate portion having a length of 10 mm or more, and a tip formed with a bone screw inserted into a bone .

The dorsal plate of the distal end of the distal radius end according to the present invention is installed on the extensor strut on the dorsal side of the distal end of the radius, so that it is necessary to cut almost the extensor retina. In addition, because the notch is formed in the part located on the Lister nodule, there is no need to scrape the Lister nodule when installing the dorsal plate, and there is no damage to the extensor (tendon) due to installation and removal , There is an effect. Moreover, since the smooth cylindrical intermediate part without protrusions, such as a screw thread of a plate lock screw, is located in the extensor retinaculum and the extensor tendon, there is an effect that these are not damaged.

  DESCRIPTION OF EMBODIMENTS Hereinafter, embodiments of a distal reduction instrument for a distal end of a radius such as a back plate according to the present invention will be described in detail with reference to the drawings. Note that the present invention is not limited to the embodiments.

  1-1 is a plan view showing a back plate according to the present invention, FIG. 1-2 is a cross-sectional view taken along line AA of FIG. 1-1, and FIG. 1B is a cross-sectional view taken along the line CC, FIG. 1-5 is a cross-sectional view taken along the line DD, and FIG. These are top views which show the modification of the dorsal plate concerning this invention, FIG. 2-1 is a figure which shows the right hand dorsal side except skin and subcutaneous fat, FIG. 2-2 is an extensor FIG. 2 is a diagram showing the right hand dorsal side with the branch band removed, FIG. 2-3 is a diagram showing the right hand dorsal side of the bone, FIG. 2-4 is a cross-sectional view of the right hand wrist, and FIG. 4 is a front view showing a plate lock screw according to the present invention, FIG. 3-2 is a top view thereof, and FIG. 4A is a front view showing a first drill guide according to the present invention. -2 is the top view FIG. 5-1 is a front view showing a first steel wire guide according to the present invention, FIG. 5-2 is a top view thereof, and FIG. 6-1 is a plan view of the blunt bar according to the present invention. FIG. 6-2 is a top view, FIG. 7-1 is a plan view showing a dorsal guide block according to the present invention, and FIG. 7-2 is a plan view of FIG. FIG. 7-3 is a cross-sectional view taken along the line BB, FIG. 7-4 is a cross-sectional view taken along the line CC, and FIG. Fig. 8 is a cross-sectional view taken along the line DD, and Fig. 8 is a cross-sectional view showing an assembled state of the distal end of the distal end of the radius of the present invention.

  As shown in FIGS. 1-1 to 1-5, the back plate 10 of the present invention is formed in a Y shape in plan view, and the first screw hole 11a is formed at the tip of the first branch portion 10a. The second screw hole 11b is arranged at the tip of the second branch part 10b, and a plurality (five) of proximal screw holes 11c to 11g that are axially spaced from each other are arranged in the Y-shaped trunk part 10c. Has been. A notch 10d is formed between the two branches 10a and 10b.

  In the first embodiment, five proximal screw holes are arranged, but at least two proximal screw holes may be arranged apart from each other in the axial direction. The screw holes 11i and 11h are also arranged in the middle part of the first and second branch parts 10a and 10b, but these are usually used because they are located at the fractured part. It is not always necessary to arrange them. The screw holes 11a to 11i are M4 screw holes, and the distance between the centers of adjacent screw holes is 5 to 7 mm.

  As shown in FIGS. 2-1 to 2-4, the dorsal plate 10 is placed on the extensor retina 23 and the total extensor tendon 24a in which the skin 21 and fat 22 on the distal end of the distal radius are cut. The plate lock screw 30 (described later) is inserted into the radius 25 through the screw holes 11a to 11g, and then the head 25 is locked to the screw holes 11a to 11g and the fractured portion 25a of the radius 25 (usually the distal end of the radius). The rib 25 near the proximal side (about 15 mm from the part) is fixed from the back side.

  The first screw hole 11a is disposed on the flexible side 25c, which is the thumb 26 side of the Lister knot 25b on the distal side of the distal end of the radius, and the plate lock screw 30 is connected to the first screw hole 11a and the extensor retina 23. Through the short flex side carpal extensor tendon 24b and the Lister node 25b (between the second section 23b and the third section 23c of the extensor branch 23 shown in FIG. 2-4) at the end of the flex side 25c. It is inserted.

  The second screw hole 11b is disposed on the little finger 27 side of the Lister knot 25b, and the plate lock screw 30 is interposed between the total finger extensor tendon 24a through the second screw hole 11b and the extensor strut 23 (see FIG. 2-4). A fourth section 23d of the extensor retina 23d) or between the total extensor tendon 24a and the little finger extensor tendon 24d (the fourth section 23d and the fifth section 23e of the extensor retina 23 shown in FIG. 2-4). Between the bones 25).

  At this time, since the notch 10d is formed between the two branches 10a and 10b of the back plate 10 which are to be positioned on the Lister node 25b, the protrusion of the Lister node 25b is raised on the back plate 10. It is not necessary to scrape the Lister nodule 25b in advance. Further, when the fractured portion 25a is crushed and a bone defect has occurred, an artificial bone or the like can be transplanted from the notch 10d.

  The plurality of proximal screw holes 11c to 11g are disposed on the proximal side of the Lister node 25b (the proximal side relative to the fractured portion 25a), and the plate lock screw 30 passes through the proximal screw holes 11c to 11g, The abductor tendon 24e and the total extensor tendon 24a are removed to the left and right and inserted into the flexor 25.

  The distance in the width direction between the center lines of the first and second screw holes 11a and 11b is 14.8 mm, and the axial distance is 3.9 mm. As shown in FIG. 2-3, the distal end portion of the rib 25 has a second finger hole 11b disposed more proximally than the first screw hole 11a because the little finger side is recessed from the rib side 25c. ing.

  Further, the distal end of the rib 25 is recessed on the palm side from the dorsal side, so that the distal end of the rib 25 is inserted into the rib 25 through the first and second screw holes 11a and 11b. As shown in FIG. 1-4, the first and second screw holes 11a and 11b are oriented so that the plate lock screw 30 does not penetrate the distal end of the rib 25 to the distal side. It is inclined 5 ° to the proximal side with respect to the vertical line.

  The thickness of the back plate 10 is 2 mm, the total length S1 is 40 mm, the total width S2 is 23 mm, the trunk portion 10c has a width S3 of 10 mm, the notch portion 10d has an opening width S4 of 8 mm, and the first branch of the notch portion 10d. The depth from the tip of the portion 10a is 18 mm. Further, the back plate 10 is bent in the width direction with a curvature radius R = 28 mm in accordance with the degree of curvature of the extensor branch 23 shown in FIG. 2-4.

  Screw holes 11a, 11i, 11g arranged on the left side of the central axis of the back plate 10 and screw holes 11b, 11h, 11f arranged on the right side of the central axis so as to match the curvature of the back plate 10. As shown in FIGS. 1-2 and 1-3, the direction of is inclined 5 ° toward the central axis.

  Three pairs of six steel wire holes 12a to 12f are provided in the vicinity of the first screw hole 11a, the second screw hole 11b, and the proximal screw hole 11d so as to sandwich the screw holes. Prior to fixing the fracture portion at the distal end of the radius with the dorsal plate 10 and the plate lock screw 30, a temporary fixing steel wire is inserted into the fracture portion through the steel wire holes 12 a to 12 f, and the fracture portion and the dorsal plate 10 Is temporarily fixed, and a pilot hole (drill hole) for inserting the plate lock screw 30 by temporary fixing can be drilled at an accurate position.

  The steel wire holes 12a and 12c are provided closer to the distal end of the radius (distal), which has higher bone strength than the steel wire holes 12b and 12d. Since the distal end of the rib 25 is recessed on the palm side than the dorsal side, the temporary fixing steel wire inserted into the rib 25 from the distal end of the rib 25 through the steel wire holes 12a and 12c is inserted into the rib. The steel wire holes 12a, 12c are oriented 10 ° proximal to the perpendicular to the dorsal plate 10 as shown in FIGS. It is tilted. The orientations of the steel wire holes 12b, 12d, 12e, and 12f are parallel to the vertical line of the back plate 10.

  The direction of the pair of steel wire holes 12a and 12b is inclined to each other, and the direction of the pair of steel wire holes 12c and 12d is inclined to each other (not parallel). Is inserted, the pair of temporarily fixed steel wires cross each other, so that the steel wire holes cannot be removed, and the fractured portion can be firmly fixed temporarily to the back plate 10.

  The corners of the end portions of the first and second branch portions 10a and 10b of the back plate 10 and the corner portions of the end portions of the trunk portion 10c have a radius of curvature R = 2 mm to 4.5 mm. . Further, the outer peripheral edge portion of the dorsal plate 10 is chamfered into a convex curved surface by sharpening the lower surface side in contact with the extensor retina 23 and the total finger extensor tendon 24a into an edge shape.

  The curvature radius of the edge portion is R = 0.2 mm, and the curvature radius of the convex curved surface is R = 3 mm. Since the lower surface side is sharpened in an edge shape and is smoothly chamfered into a convex curved surface shape, when the fracture portion is fixed with the dorsal plate 10 and the skin 21 is sutured, there is less irritation to the skin 21 and the skin 21 It is difficult to generate a cavity between the two.

  As shown in FIG. 1-5, the peripheral edge surrounding the notch 10d of the dorsal plate 10 is chamfered into a convex curved surface by sharpening the upper surface side contacting the stitched skin 21 or fat 22 in an edge shape. ing. The curvature radius of the edge portion is R = 0.2 mm, and the curvature radius of the convex curved surface is R = 3 mm. Since the upper surface side is sharpened in an edge shape and chamfered into a convex curved surface, the portion in contact with the extensor rebar 23 is a smooth curved surface, and there is little irritation to the extensor rebar 23.

  Depending on the position of the fractured portion 25a and the size of the ribs by the individual, the dorsal plate 10 is prepared in three sizes with a total width S2 = 23 mm to 28 mm and a total length S1 = 40 to 52 mm. It is good to leave.

  Next, with reference to FIGS. 1-6, the back side plate 15 of the modification of the back side plate 10 of Example 1 is demonstrated. The dorsal plate 15 has a bridging portion 10e that connects the first and second branch portions 10a and 10b of the dorsal plate 10, and the notch portion 10d includes first and second branch portions 10a, A large hole is surrounded by 10b and the bridging portion 10e.

  The back plate 15 of the present invention is not Y-shaped. The other parts are the same as the back plate 10. The back side plate 15 has the same effect as the back side plate 10 and has a higher strength than the back side plate 10 because the first and second branch portions 10a and 10b are bridged.

  Next, referring to FIGS. 3A and 3B, the rib 25 is inserted through the screw holes 11a to 11i of the dorsal plates 10 and 15, and the ribs 25 and the dorsal plates 10 and 15 are not brought into direct contact with each other. The plate lock screw 30 of the present invention that is fixed in the above will be described.

  The plate lock screw 30 includes a head portion 30a formed with an M4 lock screw that is locked by being screwed into the screw holes 11a to 11i of the dorsal plates 10 and 15, a middle portion 30b formed in a columnar shape, and a stab into a bone. And a tip portion 30c formed with a bone screw to be inserted. The head 30a is formed with a plus groove 30d that can be engaged with a plus driver, and the M4 lock screw has a leading screw thread lower than other screw threads so that it can easily enter the screw hole.

  At the tip of the bone screw 30c, notches 30e are provided at three locations in the circumferential direction in order to improve the biting into the bone. The outer diameter of the bone screw 30c is φ = 3 mm, the valley diameter is φ = 2.2 mm, and the thread thickness is 0.1 mm. The thread pitch of the bone screw 30c is P = 1.4 mm, which is larger than the pitch P of the M4 lock screw of the head 30b = 0.7 mm. The outer diameter of the intermediate part 30b is φ = 2.2 mm.

  When the plate lock screw 30 is inserted into the rib 25 and the lock screw of the head 30b is screwed into the screw hole of the back plate 10, the amount of the plate lock screw 30 entering the bone per rotation is the amount of entry into the screw hole. Therefore, the dorsal plates 10 and 15 are attracted to the bone side, and the dorsal plates 10 and 15 that have been lifted by the elasticity of the extensor retina 23 are attracted to the bone side and firmly fixed. can do.

  The length of the head 30a is L1 = 3 mm, the length of the intermediate portion 30b is L2 = 10 mm or more, and the length of the bone screw 30c is L3 = 8 mm. When the plate lock screw 30 is inserted into the rib 25 and the lock screw of the head 30b is locked in the screw hole of the back plate 10 or 15, the smooth columnar intermediate portion 30b having no protrusion such as a screw thread is extended. The length of the intermediate portion 30b is set to L2 = 10 mm or more, which is larger than the thickness of the extensor retina 23, so as to be positioned in the reinforcer 23 and the extensor tendon so as not to be damaged. It is preferable to prepare several types of plate lock screws 30 in which the length of the intermediate portion 30b is increased from 10 mm to 2 mm.

  Next, with reference to FIGS. 4A and 4B, the drill guide 40 of the present invention which is screwed into the screw holes 11a to 11i of the back plates 10 and 15 and attached to the back plates 10 and 15 will be described. .

  The drill guide 40 is formed in a cylindrical shape having a drill guide hole 40a of φ = 2.4 mm, and protrudes from the lower end portion toward the radius 25 side from the screw holes 11a to 11i to connect the extensor retina 23 and the extensor tendon. A protective cylinder portion 40g for preventing the extensor retina 23 and extensor tendon from coming into contact with the drill and damaging them, an M4 lock screw 40b which is locked by being screwed into the screw holes 11a to 11i, A cylindrical portion 40c having a diameter of 4.5 mm, a hexagonal cylindrical portion 40d having an opposite side distance of 3.69 mm, and an M3 steel wire guide lock screw hole 40e are formed.

  The length of the protective cylinder part 40g is M0 = 6 mm, the length of the lock screw 40b is M1 = 2 mm, the length of the cylindrical part 40c is M2 = 12 mm, the length of the hexagonal cylinder part 40d is M3 = 16 mm, and the steel wire guide lock screw hole The depth of 40e is 1 mm or more. The drill guide 40 is attached to the dorsal plates 10 and 15 and guides the direction of a drill for drilling a pilot hole for inserting the plate lock screw 30 into the rib 25.

  Next, with reference to FIGS. 5A and 5B, a steel wire guide 50 according to the present invention for guiding a perforated steel wire inserted into the drill guide 40 and perforating a leading hole of the drill will be described.

  The steel wire guide 50 is formed in a cylindrical shape having a steel wire guide hole 50a with φ = 1.3 mm, a cylindrical portion 50b with an outer diameter φ = 2.4 mm, and a cylindrical head with an outer diameter φ = 4.5 mm. Part 50c. A screw portion 50d having a length of M3 and a length of 1 mm is formed on the head portion 50c side of the cylindrical portion 50b.

  The length of the cylindrical portion 50b is N1 = 35 mm, and the length of the head portion 50c is N2 = 3 mm. The steel wire guide 50 is inserted into the drill guide 40 and the screw portion 50d is screwed into the steel wire guide lock screw hole 40e and fixed, and guides the direction of the drilled steel wire that drills the lead hole of the drill in the rib 25. Since the screw portion 50d is screwed into the steel wire guide lock screw hole 40e and is fixed, the steel wire guide 50 does not fall off the drill guide 40 during the reduction operation.

  Next, referring to FIG. 6A and FIG. 6B, the drilling steel wire insertion position of the rib 25 inserted into the steel wire guide 50 and previously drilled with a needle or the like is searched for. The blunt bar 60 will be described.

  The blunt rod 60 has a round bar portion 60a having an outer diameter φ = 1.2 mm and a columnar head portion 60b having an outer diameter φ = 4.5 mm. The tip of the round bar 60a is formed in a hemispherical shape. The length of the round bar 60a is R1 = 53 mm, and the length of the head 60b is R2 = 3 mm. When the blunt rod 60 is inserted into the steel wire guide 50, the tip of the blunt rod 60 protrudes about 20 mm from the lower surface of the dorsal plate 10 and penetrates the extensor retina 23 to pass through the extensor tendons into the rib 25 in advance. The perforated steel wire insertion position (plate lock screw 30 insertion position) in which the needle hole has been opened can be found.

  Next, referring to FIGS. 7-1 to 7-5, the dorsal side of the present invention which is installed on the dorsal plates 10 and 15 and guides the direction of inserting the temporary fixing steel wire and the plate lock screw into the bone. The guide block 70 will be described.

  The dorsal guide block 70 is made of resin, has an outer shape identical to that of the dorsal plates 10 and 15 and has a shape without a notch, and includes first and second screw holes 11a of the dorsal plates 10 and 15, Screw guide holes 71a to 71i in the same direction as the respective screw holes are formed at positions corresponding to 11b and the plurality of proximal screw holes 11c to 11i. Further, steel wire guide holes 72 a to 72 f in the same direction as the respective steel wire holes are formed at positions corresponding to the steel wire holes 12 a to 12 f of the back side plate 10.

  The thickness of the back guide block 70 is 5 mm, the inner diameters of the screw guide holes 71a to 71i are φ = 5 mm, and the inner diameters of the steel wire guide holes 72a to 72f are φ = 1.4 mm. The dorsal guide block 70 is installed on the dorsal plate 10 and guides the direction in which the temporarily fixed steel wire and the plate lock screw 30 are inserted into the bone.

  Since the protrusion of the Lister node 25 b is lower than the height of the upper surface of the back side plates 10, 15, the Lister node 25 b does not hit the back side guide block 70. Further, as shown in FIGS. 7-2 and 7-3, the lower surface of the back guide block 70 is curved in the width direction with a curvature radius R = 30 mm in accordance with the curvature of the upper surface of the back plate 10. Yes. The guide block 70 is prepared in three types according to the three types of sizes of the back side plates 10 and 15.

  Of the distal radius reduction instrument described above, parts other than the back guide block 70 are made of a titanium alloy. Moreover, although the back-side plates 10 and 15 and the back-side guide block 70 have been described for the right-handed one, the left-handed one may be in a line-symmetrical (unusual) shape with the right-handed one.

  Next, with reference to FIG. 8, the fixation method of the distal radius fracture using the aforementioned distal radius distal dorsal reduction device will be described.

  First, the first drill guide 40 is attached to each of the first and second screw holes 11a and 11b and the proximal screw holes 11c and 11e of the back plate 10, and the first steel wires are respectively attached to the first drill guide 40. The guide 50 is attached, the blunt rod 60 is inserted into the first steel wire guide 50 attached to the first screw hole 11a, and the back guide is passed through the first drill guide 40 into the screw guide hole of the back guide block 70. A block 70 is placed on the dorsal plate 10 and assembled and prepared as a dorsal reduction instrument for the distal end of the radius.

  While looking at the X-ray, the state of the fractured portion and the insertion position of the plate lock screw 30 on the flexible side 25c of the Lister node 25b are determined. Next, the skin 21 on the dorsal end of the radius is incised to remove the fat 22 and expose the extensor retina 23, the total extensor muscle 24a and the short thumb extensor 24e. A small incision is made in the extensor retinaculum 23 on the inserted position of the plate lock screw 30 that has been registered.

  Remove the short flex side carpal extensor tendon 24b to the left and the Lister nodule 25b to the right, and make a needle hole with a thick injection needle at the insertion position of the plate lock screw 30 while viewing with X-rays. Bring the assembled instrument at the distal end of the distal end of the radius, insert the tip of the blunt rod 60 into the small incision of the extensor retinaculum 23, find the needle hole of the injection needle, and place the dorsal plate 10 at that position. Position it. At this time, the protective cylinder portion 40g of the drill guide 40 protruding downward from the dorsal plate 10 pushes the extensor branch 23 and the extensor tendon to the left and right, and the extensor strut 23 and the extensor tendon do not contact the drill. Like that.

  Through the steel wire guide holes 72a to 72d of the dorsal guide block 70 and the steel wire holes 12a to 12d of the dorsal plate 10, except for each tendon, the pointed temporary fixing steel wire of φ = 1.2 mm is rotated. The fracture piece and the dorsal plate 10 are temporarily fixed by inserting into the fracture piece at the distal end of the radius. Pull the finger to reduce the position of the fracture piece and the proximal flexor, and then pass through the steel wire guide holes 72e and 72f and the steel wire holes 12e and 12f. A steel wire is inserted and the fractured part is temporarily fixed by the dorsal plate 10.

  The first steel wire guide 50 guides the perforated steel wire, which is the same as the temporarily fixed steel wire, through the necessary portions of the screw holes 11a to 11e of the back plate 10, and pierces the leading hole of the drill. . The first steel wire guide 50 is removed, the first drill guide 40 and the guide hole are guided, and a pilot hole of the plate lock screw 30 is drilled at a required portion of the flexure. At this time, since the protective cylinder portion 40g protects the extensor retina 23 and the extensor tendon, the extensor retina 23 and the extensor tendon are not damaged by the drill.

  With the first drill guide 40 attached, a depth gauge is inserted into the lower hole, the depth of each lower hole is measured, and the first drill guide 40 is removed. The screw guide holes 71a to 71e of the back guide block 70 are guided, the plate lock screws 30 of the respective lengths are inserted into the necessary portions of the flexure 25, and the lock screws 30a are locked to the necessary portions of the screw holes 11a to 11e. Then, the fracture portion is fixed to the dorsal plate 10.

  The dorsal guide block 70 is removed, and when there is a defect in the fractured part, an artificial bone or the like is transplanted from the notch 10d. When the cut skin 21 is sutured, the fixation of the distal radius fracture is completed.

  FIG. 9-1 is a plan view showing a palm-side plate according to the present invention, FIG. 9-2 is a cross-sectional view taken along the line AA of FIG. 9-1, and FIG. FIG. 9-4 is a sectional view taken along the line CC, FIG. 10-1 is a front view showing a second drill guide according to the present invention, 10-2 is a top view thereof, FIG. 11-1 is a front view showing a third drill guide according to the present invention, FIG. 11-2 is a top view thereof, and FIG. These are a front view which shows the 2nd steel wire guide concerning this invention, FIG. 12-2 is the same top view, FIG. 13-1 is a top view which shows the palm side guide block concerning this invention. FIG. 13-2 is a side view of the same, and FIG. 14 is a longitudinal sectional view of the distal radius reduction instrument.

  As shown in FIGS. 9-1 to 9-4, the palm-side plate 100 of the present invention has a thickness of 2 mm and has a long and narrow shape in which a substantially trapezoidal head 100a and a substantially rectangular trunk 100b are connected in plan view. It is formed in a substantially delta shape. First, second, and third distal screw holes 101a, 101b, and 101c are arranged in a row at the tip of the head 100a, and a plurality (two) of the trunk 100b are separated from each other in the axial direction. Proximal screw holes 101d and 101e are arranged. The screw holes 101a to 101e are M4 screw holes. The distance between the centers of the adjacent distal screw holes 101a, 101b, and 101c is 6 mm, and the distance between the centers of the proximal screw holes 101d and 101e is 18.5 mm.

  Three stepped holes 102a to 102c including an upper surface side large-diameter hole having an inner diameter of φ4.5 mm, a lower surface side small-diameter hole having an inner diameter of 3.3 mm, and an intermediate taper hole are disposed in the central portion of the head portion 100a. However, these are usually used at a fractured part and are rarely used and need not be arranged. However, the stepped holes 102a to 102c are used to fix each fractured piece to the palm plate 100 with the plate lock screw 30 when the fractured part is broken into a plurality of fractured pieces due to a complicated fracture or the like. .

  The stepped holes 102a to 102c may be screw holes. The distance between the centers of the adjacent stepped holes 102a, 102b, 102c is 6.5 mm. A stepped long hole 103 having a width of 4.5 mm and a length of 9 mm is disposed between the proximal screw holes 101d and 101e.

  Although not shown, the palm side plate 100 cuts through the skin and fat on the distal end of the radius bone, removes the palmar carpal flexor tendon and deep flexor tendon on the left side, cuts the fascia, After the plate lock screw 30 is inserted into the bone 25 through the screw holes 101a to 101e, the head is locked to the screw holes 101a to 101e, and then the bone 25 The radius 25 in the vicinity of the fractured portion 25a (usually proximal to the distal end of the radius about 15 mm, see FIG. 2-3) is fixed from the palm side.

  The distance in the width direction between the distal screw holes 101a and 101c is 12 mm, and the axial distance is 2.7 mm. The distal end portion of the rib 25 has a third finger screwed in the proximal side of the first distal screw hole 101a because the little finger side is recessed from the rib side 25c. Further, the distal end of the rib 25 is recessed on the palm side from the dorsal side, so that the rib 25 is pierced from the distal end palm side of the rib 25 through the first to third distal screw holes 101a to 101c. As shown in FIG. 9-4, the direction of the first to third distal screw holes 101a to 101c is changed so that the inserted plate lock screw 30 is inserted along the distal end portion of the radius 25. The palm plate 100 is inclined 15 ° distal to the perpendicular of the trunk 100b.

  The total length T1 of the palm side plate 100 is 49 mm, the total width T2 is 20 mm, and the width T3 of the trunk 100b is 9 mm. Further, the palm side plate 100 is curved to the upper surface side in the axial direction with a radius of curvature R = 50 mm as shown in FIG. The direction of the stepped holes 102 a to 102 c is inclined 10 ° to 17 ° to the distal side with respect to the perpendicular of the trunk portion 100 b of the palm side plate 100 so as to match the curvature of the palm side plate 100.

  In order to sandwich the distal screw hole 101b and the stepped elongated hole 103 in the vicinity of the second distal screw hole 101b and in the vicinity of the stepped elongated hole 103 and in the vicinity of the proximal threaded holes 101d and 101e, A total of six steel wire holes 104a to 104f are provided. Prior to fixing the vicinity of the fractured portion of the distal end of the radius with the palm plate 100 and the plate lock screw 30, a temporary fixing steel wire was inserted into the vicinity of the fractured portion through the steel wire holes 104a to 104f, and the fracture was performed. The vicinity of the portion and the palm-side plate 100 are temporarily fixed, and the preliminary hole allows the lower hole (drill hole) for inserting the plate lock screw 30 to be drilled at an accurate position.

  The steel wire holes 104e and 104f in the vicinity of the proximal screw hole are spaced apart from each other in the axial direction of the radius and are arranged on the left side and the right side of the central axis of the palm side plate 100. Since it is placed on the left and right sides, the temporary steel wire is first inserted into the steel wire hole with good visual field during the operation and temporarily fixed, and after temporary fixing, the hand is moved and the visual field is poor. A temporary fixing steel wire can be inserted into the steel wire hole on the other side.

  Further, since the steel wire holes 104e and 104f are separated from each other in the axial direction, a force in the left-right direction acts on the distal fracture piece temporarily fixed to the palm side plate 100 with the temporary fixation steel wire, and the fracture piece moves. Even in this case, the steel wire holes 104e and 104f serving as fulcrums are separated from each other, so that a strong resistance is applied and the fracture piece does not move.

  As shown in FIG. 9-4, the direction of the steel wire holes 104 a to 104 d is inclined 15 ° to the distal side with respect to the vertical line of the trunk portion 100 b of the palm side plate 100. The direction of the steel wire holes 104e and 104f is parallel to the perpendicular of the trunk portion 100b.

  Since the direction of the steel wire holes 104a to 104d and the direction of the steel wire holes 104e and 104f are inclined with respect to each other (not parallel), the temporary fixing steel wires are inserted in the vicinity of the respective steel wire holes and the broken portion. The temporarily fixed steel wires cross each other and cannot be removed from the steel wire hole, and the vicinity of the fractured portion can be firmly temporarily fixed to the palm side plate 100.

  The corners of the end of the head 100a of the palm side plate 100 and the corners of the end of the trunk 100b have a radius of curvature R = 3 mm to 4 mm. Further, the outer peripheral edge portion of the palm side plate 100 is chamfered into a convex curved surface by sharpening the lower surface side in contact with the square pronation muscle in an edge shape. The radius of curvature of the edge portion is R = 0.2 mm, and the radius of curvature of the convex curved surface is R = 2 mm.

  Since the lower surface side is sharpened in an edge shape and chamfered into a convex curved surface, when the fractured portion is fixed with the palm side plate 100 and the skin 21 is sutured, the skin 21, deep flexor tendon, palm side carpal There are few irritation | stimulation to a flexor tendon and a fascia, they are not damaged, and a cavity part is hard to generate | occur | produce. The back plate 100 may be prepared in three types of total length T1 = 49 mm, 56 mm, and 64 mm in accordance with the position of the fractured portion 25a.

  Next, the second drill guide 140 of the present invention that is screwed into the screw holes 101a to 101e and attached to the palm side plate 100 will be described with reference to FIGS. 10-1 and 10-2.

  The drill guide 140 is formed in a cylindrical shape having a drill guide hole 140a of φ = 2.4 mm, and an M4 lock screw 140b that is screwed into the screw holes 101a to 101e and is locked in order from the lower end portion; A 5 mm cylindrical portion 140c and a hexagonal cylindrical portion 140d having an opposite side distance of 3.69 mm are formed.

  The length of the lock screw 140b is M1 = 2 mm, the length of the cylindrical portion 140c is M2 = 12 mm, and the length of the hexagonal cylindrical portion 140d is M3 = 16 mm. The hexagonal cylinder portion 140d is formed with a circumferential groove having a width of 1 mm and filled with a red paint as an identification mark. The second drill guide 140 has the same size and shape as the first drill guide 40 described above, is attached to the palm side plate 100, and is a pilot hole (leading guide) for inserting the plate lock screw 30 into the rib 25 from the palm side. Guide the direction of the drilling hole.

  Next, the third drill guide 143 of the present invention that is screwed into the screw holes 101a to 101e and attached to the palm side plate 100 will be described with reference to FIGS. 11-1 and 11-2.

  The third drill guide 143 is formed in a cylindrical shape having a drill guide hole 143a of φ = 2.4 mm, and in order from the lower end, an M4 lock screw 143b that is screwed into the screw holes 101a to 101e and locked, A cylindrical portion 143c having a diameter of 4.5 mm and a hexagonal cylindrical portion 143d having an opposite side distance of 3.69 mm are formed.

  The length of the lock screw 143b is M1 = 2 mm, the length of the cylindrical portion 143c is M2 = 12 mm, the length of the hexagonal cylinder portion 143d is M4 = 26 mm, and is 10 mm longer than the hexagonal cylinder portion 140d of the second drill guide 140. is doing. The hexagonal cylinder portion 143d is formed with a circumferential groove having a width of 1 mm and filled with a green paint as an identification mark. The third drill guide 143 has the same size and shape as the second drill guide except for the hexagonal cylinder portion 143d, is attached to the palm side plate 100, and is used to insert the plate lock screw 30 into the rib 25 from the palm side. Guide the position and direction of the drill to drill the pilot hole.

  Next, referring to FIG. 12-1 and FIG. 12-2, the second of the present invention for guiding the drilled steel wire inserted into the second and third drill guides 140, 143 and drilling the leading hole of the drill. The steel wire guide 150 will be described.

  The second steel wire guide 150 is formed in a cylindrical shape having a steel wire guide hole 150a with φ = 1.3 mm, a cylindrical portion 150b with an outer diameter φ = 2.4 mm, and a head with an outer diameter φ = 4.5 mm. Part 150c.

  The length of the cylindrical portion 150b is N3 = 28 mm, and the length of the head portion 150c is N2 = 3 mm. Unlike the first steel wire guide 50, the second steel wire guide 150 does not include the screw portion 50d. Further, the length of the cylindrical portion 150b is shorter than the length of the cylindrical portion 50b of the first drill guide. The second steel wire guide 150 is inserted into the second and third drill guides 140 and 143, and guides the direction of the drilled steel wire for drilling the leading hole of the drill in the rib 25.

  Next, referring to FIGS. 13A and 13B, the palm-side guide of the present invention is installed on the palm-side plate 100 and guides the direction of insertion of the temporary fixing steel wire and the plate lock screw 30 into the bone. The block 170 will be described.

  The dorsal guide block 170 is made of resin, has an outer shape substantially the same as that of the palm side plate 100, and is located at a position corresponding to the first to third distal screw holes 101a to 101c of the palm side plate 100, respectively. Screw guide holes 171a to 171c having the same direction as the distal screw hole are formed. Further, steel wire guide holes 172a to 172f in the same direction as the respective steel wire holes are formed at positions corresponding to the steel wire holes 112a to 112f of the palm side plate 100, and at positions corresponding to the stepped long holes 103, Two long holes 113 having a width of 1.3 mm and a length of 7 mm are arranged in parallel with a distance of 2 mm between the centers.

  The palm side guide block 170 has a thickness of 5 mm, the inner diameters of the screw guide holes 171a to 171c are φ = 5 mm, and the inner diameters of the steel wire guide holes 172a to 172f are φ = 1.4 mm. As shown in FIG. 13-2, the palm-side guide block 170 is installed on the palm-side plate 100 in a shape bent at an angle of 15 ° on the distal side of the stepped slot 103, and is temporarily fixed steel. Guides the insertion direction of the wire and plate lock screw 30 into the bone. The palm side guide block 170 is prepared in three sizes according to the three sizes of the palm side plate 100.

  Of the distal end palm side reduction devices described above, the parts other than the palm side guide block 170 are made of a titanium alloy. Further, the palm-side plate 100 and the palm-side guide block 170 have been described for the right hand, but the left hand may have a line-symmetrical (unusual) shape with the right hand.

  Next, with reference to FIG. 14, the fixation method of the distal radius fracture using the distal radius palmar reduction device described above will be described.

  First, the second drill guide 140 is attached to the first and third screw holes 101a, 101c of the palm-side plate 100, the third drill guide 143 is attached to the second screw hole 101b, and the second, third The second steel wire guide 150 is attached to each of the drill guides 140 and 143, and the palm side guide block 170 is placed on the palm side through the second and third drill guides 140 and 143 in the screw guide holes 171a to 171c of the palm side guide block 170. It is installed on the plate 100 and assembled and prepared as a distal radius palmar reduction device.

  The state of the fractured portion is observed with an X-ray, and the insertion position of the plate lock screw 30 is determined. Next, the skin on the palmar distal end palmar side is incised to remove fat and the exposed palmar carpal flexor tendon is removed on the left side. Next, the exposed fascia is incised, and the deep flexor tendon exposed through the incision is removed to the left to expose the square pronation muscle. A small incision is made in the square pronation muscle on the insertion position of the registered plate lock screw 30 and the assembled distal distal palmar reduction device is brought to position the palm plate 100 at that position.

  The distal end of the radius while rotating the pointed temporary fixing steel wire with φ = 1.2 mm through the steel wire guide holes 172a to 172d of the palm side guide block 170 and the steel wire holes 104a to 104d of the palm side plate 100 The fracture piece and the palm plate 100 are temporarily fixed by inserting into the fracture piece at the end. The guide steel wire is inserted into the proximal side of the radius through the central position of the elongated hole 113 of the palm side guide block and the stepped elongated hole 103 of the palm side plate 100.

  While guiding the guide steel wire, the palm side plate 100 is moved back and forth to reduce the position of the fracture piece and the proximal flexure, and then passed through the steel wire guide holes 172e and 172f and the steel wire holes 104e and 104f. A temporary fixing steel wire is inserted on the side, and the fracture portion is temporarily fixed with the palm side plate 100.

  A drilled steel wire similar to the temporarily fixed steel wire is guided by the second steel wire guide 150 and is inserted into the fractured piece through the screw holes 101a to 101c of the palm side plate 100 to drill the leading hole of the drill. The second steel wire guide 150 is removed, and the second and third drill guides 140 and 143 and the guide hole are guided to drill the prepared hole of the plate lock screw 30 in the fracture piece.

  With the second and third drill guides 140 and 143 attached, a depth gauge (not shown) is inserted into the lower hole, and the depth of each lower hole is measured. At this time, the depth gauge includes a red pointer for the second drill guide 140 and a green pointer for the third drill guide 143 as a fixed pointer for reading the scale by pointing to a gauge scale that moves according to the depth of the pilot hole. Is provided.

  The red pointer and the green pointer are separated by 10 mm, which is the difference between the lengths of the second and third drill guides 140 and 143, and the second and third drill guides 140 and 143 are attached in red. The depth of the pilot hole can be measured by reading the scale with the pointer and the green pointer.

  When removing the first and second drill guides 140 and 143 from the palm side plate 100 (even when they are attached), the heights of the adjacent drill guides are different from each other. Or the spanner does not interfere and is easy to detach.

  After removing the first and second drill guides 140 and 143, the guide guides 170 are guided through the screw guide holes 171a to 171c of the palm side guide block 170, and the plate lock screws 30 having the respective lengths are inserted into the fractured pieces. Is locked to the screw holes 101 a to 101 c to fix the fractured piece to the palm side plate 100.

  Next, the distal temporary fixing steel wire and the palm-side guide block 170 are removed, a drill hole is drilled in the rib 25 at the position of the exposed proximal screw holes 101d and 101e, and the plate lock screw 30 is moved proximally. The lock screw 30a is locked in the screw holes 101d and 101e, and the fracture portion is fixed to the palm side plate 100.

  Remove the proximal steel wire on the proximal side, return the palmar carpal flexor tendon and deep digital flexor tendon to the left and return to the original position, and suture the incised skin to secure the distal radius fracture. Fixing is complete.

  As described above, the distal radius reduction device and the distal radius reduction device according to the present invention are useful for reducing the distal radius fracture, and in particular, almost all muscles and tendons. The fracture can be reduced without damaging it.

It is a top view which shows the back side plate concerning this invention. It is sectional drawing which follows the AA line of FIGS. 1-1. It is sectional drawing which follows the BB line. It is sectional drawing which follows the CC line. It is sectional drawing which follows the DD line. It is a top view which shows the modification of the back side plate concerning this invention. It is a figure which shows the right hand dorsal side which removed skin and subcutaneous fat. It is a figure which shows the right hand back side which removed the extensor retinaculum. It is a figure which shows the right hand back side of a bone. It is sectional drawing of a right hand wrist. It is a front view which shows the plate lock screw concerning this invention. It is a top view which shows the plate lock screw concerning this invention. It is a front view which shows the 1st drill guide concerning this invention. It is a top view which shows the 1st drill guide concerning this invention. It is a front view which shows the 1st steel wire guide concerning this invention. It is a top view which shows the 1st steel wire guide concerning this invention. It is a front view of the blunt bar concerning the present invention. It is a top view of the blunt bar concerning this invention. It is a top view which shows the back side guide block concerning this invention. It is sectional drawing which follows the AA line of FIGS. It is sectional drawing which follows the BB line. It is sectional drawing which follows the CC line. It is sectional drawing which follows the DD line. It is sectional drawing which shows the assembly state of the radius distal end back side reduction instrument of this invention. It is a top view which shows the palm side plate concerning this invention. It is sectional drawing which follows the AA line of FIGS. It is sectional drawing which follows the BB line. It is sectional drawing which follows the CC line. It is a front view which shows the 2nd drill guide concerning this invention. It is a top view which shows the 2nd drill guide concerning this invention. It is a front view which shows the 3rd drill guide concerning this invention. It is a top view which shows the 3rd drill guide concerning this invention. It is a front view which shows the 2nd steel wire guide concerning this invention. It is a top view which shows the 2nd steel wire guide concerning this invention. It is a top view which shows the palm side guide block concerning this invention. It is a side view which shows the palm side guide block concerning this invention. It is a longitudinal cross-sectional view of a radius distal end palm side reduction instrument.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10 Back side plate 10a, 10b Branch part 10c Trunk part 10d Notch part 11a 1st screw hole (screw hole)
11b Second screw hole (screw hole)
11c-11g Proximal screw hole (screw hole)
12a to 12f Steel wire hole 23 Extensor support band 25 Rib 25b Lister knot 25c Saddle side 30 Plate lock screw 30a Head 30b Intermediate part 30c Tip part 40 Drill guide 40a Drill guide hole 40b Lock screw 40c Cylindrical part 40d Hexagonal cylinder part 40g Protection cylinder part 40e Steel wire guide lock screw hole 50 Steel wire guide 50a Steel wire guide hole 50b Cylindrical part 50c Head part 50d Screw part 60 Blunt bar 60a Round bar part 60b Head part 70 Back side guide block 71a-71i Screw guide hole 72a-72f Steel wire Guide hole 100 Palm side plate 101a-101c Distal screw hole 101d, 101e Proximal screw hole 103 Stepped long hole 104a-104f Steel wire hole 140, 143 Drill guide 140a, 143a Drill guide hole 140b, 143b Lock screw 140c, 143c Cylindrical portion 140d, 143d Hexagonal cylindrical portion 140e, 143e Identification mark 150 Steel wire guide 150a Steel wire guide hole 150b Cylindrical portion 150c Head 170 Palm side guide block 171a-171c Screw guide hole 172a-172f Steel wire guide hole 113 Long hole

Claims (16)

A plurality of screw holes and a notch formed in a portion of the distal end of the distal end of the radius that is located on the Lister nodule. A back plate for fixing the part from the back side;
A plate lock screw having a head formed with a lock screw to be locked in the screw hole, an intermediate part having a columnar shape and a length of 10 mm or more, and a tip part having a bone screw inserted into a bone; ,
A distal reduction instrument for the distal end of the radius. The plurality of screw holes are
A first screw hole disposed on the flex side which is the thumb side of the Lister knot;
A second screw hole disposed on the little finger side of the Lister nodule;
A plurality of proximal screw holes disposed proximally of the Lister knot and spaced apart from each other in the axial direction of the radius;
The distal end of the distal radius reduction instrument according to claim 1, comprising:   The dorsal plate is formed in a Y shape, the first and second screw holes are arranged at the ends of the two Y-shaped branch portions, and the plurality of proximal screw holes are in the Y shape. The distal end of the distal end of a radius reduction device according to claim 2, wherein the notch is disposed between the two branches.   3. The distal end of the distal end of the radial bone according to claim 2, wherein the direction of the first and second screw holes is inclined proximally with respect to the normal of the dorsal plate. .   The steel wire hole which lets the temporary fixing steel wire for temporarily fixing a fracture piece to the said back | dorsal plate pass in the vicinity of the said 1st, 2nd screw hole is provided. A distal reduction instrument for the distal radius.   6. The bending according to claim 5, wherein a pair of the steel wire holes are provided so as to sandwich the first and second screw holes, and the directions of the pair of steel wire holes are inclined with respect to each other. Distal reduction device at the distal end of the bone.   The direction of the steel wire hole provided distally among the pair of steel wire holes is inclined to the proximal side with respect to the perpendicular of the back plate. Bone distal end dorsal reduction device.   The steel wire hole through which the temporarily fixed steel wire for temporarily fixing the proximal side of the rib to the back plate is provided in the vicinity of the proximal screw hole. Bone distal end dorsal reduction device.   The distal end reduction instrument of the distal end of a bone according to claim 1, wherein the outer peripheral edge portion of the back plate is chamfered in a convex curved shape with the lower surface side sharpened.   The peripheral portion surrounding the notch portion of the dorsal plate is chamfered into a convex curved surface with the upper surface side sharpened, and the distal end of the distal end of the radial bone according to claim 1.   The distal end reduction instrument according to claim 1, wherein a screw pitch of the lock screw is smaller than a screw pitch of the bone screw.   2. The distal end of the distal end of the radial bone according to claim 1, wherein a screw thread at the head of the lock screw is set lower than other screw threads. A drill guide for guiding a drill for drilling a lower hole of the plate locking screw mounted in front Symbol screw hole is formed in a cylindrical shape having a drill guide holes, in order from the lower end, the Shinsujiken the drill further comprising a protective tubular portion so as not to contact, and locking screws to be locked into the screw hole of the back side plate, a cylindrical portion, and a hexagonal tubular portion, and the steel wire guide locking screw holes, the de Rirugaido formed is The radial distal end dorsal reduction device according to claim 1 . A steel wire guide for guiding the drilling steel wire drilling a guide hole of the drill is attached to the drill guide, it is formed into a cylindrical shape having a steel wire guide hole, in order from the lower end inserted into the drill guide hole a cylindrical portion that is, wrinkles according to claim 13 and a threaded portion which is locked to the steel wire guide locking screw hole, a cylindrical head, further comprising a steel wire guide that has been formed Distal reduction device at the distal end of the bone . The steel wire guide comprises a round bar portion inserted into a steel wire guide hole and projecting a tip portion from the steel wire guide, and a head, and is inserted into the steel wire guide and provided in the bone in advance. radial distal dorsal repositioning appliance according to claim 14, further comprising a blunt rod that look for pinhole indicating the insertion position of the steel wire in the tip section. Before SL first, a position corresponding to the second screw holes and a plurality of proximal threaded holes is threaded guide hole in the same direction as each screw hole is formed at a position corresponding to said steel wire holes, respectively formed steel wire guide hole in the same direction as the steel wire hole further comprises a dorsal guide block you guide the insertion direction to the temporary bonding steel wire and plate locking screw bone placed on the back side plate 6. The distal radius reduction instrument according to claim 5, wherein:

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