JP5662094B2 - Femoral fracture treatment device - Google Patents

Description

  In the present invention, when a fracture occurs in the femur, the proximal portion of the femur, which is the proximal portion, is fixed to the distal portion of the femur that is the distal portion from the fracture position in the femur. The present invention relates to a femoral fracture treatment device.

  Conventionally, when a fracture occurs in the femur, the proximal part of the femur, which is the proximal part, is fixed to the distal part of the femur, which is the distal part from the fracture position in the femur. A femoral fracture treatment device for treatment is known (see Patent Document 1). A femoral fracture treatment device disclosed in Patent Document 1 includes a rack screw that engages with a proximal portion of a femur as a femoral head, a sleeve that slidably receives the rack screw, and a medullary cavity of the femur. And an intramedullary rod to be inserted. In addition, the femoral fracture treatment device disclosed in Patent Document 1 is a compression screw that applies a compression force to a fractured portion of the femur by engaging the sleeve and the rack screw in a threaded manner with a screw on the inner surface of the rack screw. Is further provided.

Japanese Patent No. 3009232

  The femoral fracture treatment device disclosed in Patent Literature 1 is screwed into the inside of a rack screw and abutted against the end of a sleeve, so that the proximal part of the femur, which is the proximal portion of the femoral fracture position A compression screw is provided for urging the part to be pressed against the distal part of the femur, which is the distal part. For this reason, fracture treatment can be performed by promoting bone fusion at the fractured portion of the femur.

  However, in the femoral fracture treatment device disclosed in Patent Document 1, after the operation of fixing the proximal portion of the femur to the distal portion of the femur and compressing it with the compression screw is completed, If deformation or the like occurs in the rack, the rack screw and the compression screw may slide with respect to the sleeve. In this case, the rack screw and the compression screw, which is a mechanism for fixing the fractured portion and urging the proximal portion of the femur to be pressed by being pressed against the distal portion of the femur, are displaced to the outside of the femur. Therefore, there is a risk that pain may occur in the patient.

  In the present invention, in view of the above circumstances, a mechanism for fixing the fracture portion and urging the proximal portion of the femur so as to press and pull the proximal portion of the femur against the distal portion of the femur is shifted out of the femur and protrudes. It is an object of the present invention to provide a femoral fracture treatment device that can prevent such a situation.

In order to achieve the above object, a femoral fracture treatment device according to the present invention is provided near a distal portion of a femur, which is a distal portion of the femur when a fracture occurs in the femur. The present invention relates to a femoral fracture treatment device for fixing and treating a proximal portion of a femur which is a distal portion. A femoral fracture treatment device according to the present invention includes a rod-shaped intramedullary nail that is inserted along the medullary cavity of the distal portion of the femur, and penetrates the intramedullary nail or the medulla. A cylindrical sleeve that penetrates the inner nail and is fixed to the intramedullary nail, and a portion that penetrates the sleeve along the cylindrical hole and that is fixed with the distal end engaged with the proximal part of the femur. A positioning part engaging member, fixed to the proximal part engaging member, and abutted against the sleeve to urge the proximal part of the femur to be pressed against the distal part of the femur A proximal portion compression mechanism, wherein the proximal portion compression mechanism is fixed to the proximal portion engaging member and is formed in a shaft shape, and is separate from the shaft member. A cap member that is provided as a member, engages with the shaft-like member, and is fixed to the sleeve , Characterized in that it has a.

  According to this invention, the intramedullary nail is inserted into the medullary cavity of the distal femur, and the proximal engaging member that penetrates the tubular hole of the sleeve fixed to the intramedullary nail is fixed to the proximal femur. Is done. Then, the proximal portion compression mechanism that is fixed to the proximal portion engaging member and abuts against the sleeve is urged so that the proximal portion of the femur is compressed and pulled against the distal portion of the femur. Thereby, fracture healing can be performed by promoting bone fusion at the fractured part of the femur. Further, the proximal portion compression mechanism is provided with a shaft member and a cap member as separate members, the shaft member is fixed to the proximal portion engaging member, the cap member is engaged with the shaft member and the sleeve is attached to the sleeve. Fixed. For this reason, the proximal part compression mechanism which can be urged | biased so that a proximal part of a femur may be pressed and pulled toward a distal part of a femur via a proximal part engaging member, and may be fixed to a sleeve is realized. be able to. Therefore, even when deformation or the like occurs in the fractured part due to a post-operative load, the fractured part is fixed and the proximal part of the femur is urged to be pressed against the distal part of the femur Therefore, the proximal portion engaging member and the proximal portion compression mechanism, which are the mechanisms to be moved, are not slid relative to the sleeve, and are prevented from projecting out of the femur.

  Therefore, according to the present invention, the mechanism for fixing the fracture portion and urging the proximal portion of the femur so as to press and pull the proximal portion of the femur against the distal portion of the femur is displaced and protrudes to the outside of the femur. A femoral fracture treatment device that can be prevented can be provided.

Femur fracture treatment device according to the present invention, before Kijikujo member, said is preferably provided as a screw member screwed to the proximal engagement member.

  According to the present invention, the shaft-shaped member is configured as a screw member, and is screwed and fixed to the proximal portion engaging member so that the proximal portion of the femur is compressed and pulled toward the distal portion of the femur. Can be energized. Therefore, the structure which presses the proximal part of the femur to the distal part of the femur can be constructed with a simple and compact configuration in which the screw part is formed on the shaft-like member.

Femur fracture treatment device according to the present invention, prior Symbol cap member is preferably fixed by screwing with the inner periphery of the sleeve.

  According to the present invention, the cap member is configured to be fixed by being screwed to the sleeve. For this reason, the cap member fixed to a sleeve can be constructed | assembled by the simple structure which formed the thread part. In addition, since the cap member is screwed and fixed to the inner periphery of the cylindrical sleeve, the cap member can be coaxially and space-efficiently fixed with respect to the sleeve and can be disposed compactly.

Femur fracture treatment device according to the present invention, the pitch of the screw of the shaft-like member as a pre-Symbol screw member, the pitch of the screw to be fixed to the sleeve provided on the outer periphery of the cap member, in the same Preferably there is .

  According to this invention, since the pitch of the screw of the shaft-like member screwed to the proximal portion engaging member is the same as the pitch of the screw screwed to the inner periphery of the sleeve at the outer periphery of the cap member, The member and the cap member can be rotated synchronously. Thereby, screwing to the proximal part engaging member of a shaft-shaped member and screwing to a sleeve of a cap member can be performed simultaneously.

Femur fracture treatment device according to the present invention, before Kijikujo member, after the tip end penetrates the cap member, the distal end portion of the opposite side, the screwed operation to the inner circumference of said cap member After that, it is preferable that the cap member is held loosely inside the cap member.

  According to this invention, the shaft-like member passes through the cap member at the tip side, and is held against the cap member in a loosely fitted state through the screwing operation to the cap member at the opposite end. Therefore, the shaft-shaped member and the cap member can be configured to be individually rotatable in a state where they can be rotated relative to each other, and the shaft-shaped member and the cap member are arranged coaxially and in a compact manner. Can be engaged.

  According to the present invention, a mechanism for fixing a fractured portion and urging the proximal portion of the femur so as to press and attract the proximal portion of the femur against the distal portion of the femur is prevented from being shifted and projected to the outside of the femur. An apparatus for treating a femoral fracture can be provided.

It is a front view shown in the state of a partially notched section about the femur fracture treatment device concerning one embodiment of the present invention. It is a figure shown with the partial cross section of a femur about the state in which the femoral fracture treatment apparatus shown in FIG. 1 was applied to the femur. It is the front view which shows the proximal part engaging member in the femoral fracture treatment apparatus shown in FIG. 1, and the figure seen from the one edge part side. It is sectional drawing which shows the sleeve in the femur fracture treatment apparatus shown in FIG. It is the front view and side view which show the sleeve fixing mechanism in the femoral fracture treatment apparatus shown in FIG. It is a front view shown in the state of a partially notched section about the set screw in the sleeve fixing mechanism shown in FIG. It is the front view which shows the proximal part compression mechanism in the femoral fracture treatment apparatus shown in FIG. 1, and the figure seen from the one edge part side. It is a front view shown in the state of a partially notched cross section about the proximal part compression mechanism shown in FIG. It is the figure seen from the front view shown in the state of a partially notched cross section about the shaft-shaped member in the proximal part compression mechanism shown in FIG. 7, and the one end part side. It is the figure seen from the front view shown in the state of a partially notch section about the cap member in the proximal part compression mechanism shown in FIG. 7, and the one end part side.

  Hereinafter, embodiments for carrying out the present invention will be described with reference to the drawings. In the present invention, when a fracture occurs in the femur, the proximal portion of the femur, which is a portion proximal to the distal portion of the femur, which is a distal portion from the fracture position in the femur, is provided. The present invention can be widely applied to a femoral fracture treatment apparatus for fixed treatment.

  FIG. 1 is a front view showing a femur fracture treatment device 1 according to an embodiment of the present invention in a partially cut-out cross-sectional state. FIG. 2 is a diagram showing a state in which the femoral fracture treatment device 1 is applied to the femur 100 in which a fracture has occurred, together with a partial cross section of the femur 100. 3 to 10, the components in the femoral fracture treatment device 1 are illustrated. However, the components illustrated in the drawings are appropriately enlarged for each drawing.

  As shown in FIG. 2, the femoral fracture treatment device 1 is applied to the femoral distal portion 101 that is a portion on the distal side of the femur 100 from the fracture position 100 a when a fracture occurs in the femur 100. It is provided as a device for fixing and treating the proximal femur 102 which is the proximal portion. In the present embodiment, a case where a fracture occurs between the proximal femur 102 and the distal femur 101 as a portion including the head of the femur 100 is illustrated. In the femur 100, the side relatively close to the trunk is referred to as “proximal”, and the side relatively far from the trunk is referred to as “distal”.

  As shown in FIGS. 1 and 2, the femoral fracture treatment device 1 includes an intramedullary nail 11, a lag screw 12, a sleeve 13, a proximal portion compression mechanism 14, a sleeve fixing mechanism 15, a rotation prevention screw 16, and the like. Configured. The intramedullary nail 11, the lag screw 12, the sleeve 13, the proximal compression mechanism 14, the sleeve fixing mechanism 15, and the anti-rotation screw 16 are titanium alloys and cobalt that have been approved as medical devices for living implants. It is made of a metal material such as chromium alloy or stainless steel.

  The intramedullary nail 11 shown in a partially cutaway state in FIGS. 1 and 2 is formed in a rod shape that is inserted into the medullary cavity 101 a of the femoral distal portion 101. For example, the intramedullary nail 11 is formed so that a portion on one end side which is the distal end side inserted into the medullary cavity 101a is thin, and the lag screw 12 is disposed in a penetrating state on the opposite side to the distal end side. The part is formed thicker than the part on one end side.

  The intramedullary nail 11 is provided with a sleeve through hole 11a, a sleeve fixing mechanism installation hole 11b, a rotation prevention screw through hole 11c, and the like. The sleeve through-hole 11a is provided at the other end of the intramedullary nail 11, and the intramedullary nail 11 is disposed in the medullary cavity 101a of the femur 100 from the distal side to the proximal side. It is provided as a hole penetrating so as to extend obliquely toward the upper side of the human body. And the sleeve 13 and the lag screw 12 are arrange | positioned in this sleeve through-hole 11a in the penetration state.

  The sleeve fixing mechanism installation hole 11b is provided in a portion on the other end side of the intramedullary nail 11, and penetrates so that the intramedullary nail 11 extends along the vertical direction of the human body in a state where the nail 11 is disposed in the medullary cavity 101a. It is provided as a formed hole. A sleeve fixing mechanism 15 is installed in the sleeve fixing mechanism installation hole 11b, and a female male screw portion 20d on the outer periphery of a main body portion 20a of a set screw 20 described later in the sleeve fixing mechanism 15 is screwed. A screw portion is provided.

  The anti-rotation screw through-hole 11 c is provided in the above-mentioned end portion of the intramedullary nail 11, and is provided as a hole that is formed through the direction perpendicular to the longitudinal direction of the intramedullary nail 11. Yes. And in this rotation prevention screw through-hole 11c, the rotation prevention screw 16 is arrange | positioned in the penetration state.

  FIG. 3 is a front view (FIG. 3A) showing the lag screw 12 and a view (FIG. 3B) viewed from one end side thereof. FIG. 3A illustrates the center line of the lag screw 12 by a one-dot chain line P, and includes a partially cutaway cross section. Moreover, FIG.3 (b) has shown the figure seen from the A line arrow direction about the lag screw 12 of Fig.3 (a).

  As shown in FIGS. 1 to 3, the lag screw 12 is provided as a shaft-like member that penetrates a cylindrical sleeve 13 along a cylindrical hole 13a (see FIG. 4). The lag screw 12 has a screw portion 12a formed as a male screw portion on the tip side, and a compression mechanism attachment end portion 12b to which a proximal portion compression mechanism 14 is attached to an end portion opposite to the screw portion 12a. Is provided. The lag screw 12 constitutes the proximal portion engaging member of the present embodiment that is fixed by screwing and engaging with the femoral proximal portion 102 in the distal screw portion 12a.

  Further, an insertion hole 12c into which a shaft-shaped member 17 described later in the proximal portion compression mechanism 14 is inserted is formed inside the compression mechanism attachment end portion 12b of the lag screw 12. A female screw portion 12d to which the male screw portion 17d (see FIG. 7) of the shaft-like member 17 is screwed and fixed is provided on the back side of the insertion hole 12c. In addition, the lag screw 12 may be integrally formed by one member, and may be integrated and comprised by fixing a some member. Further, in the lag screw 12 of the present embodiment, the maximum diameter of the screw portion 12a is set to be larger than the inner peripheral diameter of the tube hole 13a of the sleeve 13, and the tube of the sleeve 13 from the end opposite to the screw portion 12a. It is configured to be inserted into the hole 13a. The lag screw 12 is inserted and assembled so as to penetrate the sleeve 13, and the sleeve 13 is inserted into the sleeve through-hole 11 a of the intramedullary nail 11 disposed in the distal femur 101. Inserted with. In addition, you may implement not only the example of this embodiment but the lag screw and sleeve of the form into which the lag screw 12 and the sleeve 13 are inserted in the sleeve through-hole 11a separately.

  FIG. 4 is a cross-sectional view showing the sleeve 13. As shown in FIGS. 1, 2, and 4, the sleeve 13 is formed as a cylindrical member, and is disposed with respect to the intramedullary nail 11 in a state of passing through the sleeve through hole 11 a in the intramedullary nail 11. Is done. In this state, the sleeve 13 is fixed to the intramedullary nail 11 by the sleeve fixing mechanism 15 installed in the sleeve fixing mechanism installation hole 11b. Further, a cylindrical hole 13a provided as a through hole having an inner circular cross section in the cylindrical sleeve 13 is configured such that the lag screw 12 can be slidably inserted. The lag screw 12 inserted through the tubular hole 13a is screwed into the proximal femur 102 in a state of passing through the tubular hole 13a. Further, a female screw portion 13b that is screwed into a sleeve screwing portion 18b (see FIG. 7) of a cap member 18 to be described later in the proximal portion compression mechanism 14 is provided on the inner periphery of one end portion side of the cylindrical hole 13a. It has been.

  FIG. 5 is a front view (FIG. 5A) and a side view (FIG. 5B) showing the sleeve fixing mechanism 15. FIG. The sleeve fixing mechanism 15 shown in FIGS. 1, 2, and 5 includes a sleeve pressing member 19 and a set screw 20. FIG. 6 is a front view showing the set screw 20 in a partially cutaway state. As shown in FIG. 2, the sleeve fixing mechanism 15 is provided as a mechanism for fixing the sleeve 13 to the intramedullary nail 11.

  As shown in FIG. 5, the sleeve pressing member 19 includes an annular head portion 19a formed in an annular shape, and a pair of leg portions (19b, 19b) protruding in parallel from one end face of the annular head portion 19a. Configured. It should be noted that the pair of legs (19b, 19b) protrude in a cantilever shape in parallel from the annular head portion 19a at positions facing each other in the diameter direction of the annular head portion 19a in the circumferential direction of the annular head portion 19a. Is provided. The tip portions of the pair of leg portions (19b, 19b) are provided as portions that contact the sleeve 13, respectively (see FIG. 2). Then, when the sleeve pressing member 19 is urged by the set screw 20, the pair of leg portions (19 b, 19 b) presses and fixes the sleeve 13. Further, on the inner peripheral side of the annular head portion 19a, a female screw portion is provided that can be screwed into the front male screw portion 20e on the outer periphery of the front end portion 20b of the set screw 20.

  The set screw 20 is provided as a member in which a screw is formed on the outer periphery and a short cylindrical portion is integrally formed in series in a step shape. The set screw 20 includes a main body portion 20a, a tip portion 20b, and a reduced diameter portion 20c. The main body 20a is provided as a portion having the largest outer diameter. And the front-end | tip part 20b is provided as a part with a smaller outer diameter than the main-body part 20a in the front end side on the opposite side to the main-body part 20a. The reduced diameter portion 20c is provided as a portion disposed between the main body portion 20a and the distal end portion 20b, and is provided as a portion whose outer diameter is smaller than that of the distal end portion 20b.

  Further, the main body portion 20a of the set screw 20 is provided with a main body male screw portion 20d on the outer periphery thereof. The main body male screw portion 20d is configured to be screwed into the inner screw portion of the sleeve fixing mechanism installation hole 11b of the intramedullary nail 11 (see FIGS. 2, 5, and 6). A hexagonal hole 20f is provided inside the main body 20a. When an operation of screwing the main body male screw portion 20d into the female screw portion of the sleeve fixing mechanism installation hole 11b is performed, an end portion of a surgical instrument (not shown) used as a tool is inserted into the hexagonal hole 20f. The rotation operation is performed. Moreover, the front-end | tip part 20b of the set screw 20 is provided with the front-end | tip male screw part 20e in the outer periphery. The distal male screw portion 20e is configured to be screwable with the female screw portion inside the annular head portion 19a of the sleeve pressing member 19.

  When the set screw 20 is attached to the sleeve pressing member 19, an operation of screwing the distal male screw portion 20e into the female screw portion of the annular head portion 19a is performed. Then, until the distal male screw portion 20e and the female screw portion of the annular head portion 19a are unscrewed and the distal end portion 20b passes through the annular head portion 19a, the set with respect to the annular head portion 19a is performed. The rotation operation of the screw 20 is performed. When the tip portion 20b passes through the annular head portion 19a, the set screw 20 is in a state in which the reduced diameter portion 20c is loosely fitted inside the annular head portion 19a.

  In the above state, the set screw 20 can abut against the end surface of the annular head portion 19a on the side where the pair of legs (19b, 19b) protrudes at the edge of the tip portion 20b on the reduced diameter portion 20c side. Thus, the sleeve pressing member 19 is locked. Further, in this state, the set screw 20 is at the edge on the reduced diameter portion 20c side of the main body portion 20a with respect to the end surface opposite to the side from which the pair of leg portions (19b, 19b) protrudes in the annular head portion 19a. Can be contacted. Then, by performing the above-described screwing operation on the female screw portion of the sleeve fixing mechanism installation hole 11b of the main body male screw portion 20d, the annular head portion 19a is biased by the main body portion 20a of the set screw 20, and a pair of legs The parts (19b, 19b) hold the sleeve 13 against the intramedullary nail 11 and fix it.

  In the state where the sleeve fixing mechanism 15 is installed in the sleeve fixing mechanism installation hole 11b, the pair of leg portions (19b, 19b) of the sleeve pressing member 19 are arranged so as to contact the sleeve 13 in the sleeve through hole 11a. Is done. The sleeve 13 is fixed between the pair of leg portions (19b, 19b) and the inner peripheral surface of the sleeve through hole 11a by the sleeve pressing member 19 being urged by the main body portion 20a of the set screw 20. Will be.

  FIG. 7 is a front view (FIG. 7 (a)) showing the proximal portion compression mechanism 14 and a view (FIG. 7 (b)) seen from one end side thereof. In addition, FIG.7 (b) has shown the figure seen from the B line arrow direction about the proximal part compression mechanism 14 of Fig.7 (a). FIG. 8 is a front view showing the proximal portion compression mechanism 14 in a partially cutaway state. The proximal compression mechanism 14 shown in FIGS. 1, 2, 7, and 8 is fixed to the lag screw 12 and abuts against the sleeve 13 to move the proximal femur 102 to the distal femur 101. It is provided as a mechanism that presses and pulls it. The proximal portion compression mechanism 14 includes a shaft-like member 17 and a cap member 18.

  FIG. 9 is a front view (FIG. 9A) showing the shaft-like member 17 in a partially cut cross-sectional state and a view (FIG. 9B) viewed from one end side. In addition, FIG.9 (b) has shown the figure seen from the C line arrow direction about the shaft-shaped member 17 of Fig.9 (a). The shaft-shaped member 17 shown in FIGS. 2 and 7 to 9 is provided as a member that is fixed to the lag screw 12 and is formed in a shaft shape.

  The shaft-like member 17 is provided with a head portion 17a and a shaft portion 17b extending in a columnar shape from the head portion 17a. A male screw portion 17c is provided on the outer periphery of the head portion 17a, and a hexagonal hole 17e is provided on the inner side of the head portion 17a. A male screw portion 17d is provided on the outer periphery of the shaft portion 17b.

  Further, as will be described later, the shaft member 17 is held in a loosely fitted state on the cap member 18 at the head portion 17a through the shaft portion 17b penetrating the cap member 18 from the distal end side. In this state, the shaft-like member 17 has the shaft portion 17b inserted into the insertion hole 12c of the lag screw 12, and is screwed into the female screw portion 12d inside the insertion hole 12c by the male screw portion 17d. Thus, the lag screw 12 is fixed. Thus, the shaft-like member 17 is provided as a screw member that is screwed into the lag screw 12 by providing the male screw portion 17d. When an operation of screwing the shaft-like member 17 into the female screw portion 12d of the lag screw 12 with the male screw portion 17d is performed, an end portion of a surgical instrument (not shown) used as a tool is inserted into the hexagonal hole 17e. Then, the surgical instrument is rotated. Thereby, the screwing operation of the shaft-shaped member 17 to the lag screw 12 is performed.

  FIG. 10 is a front view (FIG. 10A) showing the cap member 18 in a partially cut cross-sectional state and a view (FIG. 10B) viewed from one end side. In addition, FIG.10 (b) has shown the figure seen from the D line arrow direction about Fig.10 (a). The cap member 18 shown in FIGS. 2, 7, 8, and 10 is provided as a separate member from the shaft-like member 17, and is provided as a member that engages with the shaft-like member 17 and is fixed to the sleeve 13. It has been.

  The cap member 18 is provided as a member in which short cylindrical portions are integrally formed in series in a step shape. The cap member 18 is provided with a sleeve contact portion 18a provided as a portion having the largest radial dimension on one end side, and as a portion having a smaller radial dimension than the sleeve contact portion 18a. A sleeve screwing portion 18b is provided on the other end side. The outer periphery of the sleeve contact portion 18a is formed in a hexagonal shape so that it can be rotated by a surgical instrument (not shown) used as a tool.

  The sleeve screwing portion 18b is configured to be insertable into the cylindrical hole 13a of the sleeve 13, and further, the outer periphery of the sleeve screwing portion 18b is screwed into the female screw portion 13b on the inner periphery of the cylindrical hole 13a. A male thread portion is provided. The cap member 18 is configured to be fixed by being screwed to the inner periphery of the sleeve 13 by providing the sleeve screwing portion 18b. The sleeve abutting portion 18a is configured such that the sleeve screwing portion 18b is screwed all the way into the female screw portion 13b of the sleeve 13 so that the sleeve abutting on the sleeve screwing portion 18b is at the edge portion on the sleeve 13 side. It is comprised so that it may contact | abut to the end surface of the edge part by which the screwing part 18b was inserted. Accordingly, when the cap member 18 is sufficiently screwed into the sleeve 13 at the sleeve screwing portion 18b, the cap member 18 comes into contact with the sleeve 13 at the sleeve abutting portion 18a and stops.

  The cap member 18 is provided with a central through hole 18c that penetrates the central portion. A female screw portion 18d that can be screwed into a male screw portion 17c on the outer periphery of the head portion 17a of the shaft-like member 17 is provided inside the sleeve contact portion 18a in the central through hole 18c. In addition, a space region that extends inside the sleeve screwing portion 18b in the central through hole 18 is configured as a loose fitting region 18e in which the head portion 17a of the shaft-like member 17 is arranged in a loose fitting state.

  When the shaft member 17 and the cap member 18 are assembled so as to be in the state shown in FIG. 8, the distal end side of the shaft portion 17 b of the shaft member 17 passes through the central through hole 18 c of the cap member 18. It is inserted. When the distal end side of the shaft portion 17 b penetrates the cap member 18, an operation of screwing the head portion 17 a, which is the end portion on the opposite side of the distal end side, with the female screw portion 18 d on the inner periphery of the cap member 18 is performed. Then, the male screw portion 17c on the outer periphery of the head portion 17a and the female screw portion 18d on the inner periphery of the cap member 18 are disengaged, and the head portion 18a is placed in the loose fitting region 18e. As described above, the shaft-like member 17, after the distal end side penetrates the cap member 18, the head portion 17 a at the end opposite to the distal end side undergoes a screwing operation to the inner periphery of the cap member 18. It is comprised so that it may be hold | maintained in the loose fitting state with respect to the inside.

  Further, in the inner wall of the cap member 18, a loose fit is provided at a portion arranged corresponding to one end side of the loose fitting region 18 e and continuing to the opening of the central through hole 18 c at the end of the sleeve screw portion 18 b. A first engagement portion 18f formed so as to be reduced in diameter from the region 18e to the opening is provided. In a state where the cap member 18 is screwed to the sleeve 13 at the sleeve screwing portion 18b and is brought into contact with the sleeve 13 at the sleeve abutting portion 18a, the shaft member 17 is a female screw portion of the lag screw 12 at the male screw portion 17d. When screwed into 12d, the head portion 17a of the shaft-like member 17 comes into contact with and engages with the first engaging portion 18f. As a result, the proximal portion compression mechanism 14 is fixed to the lag screw 12 by the shaft-shaped member 17 and abuts against the sleeve 13 by the cap member 18 so that the proximal femur 102 becomes the distal femur 101. It is comprised so that the urging | biasing force urged | biased so that it may squeeze and may be drawn may be demonstrated.

  Further, a portion of the inner wall of the cap member 18 that is disposed corresponding to the other end side of the loosely fitting region 18e and continues to the female screw portion 18d is reduced in diameter from the loosely fitting region 18e to the female screw portion 18d. A second engagement portion 18g formed so as to be narrowed is provided. The second engagement portion 18g is also configured as an end portion of the female screw portion 18d. The direction in which the lag screw 12 and the shaft-shaped member 17 are slid in the sleeve 13 in the case where deformation or the like occurs in the fracture portion due to a post-operative load after the operation for installing the femoral fracture treatment device 1 is completed. The power of can be generated. When this force is generated, the head portion 17a of the shaft-like member 17 comes into contact with and engages with the second engagement portion 18g. Thereby, the sliding movement in the sleeve 13 of the lag screw 12 and the shaft-shaped member 17 is prevented.

  In the proximal portion compression mechanism 14, the screw pitch of the male screw portion 17 d of the shaft-like member 17 serving as the screw member and the sleeve screwing portion 18 b provided on the outer periphery of the cap member 18 and fixed to the sleeve 13. The thread pitch of the male screw portion is configured to be the same. Therefore, when the proximal portion compression mechanism 14 is attached to the lag screw 12 and the sleeve 13, the screwing operation of the male screw portion 17 d of the shaft-like member 17 and the female screw portion 12 d of the lag screw 12 and the sleeve screwing are performed. The screwing operation of the male screw portion of the joint portion 18b and the female screw portion 13b of the sleeve 13 can be performed in synchronization.

  As described above, the shaft-like member 17 and the cap member 18 are rotated synchronously, so that the screwing of the shaft-like member 17 to the lag screw 12 and the screwing of the cap member 18 to the sleeve 13 are simultaneously performed. In this case, for example, a surgical instrument used as a tool capable of rotating the shaft-shaped member 17 and the cap member 18 at the same time may be used. As this surgical instrument, for example, a socket portion that fits into a hexagonal portion on the outer periphery of the sleeve contact portion 18 a of the cap member 18, and a wrench portion that fits into the hexagonal hole 17 e of the head portion 17 c of the shaft-like member 17. Can be used as a surgical instrument having a double driver structure. Further, the socket part and the wrench part may be configured to be capable of performing an operation of rotating the socket part and an operation of rotating the wrench part independently of the socket part. In this case, by simultaneously rotating the socket part and the wrench part, the shaft member 17 can be screwed to the lag screw 12 and the cap member 18 can be screwed to the sleeve 13 at the same time. Then, in the state where the fixing to the sleeve 13 to the cap member 18 is completed, the wrench portion is independently rotated to further screw the shaft-like member 17 to the lag screw 12, and the proximal portion of the femur An urging force that compresses and pulls 102 against the distal femur 101 can be generated.

  The anti-rotation screw 16 shown in FIGS. 1 and 2 is configured to be inserted through the anti-rotation screw through-hole 11 c provided in the intramedullary nail 11. The antirotation screw 16 is provided with a male screw portion that is screwed into the distal femur 101. The anti-rotation screw 16 is screwed into the distal femur 101 in a state of passing through the anti-rotation screw through hole 11c of the intramedullary nail 11, so that the rotation direction of the intramedullary nail 11 with respect to the distal femur 101 is rotated. The displacement is restricted and prevented. Further, the anti-rotation screw 16 is screwed into the distal femur 101 in a state of penetrating the intramedullary nail 11, so that the displacement of the intramedullary nail 11 sinking toward the back side in the medullary cavity 101a is also regulated. In addition, the intramedullary nail 11 is configured to be prevented from sinking in the medullary cavity 101a.

  When the above-described femoral fracture treatment device 1 has a fracture in the femur 100, as shown in FIG. 2, the femoral fracture treatment device 1 is located on the proximal side with respect to the distal femur 101 on the distal side of the fracture position 100a. It will be used to fix and treat the proximal femur 102. When an operation in which the femoral fracture treatment device 1 is installed and the proximal femur 102 is fixed to the distal femur 101 is performed, the surgeon inserts the intramedullary nail 11 into the medulla of the distal femur 101. The sleeve 13 is inserted into the cavity 101a, and then the lag screw 12 passes through the cylindrical hole 13a. The sleeve 13 is inserted into the sleeve through-hole 11a of the intramedullary nail 11 together with the lag screw 12. In the femur 100, a hole into which the sleeve 13 and the lag screw 12 are inserted is processed in advance.

  As described above, the lag screw 12 and the sleeve 13 assembled in a state in which the lag screw 12 penetrates the sleeve 13 is disposed to penetrate the intramedullary nail 11 at the distal femur 101. At this time, the lag screw 12 is placed on the femur 100 so that the screw portion 12a is sufficiently screwed and fixed to the proximal femur 102.

  As described above, the sleeve 13 is disposed in the sleeve through-hole 11 a of the intramedullary nail 11, and the lag screw 12 is fixed to the proximal femur 102 and is disposed in the cylindrical hole 13 a of the sleeve 13. A position compression mechanism 14 is attached to the lag screw 12 and the sleeve 13. In the attachment of the proximal portion compression mechanism 14, the proximal portion compression mechanism 14 in a state where the shaft-like member 17 and the cap member 18 are assembled as described above (the state shown in FIG. 8) is used.

  When the proximal portion compression mechanism 14 is attached, the shaft portion 17b of the shaft-like member 17 is inserted into the insertion hole 12c of the lag screw 12, and the male screw portion 17d of the shaft-like member 17 is replaced with the female screw portion of the lag screw 12. The shaft member 17 is rotated so as to be screwed to 12d. Then, the sleeve screw portion 18b of the cap member 18 is inserted into the cylindrical hole 13a of the sleeve 13, and the male screw portion of the sleeve screw portion 18b is screwed to the female screw portion 13b of the sleeve 13. A rotation operation is performed. At this time, for example, the above-described surgical instrument having a double driver structure is used. By using the surgical instrument having the double driver structure, the screwing of the shaft member 17 to the lag screw 12 and the screwing of the cap member 18 to the sleeve 13 are simultaneously performed.

  When the sleeve screwing portion 18b of the cap member 18 is screwed into the female screw portion 13b of the sleeve 13 as far as it will go, the edge portion on the sleeve screwing portion 18b side of the sleeve contact portion 18a becomes the edge portion of the sleeve 13. Abuts against the end face. As a result, the cap member 18 comes into contact with the sleeve 13 and stops. On the other hand, at this time, the shaft-like member 17 has its head portion 17a held in a loosely fitted state in the loosely fitting region 18e of the cap member 18. For this reason, the shaft-like member 17 is in a state in which it can be independently rotated.

  In the above state, when the shaft-like member 17 is further rotated, the male screw portion 17d of the shaft-like member 17 and the female screw portion 12d of the lag screw 12 are further screwed together. The shaft-like member 17 is attached so as to draw the lag screw 12 by the above-described screwing operation in a state where the head portion 17a is engaged with the first engaging portion 18f of the cap member 18 that is in contact with the sleeve 13. It will be. Accordingly, the proximal femur 102 is urged so as to be pressed and pulled against the distal femur 101. Then, when the compression force of the proximal femur 102 to the distal femur 101 reaches an appropriate level, the above screwing operation is terminated.

  In addition to the above-described operation of attaching the proximal portion compression mechanism 14, an operation of attaching the sleeve fixing mechanism 15 and an operation of attaching the anti-rotation screw 16 are performed. In attaching the sleeve fixing mechanism 15, as described above, the sleeve fixing mechanism 15 in a state (shown in FIG. 5) in which the set screw 20 is attached to the annular head portion 19a of the sleeve pressing member 19 in a loosely fitted state is used. .

  When the sleeve fixing mechanism 15 is attached, the sleeve pressing member 19 and the set screw 20 are inserted into the sleeve fixing mechanism installation hole 11 b of the intramedullary nail 11 and installed. At this time, the sleeve pressing member 19 is arranged so that the pair of legs (19b, 19b) in the sleeve pressing member 19 presses the sleeve 13 in the sleeve through hole 11a. Further, the set screw 20 is rotated so that the main body male screw portion 20d of the set screw 20 is screwed into the inner screw portion of the sleeve fixing mechanism installation hole 11b. Thereby, the annular head 19a of the sleeve pressing member 19 is urged by the main body 20a of the set screw 20, and the pair of legs (19b, 19b) presses and fixes the sleeve 13 against the intramedullary nail 11. become.

  When the anti-rotation screw 16 is attached, the anti-rotation screw 16 is inserted into the hole that has been processed in advance in the distal femur 101 while being rotated. As a result, the anti-rotation screw 16 is inserted into the anti-rotation screw through hole 11c of the intramedullary nail 11 disposed in the medullary cavity 101a while being screwed into the femoral distal portion 101 at the female screw portion. . Then, with the anti-rotation screw 16 penetrating through the anti-rotation screw through hole 11c, the attachment of the anti-rotation screw 16 is completed in a state where the anti-rotation screw 16 is screwed into the femoral distal portion 101 and penetrated.

  With the above, the state shown in FIG. 2 is obtained, and the installation of the femoral fracture treatment device 1 to the femur 100 is completed, and the operation of fixing the proximal femur 102 to the distal femur 101 is completed. . Then, the proximal femur 102 is fixed while being pressed against the distal femur 101. In addition, after the operation for installing the femoral fracture treatment device 1 is completed, when the fracture or the like occurs in the fracture portion due to a load applied after the operation, as described above, the head 17a of the shaft-shaped member 17 is the second head 17a. It will be brought into contact with and engaged with the engaging portion 18g. Thereby, the sliding movement in the sleeve 13 of the lag screw 12 and the shaft-shaped member 17 is prevented.

  According to the femoral fracture treatment device 1 described above, the intramedullary nail 11 is inserted into the medullary cavity 101a of the distal femur 101, and the vicinity of the sleeve 13 fixed to the intramedullary nail 11 passes through the tubular hole 13a. A lag screw 12 that is a position engaging member is fixed to the proximal femur 102. Then, the proximal part compression mechanism 14 fixed to the lag screw 12 and in contact with the sleeve 13 is urged so that the proximal part 102 of the femur is compressed and pulled against the distal part 101 of the femur. . Thereby, the bone healing of the fracture part of the femur 100 can be accelerated | stimulated, and a fracture treatment can be performed. Further, the proximal portion compression mechanism 14 is provided with a shaft member 17 and a cap member 18 as separate members, the shaft member 17 is fixed to the lag screw 12, and the cap member 18 is engaged with the shaft member 17. At the same time, it is fixed to the sleeve 13. For this reason, the proximal part compression mechanism 14 which can be urged | biased by pressing the proximal part 102 of the femur to the distal part 101 of the femur through the lag screw 12 and being fixed to the sleeve 13 is realized. can do. Therefore, even when a deformation or the like occurs in the fracture portion due to a post-operative load load, the fracture portion is fixed and the proximal femur 102 is pressed against the distal femur 101 and pulled. The lag screw 12 and the proximal portion compression mechanism 14 that are urging mechanisms do not slide with respect to the sleeve 13, and are prevented from protruding out of the femur 100.

  Therefore, according to the present embodiment, the mechanism that fixes the fracture portion and urges the proximal femur 102 to press and pull the proximal femur 102 against the distal femur 101 is displaced to the outside of the femur 100. It is possible to provide a femoral fracture treatment device 1 that can prevent the above-described problem.

  Further, according to the femoral fracture treatment device 1, the shaft-shaped member 17 is configured as a screw member, and is screwed and fixed to the lag screw 12, whereby the femoral proximal portion 102 is connected to the femoral distal portion 101. Can be urged to squeeze and pull. Therefore, it is possible to construct a structure for pressing the proximal femur 102 to the distal femur 101 with a simple and compact configuration in which the screw portion is formed on the shaft-like member 17.

  Further, according to the femoral fracture treatment device 1, the cap member 18 is configured to be fixed by being screwed to the sleeve 13. For this reason, the cap member 18 fixed to the sleeve 13 can be constructed with a simple configuration in which a screw portion is formed. In addition, since the cap member 18 is fixed to the sleeve 13 coaxially with space efficiency, the cap member 18 can be arranged in a compact manner because the cap member 18 is fixed to the inner periphery of the cylindrical sleeve 13 by screwing.

  Further, according to the femoral fracture treatment device 1, the pitch of the screw of the shaft-like member 17 screwed to the lag screw 12 and the pitch of the screw screwed to the inner periphery of the sleeve 13 at the outer periphery of the cap member 18 are the same. Therefore, the shaft-shaped member 17 and the cap member 18 can be rotated synchronously. Thereby, screwing of the shaft-shaped member 17 to the lag screw 12 and screwing of the cap member 18 to the sleeve 13 can be performed simultaneously.

  Further, according to the femoral fracture treatment device 1, the shaft-like member 17 passes through the cap portion 18 at the distal end side, and is loosened through a screwing operation to the cap member 18 at the head portion 17 a that is the opposite end portion. The cap member 18 is held in the fitted state. Therefore, the shaft-shaped member 17 and the cap member 18 can be configured to be individually rotatable while being rotatable relative to each other, and the shaft-shaped member 17 and the cap member 18 are coaxially and compactly arranged. 17 and the cap member 18 can be engaged with each other.

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

(1) The femoral fracture treatment apparatus is not limited to the form of the femoral fracture exemplified in FIG. 2, and can be applied to various forms of femoral fractures. Further, in the above-described embodiment, the proximal portion engaging member has been described by taking the form of the lag screw as an example. However, this need not be the case, and the proximal portion engaging member may be engaged and fixed to the proximal femur. I just need it. For example, a form in which a distal end portion in which a spiral groove is formed is formed and the proximal portion of the femur is engaged and fixed by the spiral groove may be employed.

(2) In the above-described embodiment, the case where the sleeve penetrates the intramedullary nail has been described as an example, but this need not be the case. The intramedullary nail may be configured to penetrate the sleeve. Moreover, as a form for fixing the sleeve to the intramedullary nail, in the above-described embodiment, the form in which the sleeve fixing mechanism is used has been described, but this need not be the case. For example, a screw portion that is screwed to the intramedullary nail may be formed on the outer periphery of the sleeve, and the sleeve may be fixed to the intramedullary nail by screwing. Further, the form of the sleeve fixing mechanism is not limited to the form exemplified in the above embodiment, and various modifications may be made.

(3) In the above-described embodiment, the shaft-like member provided as a screw member screwed to the proximal portion engaging member has been described as an example, but this need not be the case. For example, the shaft-shaped member may be configured to be fitted into the proximal portion engaging member at the protruding portion by being rotated by a predetermined angle after being inserted into the proximal portion engaging member. . In the above-described embodiment, the cap member is screwed to the inner periphery of the sleeve and fixed. However, this need not be the case, and the cap member may be formed in a form other than screwing. It may be fixed to the sleeve.

(4) In the above-described embodiment, the screw pitch of the shaft member as the screw member and the pitch of the screw provided on the outer periphery of the cap member and fixed to the sleeve have been described as an example. However, this need not be the case, and each of the above pitches may be different.

(5) In the above-described embodiment, when the proximal portion compression mechanism is attached to the proximal portion engaging member and the sleeve, the shaft member is assembled so as to be held loosely in the cap member. However, this need not be the case. The form in which the attaching operation of the shaft-shaped member and the cap member may be performed individually.

  In the present invention, when a fracture occurs in the femur, the proximal portion of the femur, which is the proximal portion, is fixed to the distal portion of the femur that is the distal portion from the fracture position in the femur. The present invention can be widely applied as a femoral fracture treatment apparatus for treating the above.

DESCRIPTION OF SYMBOLS 1 Femur fracture treatment apparatus 11 Intramedullary nail 12 Lag screw (proximal part engagement member)
13 Sleeve 14 Proximal portion compression mechanism 17 Shaft-shaped member 18 Cap member 100 Femur 100a Fracture position 101 Femur distal portion 101a Spinal cavity 102 Proximal femur

Claims (3)

When a fracture occurs in the femur, the proximal part of the femur, which is the proximal part, is fixed to the distal part of the femur, which is the distal part from the fracture position in the femur. A femoral fracture treatment device,
A rod-shaped intramedullary nail inserted into the medullary cavity of the distal femur;
A cylindrical sleeve that penetrates the intramedullary nail or penetrates the intramedullary nail and is secured to the intramedullary nail;
A proximal portion engaging member that penetrates the sleeve along the cylindrical hole and has a distal end engaged with and fixed to the proximal portion of the femur;
A proximal portion compression mechanism that is fixed to the proximal portion engaging member and abuts against the sleeve to urge the proximal portion of the femur to be compressed and pulled against the distal portion of the femur;
With
The proximal portion compression mechanism is fixed to the proximal portion engaging member and is formed as a shaft-shaped member, and the shaft-shaped member is provided as a separate member. A cap member that engages and is secured to the sleeve ;
The shaft-like member is provided as a screw member that is screwed into the proximal portion engaging member,
The shaft-like member is loosely fitted to the cap member on the inner side thereof after the tip side penetrates the cap member and the end opposite to the tip side is screwed into the inner periphery of the cap member. characterized Rukoto is held in a state, femur fracture treatment device. The femoral fracture treatment device according to claim 1 ,
The femoral fracture treatment device, wherein the cap member is fixed by being screwed to an inner periphery of the sleeve. The femoral fracture treatment device according to claim 2 ,
The femoral fracture treatment device, characterized in that the screw pitch of the shaft-like member as the screw member and the pitch of the screw provided on the outer periphery of the cap member and fixed to the sleeve are the same. .

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