JP6991284B1 - Intramedullary nail aids and intramedullary nails - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an assisting device for an intramedullary nail which assists the position of a distal bone fragment, the position of a proximal bone fragment, and the position of an intramedullary nail in order to prevent excessive cervical shortening after surgery. SOLUTION: A first intramedullary nail member is a fixing member for a distal bone fragment by inserting the other end into the inside of the distal bone fragment with one end protruding from the proximal bone fragment. The second intramedullary nail member, which is fixed to the distal bone fragment, is fixed by inserting the other end into the inside of the proximal bone fragment with one end protruding from the distal bone fragment. A mounting portion to be attached to one end of the intramedullary nail member, and a bent portion bent at approximately 90 degrees so as to be placed at a close distance to the first intramedullary nail member during surgery. It has an insertion part to be inserted inside the distal bone fragment, and the attachment part, the bending part, and the insertion part have a single elongated substantially flat plate shape, and during the operation, the insertion part inserts the proximal bone piece. It penetrates and is placed between the first intramedullary nail member and the inner surface of the distal bone fragment. [Selection diagram] FIG. 5

Description

The present invention relates to an intramedullary nail assist device and an intramedullary nail used to heal a fracture of the femur.

In order to heal a fracture of the femur, a method is known in which intramedullary nails are inserted inside the distal bone fragment and inside the proximal bone fragment to fix the position of the femur. In Patent Document 1, with respect to an intramedullary nail for a proximal femoral fracture, the intramedullary nail comprises a long body having a longitudinal bore, and the elongated body has an oblique lateral bore for a proximal locking member. Containing a proximal portion having and a distal portion having at least one lateral bore for a distal locking member, the inlet end of the oblique lateral bore is configured as a recess having a recessed surface. , A technique comprising a recessed side surface portion, a recessed proximal surface portion and a recessed distal surface portion, is disclosed. In Patent Document 2, the engaging member arranged in the shaft hole of the intramedullary nail body provided with the shaft hole and the lateral hole is provided with an opening corresponding to the lateral hole, and the opening is based on the opening shape of the lateral hole. Also has an opening shape that extends in the direction of the axis, and an inclined edge that is inclined with respect to the axis is formed on the inner edge on one side of the opening, and when the engaging member moves along the axis, the bone screw The contact point of the inclined edge portion that abuts on the insertion site of the hole moves relative to the opposite side of the side, and the insertion site moves between the inner edge on one side of the opening and the inner edge on the opposite side of the lateral hole. Disclosed is a technique relating to an intramedullary nail that receives or increases its pinching pressure with the inclination of the inclined edge.

Japanese Unexamined Patent Publication No. 2017-535401 Japanese Unexamined Patent Publication No. 2013-9803

Patent Document 1 and Patent Document 2 do not describe an auxiliary device that assists the position of the distal bone fragment, the position of the proximal bone fragment, and the position of the intramedullary nail to prevent excessive postoperative head rotation. .. There is a need for a technique for preventing excessive head rotation (FIGS. 3 (b) and 4 (b)) shown in FIG. Specifically, when sagittal swing motion occurs, the anterior contacted cortex shifts and a load is applied, so that the proximal bone fragment shifts and shortens (Sw in FIG. 3 (b)). , Prevent this phenomenon.

The present invention provides an assistive device for intramedullary nails that assists in the location of distal and proximal bone fragments as well as the position of intramedullary nails to prevent excessive postoperative head rotation. The purpose. The present invention also includes an intramedullary nail assist device that assists in the position of the distal and proximal bone fragments as well as the position of the intramedullary nail in order to prevent excessive postoperative head rotation. It may be aimed at providing an inner nail.

In order to solve the above problems, one embodiment of the present invention includes a first intramedullary nail member inserted inside a distal bone fragment to heal a fracture of the femoral bone, and the first intramedullary bone. For intramedullary nails that assist in fixing the position of the distal bone fragment fixing member that fixes the nail member to the distal bone fragment and the second intramedullary nail member that is inserted inside the proximal bone fragment. The first intramedullary nail member, which is an auxiliary device, penetrates the proximal bone fragment with one end of the first intramedullary nail member protruding from the proximal bone fragment. The other end of the first intramedullary nail member is inserted into the distal bone fragment and fixed to the distal bone fragment by the distal bone fragment fixing member, and the second intramedullary nail member is With one end of the second intramedullary nail member protruding from the distal bone fragment, the distal bone fragment is penetrated and the other end of the second intramedullary nail member is the proximal bone. A mounting portion that is inserted and held inside the piece and attached to one end of the first intramedullary nail member and is placed at a close distance to the first intramedullary nail member during surgery. As described above, it has a bent portion that can be bent at approximately 90 degrees and an insertion portion that is inserted into the distal bone fragment, and the mounting portion, the bending portion, and the insertion portion are a single elongated substantially flat plate. Shaped and intraoperatively, the insertion site penetrates the proximal bone fragment and is between the first intramedullary nail member and the inner surface of the distal bone fragment , either posterior or anterior. Provided is an assistive device for intramedullary nails, characterized in that it is placed in. Further, in order to solve the above-mentioned problems, one embodiment of the present invention includes a first intramedullary nail member to be inserted inside a distal bone fragment in order to heal a fracture of the femoral bone, and the first intramedullary nail member. Intramedullary to assist and fix the position of the distal bone fragment fixing member that fixes the intramedullary nail member to the distal bone fragment and the second intramedullary nail member that is inserted inside the proximal bone fragment. The first intramedullary nail member, which is an auxiliary device for nailing, penetrates the proximal bone fragment with one end of the first intramedullary nail member protruding from the proximal bone fragment. The other end of the first intramedullary nail member is inserted into the distal bone fragment and fixed to the distal bone fragment by the distal bone fragment fixing member, and the second intramedullary nail member is used. The member penetrates the distal bone fragment with one end of the second intramedullary nail member protruding from the distal bone fragment, and the other end of the second intramedullary nail member is close to the distal bone fragment. Insertion inserted into the distal bone fragment so that it is inserted and held inside the bone fragment and placed during the operation at a close distance to the first intramedullary nail member. The insertion portion has a portion, and the insertion portion has an elongated substantially flat plate shape, and penetrates the proximal bone fragment intraoperatively to include the first intramedullary nail member and the inner surface of the distal bone fragment. It may be an intramedullary nail assist device characterized in that it is located between and either posteriorly or anteriorly .

Another embodiment of the present invention is any of the above-mentioned assistive devices for intramedullary nails, which are between 200 mm and 350 mm in length, 3 mm and 30 mm in width, and 1 mm to 10 mm in thickness. It may be an assistive device for intramedullary nails, characterized in that it is between.

In another embodiment of the present invention, any of the above-mentioned assistive devices for intramedullary nails, the first intramedullary nail member, the fixation member for distal bone fragments, and the second intramedullary nail member are provided. It may be an intramedullary nail characterized by having.

According to the intramedullary nail assist device and the intramedullary nail according to the present invention, the position of the distal bone fragment, the position of the proximal bone fragment, and the position of the intramedullary nail are used to prevent excessive postoperative rotation of the head. Can be assisted.

It is explanatory drawing explaining an example of a femur and a fracture. It is explanatory drawing explaining the use example of the intramedullary nail for the proximal part of a femur. It is explanatory drawing explaining an example of the state (head rotation) which occurs after the operation of a femur. It is a photograph of the CT multi-section reconstruction image explaining an example of the state (head rotation) that occurs after the operation of the femur. It is explanatory drawing explaining an example of the intramedullary nail (auxiliary device 14 for an intramedullary nail) for the proximal part of the femur which concerns on embodiment of this invention. It is explanatory drawing explaining an example (in the case of not fixing) of the intramedullary nail for the proximal part of the femur (the auxiliary device 14B for the intramedullary nail) which concerns on embodiment of this invention. It is explanatory drawing explaining an example of the auxiliary device for an intramedullary nail which concerns on embodiment of this invention.

The present invention will be described with reference to an example of an auxiliary device for intramedullary nails (hereinafter referred to as “auxiliary device”) and an intramedullary nail according to an embodiment. The present invention can be used for any of the auxiliary devices and intramedullary nails described below, as long as they are inserted into the bone to heal a fracture of the femur. The material, color and pattern of the auxiliary device and the intramedullary nail are not particularly limited.

The present invention will be described below.

The configurations of the auxiliary device and the intramedullary nail according to the embodiment of the present invention will be described with reference to FIGS. 1 to 7. Here, FIG. 1A is a front view illustrating an example of the outer shape of the femur FM. FIG. 1B is a front view illustrating an example of a femur fracture BR. FIG. 2A is an explanatory diagram illustrating an example of use of an intramedullary nail (11, 12, 13) for the proximal femur. FIG. 2B is a photograph of a CT multi-section reconstruction image illustrating an example of use of an intramedullary nail (11, 12, 13) for the proximal femur. FIG. 3A is an explanatory diagram illustrating an example of the femur after surgery. FIG. 3B is an explanatory diagram illustrating an example of postoperative rotation of the femur head. FIG. 4A is a photograph of a CT multi-section reconstruction image illustrating an example of the femur one day after the operation. FIG. 4B is a photograph of a CT multi-section reconstruction image illustrating an example of the rotation of the femoral head 2 weeks after the operation. FIG. 5A is an explanatory diagram illustrating an example of use of the intramedullary nail 100 including the auxiliary device 14 according to the embodiment of the present invention (the outer shape of the femur is shown by a broken line). FIG. 5B is an explanatory diagram illustrating another use example of the intramedullary nail 100 including the auxiliary device 14 according to the embodiment of the present invention (the outer shape of the femur is shown by a broken line). FIG. 6A is an explanatory diagram illustrating an example of use of the intramedullary nail 100 including the auxiliary device 14B according to the embodiment of the present invention (the outer shape of the femur is shown by a broken line). FIG. 6B is an explanatory diagram illustrating another use example of the intramedullary nail 100 including the auxiliary device 14B according to the embodiment of the present invention (the outer shape of the femur is shown by a broken line). FIG. 7A is a schematic front view illustrating an example of the auxiliary device 14 according to the embodiment of the present invention. FIG. 7B is a schematic side view illustrating an example of the auxiliary device 14 according to the embodiment of the present invention. FIG. 7 (c) is a schematic side view illustrating another example of the auxiliary device 14 according to the embodiment of the present invention. FIG. 7D is a schematic side view illustrating an example of the cross-sectional shape of the auxiliary device 14 according to the embodiment of the present invention. FIG. 7 (e) is a schematic side view illustrating another example of the cross-sectional shape of the auxiliary device 14 according to the embodiment of the present invention. The configuration of the auxiliary device and the intramedullary nail shown in FIG. 1 and the like is an example, and the present invention is not limited to the auxiliary device and the intramedullary nail shown in FIG. 1 and the like.

A femoral trochanteric fracture (hereinafter referred to as a "fracture") is a fracture at the trochanteric portion of the femoral head of the femur. Specifically, the femoral FM shown in FIG. 1 (a) is divided into a proximal bone fragment FMn and a distal bone fragment FMf as shown in FIG. 1 (b), and fracture BR is performed. Intramedullary nails (eg, FIGS. 2A and 2B) are inserted inside the distal and proximal bone fragments to support the bone and at the reduction site to heal the fracture of the femur. It is a medical device that promotes bone fusion by applying appropriate pressure. The intramedullary nail assist device and the intramedullary nail according to the present invention are provided with the position of the distal bone fragment and the position of the distal bone fragment in order to prevent excessive postoperative head rotation (for example, FIGS. 3 (b) and 4 (b)). The position of the proximal bone fragment as well as the position of the intramedullary nail can be assisted (correction, adjustment, correction, support, etc.).

As shown in FIGS. 2 (a), 5 (a) and 5 (b), the intramedullary nail 100 according to the present invention is inserted inside a distal bone fragment in order to heal a fracture of the femoral bone. Intramedullary nail member for distal bone fragment (first intramedullary nail member) 11 and intramedullary nail member for proximal bone fragment to be inserted inside the proximal bone fragment (second intramedullary nail member, lag screw) ) 12, the distal bone fragment fixing member (first intramedullary nail member lateral stop screw) 13 for fixing the distal bone fragment intramedullary nail member 11 to the distal bone fragment, and the distal bone fragment. It has an auxiliary device (intramedullary nail assist device) 14 (FIG. 5) that assists (corrects, adjusts, corrects, supports, etc.) the position of the position and the position of the proximal bone fragment and the position of the intramedullary nail. Here, one end of the distal bone fragment intramedullary nail member (first intramedullary nail member) 11 protrudes from the proximal bone fragment, as shown in FIGS. 2 (a) and 2 (b). In the state, it penetrates the proximal bone fragment, inserts the other end into the inside of the distal bone fragment, and is fixed to the distal bone fragment by the distal bone fragment fixing member 13. The proximal bone fragment intramedullary nail member (second intramedullary nail member) 12 has one end protruding from the distal bone fragment, as shown in FIGS. 2 (a) and 2 (b). It penetrates the distal bone fragment and the other end is inserted inside the proximal bone fragment to hold or fix it. Further, as shown in FIGS. 6 (a) and 6 (b), the intramedullary nail 100 according to the present invention is a distal bone fragment inserted inside the distal bone fragment in order to heal a fracture of the femoral bone. Intramedullary nail member (first intramedullary nail member) 11 and intramedullary nail member for proximal bone fragment (second intramedullary nail member, lug screw) 12 to be inserted inside the proximal bone fragment. The position and proximality of the distal bone fragment fixing member (first intramedullary nail member lateral retaining screw) 13 that fixes the distal bone fragment intramedullary nail member 11 to the distal bone fragment. It has an auxiliary device (auxiliary device for intramedullary nail) 14B (FIG. 6) that assists (corrects, adjusts, corrects, supports, etc.) the position of the bone fragment and the position of the intramedullary nail. The shape, size, material, attachment method, etc. of the intramedullary nail member 11 for the distal bone fragment, the intramedullary nail member 12 for the proximal bone fragment, and the fixing member 13 for the distal bone fragment are particularly limited in the present invention. It is not possible to use known techniques.

As shown in FIGS. 5A and 5B, the auxiliary device (auxiliary device for intramedullary nail) 14 according to the present invention has a single elongated substantially flat plate shape. As shown in FIGS. 5A and 5B, the auxiliary device 14 includes an opening attached to one end of the intramedullary nail member 11 for a distal bone fragment by a fixing portion (end cap) 14S in the present embodiment. Inside the attachment part (14a in FIG. 7A), the bending part (14b in FIG. 7A) that is bent along the intramedullary nail member 11 for the distal bone fragment during the operation, and the inside of the distal bone fragment. It has an insertion portion (14c in FIG. 7A) to be inserted. As shown in FIGS. 7 (a) and 7 (b), the auxiliary device 14 has an elongated substantially flat plate shape in which the mounting portion 14a, the bending portion 14b, and the insertion portion 14c are formed in the present embodiment. As shown in (d) or (e), it has a substantially fan-shaped or substantially rectangular cross-sectional shape. Here, in the bent portion 14b, as shown in FIGS. 5A and 5B, during the operation, the auxiliary device 14 with respect to the distal bone fragment intramedullary nail member (first intramedullary nail member) 11. It is bent at approximately 90 degrees so that it is placed at close distances and not separated. Specifically, the assistive device 14 is arranged along the longitudinal direction (keeping a short distance and not separated) from one end of the distal bone fragment intramedullary nail member (first intramedullary nail member) 11. To. At this time, the auxiliary device 14 (insertion portion 14c) penetrates the proximal bone fragment and connects the distal bone fragment intramedullary nail member (first intramedullary nail member) 11 and the inner surface of the distal bone fragment. It is placed (inserted) in between. As shown in FIG. 7 (c), the bent portion of the auxiliary tool 14 according to the present invention may be bent in advance by approximately 90 degrees. Further, as shown in FIGS. 6 (a) and 6 (b), the auxiliary device (assistant device for intramedullary nail) 14B according to the present invention occupies the medullary cavity and is firmly fixed to the spinal cord. It does not have to be attached to the inner nail. Further, the method of attaching the attachment portion of the auxiliary device to one end of the intramedullary nail member for the distal bone fragment is not particularly limited in the present invention, and known techniques can be used.

As a result, the auxiliary device 14 inserts (places) the insertion portion 13c between the distal bone fragment intramedullary nail member (first intramedullary nail member) 11 and the inner surface of the distal bone fragment during the operation. It fills the gap in the spinal cavity and can assist (correction, adjustment, correction, support, fixation, etc.) in the position of the distal and proximal bone fragments and the position of the intramedullary nail after surgery. Excessive postoperative head rotation (FIG. 3 (b) and FIG. 4 (b), sagittal swing motion) can be prevented. As shown in FIGS. 5A and 5B, the position where the auxiliary device 14 according to the present invention is inserted may be either rearward or anterior.

The auxiliary device 14 according to the present invention may be, for example, either 200 mm to 350 mm in length, 3 mm to 30 mm in width, or 1 mm to 10 mm in thickness, but is particularly large. It is not limited to that. The shape, size and material of the assistive device according to the present invention can be determined by experiment and / or design, and can be predetermined in a shape, size and material suitable for the bone of the patient. The cross-sectional shape of the assistive device according to the present invention can be determined experimentally and / or by design, and can be predetermined to be substantially fan-shaped, substantially rectangular, or a shape suitable for the patient's bone.

When treating a fracture, anatomical reduction, or restoration, is usually used to fix the fracture, but in the case of a femoral trochanteric fracture, the fracture is weighted before the bone fusion is complete. Since the load is applied to the part, there is a limit to fixing with the device alone, so contacting the bone cortex in front of the neck (rotation) enables support (support) between the bones and forms a strut between the bones. According to the assistive device for intramedullary nails and the intramedullary nail according to the present invention, the position of rotation (by inserting the insertion part of the assistive device into the inside of the proximal bone fragment to fix the position of the proximal bone fragment ( Bone-to-bone support and formed bone-to-bone struts) can be maintained after surgery. Note that rotation means that the proximal anterior cortex is located slightly anterior to the distal anterior cortex.

As described above, according to the assistive device for intramedullary nail and the intramedullary nail according to the present invention, the insertion portion of the assistive device is inserted into the inside of the proximal bone fragment to fix the position of the proximal bone fragment, and the bones are connected to each other. It can support the position of the distal bone fragment and the position of the proximal bone fragment as well as the position of the intramedullary nail because it acts as a strut. Further, according to the intramedullary nail assist device and the intramedullary nail according to the present invention, the position of the distal bone fragment, the position of the proximal bone fragment, and the position of the intramedullary nail can be assisted by using the assist device. Therefore, excessive rotation of the head of the bone can be prevented after the operation, complications can be reduced, and leg shortening can be eliminated.

Further, according to the assistive device for intramedullary nails and the intramedullary nails according to the present invention, the assist is as compared with the case where the fixation is strengthened by using two lag screws (intramedullary nail members for proximal bone fragments). The insertion part of the instrument can be inserted inside the proximal bone fragment to fix the position of the proximal bone fragment and maintain the function of the strut between the bones, so that the shortening of the neck can be minimized. .. Further, according to the assistive device for intramedullary nail and the intramedullary nail according to the present invention, the insertion portion of the assistive device is inserted into the inside of the proximal bone fragment to fix the position of the proximal bone fragment, and the bones are connected to each other. Since the function of the strut can be maintained, as shown in Sw in FIG. 3 (b), the sagittal swing motion (proximal bone fragment is centered on the distal lateral stop screw) generated by moving the hip joint of the proximal bone fragment. Proximal bone fragments rotate with the intramedullary nail) can be prevented.

As described above, the embodiments according to the present invention have been described, but the present invention is not limited to the above embodiments. That is, the present invention may be variously modified, modified or otherwise arbitrarily modified based on the contents described in the claims.

100: Intramedullary nail 11: Intramedullary nail member for distal bone fragment (first intramedullary nail member)
12: Intramedullary nail member for proximal bone fragment (second intramedullary nail member, lug screw)
13: Fixing member for distal bone fragment (side stop screw for first intramedullary nail member)
14, 14B: Auxiliary member for distal bone fragment (auxiliary device for intramedullary nail)
14a: Mounting part 14b: Bending part 14c: Inserting part 14S: Fixed part (end cap)
BR: Fracture line (fracture part)
FMa: Example of neck shortening FM: Femoral bone FMn: Proximal bone fragment of femoral bone FMf: Distal bone fragment of femoral bone RT: Example of head rotation Sw: sagittal swing motion (Proximal bone fragment is distal lateral stop) Example of proximal bone fragment rotating around a screw with an intramedullary nail)

Claims (4)

A first intramedullary nail member to be inserted inside the distal bone fragment to heal a fracture of the femur, and a distal bone fragment fixation to fix the first intramedullary nail member to the distal bone fragment. An auxiliary device for intramedullary nails that assists and fixes the position of the member and the second intramedullary nail member that is inserted into the proximal bone fragment.
The first intramedullary nail member penetrates the proximal bone fragment with one end of the first intramedullary nail member protruding from the proximal bone fragment, and the first intramedullary nail member is formed. The other end of the member is inserted into the distal bone fragment and fixed to the distal bone fragment with the distal bone fragment fixing member.
The second intramedullary nail member penetrates the distal bone fragment with one end of the second intramedullary nail member protruding from the distal bone fragment, and the second intramedullary nail member is formed. The other end of the member is inserted and held inside the proximal bone fragment and held.
A mounting portion to be attached to one end of the first intramedullary nail member,
A bent portion that can be bent at approximately 90 degrees so that it can be placed at a close distance to the first intramedullary nail member during surgery.
It has an insertion site to be inserted inside the distal bone fragment and has an insertion site.
The mounting portion, the bending portion, and the insertion portion have a single elongated substantially flat plate shape.
During the operation, the insertion site is placed through the proximal bone fragment between the first intramedullary nail member and the inner surface of the distal bone fragment, either posteriorly or anteriorly. ,
Auxiliary device for intramedullary nails. A first intramedullary nail member to be inserted inside the distal bone fragment to heal a fracture of the femur, and a distal bone fragment fixation to fix the first intramedullary nail member to the distal bone fragment. An auxiliary device for intramedullary nails that assists and fixes the position of the member and the second intramedullary nail member that is inserted into the proximal bone fragment.
The first intramedullary nail member penetrates the proximal bone fragment with one end of the first intramedullary nail member protruding from the proximal bone fragment, and the first intramedullary nail member is formed. The other end of the member is inserted into the distal bone fragment and fixed to the distal bone fragment with the distal bone fragment fixing member.
The second intramedullary nail member penetrates the distal bone fragment with one end of the second intramedullary nail member protruding from the distal bone fragment, and the second intramedullary nail member is formed. The other end of the member is inserted and held inside the proximal bone fragment and held.
It has an insertion site to be inserted inside the distal bone fragment so that it is placed in close proximity to the first intramedullary nail member during surgery.
The insertion portion is a single elongated, substantially flat plate shape that penetrates the proximal bone fragment intraoperatively and is between the first intramedullary nail member and the inner surface of the distal bone fragment. Placed either behind or in front ,
Auxiliary device for intramedullary nails. It is either between 200 mm and 350 mm in length, between 3 mm and 30 mm in width, and between 1 mm and 10 mm in thickness.
The assistive device for intramedullary nails according to claim 1 or 2, wherein the device is characterized by the above. The auxiliary device for an intramedullary nail according to any one of claims 1 to 3, the first intramedullary nail member, the distal bone fragment fixing member, and the second intramedullary nail member. An intramedullary nail characterized by having.

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