JP7052980B2 - Bone fixation device - Google Patents

Description

The present invention relates to a bone fixation device used for fixing bone.

Conventionally, various bone fixing devices used for fixing bone have been known. As such a bone fixing device, a bone fixing device having a bone engaging portion that engages with a bone such as a screw, a nail, or a pin may be used alone. Many are configured to insert a bone fixture and are equipped with an implant body that is positioned in place with respect to the bone. For example, taking an example of a bone fixation device used for fracture treatment of a proximal part of the femur, an intramedullary nail body corresponding to the implant body is inserted into the intramedullary cavity of the femur and provided in the intramedullary nail body. There is an intramedullary fixation device used to fix a fractured portion of the proximal femur by inserting a lag screw (screw) corresponding to the bone fixing tool into the transverse hole (for example, Patent Document 1 below). And 2).

In the above-mentioned intramedullary fixation device, a lug screw is inserted into the transverse hole of the intramedullary nail body in the intramedullary cavity of the femoral bone and screwed toward the head of the femoral bone to be screwed toward the fractured portion of the proximal portion. The screw at the tip of the lug screw is engaged with the side of the bone head, and the tip of an engaging member such as a set screw arranged in the shaft hole of the intramedullary nail body by screw connection or the like is attached to the outer peripheral surface of the lug screw. By engaging with the formed groove, the lug screw is held in a predetermined manner with respect to the intramedullary nail body. In this case, when the engaging member is strongly pressed against the lug screw, the lug screw is in a slide-locked state in which the lug screw is also locked in the axial direction thereof. On the other hand, by slightly returning the engaging member so that the tip portion thereof is separated from the inner bottom surface of the concave groove, the lug screw is in a slide-free state in which it can move in the axial direction thereof.

Further, in the CHS (compression hip screw) system, the implant body having a tubular barrel portion and a plate portion is installed on the lateral portion of the femur, and the barrel portion is perforated toward the bone head. It is inserted, the lug screw is screwed toward the bone head through the barrel portion, and the plate portion is fixed to the diaphysis with a cortical screw (see, for example, Patent Document 3 below). It should be noted that a plate system having a plate having only a plurality of screw holes without the barrel portion and a screw (screw) inserted into one screw hole of the plate and engaged with the bone is also known. (For example, see Patent Document 4 below).

Japanese Unexamined Patent Publication No. 02-21859 Japanese Unexamined Patent Publication No. 2000-342596 Japanese Unexamined Patent Publication No. 2002-06687 Japanese Unexamined Patent Publication No. 2004-09746

By the way, in the above-mentioned intramedullary fixation device, when the lug screw is held in a desired state with respect to the intramedullary nail body, the tip portion of an engaging member such as a set screw engages with the concave groove of the lug screw. It may require skill because it must be set precisely. For example, in the system described in Patent Document 1, the lug screw may be in the slide-free state with respect to the intramedullary nail body depending on the fracture mode, but in this slide-free state, an engaging member such as a set screw may be provided. By returning the screwing mode slightly from the abutting position corresponding to the slide lock state, the tip portion of the engaging member must be set so as to separate from the inner bottom surface of the concave groove of the lug screw. If this set position is not appropriate, axial movement due to bone fusion during the fracture healing process will be inadequate. Further, in this slide-free state, since the engaging member does not receive the axial force from the intramedullary nail body, the engaging member may move in the axial direction due to the rotation, and the holding state may change.

On the other hand, in the system described in Patent Document 2, since the first set member that can be in the slide-free state and the second set member that can be in the slide lock state are used, as described above. The surgeon does not need to make precise manual adjustments. However, it is necessary to select and use two set members according to the surgical situation, and there may be a mistake in mistaken use of the two set members, and it cannot be confirmed from the outside. There is a problem such as an increase in the inventory of the operation. Incidentally, since the holding state of the bone fixative with respect to the implant body may have a great influence on the healing process such as a fracture even if it is a slight change, it is desired to surely obtain a predetermined holding state.

Therefore, it is an object of the present invention to reduce the difficulty of work and preparation for obtaining the holding state of the bone fixative at the time of surgery, and to realize the desired holding state of the bone fixative with respect to the implant body. ..

The bone fixing device of the present invention includes a bone engaging portion that engages with a bone and a shaft portion extending from the bone engaging portion, and the bone fixing device having a bone fixing tool side engaging portion on the shaft portion. An implant body placed inside or on the surface of the bone, provided with an insertion hole through which the shaft portion of the bone fixture is inserted, and the bone fixture side engagement placed inside the insertion hole. It comprises the implant body, including a body-side engaging portion that holds the bone fixture to the implant body by engaging with the portion. The bone fixative includes a first bone fixative-side engaging portion and a second bone-fixing-side engaging portion with which each (each) can engage with the main body-side engaging portion. The first bone fixative-side engaging portion and the second bone-fixture-side engaging portion have different engagement structures with respect to the main body-side engaging portion. The first holding mode of the bone fixture with respect to the implant body when the main body side engaging portion engages with the first bone fixture side engaging portion, and the main body side engaging portion is the second. The second holding mode of the bone fixture with respect to the implant body when engaged with the bone fixture side engaging portion of the bone fixture is different.

In the present invention, the first bone fixing tool side engaging portion and the second bone fixing tool side engaging portion are positioned in a direction along the axis of the bone fixing tool and the bone fixing tool. The bone fixture of the bone fixture to the implant body when the body-side engaging portion engages with the first bone-fixing tool-side engaging portion, which is provided at at least one different site from the angular position around the axis. The bone fixture with respect to the implant body when the position along the axis or the angular posture around the axis and the body-side engaging portion engage with the second bone-fixing tool-side engaging portion. It is preferable that the position in the direction along the axis or the angular posture around the axis is different from each other corresponding to the difference between the position of the portion and the angle position of the portion.

In the present invention, the first bone fixing tool side engaging portion and the second bone fixing tool side engaging portion are provided at different angular positions around the axis of the bone fixing tool, and are provided on the main body side. The angular posture around the axis of the bone fixture with respect to the implant body when the engaging portion engages with the first bone fixture side engaging portion, and the body side engaging portion is the second. It is preferable that the angular posture of the bone fixture with respect to the implant body when engaged with the bone fixture side engaging portion is different from each other in response to the difference in the angular position. In this case, both the first bone fixative-side engaging portion and the second bone-fixing-side engaging portion have a shape extended along the axis of the bone fixative, and the above-mentioned It is desirable to have a formation range in which the positions of the bone fixatives in the direction along the axis are common to each other.

In the present invention, it is preferable that both the first holding mode and the second holding mode regulate the rotation of the bone fixative with respect to the implant body around the axis. In this case, the bone fixative side engaging portion is a concave groove or a ridge formed on the outer surface of the bone fixing tool, and the main body side engaging portion can be fitted to the bone fixing tool side engaging portion. It is desirable that it is a convex or concave portion. Further, the bone fixative side engaging portion is a flat portion formed on the outer surface of the bone fixative, and the main body side engaging portion is a flat portion that can face the bone fixing tool side engaging portion. Is desirable.

In the present invention, the first holding aspect enables the movement of the bone fixing device along the axis of the bone fixing device, and the second holding mode is the bone along the axis of the bone fixing device. It is preferable to regulate the movement of the fixative at least in a mode that restrains it rather than the first holding mode. In this case, the contour shape of the second bone fixative side engaging portion along the direction orthogonal to the axis of the bone fixing tool may correspond to the contour shape of the main body side engaging portion. desirable.

In this case, the first bone fixing tool side engaging portion accommodates the main body side engaging portion, and is relative to the main body side engaging portion so that the first holding mode can be realized. It has a relatively low top that is accommodated in a deep inner bottom portion or the main body side engaging portion and enables the first holding mode to be realized between the main body side engaging portion and the above. The second bone fixing tool side engaging portion is a relatively shallow inner bottom portion that accommodates the main body side engaging portion and enables the second holding mode to be realized between the second main body side engaging portion and the main body side engaging portion. Alternatively, it may be accommodated in the main body-side engaging portion and may be provided with a relatively high top that enables the second holding mode to be realized between the main body-side engaging portion and the main body-side engaging portion.

Further, the first bone fixing tool side engaging portion accommodates the main body side engaging portion, and is relatively capable of realizing the first holding mode between the first main body side engaging portion and the main body side engaging portion. A wide first groove width, or a relatively narrow first convex that is accommodated in the main body-side engaging portion and enables the first holding mode to be realized between the main body-side engaging portion and the main body-side engaging portion. The second bone fixing tool side engaging portion has a strip width, and accommodates the main body side engaging portion so that the second holding mode can be realized between the second main body side engaging portion and the main body side engaging portion. A relatively narrow second groove inner width, or a relatively wide second holding portion accommodated in the main body side engaging portion and capable of realizing the second holding mode between the main body side engaging portion and the main body side engaging portion. It may have 2 ridge widths.

In the present invention, the first holding aspect allows the implant body to move along the axis of the bone fixing device over the first range of the bone fixing device, and the second holding mode is. It is preferred to allow movement of the bone fixative along the axis of the implant body over a second range different from the first range of the bone fixative. Here, the difference between the first range and the second range means that the two ranges do not completely match, that is, whether or not there is a part common to both ranges, each range It means that at least one of the positions at both ends is different.

In the present invention, the main body side engaging portion is provided on the engaging member, and the main body side engaging portion is separated from the first bone fixing tool side engaging portion and the second bone fixing tool side engaging portion. The engagement between the separated arrangement and the engagement arrangement in which the main body side engaging portion engages with the first bone fixing tool side engaging portion and the second bone fixing tool side engaging portion. It is preferable that the member is configured to be movable. Here, in the separated arrangement, it is desirable that the main body-side engaging portion does not protrude into the insertion hole, and in the engaging arrangement, the main body-side engaging portion protrudes into the insertion hole. Further, a screwing structure is provided in which the engaging member or the member for positioning the engaging member and the implant body or the member held by the implant body are screwed around an axis intersecting the insertion hole. It is desirable that the separated arrangement and the engaging arrangement of the engaging member are realized by changing the screwing depth of the screwing structure, respectively. In this case, when the main body side engaging portion engages with the first bone fixture side engaging portion, the engaging member in the engaging arrangement is attached to the implant main body or the held member. Positioned by abutting and being restricted in the direction of the axis, when the main body side engaging portion engages with the second bone fixture side engaging portion, the engaging member in the engaging arrangement. Is preferably positioned by abutting on the bone fixture and being restricted in the direction of the axis.

In the present invention, the implant body has an operation hole that intersects and communicates with the insertion hole, and is arranged inside the operation hole so as to be movable in a direction along the axis of the operation hole, and the operation hole of the operation hole. It is preferable that an engaging member configured to be positioned along the axis is further provided, and the main body side engaging portion is provided on the engaging member. In this case, it is desirable that the engaging member is supported by the elastic force toward the implant body along the axis of the operating hole and opposite to the insertion hole.

In the present invention, a screwing structure is provided in which the engaging member or the member for positioning the engaging member and the implant body or the member held by the implant body are screwed to each other, and the engaging member is It is preferable that the operation hole is positioned along the axis of the operation hole according to the screwing depth of the screw structure. At this time, in the first holding mode, the main body side engaging portion has a gap between the main body side engaging portion and the first bone fixative side engaging portion in the direction along the axis of the operation hole, and the first. In the holding mode 2, the main body-side engaging portion abuts on the second bone fixative-side engaging portion in the direction along the axis of the operation hole. Further, the axial position of the engaging member with respect to the implant body in the first holding mode is the operation between the engaging member or the positioning member and the implant body or the held member. The position in the direction along the axis of the operation hole of the engaging member with respect to the implant body in the second holding mode is defined by the movement limit position in the direction along the axis of the hole. It is desirable that the main body side engaging portion abuts on the second bone fixture side engaging portion before reaching.

In the present invention, it is preferable that the engaging member is configured to be able to be positioned at the predetermined position by a drive operation generated inside the operation hole. In this case, it is desirable that the implant body further includes a fixing member that directly or indirectly fixes the engaging member inside the operation hole. This fixing member can be configured, for example, as an end cap that seals an end opening provided on the opposite side of the operation hole of the implant body to the insertion hole.

The present invention further includes a driving member configured to be screwed into the engaging member inside the operating hole and to be able to drive the engaging member in a direction along the axis of the implant body by rotation thereof. preferable. In this case, it is arranged inside the operation hole on the side opposite to the insertion hole with respect to the drive member, holds the drive member in the direction of the axis of the implant body, and has the same with respect to the drive member. It is desirable to further include a holding member with an opening that is accessible from the side of the opening end. The driving member and the holding member correspond to the members held by the implant body.

In the present invention, the implant body is screwed into the implant body inside the operation hole and abuts on the engagement member, and the engagement member can be driven in a direction along the axis of the implant body by the contact. It is preferable to further include a drive member. In this case, the engaging member is arranged inside the operating hole on the side opposite to the insertion hole with respect to the engaging member, and the engaging member is placed on the axis of the operating hole with the elastic bearing force. It is desirable to further include a holding member having an opening that allows the engaging member to be accessible from the side opposite to the insertion hole while being held in a directionally movable state. The driving member corresponds to a member for positioning the engaging member.

In the present invention, the implant body is an intramedullary nail body that extends along an axis and is inserted into the spinal cord, and the insertion hole is formed so as to cross the axis of the intramedullary nail body. It is a cross-sectional hole, and the operation hole is preferably a shaft hole provided along the axis line and having an open end at the proximal end.

In the present invention, the main body side engaging portion may be fixedly provided on the implant main body. In this case, in at least one of the first holding mode and the second holding mode, the bone fixator moves within a predetermined range along the direction of the axis of the bone fixator with respect to the implant body. It is preferably configured to be possible. At this time, the first movable along the direction of the axis of the bone fixture with respect to the implant body when the main body side engaging portion and the first bone fixture side engaging portion are engaged. A second movable along the axis direction of the bone fixture with respect to the implant body when the range and the body-side engaging portion and the second bone-fixing-side engaging portion are engaged. It is desirable that the range is different. Further, in at least a part of the predetermined range, the state in which the first bone fixative side engaging portion is engaged with the main body side engaging portion and the first with respect to the main body side engaging portion. It is desirable to have a structure that can change the state in which the engaging portion on the bone fixative side of 2 is engaged. This is, for example, in the case where the first holding mode and the second holding mode are switched by the angular posture around the axis of the bone fixative, in at least a part of the predetermined range, the implant body is covered with the implant body. On the other hand, it means that the bone fixative is rotatably configured around the axis of the bone fixative.

According to the present invention, there is a remarkable effect that the difficulty of the work for obtaining the holding state of the bone fixative at the time of surgery can be reduced and the desired holding state of the bone fixative with respect to the implant body can be realized. Play.

It is a front view (a) and a side view (b) which show the implant main body of the bone fixation apparatus of 1st Embodiment. Side view and both end view (a) of the bone fixator of the same embodiment, vertical cross-sectional view and cross-sectional view (b), enlarged cross-sectional view (c) with enlarged cross section, and insert device for bone fixative. It is an end view (d) which shows the appearance in the direction along the axis of the structure connected to the base end of. A partial vertical cross-sectional view (a) showing the internal structure of the main part of the same embodiment, a cross-sectional view (b) showing the engaging part in the slide-free state, and a cross-sectional view showing the engaging part in the slide-locked state. FIG. 3C. A partial vertical cross-sectional view (a) showing the internal structure of the main part of the same embodiment, a partial explanatory view (b) showing a first configuration example of the engagement structure, and a second configuration example of the engagement structure are shown. It is a partial explanatory drawing (c). 2 is a side view and both end views (a), a vertical sectional view and a horizontal sectional view (b) of the bone fixative of the second embodiment, and an enlarged cross-sectional view (c) of an enlarged cross section. It is a partial longitudinal sectional view which shows the internal structure of the main part of the implant body of 3rd Embodiment. It is a partial vertical sectional view which shows the internal structure of the main part of the implant body of 4th Embodiment. It is a partial longitudinal sectional view which shows the internal structure of the main part of the implant body of 5th Embodiment. It is a partial longitudinal sectional view which shows the internal structure of the main part of the implant body of 6th Embodiment. It is a figure (a) which shows the bone fixative of the 7th Embodiment, and the vertical sectional views (b) and (c) which show the application state to the fracture aspect I. In the figure (a) which shows the bone fixative of the 7th embodiment, the vertical sectional view (b) which shows the application state to the fracture aspect II, and the cross-sectional view (c) which shows the sectional view along the YY line. be. The figure (a) showing the bone fixative of the eighth embodiment, the vertical cross-sectional views (b) and (c) showing the application state to the fracture aspect I, and the first working state at the time of attachment to a fracture part. It is explanatory drawing (d) which shows. FIG. (A) showing the bone fixative of the eighth embodiment, vertical cross-sectional views (b) and (c) showing the application state to the fracture mode I, and cross-sectional view (d) showing the cross section along the YY line. ), And an explanatory diagram (d) showing the next working state at the time of attachment to the fractured portion.

Next, an embodiment of the present invention will be described in detail with reference to the accompanying drawings. First, the configuration of the first embodiment according to the present invention will be described with reference to FIGS. 1 to 4.

[First Embodiment] FIG. 1 is a front view (a) and a side view (b) showing an implant body 11 of the intramedullary fixation device which is the bone fixation device of the first embodiment. In the illustrated example, the implant body 11 is an intramedullary nail used in a state of being inserted into the medullary cavity of a long bone. In the implant body 11, the front surface indicates a surface facing the front surface of the patient when attached to the patient, and the side surface indicates a surface facing the side surface of the patient. The implant body 11 has a shape extending along the axis 11x. The implant body 11 is used in a posture in which the axis 11x is inserted into the medullary cavity of the bone. The implant body 11 has a proximal region 11A and a distal region 11B, and the axis 11x is slightly refracted between the proximal region 11A and the distal region 11B.

Crossing holes 12 and 13 corresponding to the insertion holes are formed in the proximal end side region 11A, and crossing holes 14A and 14B are formed in the distal end side region 11B. Further, in the proximal end side region 11A, a shaft hole 11a corresponding to the operation hole formed along the axial line 11x from the proximal end opening 11b is formed. The shaft hole 11a intersects with and communicates with the crossing holes 12 and 13. In the present embodiment, the shaft hole 11a is continuously formed in the tip side region 11B, and is a through hole having a tip side opening. A keyway 11c is provided in the base end opening 11b of the shaft hole 11a. The keyway 11c fits into the keyed end of an insertion device (not shown) used to introduce the implant body 11 into the bone, allowing the implant body 11 and the insertion device to be connected only in a predetermined posture relationship.

In the present embodiment, the cross-sectional holes 12 and 13 include axis lines 12x and 13x that intersect diagonally with respect to the axis line 11x. The axes 12x and 13x are parallel to each other. Further, the crossing holes 14A and 14B include axis lines 14ax, 14bx and 14by orthogonal to the axis line 11x. The crossing holes 14A and 14B are holes for inserting a cortical screw (cortical screw) for lateral fixing (not shown).

The bone fixing device 10 of the present embodiment is used in a state where the bone fixing tool 15 shown in FIG. 2 is inserted into the cross-sectional hole 12 of the implant body 11 shown in FIG. The bone fixative 15 has a shape extending from the tip end to the base end portion along the axis 15x. The bone fixative 15 includes a shaft hole 15a that is penetrated so that a guide tool such as a guide pin can be inserted. Further, the bone fixative 15 includes a bone engaging portion 15s that engages with the bone at the tip portion. In the illustrated example, the bone fixative 15 is a lug screw, and the bone engaging portion 15s is composed of a tapping screw screwed into the bone. In general, the bone fixative 15 is not limited to a bone screw such as a lug screw, but may be composed of a nail to be driven into the bone, a hook to bite into the bone, a pin to be press-fitted into the bone, or the like. Therefore, the bone engaging portion 15s also has a blade-shaped portion having a blade shape, an enlarged portion formed to expand in the bone by operation, a hook portion protruding into the bone by operation, and a sharp shape that bites into the bone. It may consist of a provided tip, a mere tip of a pin, or the like.

Further, the bone fixative 15 includes a connecting portion 15b to which a tool (not shown) is engaged with the base end portion and the instrument is connected. In the illustrated example, the connecting portion 15b is connected to a tool engaging structure 15g that engages with a tool such as a wrench and a tip portion of various instruments used when inserting or pulling the bone fixative 15 during surgery. It is provided with an instrument connecting structure 15h having a screw structure (female screw) or the like. It is preferable that the connecting portion 15b has a function of defining the posture around the axis when connecting to a tool or an instrument. In the illustrated example, the tool engagement structure 15g is composed of a hexagonal hole with a keyway 15k, and a tool consisting of a hexagonal wrench with a key (not shown) is engaged with the tool in a rotational posture in which the key is fitted into the keyway. Thereby, the relative posture around the axis of the tool with respect to the bone fixative 15 is defined.

When a tool or instrument is connected to the tool engagement structure 15g, the angular posture of the hand portion of the tool or instrument (for example, the T-shaped handle portion of the wrench) directly indicates the angular posture of the bone fixative 15. , The angular posture of the bone fixative 15 can be confirmed outside the body. For example, while the operator has passed the tool through a reference instrument such as a sleeve for which a predetermined angular posture relationship has been established with respect to the implant body 11, the bone fixative 15 connected to the tip of the tool is boned. In the case of introduction into the inside, the operator can know the angular posture of the bone fixative 15 at hand by the angular posture of the tool with respect to the reference instrument.

The bone fixative 15 includes a shaft-shaped shaft portion between the tip end portion and the base end portion. Bone fixative side engaging portions 15c and 15d are formed on the outer surface of this shaft portion. In the case of the illustrated example, the bone fixative side engaging portions 15c and 15d are concave grooves each having a shape extended in the direction along the axis 15x. Here, the bone fixative side engaging portion 15c has a relatively shallow groove shape, and the bone fixative side engaging portion 15d has a relatively deep groove shape. The two-point chain line described inside the bone fixative side engaging portion 15d (corresponding to the above-mentioned first bone fixing device side engaging portion) in FIG. 2 (c) is the depth of the concave groove. In order to show the difference between the two, the position and shape of the contour of the inner bottom surface of the bone fixative side engaging portion 15c (corresponding to the above-mentioned second bone fixing tool side engaging portion) are shown. The inner bottom surfaces of the bone fixative side engaging portions 15c and 15d have an arcuate contour when viewed in the width direction. In the case of the illustrated example, two engaging portions 15c and 15d on the bone fixative side are formed so as to be alternately arranged around the axis 15x at intervals of 90 degrees. In the case of the illustrated example, the bone fixative side engaging portions 15c and 15d are configured so that the formation ranges in the directions along the axis 15x are common and the same (completely coincident ranges). This point is the same for the following bone fixative 25.

As shown in FIG. 3A, an engaging member 16 having a body-side engaging portion 16s that engages with the bone fixative 15 is built in the shaft hole 11a of the implant body 11. The engaging member 16 includes a shaft hole 16a penetrating along the axis 11x of the implant body 11. Further, the base end portion 16b of the engaging member 16 is formed in a flange shape protruding from the periphery. The proximal end portion 16b is urged toward the proximal end side of the implant body 11 by an elastic member 17 made of a coil spring or the like housed between the inner surface step of the implant body 11 formed in the shaft hole 11a. The engaging member 16 is movably arranged along the axis 11x inside the shaft hole 11a. At this time, in the initial position (the above-mentioned separated arrangement) shown in FIG. 3, the main body side engaging portion 16s does not protrude into the inside of the cross hole 12 due to the elastic member 17. Actually, as shown in the illustrated example, the main body side engaging portion 16s is arranged at a position slightly retracted from the cross hole 12 into the shaft hole 11a. Therefore, the bone fixative 15 can be easily inserted into the transverse hole 12 without being interfered with by the main body side engaging portion 16s.

Further, the engaging member 16 is provided with a vertical groove 16e along the axis 11x, and the regulating portion 22a, which is the tip of the regulating pin 22 fixed to the implant main body 11, is fitted into the vertical groove 16e. As a result, the engaging member 16 is movable along the axis 11x, but is restricted by the restricting portion 22a so as not to rotate around the axis 11x, and its angular posture is kept constant. The configuration for restricting the rotation of the engaging member 16 around the axis is not limited to the structure using the restricting portion 22a of the restricting pin 22, and as a result, the rotation of the engaging member 16 around the axis is caused by some restricting portion. You just have to be hindered. For example, the contour of the outer circumference of the engaging member 16 is a non-circular shape such as a hexagonal shape (a variant different from the circular shape), and the contour of the inner circumference of the shaft hole 11a is a corresponding engaging shape such as a hexagonal hole. As a result, the posture of the engaging member 16 can be regulated without performing fixing work such as mounting or welding of the regulating pin 22 as described above. This point is the same in other examples described later.

The main body side engaging portion 16s is provided on both sides of the shaft hole 16a along the axis line 12x of the crossing hole 12 at the tip end portion (lower end in the drawing) of the engaging member 16. As shown in FIGS. 3 (b) and 3 (c), the tip of the main body-side engaging portion 16s has an arcuate contour (in the width direction) along a plane orthogonal to the axis 12x. The arc-shaped contour of the tip of the main body-side engaging portion 16s matches the arc-shaped contour along the plane orthogonal to the axis 15x of the inner bottom surface of the bone fixing tool-side engaging portion 15c of the bone fixative 15. .. This situation is also shown by a two-dot chain line in FIG. 2, which depicts the bone fixative 15. As a result, when the main body side engaging portion 16s is fitted to the inner bottom surface of the bone fixative side engaging portion 15c, the contact area between the two can be increased. As a result, the resistance to the sliding motion in the direction along the axis 15x of the bone fixative 15 can be increased, so that the restrictive force for the sliding motion in the slide locked state can be increased, and a reliable locked state can be realized. ..

A bone fixative 23 (see FIGS. 3 (b) and (c)) such as a screw, a pin, or a nail different from the bone fixative 15 can be inserted into the cross hole 13 of the present embodiment. .. However, in the present embodiment, there is no structure for switching the holding state of the bone fixative 23 inserted into the transverse hole 13 by the implant body 11. For the configuration in which the holding state of the bone fixative 23 inserted into the cross hole 13 can be switched, refer to the fifth embodiment described later. The engaging member 16 is formed with an insertion hole 16c for allowing the bone fixative 23 to be inserted through the cross hole 13 to be inserted. The insertion hole 16c allows the insertion of the bone fixative 23 to be inserted into at least the cross-sectional hole 13 within the operating range Ld of the engaging member 16 in the direction along the axis 11x. It is formed in a shape extended in the direction along 11x (an oval shape or an elliptical shape in the illustrated example). Here, the operating range Ld corresponds to, for example, a position where the main body side engaging portion 16s does not protrude into the inside of the cross-sectional hole 12 (for example, a position where the engaging portion 16s is slightly retracted as shown in FIG. 3A, and the above-mentioned separation arrangement. The range is from () to the most protruding position (corresponding to the above-mentioned engagement arrangement) in the cross-sectional hole 12 when the slide-free state shown in FIG. 3 (b) is realized.

A female screw 16d is formed on the upper inner surface of the shaft hole 16a of the engaging member 16, and the male screw 18d of the drive member 18 is screwed into the female screw 16d. The drive member 18 includes a shaft hole 18a penetrating along the axis line, and also includes a flange-shaped base end portion 18b. A tool engaging portion 18c such as a hexagonal hole is formed on the inner surface of the shaft hole 18a on the proximal end side inside the proximal end portion 18b. The drive member 18 is held by the holding member 19 in the direction of the axis 11x. The holding member 19 is screwed into the female screw 11d formed on the inner surface of the shaft hole 11a, and is restricted so as not to move to the tip end side of the shaft line 11x by abutting on the inner surface step of the shaft hole 11a. The driving member 18 is in a state where the flange-shaped base end portion 18b is in contact with the inner step portion 19c of the holding member 19 due to the urging force of the elastic member 17 received via the engaging member 16, whereby the axis line 11x The position of the driving member 18 in the direction along the above is maintained. That is, the drive member 18 is a member that is held in the direction along the axis 11x with respect to the implant main body 11, similarly to the holding member 19.

In the state shown in FIG. 3, the screwing depth between the engaging member 16 and the driving member 18 is maximum, and at this time, the base end portion 18b of the driving member 18 has a flange shape of the engaging member 16. It is in contact with the base end portion 16b from the base end side. An opening 19a is formed in the holding member 19. The surgeon can engage a tool (for example, a hexagon wrench or the like) (for example, a hexagon wrench) (for example, a hexagon wrench) with the tool engaging portion 18c of the driving member 18 through the opening 19a to rotate the driving member 18. A tool engaging portion 19b such as a hexagonal hole is also formed on the inner surface of the opening 19a of the holding member 19 in order to screw the holding member 19 into the female screw 11d of the implant body 11 to attach the holding member 19 to a predetermined position. ..

When the operator rotates the drive member 18 via the tool engaging portion 18c with a tool (not shown), the engaging member 16 is restricted from rotating as described above, so that the screw depth of the male screw 18d and the female screw 16d is increased. Changes. As a result, the engaging member 16 moves up and down along the axis 11x inside the shaft hole 11a according to the rotation of the driving member 18 within the above operating range. By moving the engaging member 16, the main body side engaging portion 16s can be projected into the inside of the cross-sectional hole 12, and the amount of protrusion thereof can be changed.

In the case of the present embodiment, as shown in FIG. 3B, when the bone fixative side engaging portion 15d is arranged at a position facing the main body side engaging portion 16s of the engaging member 16, when it is arranged at a position facing the main body side engaging portion 16s, By rotating the drive member 18, the operator can move the engaging member 16 downward in the drawing until the restricting portion 22a abuts on the upper end portion 16f of the vertical groove 16e. At this time, the tip of the main body side engaging portion 16s is located on the free line FL shown in FIG. 3 in the concave groove of the bone fixative side engaging portion 15d. However, the tip of the main body side engaging portion 16s does not come into contact with the inner bottom surface of the concave groove of the bone fixative side engaging portion 15d. Therefore, the bone fixative 15 is in a slide-free state in which it can move along the axis 15x with respect to the implant body 11, although rotation around the axis 15x is restricted. Here, when the upper end portion 16f abuts on the regulating portion 22a, an axial force in the direction along the axis 11x is applied to the screw structure between the engaging member 16 and the driving member 18. This axial force suppresses the loosening of the screw structure between the female screw 16d and the male screw 18d.

On the other hand, as shown in FIG. 3C, when the bone fixture side engaging portion 15c is arranged to face the main body side engaging portion 16s, the surgeon moves the engaging member 16 downward in the drawing by the above operation. When moved, the tip of the main body side engaging portion 16s abuts on the inner bottom surface of the concave groove of the bone fixative side engaging portion 15c before the upper end portion 16f of the vertical groove 16e abuts on the restricting portion 22a. At this time, the tip of the main body side engaging portion 16s is located on the lock line LL shown in FIG. As a result, the bone fixative 15 is put into a slide lock state in which not only the rotation around the axis 15x is restricted but also the movement in the direction along the axis 15x is restricted. Here, when the main body side engaging portion 16s abuts on the inner bottom surface of the bone fixative side engaging portion 15c, the axial force in the direction along the axis 11x is applied to the screw structure between the engaging member 16 and the driving member 18. Given. This axial force suppresses the loosening of the screw structure between the female screw 16d and the male screw 18d.

In the bone fixative 15 of the present embodiment, the bone fixator side engaging portions 15c and 15d are formed as concave grooves, and the bone fixator side engaging portion 15d is formed deeper than the bone fixative side engaging portion 15c. .. As a result, the body-side engaging portion 16s of the engaging member 16 positioned at a specific position (corresponding to the above-mentioned engagement arrangement) in the direction along the axis 11x on the implant body 11 is engaged on the bone fixture side. By engaging with the portion 15c, the bone fixture 15 is in a slide-locked state with respect to the implant body 11. Further, the main body side engaging portion 16s of the engaging member 16 positioned at a specific position (corresponding to the above engaging arrangement) in the direction along the axis 11x in the implant main body 11 is the bone fixture side engaging portion. By engaging with 15d, the bone fixture 15 becomes a slide-free state with respect to the implant body 11.

In the present embodiment, since the drive member 18 is always urged toward the proximal end side by the elastic member 17 via the engagement member 16, the position of the drive member 18 in the direction along the axis 11x is defined by the holding member 19. It is always held in the position shown in the figure. As a result, the operation position does not move even when the drive member 18 is rotated by a tool (not shown). This can prevent the surgeon's sensory changes, and is incorporated into a structure for rotating the drive member 18 via an insertion instrument connected to the implant body 11, for example, inside the insertion instrument. It has the advantage that there is no problem even if the size or other structure of the operation mechanism or the tool arranged in the shaft hole 11a at the time of surgery is constant. Further, since the drive member 18 and the engagement member 16 are in a state of being elastically supported by the elastic member 17, the drive member 18 and the main body side engaging portion 16s are placed on the free line FL or the lock line LL together with the engagement member 16. It can be pushed down to the reachable position. This means that whether or not the bone fixative side engaging portions 15c and 15d of the bone fixative 15 are at an angle position where they can engage with the main body side engaging portion 16s is determined by rotating the bone fixative 15 while driving the member. It means that it can be confirmed by feeling the change in the depth that can be pushed down by 18. As a result, the main body side engaging portion 16s is abutted on the outer peripheral surface of the bone fixing tool 15 at an angle position deviating from the bone fixing tool side engaging portions 15c and 15d, so that the rotation of the bone fixing tool 15 is restricted. It is possible to avoid the occurrence of problems such as not being able to obtain.

FIG. 4 is an explanatory diagram showing a configuration when end caps 21A and 21B (corresponding to the above-mentioned fixing member) are further attached to the implant main body 11 of the present embodiment. The end cap 21A shown in FIG. 4B has a tip portion 21Aa that can be inserted into the shaft hole 18a of the drive member 18, a tool engaging portion 21Ab such as a hexagonal hole provided at the base end portion, and an implant body 11. A male screw 21Ac screwed into the female screw 11d of the shaft hole 11a and a step portion 21Ad abutting on the base end of the drive member 18 are provided. The surgeon inserts the end cap 21A into the shaft hole 11a, screwes the male screw 21Ac into the female screw 11d, and screws the end cap 21A. The cap 21 is positioned. At this time, by attaching the end cap 21A, the stepped portion 21Ad comes into contact with the base end portion 18b of the driving member 18, so that the driving member 18 is pressed from above in the drawing to prevent the screwed portion from loosening. By generating an axial force between the drive member 18 and the end cap 21A, the effect of preventing the end cap 21A from loosening can also be obtained. As a result, the vertical positions of the engaging member 16 and the driving member 18 are also restricted, so that the holding state of the bone fixture 15 with respect to the implant body 11 is stable.

The end cap 21B shown in FIG. 4C includes a tip portion 21Ba that can be inserted into the shaft hole 18a of the drive member 18, a tool engaging portion 21Bb such as a hexagonal hole provided at the base end portion, and an implant body 11. A male screw 21Bc screwed with the female screw 11d of the shaft hole 11a and a step portion 21Bd abutting on the base end of the holding member 19 are provided. The surgeon inserts the end cap 21B into the shaft hole 11a, screwes the male screw 21Bc into the female screw 11d, and screws the end cap 21B. Is positioned. At this time, the tip portion 21Ba is inserted into the shaft hole 18a of the drive member 18, but other portions of the end cap 21B, particularly the step portion 21Bd, do not come into contact with the drive member 18. Therefore, by attaching the end cap 21B, the holding member 19 is suppressed from above in the drawing to prevent the screwed portion from loosening, and the axial force generated between the holding member 19 and the holding member 19 prevents the end cap 21B from loosening. You can also get the effect. As a result, the vertical positions of the engaging member 16 and the driving member 18 are also indirectly restricted, so that the holding state of the bone fixative 15 with respect to the implant body 11 is stabilized.

In the present embodiment, the surgeon attaches the bone fixative 15 to the implant body 11 in a state where the insertion tool 20A of the introduction device 20 schematically shown in FIG. 2D is connected to the connection portion 15b of the bone fixative 15. It is inserted into the cross-sectional hole 12 of. Here, the insertion path of the bone fixative 15 through which the transverse hole 12 is inserted is pre-drilled into the bone by a drill, a reamer, or the like. The introduction device 20 typically includes the insertion tool 20A and a guide sleeve 20B that guides the insertion tool 20A and the bone fixative 15 connected to the insertion tool 20A toward the insertion path. As the insertion tool 20A, for example, a wrench corresponding to the tool engagement structure 15g of the connection portion 15b is used. Here, the connecting portion of the insertion tool 20A has an inner / outer double structure composed of an inner member and an outer member, and a male screw formed at the tip of the inner member is screwed into an instrument connecting structure 15h such as a female screw to the outer periphery of the tip of the outer member. With the formed wrench engaging portion fitted to the tool engaging structure 15g, a tightening screw so as to generate a holding force in the direction of pulling out the proximal end of the inner member toward the proximal end with respect to the proximal end of the outer member. By holding the tool 20A or the like, the connection portion 15b of the bone fixative 15 can be connected and fixed to the tip end portion of the insertion tool 20A.

It is desirable that the connection mode between the insertion tool 20A and the connection portion 15b has a connection structure in which the angular posture around the axis 15x of the bone fixative 15 with respect to the insertion tool 20A is uniquely determined. In the illustrated example, by using the insertion tool 20A provided with the keyed engaging portion (hexagonal wrench portion) 20As corresponding to the tool engaging portion (hexagonal hole) 15 g provided with the key groove 15k, the insertion tool 20A and the above are used. The relationship between the angular postures around the axis of the bone fixative 15 can always be constant. Therefore, for example, the insertion tool 20A is configured so that the angle position of the insertion tool 20A corresponding to each of the angle positions of the bone fixator side engaging portions 15c and 15d of the bone fixative 15 can be identified in the operation base. Just by looking at the operation base of, whether or not the bone fixative side engaging portions 15c and 15d of the bone fixative 15 connected to this are in a position facing the main body side engaging portion 16s, the bone fixture side clerk. It is possible to easily know which of the joints 15c and 15d is in the position.

In addition, as an aspect of the above-mentioned identifiable configuration, the mark 20M indicating the angular position of the bone fixative side engaging portions 15c and 15d on the insertion tool 20A (in the illustrated example, one of the bone fixative side engaging portions). It is conceivable to provide a mark indicating an angular position corresponding to 15d). In the illustrated example, the mark 20M is provided on the insertion tool 20A, but if the structure has a structure in which the insertion tool 20A and the guide sleeve 20B have corresponding angular postures, a visible portion of the guide sleeve 20B (such as the outer surface of the base end). May be provided with a mark. However, instead of providing a special mark, the angle around the axis of the T-shaped handle 20Ah of the insertion tool 20A may be adjusted to either one of the bone fixative side engaging portions 15c and 15d. In the illustrated example, the T-shaped handle 20Ah shows an angular position corresponding to the other bone fixative side engaging portion 15c. The marks and handles constitute a posture identification means that indicates the posture (angled posture around the axis) of the bone fixative 15 to the surgeon outside the patient's body.

In the present embodiment, the concave groove of the bone fixative side engaging portion 15c is formed not only shallow but also narrow, and the concave groove of the bone fixative side engaging portion 15d is formed not only deeply but also wide. Has been done. Therefore, instead of changing the holding mode of the bone fixture 15 due to the difference in the depth of the concave groove between the bone fixture side engaging portions 15c and 15d as in the present embodiment, the main body side engaging portion 16s is engaged. By appropriately setting the tip shape of the joint portion 16s and the concave groove shape of the bone fixing tool side engaging portions 15c and 15d, the main body side engaging portion 16s becomes the concave groove of the bone fixing tool side engaging portions 15c and 15d. The holding mode of the bone fixture 15 can be changed depending on the width.

FIG. 5 shows the configuration of the second embodiment according to the present invention, which is configured as described above. This embodiment shows a bone fixative 25 which is a modification of the bone fixative 15 of the first embodiment. In this bone fixative 25, as shown in FIG. 5, the four bone fixative side engaging portions 25c, 25d, 25e, 25f are all composed of concave grooves having the same depth, and four bones. It is different from the first embodiment in that the structures of the concave grooves of the fixture-side engaging portions 25c, 25d, 25e, and 25f are all different from each other. As shown in FIG. 5C, each concave groove includes an inner bottom surface b and inner side surfaces s provided on both sides of the inner bottom surface b in the width direction. Although not particularly limited, in the illustrated example, the inner bottom surface b is a flat surface, and the inner surface surface s is configured as a flat surface inclined with respect to the inner bottom surface b.

The bone fixative side engaging portion 25c is the main body side engaging portion 16s as can be seen by comparison with the contour shape of the tip of the main body side engaging portion 16s shown by the illustrated two-dot chain line arranged on the free line FL. It has a wide groove width that accommodates the tip of the sword and does not come into contact with the tip. On the other hand, the bone fixative side engaging portion 25d has a narrower groove width than the bone fixing device side engaging portion 25c, and has a width with respect to the contour shape of the tip of the main body side engaging portion 16s at the above position. The groove width is such that the inner side surfaces s on both sides of the direction come into contact with each other. Further, the bone fixative side engaging portion 25e has a narrower groove width than the bone fixative side engaging portion 25d, and the tip of the main body side engaging portion reaches before the main body side engaging portion 16s reaches the above position. It comes into contact with the inner side surfaces s on both sides in the width direction. Further, the bone fixing device side engaging portion 25f has a narrower groove width than the bone fixing device side engaging portion 25e, and the position when the main body side engaging portion 16s engages with the bone fixing tool side engaging portion 25e. Further in front (upper part of the drawing), the tip of the main body side engaging portion 16s is configured to abut on the inner side surfaces s on both sides in the width direction.

By abutting in the width direction with respect to the tip of the main body side engaging portion 16s as in the above-mentioned bone fixing device side engaging portions 25c to 25f, the slide along the axial direction of the bone fixing tool 25 with respect to the implant main body 11. It may be configured to regulate operation. Further, it is also possible to form three or more mutually different concave groove shapes as the bone fixative side engaging portion, such as the above-mentioned bone fixative side engaging portions 25c to 25f. As a result, the restricted state of the sliding motion of the bone fixative 25 with respect to the implant body 11 along the axial direction can be switched to three or more stages. In this second embodiment, the restrictive force of the axial slide motion of the bone fixative 25 with respect to the implant body 11 is 0 when the body side engaging portion 16s engages with the bone fixative side engaging portion 25c. On the other hand, when the engagement partners of the main body side engagement portion 16s are the bone fixative side engagement portions 25d, 25e, 25f, the engagement partners are the bone fixture side engagement portions 25d, 25e,. In the order of 25f, the restrictive force for the sliding motion of the bone fixture 25 with respect to the implant body 11 increases.

The structure and significance of the tool engagement structure 25g with the keyway 25k of the bone fixative 25 and the female screw 25h shown in FIG. 5 are the tool engagement structure with the keyway 15k of the bone fixative 15 shown in FIG. It is the same as 15 g. Therefore, the structure of the introduction tool 20 including the insertion tool 20A can be configured in the same manner as in the case of the first embodiment.

Next, with reference to FIG. 6, the configuration of the bone fixing device 30 according to the third embodiment of the present invention will be described. This embodiment shows a modified example of the engagement structure of the implant body 11 of the first embodiment. The implant body 31 of this embodiment is provided with a shaft hole 31a extending in a direction along the axis 31x from a proximal opening 31b provided with a keyway 31c, and is provided with a female screw 31d on the inner surface of the shaft hole 31a. It is the same as the embodiment. However, in this embodiment, unlike the above, the female screw 31f is formed in the small diameter portion provided in the inner part of the shaft hole 31a, and the engaging member 36 screwed into the female screw 31f is provided. A main body side engaging portion 36s is formed at the tip end portion of the engaging member 36. The engaging member 36 includes a tool engaging portion 36c such as a hexagonal hole that opens in the end surface of the base end portion 36b, and a male screw 36d that is provided on the outer periphery and is screwed with the female screw 31f. When the implant body 31 is introduced into the body, the insertion device 26 such as the target device shown by the two-dot chain line in the figure is connected to the implant body 31 via the connecting screw 27. The connecting screw 27 has a shaft hole 27a, a flange-shaped base end portion 27b, a tool engaging portion 27c formed at the base end of the shaft hole 27a, and a male screw 27d formed on the outer periphery. With the base end portion 27b engaged with the connection hole 26a formed in the connection end portion of the insertion tool 26, a position close to the base end opening 31b of the shaft hole 31a by a rotation operation using the tool engagement portion 27c. By screwing the male screw 27d of the connecting screw 27 into the female screw 31d formed in the large-diameter portion provided in the implant body 26, the connecting end portion of the insertion instrument 26 can be fixed to the implant body 31. The engaging member 36 is configured to be able to pass through the shaft hole 27a of the connecting screw 27. Therefore, with the insertion device 26 connected to the implant body 31, the engaging member 36 is inserted from the upper opening of the connection hole 26a, and the engaging member 36 is passed through the shaft hole 27a and is shown in the implant body 31. Can be introduced to the position.

When the operator engages a tool such as a hexagon wrench with the tool engaging portion 36c and operates the rotation, the engaging member 36 moves in the shaft hole 31a in the direction along the axis 31x with respect to the implant body 31. Moving. The engaging member 36 rotates around the axis by the above rotation operation, but since the main body side engaging portion 36s at the tip has a rotating body shape centered on the rotating axis of the engaging member 36, the main body side engaging portion The substantially engaging shape of the 36s does not change even when the engaging member 36 is rotated. Further, the screwing depth of the engaging member 36 with respect to the implant body 31 is restricted by the outer peripheral step portion 36e of the engaging member 36 coming into contact with the corresponding inner peripheral step portion 31e of the implant body 31.

In the present embodiment, as shown in FIG. 6, when the bone fixing tool side engaging portion 15c of the bone fixing tool 15 inserted through the cross-sectional hole 32 is arranged to face the main body side engaging portion 36s. When the operator screwed in the engaging member 36, the main body side engaging portion 36s was the bone fixing tool 15 before the screwing depth of the engaging member 36 with respect to the implant main body 31 was restricted. It abuts on the side engaging portion 15c. Therefore, the main body side engaging portion 36s is arranged on the lock line LL, and the bone fixative 15 is in the slide lock state. At this time, since the axial force acts between the bone fixative 15 and the engaging member 36, the point that the loosening of the engaging member 36 is suppressed is the same as that of the first embodiment.

On the other hand, when the bone fixative side engaging portion 15d (not shown) of the bone fixing tool 15 is arranged to face the main body side engaging portion 36s, the engaging member 36 is screwed in. When the outer peripheral step portion 36e abuts on the inner peripheral step portion 31e of the implant body 31, the screwing depth is restricted, and further screwing becomes impossible. Therefore, the main body side engaging portion 36s (indicated by the dotted line in the figure) is arranged on the free line FL. At this time, the main body side engaging portion 36s is housed in the concave groove of the bone fixative side engaging portion 15d, but since it does not abut on the inner bottom surface of the concave groove, the bone fixative 15 does not rotate around the axis. Although it is restricted, it is in a slide-free state where slide movement is possible. Again, since the axial force acts between the implant body 31 and the engaging member 36, the point that loosening of the engaging member 36 is suppressed is the same as in the first embodiment.

In the present embodiment, instead of directly screwing the engaging member 36 to the female screw 31f of the implant body 31, the member is held by screwing or the like to the implant body 31 (such as the holding member 19 of the first embodiment). It may be screwed. This member corresponds to the member held by the implant body. This member may be composed of an elastic ring or the like that elastically engages with the concave groove in the shaft hole 31a of the implant body 31.

Next, with reference to FIG. 7, the configuration of the bone fixing device 40 according to the fourth embodiment of the present invention will be described. This embodiment also shows a modified example of the engagement structure of the implant body 11 of the first embodiment. The implant body 41 of this embodiment is provided with a shaft hole 41a extending in a direction along the axis 41x from a proximal opening 41b provided with a key groove 41c, and is provided with a female screw 41d on the inner surface of the shaft hole 41a. It is the same as the embodiment. In this embodiment, the engaging member 46 is provided so as to be movable along the direction of the axis 41x in the shaft hole 41a, and the main body side engaging portion 46s is provided at the tip end portion of the engaging member 46. An elastic member 47 such as a coil spring accommodated between the flange-shaped base end portion 46b of the engagement member 46 and the internal step of the implant body 41 is engaged, and the elastic member 47 causes the engagement member 46 to engage. It is urged upward in the figure. An opening 46c having an enlarged diameter of the shaft hole 46a is provided on the end surface of the base end portion 46b.

Inside the shaft hole 41a of the implant body 41, a holding member 49 having an opening 49a, which is composed of a retaining ring or the like, is fixed. The engaging member 46 is held by the holding member 49 from above in the drawing. Therefore, the engaging member 46 is positioned along the axis 41x at a position where the main body side engaging portion 46s does not protrude into the cross-sectional hole 42 by the elastic member 47 and the holding member 49 in a state where the engaging member 46 is not subjected to an external force. (Corresponds to the above-mentioned separation arrangement). Further, the male screw 48d of the end cap 48, which is also a driving member shown by the two-dot chain line shown in the figure, is screwed into the female screw 41d formed on the inner surface of the shaft hole 41a of the implant body 41. The end cap 48 includes a tip portion 48a configured to have a diameter smaller than that of the male screw 48d. A convex portion 48s projects from the tip of the tip portion 48a. The tip portion 48a can be inserted downward in the drawing through the opening portion 49a of the holding member 49. Further, the convex portion 48s is configured to be insertable into the opening portion 46c provided in the base end portion 46b of the engaging member 46. Further, a tool engaging portion 48c such as a hexagonal hole is provided at the base end portion 48b of the end cap 48.

When the surgeon engages a tool such as a hexagon wrench with the tool engaging portion 48c to rotate the end cap 48, the end cap 48 is rotated along the axis 41x with respect to the implant body 41 in the shaft hole 41a. Move in the same direction. The end cap 48 rotates around the axis by the rotation operation, but the tip portion 48a and the convex portion 48s have a shape of a rotating body centered on the rotation axis of the end cap 48, so that the rotation operation also substantially causes the end cap 48. The engaging shape does not change. By screwing the end cap 48, the tip portion 48a pushes down the engaging member 46 downward in the drawing. When the engaging member 46 is lowered in this way, the main body-side engaging portion 46s protrudes into the cross-sectional hole 42. Here, the outer peripheral step portion 46e formed on the base end portion 46b of the engaging member 46 abuts on the inner peripheral step portion 41e of the implant body 41 corresponding thereto, so that the engaging member 46 with respect to the implant body 41 Depth is regulated.

In the present embodiment, as shown in FIG. 7, when the bone fixing tool side engaging portion 15c of the bone fixing tool 15 inserted through the cross-sectional hole 42 is arranged to face the main body side engaging portion 46s. When the operator screwed in the end cap 48, the main body side engaging portion 46s became the bone fixing tool side engaging portion of the bone fixing tool 15 before the depth of the engaging member 46 with respect to the implant main body 41 was restricted. It hits 15c. Therefore, the main body side engaging portion 46s is arranged on the lock line LL (corresponding to the above engaging arrangement), and the bone fixative 15 is in the above slide lock state. At this time, since an axial force acts between the end cap 48 and the implant body 41 via the bone fixative 15 and the engaging member 46, the end cap 48 is prevented from loosening, which is the same as in the first embodiment. ..

On the other hand, when the bone fixing tool side engaging portion 15d of the bone fixing tool 15 is arranged to face the main body side engaging portion 46s, when the end cap 48 is screwed in, the outer peripheral step portion 46e becomes the implant main body 41. By abutting on the inner peripheral step portion 41e, the screwing depth is restricted, and no further screwing is possible. Therefore, the main body side engaging portion 46s (indicated by the dotted line in the figure) is arranged on the free line FL (corresponding to the above engaging arrangement). Here, the main body side engaging portion 46s is housed in the concave groove of the bone fixative side engaging portion 15d, but since it does not abut on the inner bottom surface of the concave groove, the bone fixative 15 does not rotate around the axis. Although it is restricted, it is in a slide-free state where slide movement is possible. At this time, since an axial force acts between the implant body 41 and the end cap 48, the point that the end cap 48 is prevented from loosening is the same as in the first embodiment. The end cap 48 of the present embodiment corresponds to a member for positioning the engaging member. In the present embodiment, only one type of drive member made of the end cap 48 needs to be prepared, and it is not necessary to perform a delicate operation or prepare a plurality of drive members as in the conventional case.

Next, with reference to FIG. 8, the configuration of the bone fixing device 50 according to the fifth embodiment of the present invention will be described. This embodiment shows a modified example of the engagement structure of the implant body 11 of the first embodiment. In this embodiment, unlike each of the above-described embodiments, the first engaging member 56A and the second engaging member 56B are arranged inside the implant body 51 so as to be movable in the direction along the axis 51x, respectively. There is. Here, the first engaging member 56A is an engaging member for holding the bone fixative 25 inserted into the crossing hole 52, and the second engaging member 56B is further based than the crossing hole 52. It is an engaging member for holding the bone fixative 23 inserted into the cross hole 53 provided on the end side. A main body side engaging portion 56As is formed at the tip end portion of the first engaging member 56A. The main body side engaging portion 56Bs is formed at the tip end portion of the second engaging member 56B.

Further, in the fifth embodiment, the female screw 51d formed on the inner surface of the shaft hole 51a is in contact with the base end portion 56b (opening edge of the shaft hole 56Aa) of the first engaging member 56A from above in the drawing. A holding member 59 with a male screw 59d to be screwed is provided. The holding member 59 includes an opening 59a, through which the operator can access the first engaging member 56A and the second engaging member 56B in the shaft hole 51a in order to perform an operation with a tool or the like. .. The first engaging member 56A can move in the direction along the axis 51x by fitting the regulation portion 58Aa at the tip of the regulation pin 58A into the vertical groove 56Ae, but rotates around the axis 51x. You will be guided not to. Further, the first engaging member 56A is provided with an insertion hole 56Ac for passing the bone fixative 23 to be inserted through the cross hole 53. Further, the second engaging member 56B is housed in the shaft hole 56Aa of the first engaging member 56A. Then, by fitting the vertical groove 56Be into the regulation pin 58B fixed to the first engaging member 56A, the second engaging member 56B is aligned with the first engaging member 56A along the axis 51x. It is guided so as to be movable in the vertical direction and not to rotate around the axis 51x. The second engaging member 56B is configured to be expandable and contractible in the direction along the axis 51x by forming a slit 56Bc on the peripheral wall thereof.

In this embodiment, by pushing down the base end portion 56Ab of the first engaging member 56A and the base end portion 56Bb of the second engaging member 56B through the opening portion 59a of the holding member 59, the main body side engaging portion 56As And 56Bs can be pressed against the bone fixatives 25 and 23. At this time, a drive member (not shown) is inserted into the shaft hole 51a of the implant body 51, and a male screw formed on the outer circumference of the drive member is screwed into the female screw 51d to position the drive member inside the shaft hole 51a. can do. Then, by bringing the tip of the drive member into contact with the proximal end portion 56Ab of the first engaging member 56A and the proximal end portion 56Bb of the second engaging member 56B, the first engaging member 56A and the second engaging member 56A and the second engaging member 56B are brought into contact with each other. The engaging member 56B can be pushed down. The amount of pushing down of the first engaging member 56A and the amount of pushing down of the second engaging member 56B can be arbitrarily set to be the same amount, but for example, the shape of the tip of the contact member is around the axis. By forming the shape so as to have a step at the inside and outside positions of the above, the pushing down amount of the first engaging member 56A and the pushing down amount of the second engaging member 56B can be made different. This driving member also corresponds to a member for positioning the engaging member.

Further, in the fifth embodiment, by arranging any one of the bone fixative side engaging portions 25c to 25f of the bone fixative 25 so as to face the shaft hole 51a, the main body side of the first engaging member 56A The engaging portion 56As can be engaged. At this time, the relationship between the amount of protrusion of the main body side engaging portion 56As into the transverse hole 52 and the holding mode of the bone fixative 25 with respect to the implant main body 51 is the same as that of the second embodiment. However, the bone fixative 15 may be inserted into the cross hole 52 in the same manner as in the first embodiment to hold the bone fixative 15. When the operator pushes down the second engaging member 56B by the driving member, the main body side engaging portion 56Bs comes into contact with the bone fixative 23, and the elastic force generated by the slit 56Bc causes the bone fixing device 23 to rotate around the axis. And slides along the axis can be regulated. At this time, if the bone fixative side engaging portion is formed by a groove or a flat portion formed on the outer surface of the bone fixing tool 23, the bone is fixed due to the difference in the engaging structure such as the depth position and the surface unevenness thereof. Similar to the tools 15 and 25, the holding mode of the bone fixative 23 can be appropriately set and changed as necessary.

Next, with reference to FIG. 9, the configuration of the bone fixing device 60 according to the sixth embodiment of the present invention will be described. This embodiment shows a modified example of the engagement structure of the implant body 11 of the first embodiment. In this embodiment, similarly to the fifth embodiment described above, the first engaging member 66A and the second engaging member 66B are arranged inside the implant body 61 so as to be movable in the directions along the axis 61x, respectively. To. However, unlike the fifth embodiment, in this embodiment, the drive member 68 is arranged between the first engaging member 66A and the holding member 69. The drive member 68 is held by the holding member 69 and the male screw 68d is screwed into the female screw 66Ad of the first engaging member 66A, as in the first embodiment. Further, as in the fifth embodiment, the main body side engaging portion 66As is provided at the tip of the first engaging member 66A. Further, the first engaging member 66A is provided with an insertion hole 66Ac for passing the bone fixative 23 to be inserted into the cross hole 63.

In the present embodiment, the second engaging member 66B is arranged in the shaft hole 68a of the driving member 68. Similar to the second engaging member 56B of the fifth embodiment, the second engaging member 66B is provided with a slit 66Bc on the peripheral wall, whereby the second engaging member 66B is configured to be expandable and contractible in the direction along the axis 61x. Further, the main body side engaging portion 66Bs is provided at the tip of the second engaging member 66B. Further, the base end portion 66Bb of the second engaging member 66B is accessible from the upper part of the drawing through the shaft hole 68a (the portion where the tool engaging portion 68c is formed) of the driving member 68.

In the present embodiment, the bone fixative 25 (which may be the bone fixative 15) inserted through the cross hole 62 is first engaged by rotating the drive member 68 in the same manner as in the first embodiment. The fitting member 66A moves in the shaft hole 61a along the shaft line 61x. Thereby, the main body side engaging portion 66As can be engaged with any of the bone fixative side engaging portions 25c to 25f in a predetermined manner, and a desired holding mode can be realized. Since the other effects at this time are the same as those in the first embodiment, they will be omitted. The driving member 68 corresponds to a member held by the implant body.

In the present embodiment, another driving member such as an end cap (not shown) pushes down the second engaging member 66B through the opening 69a of the holding member 69 and the shaft hole 68a of the driving member 68, thereby engaging the main body side. By pressing the portion 66Bs against the outer peripheral surface of the bone fixative 23 inserted through the cross-sectional hole 63, the bone fixative 23 can be held against the implant body 61 by the frictional force. At this time, similarly to the first embodiment, by using the end caps 21A and 21B as the other driving members, it is possible to achieve the same operation as described above in the first embodiment and the fifth embodiment. become. Here, as in the fifth embodiment, the second engaging member 66B also relates to the present invention by providing the bone fixing device 23 with a plurality of mutually different engaging structures on the bone fixing device side. It becomes possible to function as an engaging member. At this time, the other driving member corresponds to a member for positioning the engaging member.

Next, with reference to FIGS. 10 and 11, the configuration of the bone fixation device 70 according to the seventh embodiment of the present invention will be described. This embodiment shows a modified example of the overall configuration of the first embodiment. 10 and 11 are cross-sectional views showing the overall configuration of the bone fixation device 70 of the seventh embodiment and the application mode to the proximal femur. In each embodiment described above, an intramedullary fixation system including an intramedullary nail inserted into the intramedullary cavity as an implant body is exemplified, but the implant body of the present invention is a bone as in the present embodiment. Includes those installed on the surface.

As shown in FIGS. 10 (b) and 11 (b), the implant body 71 of the present embodiment has a tubular barrel portion 71A inserted into the bone (proximal femur) and the surface of the bone. It has a structure integrally configured with a plate portion 71B installed (on the lateral portion of the femur). The barrel portion 71A is provided with an insertion hole 71Aa that penetrates in the axial direction from the tip end 71Ab to the base end 71Ac. At the tip 71Ab of the barrel portion 71A, the insertion hole 71Aa has an opening shape with a partially reduced angular position. In the case of the illustrated example, as shown in FIG. 11C, a main body side engaging portion 71Ad composed of a pair of protrusions protruding into the opening of the insertion hole 71Aa is formed at the tip 71Ab. However, the main body side engaging portion 71Ad is not limited to such a protrusion, and is provided with various engaging structures that can slidably engage with the bone fixing tool side engaging portion of the bone fixative 75 described later. Can be configured. For example, it may be composed of a flat portion provided on a part of a circular opening edge.

A plurality of openings 71Ba are provided in the plate portion 71B, and a bone fixative (cortical screw) 73 having a bone engaging portion 73a and a head 73b is inserted through these openings 71Ba. In the bone fixative 73, the plate portion 71B is placed on the outer surface of the lateral portion in a state where the head 73b is engaged with the seat surface 71Bb of the opening 71Ba and the bone engaging portion 73a is engaged with the cortex of the trunk of the femur. Fix in a pressing manner.

A bone fixative 75 is inserted into the insertion hole 71Aa of the barrel portion 71A. As shown in FIGS. 10 (a) and 11 (a), the bone fixative 75 includes a bone engaging portion 75a including a tapping screw or the like that engages with the bone, and a shaft portion 75b. A plurality of bone fixative side engaging portions 75c and 75d are provided on the outer surface of the shaft portion 75b. In the illustrated example, the bone fixative side engaging portions 75c and 75d are concave grooves extending in the direction along the axis of the bone fixative 75, respectively. In the case of the illustrated example, the bone fixative side engaging portions 75c and 75d have a forming range in which the positions in the directions along the axes are common to each other. That is, both engaging portions have portions formed in a common position range in the direction along the axis. This point is the same in the following eighth embodiment. Here, as shown in FIGS. 10 and 11, the length of the bone fixative side engaging portion 75c in the direction along the axis is longer than the same length of the bone fixative side engaging portion 75d by a distance A. .. Both of these bone fixative side engaging portions 75c and 75d engage with the main body side engaging portion 71Ad, and the distance A determines different holding modes of the bone fixative 75 with respect to the implant main body 71. ..

As shown in FIGS. 10 (b) and 11 (b), the bone fixture 75 is introduced into the femoral head so that the bone engaging portion 75a is engaged with the bone at a suitable depth. After screwing, the barrel portion 71A of the implant body 71 is introduced into the bone, and the bone fixture 75 is inserted into the insertion hole 71Aa of the barrel portion 71A from its base end. At this time, as shown in FIGS. 10A and 10B, the barrel is adjusted by adjusting the angular posture around the axis of the bone fixture 75 so that the engaging portion 75c on the bone fixture side faces the illustrated vertical direction. The main body side engaging portion 71Ad of the portion 71A is fitted to the bone fixing device side engaging portion 75c, and the bone fixing tool 75 is restricted from rotating around the axis of the implant body 71 and along the axis. It is a holding mode that can slide in the direction. At this time, due to the distance A of the bone fixative side engaging portion 75c with respect to the bone fixing device side engaging portion 75d, the slide range in the direction along the axis thereof is the above-mentioned case as compared with the case where the bone fixing device side engaging portion 75d. It becomes longer by the distance A.

On the other hand, when the angular posture of the bone fixture 75 is adjusted so as to be an angular position 90 degrees different from the angular position in the illustrated example, as shown in FIGS. 11A and 11B, the main body side engaging portion is used. 71Ad fits into the engaging portion 75d on the bone fixture side. At this time, the bone fixative 75 is restricted in rotation around its axis as described above and can slide in the direction along the axis, but the bone fixative 75 is at the position shown in FIG. 11 (b). It is said that it cannot slide to the base end side.

As described above, in the bone fixing device 70 of the present embodiment, the bone fixing tool 75 is restricted from rotating around the axis of the barrel portion 71A with respect to the implant body 71 and is slidably held in the direction along the axis. Therefore, the healing process of lateral fractures (see Fracture Aspect I with Fracture Lines Shown in FIG. 10 (b)) and subtrochanteric fractures (see Fracture Aspect II with Fracture Lines Shown in FIG. 11 (b)). In the above, it is possible to prevent the rotation of the bone head and to slide the bone fixture 75 according to the change in the repositioning mode caused by the repair of the fractured portion. FIG. 10 (c) shows the state of the bone fixative 75 after sliding due to the shortening of the bone head. In this case, in the case of the lateral fracture, the bone fixative 75 is configured to be extra slidable toward the proximal end side by the distance A from the state shown in FIG. 10 (b), so that a large slide required in the healing process is possible. The amount can be secured. However, the distance A, which is the amount of slide at this time, is such that even if the bone fixative 75 slides toward the proximal end side from the illustrated state, the proximal end of the bone fixative 75 is an implant as shown in FIG. 10 (c). The distance A is the distance between the base end of the shaft portion 75b of the bone fixative 75 and the base end 71Ac of the barrel portion 71A in the illustrated state so that the base end 71Ac of the barrel portion 71A of the main body 71 does not protrude. It is preferable that the length is substantially the same. In the application state of the present embodiment (CHS system) for such a lateral fracture, the rotational movement of the bone fixative 75 around the axis is restricted and the sliding movement along the axis is permitted. This state corresponds to the slide-free state in the first to sixth embodiments of the above-mentioned intramedullary fixation system.

On the other hand, in the case of the subtrochanteric fracture, as shown in FIG. 11B, the proximal femur fixed by the barrel portion 71A and the bone fixture 75, the plate portion 71B, and the bone fixture 73. Since the fracture line (fracture aspect II) is formed between the lateral portion to be fixed, the slide amount of the bone fixture 75 required in the healing process is 0 or extremely small. Therefore, the slide range is limited by engaging the bone fixative side engaging portion 75d having a short slide range with the main body side engaging portion 71Ad. In the application state of the present embodiment (CHS system) for such a subtrochanteric fracture, the rotational movement of the bone fixative 75 around the axis is restricted, and the sliding motion along the axis is also restricted. This state corresponds to the slide lock state in the first to sixth embodiments of the above-mentioned intramedullary fixation system.

In the above embodiment, the main body side engaging portion 71Ad of the implant main body 71 is a protrusion, and the bone fixing tool side engaging portions 75c and 75d of the bone fixative 75 are concave grooves, but the configuration of this embodiment is this. The fitting mode of the concave-convex structure is not limited to the above. For example, the uneven relationship between the main body side engaging portion 71Ad and the bone fixative side engaging portions 75c and 75d may be configured in the reverse of the illustrated example. Further, the main body side engaging portion 71Ad is a flat surface portion formed on a part of the inner peripheral surface facing the insertion hole 71Aa of the barrel portion 71A, and the bone fixing tool side engaging portions 75c and 75d are the outer periphery of the bone fixing tool 75. A flat surface portion formed on a part of the surface may be used, and both flat surface portions may be engaged with each other in a state of facing each other. These are the same in the following eighth embodiment.

As a modification of the present embodiment, as shown in FIGS. 10 (b) and 10 (c), it is not due to the sliding motion after the operation, but intentionally along the axis of the bone fixative 75 in the insertion hole 71Aa at the time of the operation. By changing the position in the vertical direction, it is possible to configure the bone fixative 75 so that the possibility of sliding movement and the resistance force are changed. For example, a plurality of bones having different engagement structures by changing the presence or absence of the uneven shape of the inner bottom surface of the concave groove of the bone fixative side engagement portion and other aspects in the direction along the axis of the bone fixative 75. Fixture-side engaging portions are arranged along the axis of the bone fixative 75. In this way, the bones with respect to the implant body 71 are formed by forming a plurality of bone fixative side engaging portions having different engaging structures (the above-mentioned inner surface aspects) in the direction along the axis of the bone fixture 75. An embodiment can be configured such that the holding mode of the fixture 75 can be different. That is, in this modification, the propriety of the bone fixative 75 for the slide movement and the resistance force during the slide movement with respect to the implant body 71 are changed only by changing the position (depth) in the direction along the axis of the bone fixative 75. can do. Here, in the above-described present embodiment, as shown in FIGS. 10 and 11, the angular posture of the bone fixative 75 is changed according to the difference in fracture mode such as lateral fracture and subtrochanteric fracture. Also in this modified example, the propriety of the slide movement and the resistance force can be adjusted by changing the position of the bone fixative 75 in the direction along the axis so as to be suitable for the difference in the fracture mode.

Next, with reference to FIGS. 12 and 13, the configuration of the bone fixing device 80 according to the eighth embodiment of the present invention will be described. This embodiment shows a modified example of the overall configuration of the first embodiment. 12 and 13 are cross-sectional views showing the overall configuration of the bone fixation device 80 of the eighth embodiment and the application mode to the proximal femur. In the seventh embodiment, the implant body includes a plate portion installed on the bone surface, but also in the present embodiment, the implant body 81 is provided with a barrel portion 81A and a plate portion 81B. However, the implant body 81 of the present embodiment is different from the seventh embodiment in that the barrel portion 81A and the plate portion 81B are detachably configured. Further, as the implant body of the present invention, the barrel portion 81A of the present embodiment can be used alone, and a tubular sleeve body is provided in place of the barrel portion 81A, and the sleeve body is provided with a tubular sleeve body. It is also possible to construct a sliding screw that forms a bone engaging portion such as a cortical thread (thread that bites into the bone) that engages the inner surface of the perforated portion of the bone near the bone surface.

As shown in FIGS. 12 (b) and 13 (b), the implant body 81 of the present embodiment has a tubular barrel portion 81A inserted into the bone (proximal femur) and a surface of the bone. It has a structure in which a plate portion 81B installed (on the lateral portion of the femur) is detachably configured by a slide structure. The barrel portion 81A includes an insertion hole 81Aa penetrating in the axial direction from the tip end 81Ab to the base end 81Ac. At the tip 81Ab of the barrel portion 81A, the insertion hole 81Aa has an opening shape with a partially reduced angular position. In the case of the illustrated example, as shown in FIG. 13D, a main body side engaging portion 81Ad composed of a pair of protrusions protruding into the opening of the insertion hole 81Aa is formed at the tip 81Ab. However, the main body-side engaging portion 81Ad is not limited to such a protrusion, and has various engaging structures that can slidably engage with the bone-fixing-side engaging portion of the bone fixative 85 described later. Can be provided. For example, it may be composed of a flat portion provided on a part of a circular opening edge.

Further, the barrel portion 81A is provided with an overhanging portion 81Ae extending so as to project from the base end 81Ac to one side. The overhanging portion 81Ae is configured to be fitable to the end portion 81Be of the plate portion 81B. That is, the overhanging portion 81Ae of the barrel portion 81A and the end portion 81Be of the plate portion 81B are fitted to each other by sliding along the extension direction of the plate portion 81B. In the illustrated example, the end portion 81Be fits in a manner of accommodating the overhanging portion 81Ae. However, on the contrary, the structure may be such that the overhanging portion 81Ae is fitted so as to accommodate the end portion 81Be.

A plurality of openings 81Ba are provided in the plate portion 81B, and a bone fixative (cortical screw) 83 having a bone engaging portion 83a and a head 83b is inserted through these openings 81Ba. In the bone fixative 83, the plate portion 81B is placed on the outer surface of the lateral portion with the head portion 83b engaged with the seat surface 81Bb of the opening 81Ba and the bone engaging portion 83a engaged with the cortex of the trunk of the femur. Fix in a pressing manner.

A bone fixative 85 is inserted into the insertion hole 81Aa of the barrel portion 81A. As shown in FIGS. 12 (a) and 13 (a), the bone fixative 85 includes a bone engaging portion 85a including a tapping screw or the like that engages with the bone, and a shaft portion 85b. A plurality of bone fixative side engaging portions 85c and 85d are provided on the outer surface of the shaft portion 85b. In the illustrated example, the bone fixative side engaging portions 85c and 85d are concave grooves extending in the direction along the axis of the bone fixative 85, respectively. Here, as shown in FIGS. 12 and 13, the length of the bone fixative side engaging portion 85c in the direction along the axis is longer than the same length of the bone fixative side engaging portion 85d. Both of these bone fixative side engaging portions 85c and 85d engage with the main body side engaging portion 81Ad, thereby determining the holding mode of the bone fixative 85 with respect to the implant main body 81.

The base end 85b1 of the shaft portion 85b of the bone fixative 85 is formed to have a small diameter that can be inserted into the insertion hole 81Aa of the barrel portion 81A, despite the presence of the main body side engaging portion 81Ad provided at the tip 81Ab. Will be done. As a result, the manufacturer can insert the base end 85b1 into the barrel portion 81A, and the main body side engaging portion 81Ad can be inserted into either the bone fixing tool side engaging portion 85c or 85d of the bone fixative 85. After engaging with the barrel portion 81A, the tubular mounting body 85b2 can be mounted and fixed to the base end 85b1 from the side of the base end 81Ac of the barrel portion 81A. The method of fixing the mounting body 85b2 to the base end 85b1 is not particularly limited, but for example, welding can be used to reliably fix the mounting body 85b2. In this way, as shown in FIGS. 12 (b) and 12 (c) and FIGS. 13 (b) and 13 (c), the bone fixative 85 has a bone fixator toward the proximal end side with respect to the barrel portion 81A. By the ends of the side engaging portions 85c and 85d, the tip side is in a state of being prevented from coming off on both sides by the mounting body 85b2, respectively. Thereby, the slide range of the bone fixative 85 with respect to the implant body 81 is defined by providing the movement limit positions on both the proximal end side and the distal end side, respectively.

As shown in FIG. 12 (d), the assembly of the bone fixative 85 and the barrel portion 81A is introduced into the femoral bone head, and the engaging portion 91a at the tip of the shaft portion 91 of the tool 90 is passed through the barrel portion 81A. Is engaged with the tool engaging portion 85f formed at the base end of the bone fixing tool 85, and the bone fixing tool 85 is in a state of being most projected toward the tip side with respect to the barrel portion 81A. At this time, the bone fixative 85 has a small-diameter portion in which the base end 85b1 is exposed in a portion on the distal end side of the attachment body 85b2, and the small-diameter portion is around the axis with the main body-side engaging portion 81Ad of the tip 81Ab. It is shaped so that it does not engage with. Therefore, assuming that the bone fixative 85 is most projected toward the tip side with respect to the barrel portion 81A, the bone fixative 85 can be freely rotated with respect to the barrel portion 81A, and thus the tool 90 can be used. The bone engaging portion 85a can be screwed into a state of being engaged with the bone at a suitable depth without rotating the barrel portion 81A. After that, after setting the angular posture around the axis of the bone fixative 85 to a predetermined posture, the barrel portion 81A of the implant body 81 is pushed in, and as shown in FIG. 13 (e), the overhanging portion of the barrel portion 81A. It is assumed that 81Ae is abutted on the surface of the bone.

Here, by forming a fitting structure with a key between the engaging portion 91a of the tool 90 and the tool engaging portion 85f of the bone fixative 85, the two are configured to engage only in a certain angle posture. At the same time, the angular posture of the bone fixative 85 can be known by observing the angular posture of the display 92 and the handle 93 displayed on the shaft portion 91. As a result, by looking at the proximal end side portion of the tool 90 (particularly, the visible portion on the hand side from the portion hidden in the patient's body), the bone fixator side engaging portion 85c, 85d of the bone fixator 85 can be seen. Since the angle position can be known, the angle position can be appropriately set during the operation. Here, the display 92 and the handle 93 constitute a posture identification means that indicates the posture (angled posture around the axis) of the bone fixative 85.

As shown in FIGS. 12 (b) and 12 (c), if the angular posture around the axis of the bone fixative 85 is adjusted so that the engaging portion 85c on the bone fixing device side faces the illustrated vertical direction, the barrel portion 81A The main body side engaging portion 81Ad is fitted to the bone fixing device side engaging portion 85c, and the bone fixing tool 85 is restricted from rotating around the axis of the implant main body 81 and is a distance along the axis. Only A is a slidable holding mode.

On the other hand, when the angular posture of the bone fixture 85 is adjusted so as to be an angular position 90 degrees different from the angular position in FIG. 12, as shown in FIGS. 13 (b) and 13 (c), the main body side. The engaging portion 81Ad fits into the engaging portion 85d on the bone fixture side. At this time, the bone fixative 85 is restricted in rotation around its axis as described above, and can slide by a distance B in the direction along the axis.

As described above, in the bone fixing device 80 of the present embodiment, the bone fixing tool 85 is restricted from rotating around the axis of the barrel portion 81A with respect to the implant body 81 and is slidably held in the direction along the axis. Therefore, in the case of a patient with osteoporosis (as shown in FIG. 12), a large slide range is secured assuming that the bone engaging portion 85a of the bone fixture 85 moves in the axial direction in the bone. However, in the applied state shown in the figure, by setting the retractable slide amount to A, it is possible to prevent the head of the bone from falling toward the fractured portion and causing problems such as cutout. On the other hand, in the case of a normal patient (as shown in FIG. 13), since the head of the bone is less depressed and the risk of cutout is low, the slide range is suppressed, and the slide amount that can be retracted in the illustrated application state is described above. It can be B, which is smaller than A. At this time, as described above, a part of the slide range, that is, the position where the bone fixative 85 protrudes most toward the tip side with respect to the barrel portion 81A in the illustrated example (the main body side engaging portion 81Ad is the base end portion 85b). Since the bone fixative 85 can rotate with respect to the barrel portion 81A at the position in the axial direction facing the small diameter portion), the partner with which the main body side engaging portion 81Ad engages with a plurality of bone fixing tool side engaging portions. It will be possible to change between 85c and 85d. Therefore, in the case of the illustrated example, if the barrel portion 81A is set to the most separated state from the bone surface, the bone fixative 85 can be rotated to change the engaging partner.

As a modification of the present embodiment, similarly to the contents described in the seventh embodiment, the bone fixture side engaging portions having different engaging structures are arranged in the direction along the axis of the bone fixture 85. By doing so, as shown in FIGS. 12 (b) and 12 (c) and FIGS. 13 (b) and 13 (c), the position of the bone fixative 85 in the insertion hole 81Aa along the axis is changed to change the position of the bone. It is possible to change whether or not the fixture 85 has a slide motion and the resistance force of the slide motion. Here, in the present embodiment, as shown in FIGS. 12 and 13, the angular posture of the bone fixative 85 is changed according to the difference between the osteoporotic bone and the clean bone, but this modification is achieved. Also in the example, by changing the position of the bone fixative 85 along the axis according to the difference in bone quality, it is possible to change the propriety of sliding movement and the resistance force.

Further, in the present embodiment, the implant body 81 in which the barrel portion 81A and the plate portion 81B are detachably configured is used, but the plate portion 81B is unnecessary and the implant main body is a cylindrical sleeve portion instead of the barrel portion 81A. The bone fixing device of the present invention can also be applied to an implant such as a sliding screw provided with a bone fixing device that can slide with respect to the sleeve portion. In such a sliding screw, not only the bone fixing portion is provided with the bone engaging portion, but also another (second) such as a screw thread that engages with the bone cortex on the outer surface of the sleeve portion corresponding to the implant body. ) It is preferable to provide a bone engaging portion.

Each of the embodiments described above has the following effects. Each of the above-mentioned bone fixtures includes the above-mentioned first bone-fixing tool-side engaging portion and the second bone-fixing tool-side engaging portion that can be engaged with the above-mentioned body-side engaging portion, and the first one. The bone fixture side engagement portion and the second bone fixture side engagement portion have different engagement structures, and the implant body when the main body side engagement portion engages with the first bone fixture side engagement portion. The first holding mode of the bone fixture with respect to the bone fixture is different from the second holding mode of the bone fixture with respect to the implant body when the main body side engaging portion engages with the second bone fixing tool side engaging portion. Therefore, the holding mode of the bone fixing tool can be appropriately set and changed only by selecting the engaging portion on the bone fixing tool side of the bone fixing tool. Therefore, the holding mode of the bone fixative can be selected from a plurality of modes and realized, and the adjustment work of the main body side engaging portion performed at the time of surgery for that purpose becomes unnecessary. Further, since it is only necessary to switch a plurality of engaging structures provided on the bone fixative to engage with the main body side engaging portion, a desired holding mode of the bone fixative can be surely and easily realized. That is, when realizing any of a plurality of holding modes different from each other, it is not necessary to perform a delicate and unstable operation such as a conventional set screw return setting, and a plurality of set members corresponding to the different holding modes are not required. It is not necessary to prepare and select and use them.

Further, since the holding mode of the bone fixative can be changed by changing the angular posture around the axis of the bone fixator, the selection work can be further easily performed. At this time, by providing the first bone fixative-side engaging portion and the second bone-fixing-side engaging portion at different angle positions around the axis, selection work and manufacturing are facilitated. The first bone fixator-side engaging portion and the second bone-fixture-side engaging portion each have a shape extended along the axis of the bone fixator, and the positions in the directions along the axis are mutually. By providing a common formation range in the above, it is possible to select one of the bone fixative side engaging portions and change the holding mode of the bone fixator without changing the arrangement of the bone fixator in the direction along the axis. ..

Further, in each of the plurality of holding modes realized in each of the above embodiments, the rotation of the bone fixative with respect to the implant body is restricted, so that the rotation of the fractured portion can be suppressed. Such a configuration can be realized, for example, when the engaging portion on the bone fixative side is a concave groove or a convex groove and the engaging portion on the main body side is a convex groove or a concave groove. Further, the bone fixative side engaging portion is a flat portion formed on the outer surface of the bone fixative, and the main body side engaging portion is a flat portion that can be engaged facing the bone fixative side engaging portion. May be good.

Further, the first holding mode allows the bone fixative to move along the axis of the bone fixator, and the second holding mode allows at least the first holding of the movement of the bone fixator along the axis of the bone fixator. By restricting the bone in a mode that restrains the bone rather than the mode, the restrained state in the direction along the axis of the bone fixture with respect to the implant body can be changed according to the fracture mode, so that the optimum fixed state for the fractured portion can be realized. In this case, the contour shape of the second bone fixing tool side engaging portion along the direction orthogonal to the axis of the bone fixing tool corresponds to the contour shape of the main body side engaging portion. Since the contact area can be increased when the joint portion is brought into contact with the second bone fixative side engaging portion, the movement of the bone fixative along the axis can be easily regulated.

Further, the first holding mode enables the movement of the bone fixture along the axis of the bone fixture with respect to the implant body over the first range, and the second holding mode is the axis of the bone fixture with respect to the implant body. By allowing movement over a second range different from the first range of the bone fixture along, the range of movement along the axis of the bone fixture with respect to the implant body can be changed according to the fracture mode. , It is possible to realize the optimum holding mode of the bone fixture for the fractured state.

Further, as in the first to sixth embodiments, the main body side engaging portion is provided on the engaging member, and the main body side engaging portion is the first bone fixing tool side engaging portion and the second bone fixing. Between the separated arrangement separated from the tool side engaging portion and the engaging arrangement in which the main body side engaging portion engages with the first bone fixing tool side engaging portion and the second bone fixing tool side engaging portion. Since the engaging member is configured to be movable, the implant main body is arranged separately regardless of the engaging structure between the main body side engaging portion and the bone fixture side engaging portion. It is possible to release the predetermined holding mode of the bone fixture with respect to. In particular, in the separated arrangement, the main body side engaging portion does not protrude into the insertion hole, and in the engaged arrangement, the main body side engaging portion protrudes into the insertion hole. The fixture can be inserted into the insertion hole without any trouble, and the bone fixator can be easily held in the implant body when the bone fixator is in the engaging arrangement. In this case, although the operation for moving the engaging member between the separated arrangement and the engaging arrangement is necessary, the work for switching between the first holding mode and the second holding mode of the bone fixative is described above. It is unnecessary as well.

In the above case, a screwing structure is provided in which the engaging member or the member for positioning the engaging member and the implant body or the member held by the implant body are screwed around the axis intersecting the insertion hole. Since the separated arrangement and the engaging arrangement of the engaging members are realized by changing the screwing depth of the screwing structure, the arrangement of the engaging members can be easily changed by using the screwing structure. Here, when the main body side engaging portion engages with the first bone fixture side engaging portion, the engaging member in the engaging arrangement abuts on the implant main body or the held member in the direction of the axis. Positioned by being restricted, when the body-side engaging portion engages with the second bone-fixing-side engaging portion, the engaging member in the engaging arrangement abuts on the bone-fixing device in the direction of the axis. By being positioned by being restricted to, the engaging member is positioned in a state where the axial force acts on the screw structure in any holding mode of the bone fixture, so that the screw structure is prevented from loosening. can.

Further, as in the seventh embodiment and the eighth embodiment, the main body side engaging portion is fixedly provided in the implant main body, so that the operation on the main body side engaging portion can be completely eliminated. In this case, when the bone fixture is configured to be slidable within a predetermined slide range along the direction of the axis with respect to the implant body in at least one of the first holding mode and the second holding mode, the said person concerned. In at least a part of the slide range, the first bone fixture side engagement portion is engaged with the main body side engagement portion and the second bone fixture side engagement portion is engaged with the main body side engagement portion. By providing a structure that can change the state in which the parts are engaged, it is possible to switch the holding mode while the bone fixture is inserted into the insertion hole, so that the work during the operation can be easily performed. Become. In particular, when the bone fixative is prevented from coming off from the implant body, it becomes an indispensable structure for switching the holding mode.

The bone fixing device of the present invention is not limited to each of the above embodiments, and various modifications included in the scope of the present invention can be applied. For example, in each of the above embodiments, as differences in the holding mode of the bone fixative with respect to the implant body, the presence or absence of restrictions on the slide motion of the bone fixative, the propriety of the slide motion, the length of the slide range of the slide motion, and the like are realized. Although the case has been described, the present invention is not limited to such a difference in the holding mode, for example, whether or not there is a restriction on the rotational movement around the axis of the bone fixative, whether or not the rotational movement is possible, and the rotational movement. It can also be applied when realizing the magnitude of the rotation range of. In addition, the "holding mode" in the present specification refers to a mode in which the bone fixative is held with respect to the implant body, and as described above, not only the fixed mode but also the bone fixator with respect to the implant body. Movable embodiments are also included, and the "different holding embodiments" in this embodiment include cases where the arrangement and width of the movable range are different from each other. The configuration for providing different holding modes in such a case is not limited to the configurations of the seventh and eighth embodiments (CHS system), but is also applied to the intramedullary fixation system such as the first to sixth embodiments. Can be done.

In the present invention, as described as a modification of the seventh embodiment and the eighth embodiment, the present invention is not limited to the case where the bone fixator side engaging portion having different engaging structures is arranged at different angular positions of the bone fixative. , Bone fixture side engaging portions with different engaging structures may be placed at different axial positions of the bone fixative. This point can also be applied to the intramedullary fixation system such as the first to sixth embodiments. Further, as an arrangement mode of the bone fixture side engaging portions having different engagement structures, a plurality of bone fixture side engagements having different engagement structures at both different axial positions and different angle positions. The portions may be arranged, or a plurality of bone fixture-side engaging portions having different engaging structures may be provided at different portions in both the axial position and the angular position. Further, the arrangement mode of the plurality of bone fixative-side engaging portions having different engaging structures is not limited to the case where the plurality of bone-fixture-side engaging portions are arranged separately from each other, and is continuous with each other. It may be formed in such a manner that it is connected to each other. Here, in the bone fixative side engaging portion, the engaging structure with respect to the main body side engaging portion is continuously directed toward at least one of the direction along the axis of the bone fixative and the circumferential direction around the axis. Alternatively, a structure that gradually changes is also an example of a configuration in which a plurality of bone fixative-side engaging portions having different engaging structures are provided.

The implant body and the bone fixative according to the present invention may each have a configuration in which a plurality of members are detachably connected to each other. For example, the present invention is provided on the intramedullary nail body as in the first to sixth embodiments, a sleeve inserted through a transverse hole of the intramedullary nail body, and the intramedullary nail body acting on the sleeve. It can also be applied to a bone fixing device including an engaging member such as a set screw or other connecting tool, and a lug screw inserted into the sleeve. Examples of such configurations to be applied include those described in JP-A-9-66061, JP-A-4-215751 and JP-A-5-176942. In this case, it is also possible to grasp the intramedullary nail body as an implant body and the lag screw and sleeve as a bone fixative, and apply the present invention. However, it is also possible to grasp the intramedullary nail body and the sleeve as the implant body and the lag screw as the bone fixative, and apply the present invention. In the latter case, the main body side engaging portion is provided on the inner surface of the sleeve, but the main body side engaging portion may be fixedly formed as in the seventh and eighth embodiments, or the above. A part of the wall surface may be movable by providing a slit on the wall surface of the sleeve, and the drive member incorporated in the intramedullary nail body may be configured to be operable by abutting the wall surface from the outside.

10, 30, 40, 50, 60, 70, 80 ... Bone fixation device, 11 ... Implant body (intramedullary nail body), 11x ... Axis line, 11A ... Base end side region, 11B ... Tip side region, 11a ... Shaft hole , 11b ... Base end opening, 11c ... Key groove, 11d ... Female screw, 12, 13, 14A, 14B ... Cross hole, 12x, 13x, 14ax, 14bx, 14by ... Axis line, 15, 23, 25 ... Bone fixative, 15a ... Shaft hole, 15x ... Axis line, 15s ... Bone engaging part, 15b ... Connecting part, 15c, 15d ... Bone fixture side engaging part, 15k ... Key groove, 16 ... Engaging member, 16a ... Shaft hole, 16s ... Main body side engaging portion, 16b ... Base end, 16c ... Insertion hole, 16d ... Female screw, 16e ... Vertical groove, 16f ... Vertical groove upper end, 17 ... Elastic member, 18 ... Drive member, 18a ... Shaft hole, 18b ... Base end, 18c ... Tool engaging, 18d ... Male screw, 19 ... Holding member, 19a ... Opening, 21A, 21B ... End cap, 21Aa21Bb ... Tip, 21Ab, 21Bb ... Tool engaging, 21Ac, 21Bc ... Male screw, 21Ad, 21Bd ... Stepped part, 22 ... Restriction pin, 22a ... Regulation part, LL ... Lock line, FL ... Free line

Claims (25)

A bone fixator having a bone engaging portion that engages with the bone and a shaft portion extending from the bone engaging portion and having a bone fixing device side engaging portion on the shaft portion.
An implant body placed inside or on the surface of a bone, the bone fixing tool side engaging portion arranged inside the insertion hole and having an insertion hole through which the shaft portion of the bone fixing tool is inserted. With the implant body, including a body-side engaging portion that holds the bone fixture to the implant body by engaging with
Equipped with
The bone fixative has a first bone fixative-side engaging portion and a second bone-fixing-side engaging portion that can be engaged with each other.
The first bone fixative-side engaging portion and the second bone-fixture-side engaging portion have different engagement structures with respect to the main body-side engaging portion.
The first holding mode of the bone fixture with respect to the implant body when the main body side engaging portion engages with the first bone fixture side engaging portion, and the main body side engaging portion is the second. Unlike the second holding mode of the bone fixture with respect to the implant body when engaged with the bone fixture side engaging portion of the bone fixture.
The first bone fixative-side engaging portion and the second bone-fixing-side engaging portion are provided at different angle positions around the axis of the bone fixator.
The angular posture around the axis of the bone fixture with respect to the implant body when the main body side engaging portion engages with the first bone fixture side engaging portion, and the main body side engaging portion is the first. The angular posture around the axis of the bone fixture with respect to the implant body when engaged with the bone fixture side engaging portion of 2 is different from each other in response to the difference in the angular position.
Bone fixation device. Both the first bone fixative-side engaging portion and the second bone-fixing-side engaging portion have a shape extended along the axis of the bone fixative, and the bone fixative has a shape. A formation range in which the positions in the direction along the axis are common to each other is provided.
The bone fixing device according to claim 1. Both the first holding mode and the second holding mode regulate the rotation of the bone fixative with respect to the implant body around the axis.
The bone fixing device according to claim 1 or 2. The engaging portion on the bone fixing device side is a concave groove or a ridge formed on the outer surface of the bone fixing device.
The main body side engaging portion is a convex portion or a concave portion that can be fitted to the bone fixative side engaging portion.
The bone fixing device according to claim 3. A bone fixator having a bone engaging portion that engages with the bone and a shaft portion extending from the bone engaging portion and having a bone fixing device side engaging portion on the shaft portion.
An implant body placed inside or on the surface of a bone, the bone fixing tool side engaging portion arranged inside the insertion hole and having an insertion hole through which the shaft portion of the bone fixing tool is inserted. With the implant body, including a body-side engaging portion that holds the bone fixture to the implant body by engaging with
Equipped with
The bone fixative has a first bone fixative-side engaging portion and a second bone-fixing-side engaging portion that can be engaged with each other.
The first bone fixative-side engaging portion and the second bone-fixture-side engaging portion have different engagement structures with respect to the main body-side engaging portion.
The first holding mode of the bone fixture with respect to the implant body when the main body side engaging portion engages with the first bone fixture side engaging portion, and the main body side engaging portion is the second. Unlike the second holding mode of the bone fixture with respect to the implant body when engaged with the bone fixture side engaging portion of the bone fixture.
The first bone fixative-side engaging portion and the second bone-fixing-side engaging portion both regulate the rotation of the bone fixative with respect to the implant body around the axis.
The engaging portion on the bone fixing device side is a concave groove or a convex shape formed on the outer surface of the bone fixing device.
The main body side engaging portion is a convex portion or a concave portion that can be fitted to the bone fixative side engaging portion.
The first holding mode allows the bone fixative to move along the axis of the bone fixator.
The second holding aspect regulates the movement of the bone fixing device along the axis of the bone fixing device at least in a manner that restrains the movement of the bone fixing device more than the first holding mode.
Bone fixation device. The second bone fixative side engaging portion has a shape whose contour shape along a direction orthogonal to the axis of the bone fixing tool corresponds to the contour shape of the main body side engaging portion.
The bone fixing device according to claim 5. The first bone fixative-side engaging portion accommodates the main body-side engaging portion and is relatively deep inside the first holding mode between the main body-side engaging portion and the main body-side engaging portion. It has a relatively low top that is housed in the bottom or the body-side engaging portion and allows the first holding mode to be realized between the bottom and the body-side engaging portion.
The second bone fixative-side engaging portion accommodates the main body-side engaging portion and is relatively shallow so as to realize the second holding mode between the second main body-side engaging portion and the main body-side engaging portion. It is housed in the bottom portion or the main body side engaging portion, and has a relatively high top portion between the main body side engaging portion and the main body side engaging portion, which enables the second holding mode to be realized.
The bone fixing device according to claim 5 or 6. The first bone fixative-side engaging portion is a relatively wide second that accommodates the main body-side engaging portion and enables the first holding mode to be realized between the first main body-side engaging portion and the main body-side engaging portion. A relatively narrow first ridge width that is accommodated in the groove inner width 1 or the main body side engaging portion and enables the first holding mode to be realized with the main body side engaging portion. Have and
The second bone fixative side engaging portion is a relatively narrow second that accommodates the main body side engaging portion and enables the second holding mode to be realized between the second main body side engaging portion and the main body side engaging portion. A relatively wide second ridge width that is accommodated in the groove inner width of 2 or the main body side engaging portion and enables the second holding mode to be realized with the main body side engaging portion. Prepare, prepare
The bone fixing device according to claim 5 or 6. The bone fixative side engaging portion is a flat portion formed on the outer surface of the bone fixative.
The main body side engaging portion is a flat portion that can be engaged facing the bone fixative side engaging portion.
The bone fixing device according to any one of claims 3 to 8. A bone fixator having a bone engaging portion that engages with the bone and a shaft portion extending from the bone engaging portion and having a bone fixing device side engaging portion on the shaft portion.
An implant body placed inside or on the surface of a bone, the bone fixing tool side engaging portion arranged inside the insertion hole and having an insertion hole through which the shaft portion of the bone fixing tool is inserted. With the implant body, including a body-side engaging portion that holds the bone fixture to the implant body by engaging with
Equipped with
The bone fixative has a first bone fixative-side engaging portion and a second bone-fixing-side engaging portion that can be engaged with each other.
The first bone fixative-side engaging portion and the second bone-fixture-side engaging portion have different engagement structures with respect to the main body-side engaging portion.
The first holding mode of the bone fixture with respect to the implant body when the main body side engaging portion engages with the first bone fixture side engaging portion, and the main body side engaging portion is the second. Unlike the second holding mode of the bone fixture with respect to the implant body when engaged with the bone fixture side engaging portion of the bone fixture.
The first holding aspect allows the implant body to move along the axis of the bone fixator over the first range of the bone fixator.
The second holding aspect allows movement of the bone fixator along the axis of the bone fixator to the implant body over a second range different from the first range.
Bone fixation device. The main body side engaging portion is provided on the engaging member, and the main body side engaging portion is separated from the first bone fixing tool side engaging portion and the second bone fixing tool side engaging portion. The engaging member can be moved between the engagement arrangement in which the main body side engaging portion engages with the first bone fixing tool side engaging portion and the second bone fixing tool side engaging portion. Composed,
The bone fixing device according to any one of claims 1 to 10. In the separated arrangement, the main body side engaging portion does not protrude into the insertion hole, and the engaging portion does not protrude into the insertion hole.
In the engagement arrangement, the main body side engaging portion projects into the insertion hole.
The bone fixing device according to claim 11. A screwing structure is provided in which the engaging member or a member for positioning the engaging member and the implant body or a member held by the implant body are screwed around an axis intersecting the insertion hole. The separated arrangement and the engaging arrangement of the engaging member are realized by changing the screwing depth of the screwing structure, respectively.
The bone fixing device according to claim 11 or 12. When the body-side engaging portion engages with the first bone fixative-side engaging portion, the engaging member in the engaging arrangement abuts on the implant body or the held member. Positioned by being regulated in the direction of the axis,
When the body-side engaging portion engages with the second bone fixative-side engaging portion, the engaging member in the engaging arrangement abuts on the bone fixative and is restricted in the direction of the axis. Positioned by being
The bone fixing device according to claim 13. The implant body has an operating hole that intersects and communicates with the insertion hole.
Further, an engaging member is further provided inside the operation hole, which is movably arranged in a direction along the axis of the operation hole and configured to be movable in a direction along the axis of the operation hole.
The main body side engaging portion is provided on the engaging member.
The bone fixing device according to any one of claims 1 to 10. The engaging member is supported by an elastic force with respect to the implant body along the axis of the operation hole toward the side opposite to the insertion hole.
The bone fixing device according to claim 15. A bone fixator having a bone engaging portion that engages with the bone and a shaft portion extending from the bone engaging portion and having a bone fixing device side engaging portion on the shaft portion.
An implant body placed inside or on the surface of a bone, the bone fixing tool side engaging portion arranged inside the insertion hole and having an insertion hole through which the shaft portion of the bone fixing tool is inserted. With the implant body, including a body-side engaging portion that holds the bone fixture to the implant body by engaging with
Equipped with
The bone fixative has a first bone fixative-side engaging portion and a second bone-fixing-side engaging portion that can be engaged with each other.
The first bone fixative-side engaging portion and the second bone-fixture-side engaging portion have different engagement structures with respect to the main body-side engaging portion.
The first holding mode of the bone fixture with respect to the implant body when the main body side engaging portion engages with the first bone fixture side engaging portion, and the main body side engaging portion is the second. Unlike the second holding mode of the bone fixture with respect to the implant body when engaged with the bone fixture side engaging portion of the bone fixture.
The implant body has an operating hole that intersects and communicates with the insertion hole.
Further, an engaging member is further provided inside the operation hole, which is movably arranged in a direction along the axis of the operation hole and configured to be movable in a direction along the axis of the operation hole.
The main body side engaging portion is provided on the engaging member, and the engaging portion is provided on the engaging member.
A screwing structure is provided in which the engaging member or the member for positioning the engaging member and the implant body or the member held by the implant body are screwed to each other, and the engaging member is screwed. Positioned along the axis of the operating hole according to the threading depth of the structure ,
In the first holding mode, the main body side engaging portion has a gap in the direction along the axis of the operating hole between the main body side engaging portion and the first bone fixative side engaging portion.
In the second holding mode, the main body side engaging portion abuts against the second bone fixative side engaging portion in the direction along the axis of the operation hole.
The position of the operating hole of the engaging member with respect to the implant body in the first holding mode in the direction along the axis is the engaging member or the positioning member and the implant body or the held member. Specified by the movement limit position in the direction along the axis of the operating hole between
In the second holding mode, the position of the engagement member with respect to the implant body in the direction along the axis of the operation hole is such that the body-side engaging portion has the second position before reaching the movement limit position. Specified by contacting the engaging part on the bone fixative side,
Bone fixation device. The engaging member is supported by an elastic force with respect to the implant body along the axis of the operation hole toward the side opposite to the insertion hole.
The bone fixing device according to claim 17. Further including a driving member configured to be screwed into the engaging member inside the operating hole and to be able to drive the engaging member in a direction along the axis of the implant body by rotation thereof.
The bone fixation device according to claim 17 or 18. A driving member configured to be screwed into the implant body inside the operation hole and abutted against the engaging member, and the engaging member can be driven in a direction along the axis of the implant body by the contact. Including,
The bone fixation device according to any one of claims 17 to 19. The implant body is an intramedullary nail body that extends along the axis and is inserted into the spinal cord.
The insertion hole is a cross hole formed so as to cross the axis of the intramedullary nail body.
The operation hole is a shaft hole provided along the axis and having an open end at the proximal end.
The bone fixing device according to any one of claims 17 to 20. A bone fixator having a bone engaging portion that engages with the bone and a shaft portion extending from the bone engaging portion and having a bone fixing device side engaging portion on the shaft portion.
An implant body placed inside or on the surface of a bone, the bone fixing tool side engaging portion arranged inside the insertion hole and having an insertion hole through which the shaft portion of the bone fixing tool is inserted. With the implant body, including a body-side engaging portion that holds the bone fixture to the implant body by engaging with
Equipped with
The bone fixative has a first bone fixative-side engaging portion and a second bone-fixing-side engaging portion that can be engaged with each other.
The first bone fixative-side engaging portion and the second bone-fixture-side engaging portion have different engagement structures with respect to the main body-side engaging portion.
The first holding mode of the bone fixture with respect to the implant body when the main body side engaging portion engages with the first bone fixture side engaging portion, and the main body side engaging portion is the second. Unlike the second holding mode of the bone fixture with respect to the implant body when engaged with the bone fixture side engaging portion of the bone fixture.
The main body side engaging portion is fixedly provided in the implant main body.
Bone fixation device. In at least one of the first holding mode and the second holding mode, the bone fixator is configured to be movable within a predetermined range along the direction of the axis of the bone fixator with respect to the implant body. Ru,
The bone fixing device according to claim 22. A first movable range along the axial direction of the bone fixture with respect to the implant body when the main body side engaging portion and the first bone fixture side engaging portion are engaged. The second movable range along the axial direction of the bone fixture with respect to the implant body when the main body side engaging portion and the second bone fixture side engaging portion are engaged is different,
The bone fixing device according to claim 23. In at least a part of the predetermined range, the state in which the first bone fixative side engaging portion is engaged with the main body side engaging portion and the second state with respect to the main body side engaging portion. It has a structure that can change the state in which the engaging part on the bone fixture side is engaged.
The bone fixing device according to claim 22 or 23.

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