JPH08112290A - Surgical operation apparatus for percutaneous connection - Google Patents

Abstract

PURPOSE: To facilitate the operation and to set and hold the fracture completely arrayed after synthesis is completed by comprising a pole-shaped bone plate having inclined joint holes or perpendicular joint holes, and long and short screws for attaching the plate to the fracture portion or the femur. CONSTITUTION: A bone plate I includes a main portion 1 under the line and a head portion 2 curved outwardly against the main portion 1 to match the shape of the bone. The head portion 2 has a large screw hole 3 and two small holes 4 for connecting to the horizontal portion of the joint arm. Following the head portion 2 are two screw holes 5 oriented to an inclined direction and penetrating the main portion 1 at an angle of about 130 degrees. The outer surface of that part of the main portion 1 becomes thicker due to two protrusions 6, therefore the length of the screw holes 5 become longer. Under the two screw holes there are three countersinks 7 which are opened though the main portion 1 at right angles to the main portion 1.

Description

Detailed Description of the Invention

[0001]

FIELD OF THE INVENTION This invention relates to an improvement on the surgical instrument disclosed in Applicant's U.S. Pat. No. 4,465,065. The surgical instrument serves to connect the fractured neck of the femur to the femoral shaft by means of a pre-drilled connecting plate without the need to make large incisions in the skin or tissue.

[0002]

2. Description of the Prior Art The connecting plate according to the invention described above and the invention has a sharply pointed lower edge which allows the connecting plate to pass through a small incision in the trochanter area, Contact with femoral shaft. During surgery, the connecting plate is temporarily attached to the horizontal part of the connecting arm,
At the same time, the vertical portion of the connecting arm extends parallel to the connecting plate and comprises a hole which is coaxial with the hole in the connecting plate. The concentric guide tube is inserted through the hole in the horizontal part of the connecting arm, pushed through the soft tissue to the connecting plate and serves as a guide for pre-drilling the bone part at the correct position to be observed by the X-ray machine. . After pre-drilling, the inner guide tube is removed and the outer tube serves for the insertion of a long screw and is later removed. The long screw is tightened to contact the fractured part. Here, after properly drilling through the tube inserted in the hole of the connecting plate that is coaxial with the hole of the connecting plate, a short screw, which helps to securely attach the connecting plate to the femoral shaft,
Insert through the vertical part of the connecting arm. Here, the connecting arm is removed from the connecting plate to close the wound.

[0003]

The surgical instrument of the present invention is similar and serves the same purpose, but avoids certain drawbacks of the original surgical instrument found during use in the type of surgery referred to. It has become. The main drawback is that long screws do not allow active tightening of the fracture, which is the most important task for quick bone treatment and quick use of the limbs by the patient, and that the long screws guide well into the holes of the connecting plate. It often happens that the fractured part after connection is unstable and the long screw is
When the patient begins to walk and pressure is applied to the fracture, they project from the bone into the soft tissue and the tether cannot be securely attached to the femur, which is difficult to puncture during surgery.

The surgical instrument according to the invention aims at eliminating these drawbacks by providing an improved component, which on the one hand accelerates the progression of the surgery and in a short time. , On the other hand, after fully interlocking, tighten the fracture and hold it in full alignment. Furthermore,
Sufficient space is provided to slide axially from the connecting screw while preventing it from protruding from the connecting plate.

[0005]

Before going into the detailed description of the structure of the surgical instrument, the following directional expressions shall be used for the femur, tool, connecting plate, screw during surgery. Please be careful. The expressions "top" and "upper part" in any part refer to the top of the femur, either "bottom" or "lower part".
Indicates the direction toward the knee joint. The expression "inner" or "inner part" refers to the part of the bone that is closer to or outside the bone, while "outer".
Alternatively, "outer part" refers to the part of the person being operated on, or facing away from the bone.

An improved surgical instrument for connecting and securing the fractured neck of the femur to the femoral shaft is described in (A)
It has components that remain in the body after surgery. This component comprises (1) a connecting plate that is substantially rectangular in shape with a straight lower portion having a pointed end that allows insertion through a small incision in the skin. Sectioned and pushed along the femur to a final position through soft tissue. The upper end of the connecting plate is short and bent outward to fit the contour of the bone. The connecting plate is pierced by at least one straight hole and a screw hole which serves to connect the connecting plate to a holding tool. The upper part of the straight part is penetrated by two diagonally oriented screw holes and the lower part is penetrated by two or more straight countersinks, all of which are drilled to pre-drill the bone part. It is used to guide and securely attach the connecting plate to the femoral shaft and insert screws to connect the fractures. The component further comprises (2) two long screws, which are used to connect the fractured part to the connecting plate and which are secured in the longitudinal and rotational direction with a relatively short sleeve. Has an outer end guided to. Extending through the superior hole through the neck of the femur and screwed to the head portion, the outer end of the sleeve is held securely in the screws of the two superior holes of the connecting plate, thus placing the screw in a secure position. Allows for axial movement as well as retention. The outer ends of the screws are recessed, each with a concentric recess of hexagonal or other polygonal cross section that follows the screw hole. The inner end of the sleeve is slightly bent to prevent the screw from slipping out of the sleeve by contacting the shoulder of the screw. The component further comprises (3) two or more short screws that attach the lower portion of the connecting plate to the femoral shaft and hide the head in the countersink. The improved surgical instrument further comprises (B) an ancillary instrument for insertion and fixation of a permanent component, the ancillary instrument including (1) a short horizontal plate for coupling to the upper end of the coupling plate. And a rectangular connecting arm including a portion and a longer vertical portion extending parallel to the direction of the connecting plate. The vertical section is pierced by two diagonally oriented holes and a more straight hole, all of which are coaxial with the holes in the connecting plate and have a larger diameter, to allow passage and fixation of the guide tube. Tolerate. The angular connecting arm preferably comprises a set screw for positioning the guide tube and means at its lower end for mounting the aiming device. The short horizontal portion extends longitudinally and includes a long screw and at least one protruding pin for engaging a threaded hole and a straight hole in the upper end of the connecting plate. The ancillary device further comprises (2) two long compound guide tubes of sufficient length to extend through the holes in the connecting arms corresponding to the diagonal holes in the connecting plate. These include an outer tube with an inner diameter corresponding to the diameter of the screw to be inserted and screwed into the fractured neck and two inner movable tubes, ie concentric with the diameter of the guide wire to be pushed into the bone. It includes a first tube pierced and a second tube concentrically pierced to a diameter of a drill suitable for piercing two long screw threads. Auxiliary instruments include (3) straight holes in the connecting arm up to the corresponding holes in the connecting plate that help pre-drill the bone before the final insertion of screws to securely attach the connecting plate to the femoral shaft. Further comprises two or more shorter guide tubes for insertion into the. The auxiliary device (4) is equipped with a special screwdriver suitable for inserting and fixing long screws and sleeves in the connecting plate and the fractured part.

The auxiliary device is removed from the body after the connecting plate is securely connected to the femoral shaft, the fractures are connected and properly tightened by the long screw, and then the wound is bandaged.

Surgery is performed as described above in conjunction with the surgical instrument disclosed in US Pat. No. 4,465,065, wherein in the surgical instrument according to the present invention, the long screw is in the hole of the connecting plate. Both active and passive movements in the axial direction are possible with each sleeve having screw ends that are positively connected. This feature allows the surgeon to actively tighten the fracture, preventing the head of the screw from gradually protruding into the soft tissue and irritating or injuring. Moreover, the improved assistive device according to the present invention not only facilitates surgery, but also takes less time than before, which is of great benefit to both the patient and the surgeon.

The method and procedure for femoral fractured neck surgery will be described in detail with reference to the drawings, which illustrate various permanent and auxiliary instrument components.

The second auxiliary surgical instrument is a gripper that is inserted percutaneously and holds the connecting plate in place while simultaneously pressing the connecting plate against the surface of the bone, and at the far side of the bone. Includes a first hook-like member that serves to grip the worm, one end of the hook being in the shape of a long straight screw bar, which then extends to the outside of the extremity while the back of the hook is narrow and sharp. Near the bone with one end of a hook-shaped member forming a chisel or knife blade, followed by a tube slidably movable along a straight bar and terminating at the outer end of the shape of the grip. Further comprising a second hook-like member useful for gripping the connecting plate disposed at, a linear handle releasably attachable to the outer end of the screw bar, and a wing nut movable with the screw bar.

The hook-like member in the first embodiment has a toothed surface facing the bone, while in other embodiments these surfaces are shaped to safely enclose the connecting plate. ing.

In another embodiment, the second member includes a toothed hook pivotally attached to a protrusion extending laterally from the tube so that the toothed hook is angularly aligned with the bone. It becomes possible to engage with the connecting plate.

In the third embodiment, the inside of the hook is a tooth and is in the shape of a connecting plate to be fastened.

The surgical instrument is inserted into the extremity through a small incision in the skin or tissue and pushed into the extremity with the hook of the first member on the far side and the hook of the second member on the near side. Until the two hooks are placed on one side of the bone,
It is made parallel to the direction of the bone while cutting soft tissues and muscles. Here, the first member is gradually rotated at a right angle, pushing the sharp pointed edge through the muscle or tissue until the hook grasps the posterior side of the bone. Then, similarly, the second member is rotated until the teeth of the second member face the connecting plate. The connecting plate is pressed against the bone and the wing nut is rotated to advance the second member toward the connecting plate until the connecting plate is held firmly there. After piercing the bone material through the holes in the connecting plate and tightening the screws through the connecting plate and the bone, the surgical instrument can be removed in the reverse order, closing the wound and bandaging .

[0015]

DESCRIPTION OF THE PREFERRED EMBODIMENTS The connecting plate I shown in FIGS.
It comprises a main part 1 below the straight line and a head part 2 which is bent outwards relative to the main part 1 to fit the contour of the bone. The head part 2 comprises one larger screw hole 3 and two smaller holes 4 for connecting to the horizontal part of the connecting arm, as will be explained in more detail below. Next to the head part 2, two screw holes 5 that are diagonally oriented are about 130 °.
Through the main portion 1 and the outer surface of the main portion 1 is thickened by the two protrusions 6 and thus the length of the screw hole 5 is long. Below the two screw holes, three countersinks 7 are drilled through the main part 1 at right angles to it. The lower end of the main part 1 is sharpened so that it penetrates the soft tissues and muscles near the femoral shaft during insertion of the main part 1 through a small incision in the skin (reference number 8).

FIGS. 3 to 7 show one of the two long screws II and its sleeve III. This long screw II comprises a relatively long shaft 10, an inner end with threads 11 similar to those provided on wood screws, and an outer end which is recessed as a hexagonal portion 12 and which follows a smaller diameter screw hole 13. And part. The outer end of the long screw II is slidably and firmly inserted into the inner bore of the sleeve 14, which has an outer end with an outer thread 15.
And two or four slots 16 for engaging the special driver shown in FIGS. 12, 13 and 14.
Is provided. Assembled long screw II and sleeve III
Are shown in a partial side sectional view in FIG. Sleeve I
The inner end of II is bent inward (reference 1
8) Therefore, contact with the step 17 of the screw shaft 10 prevents the screw from sliding out of the sleeve III. Connection plate I with three countersinks 7
The three screws for connecting the toe to the femoral shaft are not shown as they are of the usual type and size used in similar surgery.

FIGS. 8, 9, 10 and 11 show an auxiliary device for inserting and tightening the long screw II and pressing the fractured part after the long screw II is inserted. The main instrument is an L-shaped connecting arm IV, which comprises a horizontal part 20 and a vertical part 21 firmly connected at right angles to each other. The horizontal part 20 is provided with two pins (not shown) at the inner end thereof, and these pins are connected plate I.
Engage holes 4 to bring connecting plate I exactly parallel to vertical portion 21. The connecting screw 22 extends through the central hole of the horizontal portion 20 and engages the screw hole 3 of the connecting plate I by the grip 23 to connect the connecting arm IV to the connecting plate I. At the same time, the two pins enter the hole 4 and prevent relative rotational movement of the connecting plate I and the connecting arm IV. The connecting screw 22 is hollow so that it has a long pointed bar 24 with grips 25 for forced insertion into the bone and for accurate placement of both the connecting plate I and the connecting arm IV with respect to the femur. Can be passed through. The vertical portion 21 comprises two large diagonally oriented holes 26 which are coaxially aligned with the threaded holes 5 of the connecting plate I and have a larger diameter. Above the two holes 26, three smaller holes 27 are drilled through the vertical section 21 at right angles to the vertical section 21 and coaxially with the countersink 7 of the connecting plate I. Setting screw 28
Penetrates the sides of holes 26 and 27 and helps hold the tubular guide in place. An additional feature of the connecting arm IV is a lateral hole 29 through the lower end of the vertical part 21, which lateral hole 29 is suitable for holding a rod-shaped sighting device which is attached by a set screw 28 '. . FIG. 15 shows the aiming instrument in position and the X-ray device placed above and below the fracture to be connected.

Further shown in FIG. 8 is the first stage of the surgery performed by the aiming instrument. After inserting the connecting plate I through the small incision into the thigh and sliding it into the proper position as seen by the X-ray machine and aiming device, the guide wire 30 allows the precise position relative to the neck to be found. The guide wire 30 is passed through an inner tubular guide 32 to provide bone material for the femoral shaft.
The inner tubular guide 32 through the hole 26 in the connecting arm IV and the connecting plate I.
Is arranged in an outer tube 31 extending to the screw hole 5 of the. When the inner tubular guide 32 is screwed into the hole 5 of the connecting plate I, the guide wire 30 is centered.
And prevent it from coming off the connecting plate I. Guide wire 30 if not positioned correctly
It is pulled out, the connecting plate I is moved to another position by the connecting arm IV, and the guide wire 30 is reinserted into the bone. If the position is found to be accurate by X-ray scanning, a pointed bar 24 is forced against the bone to finally lock the position of the bone and the connecting plate I,
At this time, the guide wire 30 and the inner tubular guide 32 are removed. These were replaced with a second medial tubular guide with a wider internal hole, a drill was inserted therein and mechanically rotated to pierce the femoral shaft and neck, followed by one of the long screws II. Insert it in the hole.

The special driver V shown in FIGS. 12, 13 and 14 comprises three concentrically arranged shafts which can be moved independently in both the axial and rotational directions. Is possible. These shafts include: (1) an innermost shaft 40 having a threaded end 41 adapted to engage a threaded hole 13 at the rear end of the long screw II and to be rotated by a grip on the outer end of the driver. (2) an inner tubular shaft 43 having a hexagonal end 44 for engaging the hexagonal recess 12 of the long screw II, and the inner tubular shaft 43 having a disc 46 fixedly attached to the inner tubular shaft 43. Is rotated to screw the long screw II into the bone material pre-drilled by the cylindrical grip 45 via (3) the cross-shaped edge 48 for engaging the slot 16 of the screw sleeve III. An outermost tubular shaft 47 having an inner end, this tubular shaft 47 being screwed onto a connecting plate I by a sleeve II by means of a cylindrical grip 49. And (4) an outer sleeve 56 that is rotationally and longitudinally movable with a movable inner tubular shaft 43, the outer sleeve 56 serving to limit longitudinal movement of the inner tubular shaft 43. Pin 5
9, a second peripheral recess 58 is provided at the other end of the outer sleeve 56 for engaging the stop member 57.

It is possible to move the components axially with respect to each other and to push them into their normal position by means of a helical spring 50, while at the same time moving the tubular shaft 43 further axially by pulling out the stop member 57. It will be possible. These particular uses will be discussed further in connection with the final stages of surgery.

The final stage of the procedure for connecting the fractured femoral head to the femoral shaft is shown in FIG. 10, where the inner tubular guide 32 is removed after the bone has been penetrated through the beveled hole. Here, the two screw-sleeve assemblies are inserted one by one with the driver V as follows and tightened. The long screw II is pulled back to the sleeve III to the outer end,
The hexagonal end 44 of the driver V is pressed into the correspondingly shaped recess 12 of the screw end. By rotating the grip 42 and pressing the grip 42 in opposition to the biasing force of the spiral spring 51, the screw end 41 of the innermost shaft 40 of the driver V is screwed into the screw hole 13 of the long screw II,
At the same time, the protruding edge 48 of the outermost tubular shaft 47 is pressed by the helical spring 50 into the slot 16 at the end of the sleeve III. By further tightening the screw end 41 into the screw hole 13, the screw-sleeve assembly connects to the driver V and is securely attached. The driver V now pushes the screw-sleeve assembly inwardly through the outer tubular guide 31 and the sleeve III
The screws of the connecting plate I are rotated as far as the screws of the connecting plate I allow, and the sleeve III is rotated by rotating the grip 49.
Screwed into. By withdrawing the stop member 57, the grip 45, which is connected to the inner tubular shaft 43 by the collar 46, is moved inwards and thus pushes the inner tubular shaft 43 inwards. Grip 45
By rotating and pushing inwardly, the long screw II is moved along the sleeve III, pressed against the head of the fractured femur and inserted into a pre-drilled hole in the bone material, The rotation is stopped as soon as the depth required to be seen by the device is reached or whenever the step 17 of the long screw II reaches the bent end 18 of the sleeve 3. The pin 60 engaging with the peripheral groove 61 is provided in the grip 4
2 limits the distance that the helical spring 51 pushes there as soon as it is moved outwards. Further, during the fracture, the pressing pin 60 is attached to the grip 4 via the grip 42.
The load is transmitted from 5 to the innermost shaft 40. A retracting device VI is attached to the grips 45 and 49 by a pin 52 inserted into a corresponding hole 53 for pulling the fractured femoral head towards the femoral shaft and forcing the fracture. By rotating the handle 54, a screw 55 pulls the grip 49 away from the grip 45 and the grip 42 (by means of the pin 60), so that the attached long screw II is screwed firmly onto the connecting plate I and is attached to the sleeve. Pull to III. After inserting and fixing the first long screw, the pointed bar 24 is removed and the second long screw is likewise inserted into the fracture.

After inserting both long screws, the connecting plate I is firmly attached to the femoral shaft with a few short screws. For this, a short tubular guide is inserted into the tissue through one of the holes 27 in the connecting arm IV and attached by means of a set screw 28. After that, a hole is drilled by a conventional method and a screw 33 is inserted so that the head of the screw 33 is placed in the countersink 7 so that the head does not protrude from the connecting plate I. After fixing all the screws and removing the screws 22 to remove the connecting arm IV from the connecting plate I out of the body, the skin incision is closed and the wound is bandaged.

16, FIG. 17, FIG. 18 and FIG.
3 shows an embodiment in which the connection plate shown in FIGS. 1 and 2 is simplified. The difference from the first embodiment is the elimination of the outwardly bent head part 2, the two small holes 4 and the two protrusions 6, the other component being both embodiments. Are the same and are given the same reference numerals. The connecting plate here has a thicker upper part, while the lower part is about the same thickness as shown in FIG. Instead of the bent head part, the underside of the thicker upper part is cut out with a slope 102 corresponding to the shape of the femur. The protrusions 6 seen in FIG. 1 are necessary to ensure a sufficient length of the screw holes 5, but due to the greater thickness of the connecting plate here, the material is sufficient for these holes. . The two holes 4 in FIG. 1 are necessary for connecting to the connecting arm IV by means of two pins which engage the holes 4. The connection here is the curved end 1 of the arm.
This is done by engaging 20 with the rounded top surface of the tie plate (see FIG. 18) so that the two are held firmly and aligned straight.

A second embodiment of the driver V is shown in FIG. 20 and the means for separating the grip 49 and the grip 45 is a cup-shaped spacer 62. The spacer 62 comprises internal threads that cooperate with the external threads of the grip 49. Rotating the spacer 62 moves the spacer 62 rearward to contact the grip 45 and moves the grip 42 rearward via the pin 60, thus engaging the long screw II with the female threaded hole 13 of the threaded end. The threaded end 41 is pulled back into the sleeve and thus tightens the fracture.

FIG. 15 illustrates the shape and use of the aiming device which is an additional feature of the present invention. This aiming instrument is used in the early stages of surgery to place the screw into the fractured bone in its optimal final position. It is attached to the connecting arm 21 and adjusted from the outside of the thigh towards the fracture. By observing the position of the aiming instrument with respect to the neck of the femur by means of the X-ray devices 73, 74, the position of the connecting plate I and the auxiliary instrument is adjusted and placed in the most suitable position. The aiming instrument comprises an aiming rod 70, which is connected at right angles to the end of the connecting bar 71 by means of fastening means 72. The connecting bar 71 is held at a predetermined position in the horizontally long hole 29 at the bottom end of the connecting arm 21, and is attached to the horizontally long hole 29 by the setting screw 28 '. After adjusting the connecting plate I, the aiming device is removed. As is known, all further stages of surgery are similarly controlled by X-ray observation.

The fastening device shown in FIGS. 23 and 24 includes a first hook-shaped member A, a second hook-shaped member B, a wing nut C, and a linear handle D. The first hook-shaped member A is a rounded hook 1 having a toothed inner surface 111.
10 of which one end of this hook 110 is subsequently in the form of a straight screw bar 113, which extends outwardly of the limb towards the surgeon during surgery. The back or outer surface 114 of the hook 110 is narrowed to form a sharp chisel or knife blade,
Carve out its own path through muscles and tissues.

The second hook-shaped member B comprises a tube 124 which slides on the screw bar 113, and the screw bar 1
Slidable along 13, the tube 124 terminates in a hook 121 open towards the hook 110 of the first hook-like member A and the tooth 12 opposite the first hook.
2 has sides. The other end of the tube 124 forms a grip 123, which allows placement and adjustment of the instrument on the bone and the connecting plate I. The wing nut C of the third component consists of a central hub pierced by an internal thread 131 cooperating with the threads of the thread bar 113 and two opposing wings 132. The handle D is a straight bar 140 provided with a suitable groove (141) to provide a secure grip, which is penetrated centrally by a screw hole 142, which cooperates with the screw bar 113.

The instrument shown in FIG. 25 has a tube 124
23 is substantially the same as that shown in FIG. 23, except for the hook of the second hook-like member which is pivotally attached by a pin 126 to the projection 125 at the distal end of the. All remaining parts are identical to the device of FIG.

The device of FIG. 26 is substantially the same as that of FIGS. 23 and 24, but without teeth on the inside of the hook and in the form of a connecting plate for fastening to bone.

As explained above, the instrument cuts its own path through the small incision in the skin and through the soft tissue and muscle until it is parallel to the bone,
Pushed to the extremities. Here, the first hook-shaped member is shown in FIG.
And as can be seen in FIG. 28, it has been rotated approximately at right angles by the handle D until it grasps the posterior side of the bone. Here, the other hooks are rotated almost at right angles until they face the connecting plate E, and are advanced toward the connecting plate E by the wing nut C until the connecting plate E is firmly fastened with the bone, and the safety hole is formed. Allows opening and inserting screws.

The described steps of percutaneous surgery are similar to those disclosed in Applicant's US Pat. No. 4,465,065, but most configurations of the device of the present invention. It should be reiterated that the elements have been and have been changed. An improvement to the surgical instrument disclosed in Applicants' first patent application is to fix the long screw of the sleeve while allowing for axial sliding movement without protruding from bone or soft tissue, and It was a quick insertion of the long screw with a tool and, after the insertion of the long screw, again using a special screwdriver to actively tighten the fracture. Moreover, the modification of the tie plate enhances the stability of the connection between the tie plate and the long screw, while the pointed bar 24 temporarily fixes the tie plate to the femur to greatly enhance the bone. Make sure to pre-drill exactly.

If only one screw is inserted in the fractured bone, only one of the oblique holes 5 of the connecting plate and one of the holes 26 of the connecting arm are used, or on the one hand the connecting plate and the connecting arm Only one diagonal hole is provided on both. In the latter case, somewhat larger diameter bolts are used with correspondingly larger sleeves and larger holes in the instrument components.

The contours and shapes of the different components, both permanent and auxiliary, are the most convenient and the shortest time for the surgeon, except by changing tools and equipment as would be necessary with conventional instruments. Made to do manual work in. However, these may be varied and modified to the extent that they assist in performing the above-mentioned stages of surgery, i.e., those that connect and tighten the fracture for the patient and at the same time maintain the percutaneous surgical procedure. You can also

[Brief description of drawings]

FIG. 1 is a partial side sectional view of a connecting plate.

2 is a plan view of the connection plate shown in FIG. 1. FIG.

FIG. 3 is a side view of a long screw.

4 is a cross-sectional view through the outer end of the long screw shown in FIG.

5 is an end view of the long screw shown in FIG. 3. FIG.

FIG. 6 is a longitudinal sectional view of a sleeve covering an outer end portion of a long screw.

7A is a side sectional view of a long screw arranged in the sleeve of FIG. 6, and FIG. 7B is a long screw II and a sleeve II.
It is a partial expanded sectional view of I.

FIG. 8 is a cross-sectional view of the connection plate, the connection arm, and the auxiliary device in the initial stage of surgery.

9 is an end view of the connecting arm taken along line 9-9 of FIG.

FIG. 10 is a cross-sectional view of the connecting plate, the connecting arm, and the driver with one long screw and the sleeve in place and the second long screw in the middle of the final position in a further advanced state of the operation. Is.

FIG. 11 is a longitudinal sectional view of a second movable tube and a drill inserted into the main sleeve.

FIG. 12 is a longitudinal cross-sectional view of a screwdriver used to insert a long screw and a sleeve.

13 is an enlarged cross-sectional view of the left-hand end portion of the driver of FIG.

FIG. 14 is an end view of the driver of FIG.

FIG. 15 shows a stage of surgery using a rod-shaped sighting instrument.

FIG. 16 is a partial side sectional view of a second embodiment of the connecting plate.

17 is a plan view of the connection plate of FIG. 13. FIG.

FIG. 18 is a cross-sectional view taken along the line 15a-15a of FIG.

19 is a cross-sectional view taken along line 16-16 of FIG. 8 showing the connection of the connecting plate of FIG. 16 to the connecting arm.

20 is a longitudinal sectional view of another embodiment of the driver of FIG.

21 is an enlarged cross-sectional view of the left end portion of the driver of FIG.

22 is an end view of the driver of FIG. 20. FIG.

FIG. 23 shows the preferred embodiment of the interlocking fastening tool in the fully assembled state.

24 is a view showing different components of the connection fastening tool of FIG. 23 in a disassembled state.

FIG. 25 is a view of the coupling and fastening tool of FIG. 23 with the addition of a second hook member pivotally attached to this member.

FIG. 26 shows a slightly modified embodiment of the device of FIG.

FIG. 27 shows an instrument for fastening a connecting plate to the neck of a fractured femur.

FIG. 28 shows an instrument for fastening a connecting plate to two parts of a fractured bone.

[Explanation of symbols]

 I ... Connection plate II ... Long screw III ... Sleeve IV ... Connection arm V ... Driver A ... First hook-shaped member B ... Second hook-shaped member C ... Wing nut D ... Handle E ... Connection plate 1 ... Main part 2 ... Head Part 3 ... Screw hole 4 ... Hole 5 ... Screw hole 6 ... Projection part 7 ... Countersink 10 ... Shaft 11 ... Thread 12 ... Hexagonal part 13 ... Screw hole 14 ... Sleeve 15 ... Outer thread 16 ... Slot 17 ... Step Part 18 ... Bent end part 20 ... Horizontal part 21 ... Vertical part 22 ... Connection screw 23, 25 ... Grip 24 ... Bar 26, 27 ... Hole 28, 28 '... Setting screw 29 ... Horizontal hole 30 ... Guide wire 31 ... Outer tube 32 ... Inner tubular guide 33, 55 ... Screw 40 ... Innermost shaft 41 ... Screw end 42, 45, 49 ... Grip 43 ... Inner tubular shaft 44 ... Hexagon Part 46 ... Collar 47 ... Outermost tubular shaft 48 ... Edges 50, 51 ... Spiral spring 53 ... Hole 54 ... Handle 56 ... Outer sleeve 57 ... Stop member 58 ... Peripheral recess 59, 60 ... Pin 61 ... Perimeter groove 62 ... Spacer 71 ... Connection bar 70 ... Aiming rod 72 ... Fastening means 73, 74 ... X-ray device 102 ... Inclination 110 ... Hook 111 ... Inner side surface 113 ... Screw bar 114 ... Outer side surface 120 ... Curved end 121 ... Hook 122 ... Teeth 123 ... Grip 124 ... Tube 125 ... Projection 126 ... Pin 131 ... Female thread 132 ... Wing 140 ... Bar 141 ... Groove 142 ... Screw hole

Claims (24)

[Claims] 1. A surgical instrument for percutaneous connection, comprising a body-remaining component for connecting an upper fracture of a patient's femur to a femoral shaft, said component being a rod-shaped connection plate (I). ), The rod-shaped connecting plate (I) has an axis, an inner surface to be placed on the femur, an outer surface, and a head portion (2).
And a bottom portion with a pointed end (8) for inserting said rod-shaped connecting plate (I) through a small incision in the patient's skin, and at least two through countersinks (7) At its lower part and at its upper part with two connecting diagonal screw holes (5) directed upwards at an angle of about 130 °, perpendicular to the axis of the rod-shaped connecting plate (I). A threaded hole (3) is provided in the head portion (2) and the component further comprises two long screws (II), which are straight screw shafts (10). A wood screw-like inner end (11) for insertion into the fractured part of the femur, and a concentrically polygonal outer concave end (12)
And a threaded hole (13) concentric with the axis of the straight shaft (10) is provided following the outer concave end (12), and the component is the length of the long screw (II). And a sleeve (III) shorter than the
The outer concave end (12) of each of the I.
I) is movably arranged in both the axial direction and the rotation direction of the sleeve (III), and the sleeve (III) corresponds to the thread of the connecting oblique screw hole (5) of the rod-like connecting plate (I). With threads (15) and with at least two recesses (16) for engaging a driver, said component being at least two short screws (33) for attaching said rod-shaped connecting plate (I) to the femoral shaft. ), The short screw (33) extending through the through countersink (7) to the bone material of the femoral shaft for percutaneous connection. 2. A short horizontal part (20) for connecting to said head part (2) of said rod-shaped connecting plate (I) and a longer vertical part extending parallel to the lower part of said rod-shaped connecting plate (I). (21), and the horizontal portion (20) engages with the screw hole (3) of the head portion (2) of the rod-shaped connecting plate (I). Head part (2) for ensuring the absolute parallelism of the rod-shaped connecting plate (I) and the vertical part (21), with an axial penetration for the passage of the screw (22). The vertical portion (21) has a shape adapted to the shape of the above, and the vertical portion (21) has two connecting diagonal screw holes (5) of the rod-like connecting plate (I).
With two adjacent diagonally oriented diagonal holes (26) aligned coaxially with, and coaxial with at least two of the through countersinks (7) of the rod-shaped connecting plate (I). A sleeve (23) comprising at least two straight holes (27) aligned, having an outer diameter cooperating with the oblique holes (26) of the angular connecting arm (IV) and covering the long screw (II). III) the inner diameter corresponding to the outer diameter, and the rod-shaped connecting plate (I) and the angular connecting arm (I).
V) a first tubular guide (31) of a length adapted to the distance between the respective oblique holes (5, 26) and an outer part of the guide wire (30) to be pushed into the upper fracture of the femur. The first having an inner diameter hole corresponding to the diameter
In the first tubular guide (31) having a first movable tube (32) for insertion into the tubular guide (31) and a hole having an inner diameter corresponding to the diameter of a drill for pre-drilling the femur. A second movable tube for insertion, a guide wire (30) to be pushed through the hole of the first movable tube (32), and a bone substance to be inserted through the hole of the second movable tube It is for inserting a drill and the straight hole (27) of the angular connecting arm (IV), and has a length adapted to the distance to the rod-like connecting plate (I), and the short screw (33). )
A second tubular guide of suitable inner diameter for the passage of the drill for pre-drilling the bone material to receive bone, and a screwdriver for inserting and fixing said long screw (II). An inner shaft (40) comprising an inner threaded end (41) for the driver to engage with the threaded hole (13) of the outer recessed end (12) of each of the long screws (II); Intermediate tubular shaft (4) with a polygonal inner end (44) for engaging the polygonal outer concave end (12) of each of the long screws (II).
3) and the sleeve (II) covering the long screw (II).
I) protruding teeth (4) for engaging said recesses (16)
8) at the inner end with an outer tubular shaft (47), all three shafts being axially and rotationally driven by grips (42, 45, 49) attached to their outer ends. Independently movable,
Helical springs (50, 51) are provided for adjusting the axial alignment of each of these shafts, an auxiliary device useful for inserting and connecting the device according to claim 1 to an upper fracture. 3. Two oblique projecting portions (6) in which an outer portion of the rod-shaped connecting plate (I) surrounding the connecting diagonal screw hole (5) protrudes from the surface of the rod-shaped connecting plate (I). The surgical instrument according to claim 1, wherein the surgical instrument is thickened as follows. 4. The head portion (2) of the rod-shaped connecting plate (I) is bent outward so as to conform to the outer shape of the femur, and the head portion (2) includes the screw hole (3). The surgical instrument according to claim 1, which is penetrated by at least one slide hole (4), both holes (3, 4) being perpendicular to the axis of the rod-shaped connecting plate (I). 5. The surgical instrument according to claim 1, wherein an inner surface of the head portion (2) of the rod-shaped connecting plate (I) is inclined outward according to the outer shape of the femur (102). 6. The surgical instrument according to claim 1, wherein the outer surface of the head portion (2) of the rod-shaped connecting plate (I) is convex. 7. Each of said long screws (II) comprises a peripheral step (17) and the inner end (18) of each of said sleeves (III) is bent inwardly, and said bent inner side The surgical instrument according to claim 1, wherein contact between the end (18) and the peripheral step (17) prevents the long screw (II) from sliding. 8. The surgical instrument according to claim 2, wherein the vertical portion (21) of the angular connecting arm (IV) comprises a set screw (28) to help attach the tubular guide. 9. The inner end (120) of the horizontal part (20) of the angular connecting arm (IV) is curved corresponding to the convex surface of the head part (2) of the rod-shaped connecting plate (I). The surgical instrument according to claim 2, wherein 10. A sighting device (7) in which the lower end of the vertical portion (21) of the angular connecting arm (IV) is rod-shaped.
0,71,72) means for holding (28 ', 2)
The surgical instrument according to claim 2, comprising 9). 11. The aiming instrument comprises an aiming rod (70) connected at right angles to a connecting bar (71), which connecting bar (71) is angular in relation to the aiming bar (71). 11. Surgical instrument according to claim 10, adapted to be attached to the lower end of the vertical portion (21) of the angular connecting arm (IV) by means of adjustable orientation. 12. The driver pulls the threaded end (41) of the inner shaft (40) onto the outer tubular shaft (47) to extend the long screw (II) outwardly of the sleeve (III). A surgical instrument according to claim 2, comprising means for assisting in pulling. 13. The outer tubular shaft wherein the screwdriver is held in place by a removable pin (57) and movable by a pin (59) along an outer peripheral recess (58) of the sleeve (III). The surgical instrument of claim 2, comprising an outer sleeve (56) that engages (47). 14. The screw (22) extending through the horizontal portion (20) of the angular connecting arm (IV) comprises a grip (23) at its outer end, and a pointed pin or screw (25). ) Passage is the above-mentioned angular connection arm (IV)
The surgical instrument of claim 2, wherein the surgical instrument is centrally pierced to be pushed into the bone for precise fixation of the. 15. A surgical instrument for percutaneous connection, comprising a body-remaining component for connecting an upper fractured part of a femur to a femoral shaft, said component comprising a rod-shaped connection plate (I). Comprises a rod-shaped connecting plate (I) for inserting said rod-shaped connecting plate (I) through an inner surface to be placed on the bone, an outer surface, a head part and a small incision in the skin. A bottom portion with a sharp end (8) for the purpose of, and having at least two through countersinks (7) in its lower portion and directed upwards at an angle of about 130 °. An oblique screw hole (5) is provided in an upper portion thereof, and a screw hole (3) perpendicular to the axis of the rod-shaped connecting plate (I) is provided in the head portion, and the component is a long screw (II). Further provided with the long screw (II) A straight shaft (10), wood screws shaped inner end for insertion into the fractured parts (11),
A hexagonal or other polygonal outer concave end (1
2) and a screw hole (13) concentric with the axis of the linear shaft (10) is provided following the outer concave end (12), and the outer concave end of the long screw (II) is provided. Division (12)
Is a sleeve (II) shorter than the length of the long screw (II).
I) movably arranged both axially and rotationally, the outer end of the sleeve (III) corresponding to the thread of the oblique threaded hole (5) of the rod-shaped connecting plate (I) ( 15) and at least two recesses (16) for engaging a driver, said component attaching said rod-shaped connecting plate (I) to the femoral shaft, through said through countersink (7) A surgical instrument for percutaneous connection comprising at least two short screws (33) extending into the bone material of the femoral shaft. 16. An additional surgical instrument for holding the rod-shaped connecting plate (I) in place on the femoral shaft while pressing it against the surface of the bone, the bone being on the opposite side of the rod-shaped connecting plate (I). A first member including a hook shaped to grip the sides of the hook, one end of the hook being integrally formed with a straight bar extending outward of the extremity, and the back of the hook being narrow. To form a chisel or knife blade adapted to cut through tissue or muscle, further comprising a second member including a hook adapted to grip the rod-shaped connecting plate (I). And one end of the hook is provided integrally with a tube arranged on the linear bar of the first member so as to extend to the outside of the extremity and slide in alignment. The hooks for tissues and muscles Handle means provided at the outer end of the straight bar of the first member, adapted to be moved and rotated through a bone to a predetermined position around the bone, and the hook of the second member to the rod-shaped connecting plate ( I) was moved to a predetermined position and rotated,
Handle means provided on the outer end of the tube of the second member, the rod of the second member moving the tube of the second member along the straight bar of the first member and towards the bone. The hook of the second member is advanced to (I), and the rod-shaped connecting plate (I) is placed at the correct position of the fractured part.
An additional surgical instrument further comprising: 17. The hooks of both the first member and the second member are provided with teeth on the surfaces facing the bone and the rod-shaped connecting plate (I), respectively.
The surgical instrument according to. 18. A shape such that the hook of the first member has a toothed surface for gripping bone and the hook of the second member conforms to the shape of the rod-shaped connecting plate (I). The surgical instrument of claim 17, wherein the surgical instrument is 19. The hook of both the first member and the second member comprises a smooth surface for gripping each of the bone and the rod-shaped connecting plate (I).
7. The surgical instrument according to 7. 20. The surgical instrument of claim 17, wherein the second member includes a hook pivotally attached to a protrusion laterally extending from an inner end of the tube of the second member. 21. The second bar of the first member, wherein the straight bar is a screw, adapted to be rotated by the straight bar and to advance the hook of the second member to the rod-shaped connecting plate (I). The surgical instrument of claim 17, including a wing nut attached to the member proximate the outer end of the tube. 22. The means for moving and rotating the hook of the first member into position about the bone is in the form of a handle with a central female threaded hole, and thus the screw of the straight bar. 22. The surgical instrument of claim 21, wherein the handle is attached to the outer end of the. 23. The means for moving and rotating the hook of the first member into position about a bone is in the form of a handle attached to the square end of the straight bar by a square hole. The surgical instrument according to claim 1. 24. The surgical procedure of claim 17 wherein the means for moving and rotating the second member is in the form of a handle that is securely attached to the outer end of the tube of the second member. Equipment.