KR100393256B1 - Intramedullary nail and interlocking method of distal screw through the nail - Google Patents

Abstract

The present invention relates to a fracture fixation device and a fracture fixation method using the same, combining a fracture fixation device having a wire for forming a loop in a u-shaped groove formed at one end of a metal well with an external aiming device having a corresponding structure. By using it, the distal engagement screw can be easily inserted into the distal screw hole at the right angle without using the fluoroscopy device, which saves the surgery time and eliminates the need to use the fluoroscopy device. No need for expensive equipment, no need for expensive equipment, normalize the medical system, reduce the procedure cost, minimize the damage to surrounding muscles when distal interlocking screw insertion, and apply additional pressure to the fracture More effective fracture unions are possible.

Description

Fracture Fixation Device for Fracture Treatment and Fracture Fixation Method Using It {Intramedullary nail and interlocking method of distal screw through the nail}

The present invention relates to a fracture fixation device for fracture treatment and a fracture fixation method using the same, which is easy to distal fixation, and more particularly, it is possible to form a loop with a wire flowing up and down inside the cylindrical body and easily by an external collimator. It relates to a fracture fixation device for fracture treatment and fixation method using the same that can fix the distal engagement screw.

In general, there are two major surgical methods used to fix bone fracture sites.

First, the internal fixation method is to cut the skin and muscles to expose the bone near the fracture, and then put a long, narrow support, for example, a round cylindrical nail support, or a plate outside the bone. There is a method of fixing the support with a metal screw, and secondly, as an in vitro fixation method, a long metal needle is placed outside of the skin at various places of the fractured bone and fixed with a metal stick outside the body.

Among these, intrabody fixation method is superior to in vitro fixation method, and intramedullary fixation method using metal fixation support is more advantageous than intraplate fixation method in many ways. Internal fixation devices are primarily intended for intramedullary fixation

1 and 2 are schematic diagrams of the intramedullary intramedullary fracture fixing device and the state inserted into the fractured intramedullary cavity according to the prior art, will be described in relation to each other.

As shown in FIG. 1, the fracture fixation device 10 having a cylindrical metal well (SN) shape has an overall cylindrical body 12 and a proximal screw hole 14 formed in the proximal portion P close to the insertion portion. PSH) and a distal screw hole 16 (DSH) formed at the distal end D closed on the opposite side of the insertion site, as shown in FIG. 2, near the fracture site 22 (FS). The insertion hole (not shown) formed in the bone 20 of the bone 20 is completely inserted into the bone marrow cavity 24 inside the bone 20, and the proximal and distal screw holes 14 and 16 to prevent rotational deformation of the fracture site. ) And fix the proximal engagement screw 13 (DIS) and the distal engagement screw 15 (PIS) from the outside. That is, after the support 10 is inserted into the bone marrow cavity 24 of the fracture portion, the proximal engagement screw 13 and the distal engagement screw 15 are respectively inserted into the proximal portion close to the insertion site and the distal side opposite to the insertion site. Fix it.

Conventional fracture fixation device 10 is used in conjunction with the external aiming device 30 shown in Figure 3, after inserting the fracture fixation device 10 into the bone marrow cavity 24, the proximal and distal engagement screw 13 In the step of fixing (15), the external aiming device (30) is used to couple to the fracture fixing device (10).

The external aiming device 30 is largely coupled to the proximal upper end of the fracture fixing device 10 at one side of the U-shaped frame 32, and at the other side of the aiming hole at a position corresponding to the proximal screw hole 14 ( 34) is formed. In the fixing step, the proximal engagement screw 13 can be inserted into the proximal screw hole 14 simply by using the aiming hole 34. However, since the distal portion of the fracture fixation device 10 is bent in the front and rear and in and out directions when inserted into the bone marrow cavity 24, the distal engagement screw 15 is accurately inserted into the distal screw hole 16 of approximately the same diameter. It is quite difficult to fit. Therefore, fluoroscopy was used to fix the distal portion to the intramedullary cavity 24 using the distal engagement screw 15. However, the fracture fixation method using fluoroscopy has several problems as follows.

(1) First, C-armed fluoroscopy for operating room is very expensive equipment, so it is difficult to perform fracture fixation method using fracture fixation device in private clinic or small hospital. Therefore, even if there is sufficient medical technology, fracture patients who need intramedullary fixation method using interlocking screws because of lack of equipment have to be taken to a large hospital, which deepens the distortion of medical delivery system.

(2) Secondly, even when using a fluoroscopy machine, it is not easy to correctly insert the distal engagement screw into the distal screw hole. That is, even a very skilled orthopedic surgeon takes at least 20 minutes to insert one distal engagement screw without a single error, and in practice, usually two distal engagement screws and three distal engagement screws, depending on the fracture pattern, The insertion time is often more than 40 minutes to 1 hour. In addition, when inserting only the radiographic picture outside the bone, the insertion itself cannot be repeated even if the angle is shifted by about 5 degrees, and the insertion is repeated again. Even if this trial and error is repeated two or four times, it makes several unnecessary holes in the bone, or Not only does this weaken the fixation strength, but also increases the time of operation, bleeding, and anesthesia.

(3) Third, in the case of using fluoroscopy, since the radiographic projection is performed on only one side, there is a problem that the accuracy of the procedure is lowered. In other words, even when the distal engagement screw is judged to be inserted correctly, when the perspective radiation is viewed at a different angle from 90 °, it is often not inserted into the hole at all. This is because radiation is always on only one plane, and many planes cannot be viewed in three dimensions at the same time.

(4) Fourth, radiation exposure cannot be avoided, and thus the procedure cannot be performed for female patients who are pregnant or will be pregnant soon. In addition, since the patient receives the procedure once or twice a lifetime, the amount of radiation exposure does not matter, but the orthopedic surgeon who needs to perform the operation with fluoroscopy every day becomes a serious problem. At present, surgery is performed while wearing a guard to reduce the radiation exposure, but the weight of the guard is about 2.5Kg to 5.0Kg, and the wind does not pass at all. Nevertheless, the hands, arms, head and lower knee that are continuously exposed to fluoroscopy cannot be protected.

To solve this problem, new technology is needed to accurately insert distal engagement screws without the use of perspective radiation.

The present invention to solve the above problems of the prior art, an object of the present invention is to provide a fracture fixing device and fracture fixing method that can fix the distal portion without using fluoroscopy.

1 is a schematic view of a fracture fixing device according to the prior art.

Figure 2 is a schematic view of the state in which the fracture fixation device of Figure 1 is inserted into the fracture bone marrow cavity.

Figure 3 is a photograph of the fracture fixing device and the external aiming device of Figure 1 combined.

Figure 4 is a schematic diagram of a fracture fixing device according to the present invention.

5 is a cross-sectional view of the fracture fixing device of FIG.

6 is a schematic view of a state in which the fracture fixation device of Figure 4 is inserted into the fractured bone marrow cavity.

Figure 7 is a perspective view of the fracture fixing device and the external aiming device of Figure 4 combined.

8 is a schematic view for explaining an operating state of the external aiming device of FIG.

9 is a front view of the guide pin used in the fracture fixing device according to the invention.

10 is a cross-sectional view taken along plane I of FIG. 8.

11A to 11C are cross-sectional views illustrating steps for fixing the fracture fixation device of FIG. 4 to the central portion of the bone marrow cavity.

12 is a real picture of the fracture fixing device of FIG.

Figure 13 is an X-ray photograph of the guide pin insertion hole formed in the bone in Figure 11b.

Fig. 14 is an X-ray photograph of the distal engagement screw insertion hole formed in the bone in Fig. 11C.

15 is an external picture of the state of FIG. 14;

Fig. 16 is an external photograph of the distal engagement screw inserted.

<Explanation of symbols for the main parts of the drawings>

10,100: fracture fixation device 12,120: body

13,130: Proximal engagement screw 14,140: Proximal screw hole

15,150: Distal engagement screw 16,160: Distal screw hole

20: bone 22: fracture site

24 bone marrow cavity

30,300: External aiming device 32,320: Frame

34: aiming hole

120: body 122,172: thread

124: U-shaped groove 126: wire hole

170: wire support screw 180: wire

322: guide hole

340: distal screw hole aimer 342: aiming frame

344: fixing screw 346: guide pin aiming hole

348: distal screw hole aiming hole 360: driver adjustment unit

380: connection portion 382: fixing screw

384: support 400: guide pin

420: guide pin insert

Features of the fracture fixation device according to the present invention for achieving the above object, includes a body having a hollow portion in the distal end and a groove, and an external collimator detachably coupled to the body, the body is A wire connected to the body so as to be movable up and down while forming a loop exposed to the outside through the groove, and a distal screw hole formed through the body,

The external aiming device includes a main frame and an aiming frame movably coupled to the main frame, the aiming frame having a guide pin aiming hole and a distal screw hole aiming hole corresponding to the groove and the distal screw hole, respectively. .

In another aspect of the present invention, the body is made of stainless steel, titanium or alloys thereof, the wire support screw is screwed to the inner surface of the proximal side of the body, the wire is in the body by a wire support screw It is possible to move upwards and downwards, so that the loop of the wire becomes larger or smaller and the groove is formed in a u-shape.

In addition, features of the fracture fixing method using a fracture fixing device according to the invention, the body having a hollow portion in the distal end includes a body, and an external collimator detachably coupled to the body, the body is the A wire coupled to the body so as to be movable up and down while forming a loop exposed to the outside through the groove, and a distal screw hole formed through the body,

The external collimator is movably coupled to the main frame and the main frame, and has a fracture fixation frame having an aiming frame having a guide pin aiming hole corresponding to the groove and the distal screw hole and a distal screw hole aiming hole, respectively. In the fracture fixation method using the device, the aiming frame is positioned on the main frame so that the guide pin aiming hole and the distal screw hole aiming hole on the aiming frame correspond to the position of the loop and the position of the distal screw hole respectively exposed to the outside of the groove on the body. Fixing to,

Inserting the body of the fracture fixation device into the bone marrow cavity of the fractured bone,

Moving the wire to the distal side to form a loop exposed to the outside of the groove, and forming a guide pin hole in the bone of the guide pin aiming hole position of the aiming frame, and inserting the guide pin into the bone through the guide pin hole. And moving the wire to the proximal portion of the body so that the guide pin is tightly coupled in the groove, and forming a distal screw hole in the bone through the distal screw hole aiming hole of the aiming frame, and distal the distal screw hole. Inserting the distal engagement screw into the screw hole;

After removing the guide pin and inserting the other distal engagement screw into the guide pin hole to fix the distal portion of the fracture fixation device.

Hereinafter, with reference to the accompanying drawings will be described in detail with respect to the bone fixation device and fixing method using the same.

4 to 6 are diagrams for explaining the intramedullary intramedullary fracture fixing device according to the present invention will be described in relation to each other.

First, the fracture fixing device 100 according to the present invention in Figure 4 is formed in a cylindrical body 120, the proximal screw hole 140 formed in the proximal portion of the body, and the distal portion of the body 120 A distal screw hole 160, a U-shaped groove 124 formed at one end of the distal body 120, and movable up and down inside the body 120 and protruding from the groove 124 and looping It has a wire 180 to form a.

The fracture fixing device 100 will be described in more detail with reference to FIG. 5.

A thread 122 is formed on the inner wall of the proximal side of the cylindrical body 120 of the fracture fixing device 100, and a wire hole 126 is formed between the inner wall of the body 120 separately from the groove 124 on the distal side. It is. In order to form a loop in the groove 124, a wire 180 having elasticity is inserted into the wire hole 126 such as metal or Teflon, and both ends thereof are fixed to the wire support screw 170. On the outer circumferential surface of the wire support screw 170, a thread 172 corresponding to the thread 122 is formed, and the screw groove 174 is formed in the shape of a straight, +, or hexagonal shape in the upper portion. When the wire support screw 170 is moved to the distal side along the thread 122, the wire 180 forms a loop at the groove 124, and when moved to the proximal side, the guide pin 400 is inserted into the loop part. ) Is inserted into the groove 124.

6 is a schematic view of the fracture fixing device of Figure 4 is inserted into the bone marrow cavity, when the fracture fixing device 100 is inserted into the bone marrow cavity of the fracture site 22 of the bone 20, the wire support screw Move the 170 to the distal side to form a loop of wire 180 in the groove 124, to form a guide pin hole in the loop portion, and insert the insertion portion 420 of the guide pin 400 After inserting, when the wire support screw 170 is moved to the proximal side again, the loop portion of the wire is reduced and the inserted guide pin inserting portion 420 is brought into close contact with the groove 124.

Then, since the position of the fracture fixing device 100 is fixed to some extent by the guide pin insertion portion 420, the position of the distal screw hole 160 can be confirmed, so that the distal engagement screw 150 is inserted into the portion. Then, the winch of the fracture fixing device 100 can be easily fixed. Then, when the distal engagement screw 150 is inserted into the empty guide pin hole after the guide pin 400 is removed, the distal portion of the fracture fixing device can be fixed. It can be fixed more firmly. One or more distal screw holes 160 may be formed as necessary, and preferably two to three distal screw holes 160 are formed.

The principle of the present invention is described as follows.

That is, in the past, the invention of many external aiming devices for precisely inserting distal engagement screws into distal screw holes without fluoroscopy has been attempted. The distal engagement screw was not able to be inserted into the distal threaded hole at the correct angle because of the deflection. That is, the ends of the fracture fixation device having a diameter of 8-9 mm and a length of about 30 cm are bent to about 7.7 mm and ± 4.5 mm (Krettek et al: J. Biomechanics, Oct. 1994) to the front and rear and inside and outside, respectively. Therefore, the angle of the distal screw hole (DSH) pre-formed in the inserted fracture fixing device is different from the angle before insertion, the changed angle was not known by the external aiming device of the conventional fracture fixing device.

In the present invention, since the material of the fracture fixation device is made of solid stainless steel, titanium, or an alloy thereof, rotational deformation of the fracture fixator body itself hardly occurs even after being inserted into the bone marrow cavity (± 0.3 degrees: Krettek et. al: J. Biomechanics, Oct. 1994) There is no rotational deformation of the fracture fixation device when the tip of the fracture fixation device bends back, forth, and lateral in the bone marrow cavity. Therefore, the present invention is focused on the fact that if the fracture fixation device can be accurately positioned in the center of the bone marrow, the angle of the distal screw hole before and after insertion becomes the same, so that the distal screw can be accurately inserted and fixed only by the target machine. .

Figure 7 is a perspective view of the external aiming device combined with the fracture fixing device according to the present invention.

First, the external aiming device 300 having a L-shape as a whole is largely a L-shaped frame 320, a guide hole 322 formed at one side of the frame 320, and a central portion of the frame 320. The connector 380, a distal screw hole collimator 340 coupled to the guide hole 322, and a driver adjuster 360 fastened to the upper end of the proximal portion of the cylindrical fracture fixing device 100 of FIG. 4.

The driver adjusting unit 360 is provided with a driver (not shown) to rotate the wire support screw 170 in the fracture fixing device 100 to move up and down, in consideration of the size of the fracture fixing device 100 If the position of the distal screw hole collimator 340 is fixed in advance, even after the bone fixation device 100 is inserted into the ear, the position of the distal screw hole 160 can be easily determined from the outside of the bone.

The connecting portion 380 adjusts the width of the frame 320 by the fixing screw 382 and the support 384, and the distal screw hole collimator 340 is formed in the guide hole 322 of the frame 320. It is fixed and consists of a frame aiming frame 342 of the rectangular frame shape, and a fixing screw 344 for fixing the distal screw hole aimer 340 to the frame 320, the aiming frame 342 has a guide pin aiming hole ( 346 and a distal screw hole aiming hole 348 are formed. The frame 320 may be integrally formed without forming the connection part 380.

8 is a schematic view for explaining the operating state of the external aiming device of Figure 7, Figure 9 is a front view of the guide pin used in the fracture fixing device according to the invention, Figure 10 is a fracture fixing device of Figure 4 is inserted 11A to 11C are cross-sectional views illustrating the steps for fixing the fracture fixation device of FIG. 4 to the center of the bone marrow cavity of the bone.

The wire loop portion of the fracture fixing device 100 and the distal screw hole collimator 340 portion of the external collimator 300 will be described in detail as follows.

First, the position and angle of the guide pin aiming hole 346 of the external aiming device 300 to match the U-shaped groove 124 of the fracture fixing device 100, and aim the distal screw hole of the external aiming device 300 The position and angle of the hole 348 are previously adjusted to coincide with the distal screw hole 160 of the fracture fixation device 100 (see FIG. 7).

Thereafter, the fracture fixation device 100 is inserted into the bone marrow cavity 24. At this time, the metal wire (TW) is inserted into the body 120 is not largely exposed to the outside. (See FIG. 11A)

Then, the wire support screw 17 is rotated downward by the driver 362 of the external collimation device 300 adjusted to the fracture fixing device 100 to move the wire 180 to the distal portion to form a loop. To form a hole in the bone 20 of the portion corresponding to the position of the guide pin aiming hole 346 with a human surgical drill. As described above, the distal end of the fracture fixing device 100 inserted into the bone marrow cavity does not have its own rotational deformation even if it is wheeled back and forth, in and out, so that the guide pin hole at an angle that exactly matches the U-shaped groove 124 from the outside. Can be penetrated.

Subsequently, after measuring the outer diameter Φ of the bone 20 with a surgical depth gauge (not shown) (current surgical measuring instrument is usually in a unit of 2mm), the diameter of the bone 20 Select the guide pin 400 having an insertion portion 420 of the same length and insert it into the guide pin aiming hole 346. At this time, the insertion portion 420 of the guide pin 400 is inserted between the loop and the groove 124 (see Figs. 9 and 11b).

Thereafter, when the wire support screw 17 is rotated upward with the driver 362 to tighten the loop of the wire 180, the wire 180 is moved to the concave center of the insertion part 420 to fix the fracture fixing device ( 100 is guided to the center of the bone marrow, and when the guide pin 400 is in close contact with the groove 124 of the fracture fixation device 100, the fracture fixation device 100 is the bone marrow central portion of the bone 20 If the hole in the distal screw hole aiming hole 348 position is to be precisely matched to the distal screw hole 160, by inserting the distal engagement screw 150 here fracture fixing device (100) ). (See FIG. 8, FIG. 10, FIG. 11C).

Here, as shown in Figure 9, the insertion portion 420 formed at the end of the guide pin 400 is variable in length. For example, the length of each insertion portion 420 may be formed differently at 2 mm intervals, and only the insertion portion 420 length Φ may be inserted into the bone 20.

It is also possible to loosen the wire 18 and remove the guide pin 400 before inserting another distal engagement screw in the hole.

In addition, an actual picture of the fracture fixation device is shown in FIG. 12, and an X-ray picture of a state in which a guide pin insertion hole is formed in the bone in FIG. 11B is shown in FIG. 13, and the distal engagement screw is inserted in FIG. 11C. An X-ray photograph of a hole forming state is shown in FIG. 14, an outer photograph of FIG. 14 state is shown in FIG. 15, and an external view of the distal engagement screw is shown in FIG. 16. have.

Fracture fixation device and fracture fixation method using the same according to the present invention uses a fracture fixation device having a wire that can form a loop in the U-shaped groove formed at one end of the metal tablet in combination with the external aiming device of the corresponding structure Thus, the distal engagement screw can be easily inserted into the distal screw hole at a precise angle without using a fluoroscopy device, which saves surgery time and eliminates the need to use a fluoroscopy device, thereby causing the patient or operator to be exposed to radiation. No need for expensive equipment, normalize the medical system and reduce the procedure cost, minimize the damage to surrounding muscles when distal interlocking screw is inserted, and apply additional compressive force to the fracture Fracture fusion has the advantage of being possible.

Claims (8)

It includes a body having a hollow inside the groove is formed in the distal end, and an external collimator detachably coupled to the body, The body includes a wire coupled to be movable up and down in the body while forming a loop exposed to the outside through the groove, and a distal screw hole formed through the body, The external aiming device includes a main frame and an aiming frame movably coupled to the main frame, the aiming frame having a guide pin aiming hole and a distal screw hole aiming hole corresponding to the groove and the distal screw hole, respectively. Fracture fixation device. 2. The fracture fixation apparatus according to claim 1, wherein the body is made of stainless steel, titanium, or an alloy thereof. The fracture fixing device according to claim 1, wherein a wire support screw is screwed to an inner surface of the proximal side of the body, and the wire is movable up and down in the body by a wire support screw. The fracture fixation apparatus according to claim 1, wherein the aiming frame is slide coupled to the main frame. 2. The fracture fixation apparatus according to claim 1, wherein the groove is formed in a u shape. delete delete delete