TWI573556B - The dynamic structure of the Dynamic Hip Screw (DHS) - Google Patents
The dynamic structure of the Dynamic Hip Screw (DHS) Download PDFInfo
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本發明與股骨動態固定器(Dynamic Hip Screw,DHS)有關,更詳而言之,是一種附加於DHS的後擋結構,該後擋結構可讓DHS的拉力螺釘及加壓螺釘有限度的微距滑退或不滑退。 The invention relates to a Dynamic Hip Screw (DHS), and more specifically, a rear stop structure attached to the DHS, which allows the DHS lag screw and the compression screw to have a limited degree of micro Slip back or not slip.
臨床上,股骨近端骨折是髖部常見的骨折,目前治療方式是採用內固定系統,例如DHS系統、髓內固定系統。據臨床實作及研究顯示,股骨近端穩定性骨折以DHS治療,效果獲得肯定。一個典型的DHS系統,如第一圖所示,其基本原理是將拉力螺釘1插入股骨頭頸部以固定骨折近端,在其尾部套入一個側固定板2以固定骨折遠端,側固定板2連接一個套筒3,套筒3穿套在拉力螺釘1外,據以支撐著拉力螺釘1且防止拉力螺釘1旋轉,加壓螺釘4從套筒3的遠端鎖入拉力螺釘1中,擰緊加壓螺釘4時因為套筒2的支撐作用,拉力螺釘1帶著骨折近端沿著套筒3向外下走行,骨折端間相互靠合,並控制緊壓力量,因此加強了垂直於骨折線的分力,從而促進骨折癒合。 Clinically, the proximal femoral fracture is a common fracture of the hip. The current treatment is the use of internal fixation systems, such as DHS system, intramedullary fixation system. According to clinical practice and research, the fracture of the proximal femur is treated with DHS, and the effect is affirmed. A typical DHS system, as shown in the first figure, is based on the principle of inserting the lag screw 1 into the neck of the femur to fix the proximal end of the fracture, and inserting a side fixation plate 2 at the end to fix the distal end of the fracture. The plate 2 is connected to a sleeve 3 which is sleeved outside the lag screw 1 to support the lag screw 1 and prevent the lag screw 1 from rotating. The compression screw 4 is locked from the distal end of the sleeve 3 into the lag screw 1 When the compression screw 4 is tightened, because of the support of the sleeve 2, the lag screw 1 travels down the sleeve 3 along the proximal end of the fracture, and the fracture ends abut each other and control the amount of pressing force, thus strengthening the vertical The component of the fracture line, thereby promoting fracture healing.
在股骨近端骨折癒合過程中,使頭頸部內翻之分力、體重壓力、肌肉牽拉合成的剪力、下肢外旋轉力,使骨折處出現應力-應變的週期性變化,產生骨折兩端的軸向微動,這些因素導致DHS的拉力螺釘1及加壓螺釘4承受很大的壓力,就可能使拉力螺釘1及加壓螺釘4產生「過度向後滑退(簡 稱back out)」的現象。第二圖描述拉力螺釘1及加壓螺釘4發生back out的情形(加壓螺釘4的釘頭及部分釘身明顯凸出該側固定板2的外表面),導致骨力矩(D1)及骨長度(D2)變短,癒後股骨長度變短,以致患者出現跛行的問題。 During the healing process of the proximal femoral fracture, the force component of the head and neck varus, the weight and pressure, the shear force of the muscle pull, and the rotational force of the lower extremities cause periodic changes in the stress-strain at the fracture, resulting in the axis at both ends of the fracture. To the micro-motion, these factors cause the DHS lag screw 1 and the compression screw 4 to withstand a large pressure, which may cause the lag screw 1 and the compression screw 4 to "extend backwards backwards" (simple The phenomenon of back out). The second figure depicts the situation in which the lag screw 1 and the compression screw 4 are back out (the nail head of the compression screw 4 and part of the nail body clearly protrude from the outer surface of the side fixing plate 2), resulting in bone moment (D1) and bone The length (D2) becomes shorter, and the length of the femur becomes shorter, so that the patient has a problem of limp.
在一些骨折復原的過程中,使拉力螺釘1及加壓螺釘4得以「有限度的向後滑退(簡稱微距滑退)」,將可減少骨折處的剪力和應力集中,並防止近端骨折塊下移形成股骨頸角崩垮內翻塌陷的問題。但在另一些骨折復原的過程中,將拉力螺釘1及加壓螺釘4固定,使其無法向後滑退,對骨折復原也是有益處的。因此,拉力螺釘1及加壓螺釘4應該被固定或者使其微距滑退,端視臨床醫師視骨折的情況決定。 In some fracture recovery processes, the lag screw 1 and the compression screw 4 can be "limited backward sliding (referred to as macro slip)", which will reduce the shear force and stress concentration at the fracture and prevent the proximal end. The fracture block moves down to form a problem of collapse of the femoral neck angle collapse. However, in the process of restoring the fracture, the lag screw 1 and the compression screw 4 are fixed so that they cannot slide backwards, which is also beneficial for fracture recovery. Therefore, the lag screw 1 and the compression screw 4 should be fixed or slightly slid back, depending on the condition of the clinician depending on the fracture.
本發明所要解決的是關於習知DHS的拉力螺釘及加壓螺釘發生「過度向後滑退(back out)」的問題。 The problem to be solved by the present invention is that the lag screw and the compression screw of the conventional DHS have a problem of "over-backward".
一種股骨動態固定器(Dynamic Hip Screw,DHS)之後擋結構,該股骨動態固定器包括一拉力螺釘、一側固定板、一套筒以及一加壓螺釘;該套筒傾斜連接於該側固定板的頂端;該套筒中具有一貫穿其軸心的軸孔,該軸孔於該套筒的兩端形成一高位孔口和一低位孔口;該拉力螺釘的尾端從該高位孔口進入該套筒中,該加壓螺釘從該低位孔口鎖入該拉力螺釘的尾端;該股骨動態固定器固定於股骨近端之股骨頸骨折部;該後擋結構包含:一擋塊以及一定位件;該定位件將該擋塊安裝於該側固定板表面緊鄰該套筒之低位孔口之位置;該擋塊具有一擋止部,該擋止部相對於該低位孔口;該擋止部的最高點在該低位孔口中的高度,與允許該拉力螺釘 以及該加壓螺釘在該套筒中從一植入位置向該低位孔口方向滑退的距離成反比;該擋止部的最高點在該低位孔口中的高度愈高,該滑退的距離愈小。 A dynamic hip screw (DHS) rear retaining structure, the femoral dynamic anchor comprises a lag screw, a side fixing plate, a sleeve and a pressing screw; the sleeve is obliquely connected to the side fixing plate a top end of the sleeve having a shaft hole extending through an axial center thereof, the shaft hole forming a high level opening and a lower position opening at both ends of the sleeve; the tail end of the lag screw entering from the high level opening In the sleeve, the compression screw is locked from the lower orifice into the tail end of the lag screw; the femoral dynamic fixator is fixed to the femoral neck fracture at the proximal end of the femur; the rear stop structure comprises: a stopper and a a positioning member; the positioning member is mounted on the surface of the side fixing plate adjacent to the lower opening of the sleeve; the stopper has a stopping portion, the blocking portion is opposite to the lower opening; the blocking portion The height of the highest point of the stop in the lower opening, and the lag screw is allowed And the distance that the pressing screw slides in the sleeve from an implantation position to the lower orifice is inversely proportional; the height of the highest point of the stopper in the lower orifice is higher, the distance of the sliding The smaller.
更進一步的,該擋止部的最高點位於該低位孔口的中心點以下,該擋止部的最高點與該植入位置之加壓螺釘的釘頭的端面之間有一距離,該距離允許該拉力螺釘以及該加壓螺釘在該套筒中從該植入位置向該低位孔口方向滑退。較佳的是,最大滑退距離控制在10mm左右。 Further, the highest point of the stopping portion is located below a center point of the lower opening, and a distance between a highest point of the stopping portion and an end surface of the nail head of the pressing screw at the implantation position is allowed The lag screw and the compression screw slide in the sleeve from the implantation position toward the lower orifice. Preferably, the maximum slip distance is controlled to be about 10 mm.
更進一步的,該擋塊的擋止部的最高點位於該低位孔口的中心點以上,該擋止部的最高點與該植入位置之加壓螺釘的釘頭的端面之間無距離,該擋止部的最高點抵制於該植入位置之加壓螺釘的釘頭的端面,該拉力螺釘以及該加壓螺釘被固定在該植入位置無法滑退。 Further, the highest point of the stopper of the stopper is located above the center point of the lower aperture, and the highest point of the stopper has no distance from the end surface of the nail head of the compression screw at the implantation position, The highest point of the stop portion resists the end face of the nail head of the compression screw at the implantation position, and the lag screw and the compression screw are fixed at the implantation position and cannot be slid off.
依據本發明,當DHS植入股骨近端骨折處之後,該後擋結構使DHS的拉力螺釘及加壓螺釘得以因應骨折兩端的軸向微動做有限度的微距滑退,微距滑退最大距離範圍控制在10mm左右,在達到所容許的微距滑退距離極限值時,拉力螺釘及加壓螺釘被該後擋結構擋止。 According to the present invention, after the DHS is implanted into the proximal femoral fracture, the backrest structure enables the DHS lag screw and the compression screw to perform a limited degree of macroscopic slippage in response to the axial micro-motion at both ends of the fracture, and the macro slippage is maximum. The distance range is controlled to about 10 mm. When the allowable macro slip distance limit value is reached, the lag screw and the compression screw are blocked by the rear stop structure.
依據本發明之後擋結構,使DHS的拉力螺釘在受到控制的情況下進行有限度的微距滑退,因此股骨近端骨折的兩端可進行控制性細微軸向運動,可以促進骨痂的形成和鈣化,加速骨折愈合,因此本發明之後擋結構具有加強DHS對股骨近端骨折動靜態加壓促癒合之效果。 According to the rear retaining structure of the present invention, the DHS lag screw is subjected to a limited degree of macro slippage under the control, so that the two ends of the proximal femoral fracture can perform controlled fine axial movement, which can promote the formation of the epiphysis. And calcification, accelerate fracture healing, so the posterior structure of the present invention has the effect of enhancing DHS on the dynamic compression of the proximal femoral fracture.
依據本發明,DHS的拉力螺釘及加壓螺釘透過後擋結構的控制進行有限度的微距滑退,以配合骨折兩端的細微軸向運動,將可分散骨折處的剪力及應力,降低近端骨折塊下移形成股骨頸角崩垮內翻塌陷及拉力 螺釘向上切割(cut out)穿出股骨頸的機率。 According to the present invention, the DHS lag screw and the compression screw are subjected to a limited degree of macroscopic sliding back through the control of the rear stop structure to match the fine axial movement at both ends of the fracture, and the shear force and stress at the dispersible fracture are reduced. End fracture block moves down to form femoral neck angle collapse, varus collapse and tension The screw cuts out the chance of penetrating the femoral neck.
依據本發明的另一實施例,當DHS植入股骨近端骨折處之後,該後擋結構將DHS的拉力螺釘及加壓螺釘定置在植入位置,使拉力螺釘及加壓螺釘不能向後滑退。 According to another embodiment of the present invention, after the DHS is implanted into the proximal femoral fracture, the backrest structure fixes the DHS lag screw and the compression screw at the implantation position, so that the lag screw and the compression screw cannot slide backward. .
依據本發明之後擋結構,除了擋止拉力螺釘及加壓螺釘之外,亦具有支撐拉力螺釘及加壓螺釘的作用,減少拉力螺釘因應力集中而彎曲或斷裂的情形。 According to the rear retaining structure of the present invention, in addition to the lag screw and the compression screw, the lag screw and the pressing screw are also supported to reduce the bending or breaking of the lag screw due to stress concentration.
依據本發明之後擋結構,適用於AO Classfication分類31-A1至31-C3所定義之骨折類型。 According to the backstop structure of the present invention, it is suitable for the type of fracture defined by the AO Classfication classifications 31-A1 to 31-C3.
1‧‧‧拉力螺釘 1‧‧‧ lag screw
2‧‧‧側固定板 2‧‧‧ side fixing plate
200‧‧‧固定孔 200‧‧‧Fixed holes
201‧‧‧容置槽 201‧‧‧ accommodating slots
202‧‧‧連通部 202‧‧‧Connecting Department
203‧‧‧凸出部 203‧‧‧protrusion
3‧‧‧套筒 3‧‧‧Sleeve
4‧‧‧加壓螺釘 4‧‧‧Compression screws
401‧‧‧釘頭 401‧‧‧nail head
402‧‧‧端面 402‧‧‧ end face
5‧‧‧軸孔 5‧‧‧ shaft hole
6‧‧‧高位孔口 6‧‧‧High aperture
7‧‧‧低位孔口 7‧‧‧Low orifice
8‧‧‧後擋結構 8‧‧‧ Rear stop structure
10‧‧‧擋塊 10‧‧‧block
11‧‧‧擋止部 11‧‧‧stops
12‧‧‧穿孔 12‧‧‧Perforation
21‧‧‧擋止部 21‧‧‧stops
22‧‧‧凹入部 22‧‧‧ recessed
30‧‧‧定位件 30‧‧‧ Positioning parts
41‧‧‧螺釘 41‧‧‧ screws
42‧‧‧釘頭 42‧‧‧nail head
P1‧‧‧擋止部最高點 P1‧‧‧The highest point of the stop
P2‧‧‧低位孔口中心點 P2‧‧‧ low hole center point
90‧‧‧股骨頭頸部 90‧‧‧ femoral head and neck
91‧‧‧股骨幹 91‧‧‧ femoral shaft
第一圖為習知DHS之剖面圖。 The first picture is a cross-sectional view of the conventional DHS.
第二圖為習知DHS之拉力螺釘發生過度向後滑退(back out)以致導致骨力矩及骨長度變短之示意圖。 The second figure is a schematic diagram of the conventional DHS lag screw being excessively back-back so as to cause the bone moment and the bone length to become shorter.
第三圖為DHS與本發明後擋結構第一實施例之立體分解圖。 The third figure is an exploded perspective view of the first embodiment of the DHS and the rear stop structure of the present invention.
第四圖為DHS與本發明後擋結構第一實施例之組合立體外觀圖。 The fourth figure is a combined perspective view of the DHS and the first embodiment of the rear stop structure of the present invention.
第五圖為DHS與本發明後擋結構第一實施例之組合剖面圖。 Figure 5 is a cross-sectional view showing the combination of the DHS and the first embodiment of the rear stop structure of the present invention.
第六圖為本發明後擋結構第一實施例在DHS中擋止拉力螺釘及加壓螺釘的剖面示意圖。 Fig. 6 is a schematic cross-sectional view showing the first embodiment of the rear stop structure of the present invention in the DHS for stopping the lag screw and the pressing screw.
第七圖為DHS與本發明後擋結構第四實施例之立體分解圖。 Figure 7 is a perspective exploded view of the fourth embodiment of the DHS and the rear stop structure of the present invention.
第八圖為DHS與本發明後擋結構第四實施例之組合立體外觀圖。 The eighth figure is a combined perspective view of the DHS and the fourth embodiment of the rear stop structure of the present invention.
第九圖為本發明後擋結構第四實施例在DHS中擋止拉力螺釘及加壓螺釘的剖面示意圖。 Figure 9 is a cross-sectional view showing the lag screw and the compression screw in the DHS of the fourth embodiment of the rear stop structure of the present invention.
為便於說明本案於發明內容一欄中所表示的中心思想,茲以具體實施例表達。實施例中各種不同物件係按適於說明之比例、尺寸、變形量或位移量而描繪,而非按實際元件的比例予以繪製,合先敘明。且以下的說明中,類似的元件是以相同的編號來表示。 For the convenience of the description, the central idea expressed in the column of the invention is expressed by a specific embodiment. Various items in the embodiments are depicted in terms of ratios, dimensions, amounts of deformation, or displacements that are suitable for illustration, and are not drawn to the proportions of actual elements, as set forth above. In the following description, like elements are denoted by the same reference numerals.
第三至第九圖描述習知典型的股骨動態固定器(Dynamic Hip Screw,DHS)。習知典型的DHS包括一拉力螺釘1、一側固定板2、一套筒3以及一加壓螺釘4。該套筒3連接於該側固定板2的頂端,兩者的交角θ大約維持110-150度。該套筒3中具有一貫穿軸心的軸孔5,該軸孔5於該套筒3的兩端形成一高位孔口6和一低位孔口7,拉力螺釘1插入股骨頭頸部90以固定骨折近端,套筒3經由高位孔口6套在拉力螺釘1的尾部外,支撐著拉力螺釘1且防止拉力螺釘1旋轉,側固定板2藉由骨螺釘(圖未示)固定於股骨幹91的外部,加壓螺釘4從套筒3的低位孔口7鎖入拉力螺釘1的尾部中,擰緊加壓螺釘4時因為套筒2的支撐且防止拉力螺釘1旋轉的作用,使拉力螺釘1帶著骨折近端沿著套筒3向外下走行,使骨折處相互靠合。確認骨折處達到預期的靠合後,該拉力螺釘1及加壓螺釘4即定位在植入位置,隨即於該DHS的側固定板2上以螺絲鎖固的方式附加一後擋結構8。 The third to ninth figures depict a conventional typical Dynamic Hip Screw (DHS). A typical DHS includes a lag screw 1, a side fixing plate 2, a sleeve 3, and a pressing screw 4. The sleeve 3 is connected to the top end of the side fixing plate 2, and the angle of intersection θ of the two is maintained at about 110-150 degrees. The sleeve 3 has a shaft hole 5 extending through the shaft center. The shaft hole 5 forms a high position hole 6 and a low position hole 7 at both ends of the sleeve 3. The lag screw 1 is inserted into the femoral head and neck 90. Fixing the proximal end of the fracture, the sleeve 3 is sleeved outside the tail of the lag screw 1 via the high-position orifice 6, supports the lag screw 1 and prevents the lag screw 1 from rotating, and the side fixing plate 2 is fixed to the strand by a bone screw (not shown) On the outside of the backbone 91, the compression screw 4 is locked from the lower opening 7 of the sleeve 3 into the tail of the lag screw 1, and when the compression screw 4 is tightened, the tension is supported by the sleeve 2 and the rotation of the lag screw 1 is prevented. The screw 1 travels down the sleeve 3 with the proximal end of the fracture, so that the fractures abut each other. After confirming that the fracture has reached the desired fit, the lag screw 1 and the compression screw 4 are positioned at the implantation position, and then a rear stop structure 8 is attached to the side fixing plate 2 of the DHS by screwing.
如第三、四圖及第七、八圖,該後擋結構8包括一擋塊10以及一定位件30,該擋塊10透過該定位件30安裝於該側固定板2表面緊鄰該套筒3之低位孔口7,該擋塊10具有一擋止部11(描述於第三圖)、21(描述於第七圖),用以擋止該拉力螺釘1及加壓螺釘4。 The rear stop structure 8 includes a stopper 10 and a positioning member 30, and the stopper 10 is mounted on the surface of the side fixing plate 2 adjacent to the sleeve through the positioning member 30, as shown in the third and fourth figures, and the seventh and eighth figures. The lower orifice 7 of the 3 has a stop 11 (described in the third figure) 21 (described in the seventh diagram) for blocking the lag screw 1 and the compression screw 4.
如第五圖和第九圖,該擋止部11,21相對於該低位孔口7,依據該 擋止部11,21的最高點P1在該低位孔口7中的高度,可大致的決定該拉力螺釘1以及該加壓螺釘4往低位孔口7方向滑動的直線距離;更具體的,該擋止部11,21的最高點P1在該低位孔口7中的高度,與允許該拉力螺釘1以及該加壓螺釘4在該套筒3中從一植入位置向該低位孔口7方向滑退的距離成反比;亦即該擋止部11,21的最高點P1在該低位孔口中7的高度愈高,該滑退的距離愈小。較佳的是,最大滑退距離控制在10mm左右。 As shown in the fifth and ninth figures, the blocking portions 11, 21 are opposite to the lower opening 7, according to the The height of the highest point P1 of the blocking portions 11, 21 in the lower opening 7 can substantially determine the linear distance between the lag screw 1 and the pressing screw 4 in the direction of the lower opening 7; more specifically, The height of the highest point P1 of the stop portions 11, 21 in the lower position opening 7 and the direction in which the lag screw 1 and the compression screw 4 are allowed to move from an implantation position to the lower position opening 7 in the sleeve 3 The distance of the slip is inversely proportional; that is, the higher the height of the highest point P1 of the stop portions 11, 21 in the lower aperture 7, the smaller the distance of the slip. Preferably, the maximum slip distance is controlled to be about 10 mm.
如第五、六圖,該擋止部11的最高點P1位於該低位孔口7的中心點P2以下,該擋止部11的最高點P1與該加壓螺釘4的釘頭401的端面402之間有一距離,該距離允許該拉力螺釘1與加壓螺釘4在骨癒合的過程中得以因應骨折兩端的軸向微動而從第五圖的植入位置往低位孔口7的方向滑退,較佳的是,最大滑退距離控制在10mm左右,吾等稱之為微距滑退。當拉力螺釘1與加壓螺釘的微距滑退達到容許極限值時,該擋止部11的最高點P1抵住該加壓螺釘4的釘頭401的端面402,該拉力螺釘1及加壓螺釘4被該擋止部11擋止,如第六圖。 As shown in the fifth and sixth figures, the highest point P1 of the stopper portion 11 is located below the center point P2 of the lower position port 7, and the highest point P1 of the stopper portion 11 and the end face 402 of the nail head 401 of the pressing screw 4 are as shown. There is a distance between the lag screw 1 and the compression screw 4 which can be slid from the implantation position of the fifth figure to the lower orifice 7 in response to axial micro-motion at both ends of the fracture during bone healing. Preferably, the maximum slip distance is controlled at about 10 mm, which we call macro slip. When the macro slip of the lag screw 1 and the press screw reaches the allowable limit value, the highest point P1 of the stopper portion 11 abuts against the end surface 402 of the nail head 401 of the pressurizing screw 4, the lag screw 1 and the pressurization The screw 4 is blocked by the stop portion 11, as shown in the sixth figure.
如第九圖,該擋塊10的擋止部21的最高點P1位於該低位孔口7的中心點P2以上,該擋止部21的最高點P1直接抵制於該植入位置的加壓螺釘4的釘頭401的端面402,使拉力螺釘1與加壓螺釘4始終保持在植入位置,該拉力螺釘1與加壓螺釘4不能滑退。 As shown in the ninth figure, the highest point P1 of the stopper portion 21 of the stopper 10 is located above the center point P2 of the lower position port 7, and the highest point P1 of the stopper portion 21 directly resists the compression screw of the implantation position. The end face 402 of the nail head 401 of 4 causes the lag screw 1 and the compression screw 4 to remain at the implantation position at all times, and the lag screw 1 and the compression screw 4 cannot slip.
如第三圖至第五圖之實施例,該擋塊10是一塊狀結構,該定位件30一體連接於該擋塊10的側面,該擋塊10與該定位件30之結合形成一個螺釘結構。該定位件30與該擋塊10之結合亦可如第七至九圖之實施例,該定位件30本身就是一顆螺釘41,該擋塊10設一穿孔12,供該螺釘41穿過, 該螺釘41的釘頭42壓制定位該擋塊10。 As shown in the third to fifth embodiments, the stopper 10 is a piece-like structure, and the positioning member 30 is integrally connected to the side of the stopper 10. The stopper 10 and the positioning member 30 are combined to form a screw. structure. The combination of the positioning member 30 and the stopper 10 can also be the embodiment of the seventh to ninth embodiments. The positioning member 30 is itself a screw 41. The stopper 10 is provided with a through hole 12 for the screw 41 to pass through. The nail head 42 of the screw 41 presses and positions the stopper 10.
如第三圖至第五圖之實施例,該擋塊10的週緣包含該擋止部11,該側固定板2於接近該套筒3之低位孔口7的位置設一固定孔200,該固定孔200為螺紋孔,該定位件30鎖入該固定孔200中,該擋塊10之擋止部11相對於該低位孔口7的下緣,該擋止部11的最高點P1位於該低位孔口7的中心點P2以下。如第五圖,拉力螺釘1及加壓螺釘4處於植入位置,該加壓螺釘4的釘頭401與該擋止部11的最高點P1之間有一段距離,基於這個距離,允許該拉力螺釘1與加壓螺釘4在骨癒合的過程中得以因應骨折兩端的軸向微動而向後下微距滑退。在股骨近端骨折癒合過程中,使頭頸部內翻之分力、體重壓力、肌肉牽拉合成的剪力、下肢外旋轉力,使骨折處出現應力-應變的週期性變化,產生骨折兩端的軸向微動,這些因素導致DHS的拉力螺釘1及加壓螺釘4承受很大的壓力,以致拉力螺釘1及加壓螺釘4發生沿著套筒3向後下滑退,當滑退距離達到微距滑退所充許的極限值時,加壓螺釘4的釘頭401被該擋塊10的擋止部11所擋止,如第六圖,因此可避免先前技術一欄中所述的過度向後滑退(back out)的問題。允許拉力螺釘1及加壓螺釘4微距滑退,使股骨近端骨折的兩端可進行控制性細微軸向運動(簡稱微動),該微動可以促進骨痂的形成和鈣化,加速骨折愈合,具有加強DHS對股骨近端骨折動靜態加壓促癒合之效果,並且可分散骨折處的剪力及應力,降低近端骨折塊下移形成股骨頸角崩垮內翻塌陷及拉力螺釘向上切割(cut out)穿出股骨頸的機率。 As shown in the third embodiment to the fifth embodiment, the periphery of the stop 10 includes the blocking portion 11 , and the side fixing plate 2 defines a fixing hole 200 at a position close to the lower opening 7 of the sleeve 3 . The fixing hole 200 is a threaded hole, and the positioning member 30 is locked into the fixing hole 200. The blocking portion 11 of the blocking block 10 is opposite to the lower edge of the lower position opening 7. The highest point P1 of the stopping portion 11 is located at the bottom. The center point P2 of the lower orifice 7 is below. As shown in the fifth figure, the lag screw 1 and the pressing screw 4 are in the implantation position, and the nail head 401 of the pressing screw 4 has a distance from the highest point P1 of the stopping portion 11, based on which the pulling force is allowed. The screw 1 and the compression screw 4 are able to slide backwards and backwards in the process of bone healing in response to axial micro-motion at both ends of the fracture. During the healing process of the proximal femoral fracture, the force component of the head and neck varus, the weight and pressure, the shear force of the muscle pull, and the rotational force of the lower extremities cause periodic changes in the stress-strain at the fracture, resulting in the axis at both ends of the fracture. To the micro-motion, these factors cause the DHS lag screw 1 and the compression screw 4 to withstand a large pressure, so that the lag screw 1 and the compression screw 4 slide back and forth along the sleeve 3, and the slip distance reaches the macro slip. When the limit value is exceeded, the nail head 401 of the compression screw 4 is blocked by the stopper portion 11 of the stopper 10, as shown in the sixth figure, so that the excessive backward sliding described in the column of the prior art can be avoided. (back out) problem. Allowing the lag screw 1 and the compression screw 4 to slip back slightly, so that the two ends of the proximal femoral fracture can perform controlled fine axial movement (referred to as micro-motion), which can promote the formation and calcification of the epiphysis and accelerate fracture healing. It has the effect of strengthening DHS on the dynamic and compression of the proximal femoral fracture, and can disperse the shear force and stress at the fracture, reduce the proximal fracture block and form the femoral neck collapse, and the lag screw is upwardly cut. Cut out) The chance of wearing a femoral neck.
第三圖至第五圖中,一容置槽201設於該側固定板2的表面,位於該套筒3之低位孔口7的下方,且該低位孔口7與該容置槽201之間具有一 連通部202。該容置槽201的槽底設上述的固定孔200。透過該定位件30將該擋塊10鎖附於該容置槽201中,該擋止部11通過該連通部202而相對於該低位孔口7的下緣。將擋塊10設於該容置槽201中,其優點是擋塊10不凸出於該側固定板2的表面,保持該側固定板2表面無凸起窒礙。 In the third to fifth embodiments, a receiving groove 201 is disposed on the surface of the side fixing plate 2, below the lower opening 7 of the sleeve 3, and the lower opening 7 and the receiving groove 201 are Have one The communication unit 202. The groove bottom of the accommodating groove 201 is provided with the above-mentioned fixing hole 200. The stopper 10 is locked in the accommodating groove 201 through the positioning member 30, and the stopper portion 11 passes through the communicating portion 202 with respect to the lower edge of the lower orifice 7. The stopper 10 is disposed in the accommodating groove 201, and the advantage is that the stopper 10 does not protrude from the surface of the side fixing plate 2, and the surface of the side fixing plate 2 is kept free from protrusions.
如第七圖至第九圖,該擋塊10的局部週緣向上延伸形成一塊狀的擋止部21。通過螺釘41穿過該擋塊10的穿孔12,將該擋塊10固定於該側固定板2,該擋止部21相對於該低位孔口7,且該擋止部21的最高點P1高於該低位孔口7的中心點P2,致該擋止部21直接抵制加壓螺釘4,使拉力螺釘1與加壓螺釘4保持在植入位置,可微距滑退距離為0mm,意即該拉力螺釘1與加壓螺釘4不能滑退。在一些骨折復原的例子中,將拉力螺釘1及加壓螺釘4固定,使其無法向後滑退,對骨折復原仍是有益處的。 As shown in the seventh to ninth drawings, the partial periphery of the stopper 10 extends upward to form a block-shaped stopper portion 21. The stopper 10 is fixed to the side fixing plate 2 by the screw 41 passing through the through hole 12 of the stopper 10, and the stopper portion 21 is opposite to the lower hole 7 and the highest point P1 of the stopper portion 21 is high. At the center point P2 of the lower orifice 7, the stopper portion 21 directly resists the pressing screw 4, and the lag screw 1 and the pressing screw 4 are held at the implantation position, and the distance of the macro sliding distance is 0 mm, that is, The lag screw 1 and the compression screw 4 cannot slip back. In some cases of fracture recovery, the lag screw 1 and the compression screw 4 are fixed so that they cannot slide backwards, which is still beneficial for fracture recovery.
如第七圖至第九圖,一容置槽201設於該側固定板2的表面,位於該套筒3之低位孔口7的下方,且該低位孔口7與該容置槽201之間具有一連通部202。該容置槽201的槽底設一上述的固定孔200。該連通部202的左右側壁上具有至少一凸出部203。該擋止部21與該擋塊20的交界處側面具有至少一凹入部22。透過該螺釘41將該擋塊10鎖附於該容置槽201中,該擋止部21通過該連通部202而相對於該低位孔口7。該凸部203嵌入該凹入部22,據以限制該擋塊22及擋止部21,使其不會繞著該螺釘41而旋轉位移。 As shown in the seventh to ninth embodiments, a receiving groove 201 is disposed on the surface of the side fixing plate 2, below the lower opening 7 of the sleeve 3, and the lower opening 7 and the receiving groove 201 are There is a communication portion 202 therebetween. A fixing hole 200 is formed in the bottom of the groove of the accommodating groove 201. The left and right side walls of the connecting portion 202 have at least one protruding portion 203. The side of the interface between the stop portion 21 and the stop 20 has at least one recess 22 . The stopper 10 is locked in the accommodating groove 201 by the screw 41, and the stopper portion 21 is opposed to the lower orifice 7 by the communicating portion 202. The convex portion 203 is fitted into the concave portion 22, thereby restricting the stopper 22 and the stopper portion 21 so as not to be rotationally displaced around the screw 41.
綜上所述,通過手術方法使DHS固定在股骨近端骨折處後,應使用第三圖至第五圖所描述的後擋結構,或第七圖至第九圖所描述的後擋結構,使拉力螺釘1及加壓螺釘4被固定在植入位置或者使其可微距滑退,端視臨床醫師視骨折的情況決定。 In summary, after the DHS is fixed at the proximal femoral fracture by surgical methods, the rear stop structure described in the third to fifth figures, or the rear stop structure described in the seventh to ninth views, should be used. The lag screw 1 and the compression screw 4 are fixed at the implantation position or are allowed to slide back in a macro direction, which is determined by the clinician depending on the fracture.
1‧‧‧拉力螺釘 1‧‧‧ lag screw
2‧‧‧側固定板 2‧‧‧ side fixing plate
200‧‧‧固定孔 200‧‧‧Fixed holes
201‧‧‧容置槽 201‧‧‧ accommodating slots
202‧‧‧連通部 202‧‧‧Connecting Department
203‧‧‧凸出部 203‧‧‧protrusion
3‧‧‧套筒 3‧‧‧Sleeve
4‧‧‧加壓螺釘 4‧‧‧Compression screws
401‧‧‧釘頭 401‧‧‧nail head
402‧‧‧端面 402‧‧‧ end face
6‧‧‧高位孔口 6‧‧‧High aperture
7‧‧‧低位孔口 7‧‧‧Low orifice
8‧‧‧後擋結構 8‧‧‧ Rear stop structure
10‧‧‧擋塊 10‧‧‧block
11‧‧‧擋止部 11‧‧‧stops
30‧‧‧定位件 30‧‧‧ Positioning parts
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TW103131443A TWI573556B (en) | 2014-09-11 | 2014-09-11 | The dynamic structure of the Dynamic Hip Screw (DHS) |
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Citations (2)
Publication number | Priority date | Publication date | Assignee | Title |
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US5041116A (en) * | 1990-05-21 | 1991-08-20 | Wilson James T | Compression hip screw system |
CN202497228U (en) * | 2012-01-13 | 2012-10-24 | 常州市康辉医疗器械有限公司 | Spiral blade type femur near-end minimally invasive lockplate |
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Patent Citations (2)
Publication number | Priority date | Publication date | Assignee | Title |
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US5041116A (en) * | 1990-05-21 | 1991-08-20 | Wilson James T | Compression hip screw system |
CN202497228U (en) * | 2012-01-13 | 2012-10-24 | 常州市康辉医疗器械有限公司 | Spiral blade type femur near-end minimally invasive lockplate |
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