WO2005092219A1 - Bone connecting tool - Google Patents

Bone connecting tool Download PDF

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Publication number
WO2005092219A1
WO2005092219A1 PCT/JP2005/005487 JP2005005487W WO2005092219A1 WO 2005092219 A1 WO2005092219 A1 WO 2005092219A1 JP 2005005487 W JP2005005487 W JP 2005005487W WO 2005092219 A1 WO2005092219 A1 WO 2005092219A1
Authority
WO
WIPO (PCT)
Prior art keywords
nail
intramedullary nail
hole
small
portion
Prior art date
Application number
PCT/JP2005/005487
Other languages
French (fr)
Japanese (ja)
Inventor
Hirotaka Shimizu
Original Assignee
Hirotaka Shimizu
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority to JP2004-091086 priority Critical
Priority to JP2004091086A priority patent/JP3609825B1/en
Priority to JP2005-052283 priority
Priority to JP2005052283A priority patent/JP2006230831A/en
Application filed by Hirotaka Shimizu filed Critical Hirotaka Shimizu
Publication of WO2005092219A1 publication Critical patent/WO2005092219A1/en

Links

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17Guides or aligning means for drills, mills, pins or wires
    • A61B17/1725Guides or aligning means for drills, mills, pins or wires for applying transverse screws or pins through intramedullary nails or pins
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17Guides or aligning means for drills, mills, pins or wires
    • A61B17/1707Guides or aligning means for drills, mills, pins or wires using electromagnetic effects, e.g. with magnet and external sensors
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/72Intramedullary pins, nails or other devices
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/72Intramedullary pins, nails or other devices
    • A61B17/7233Intramedullary pins, nails or other devices with special means of locking the nail to the bone
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/72Intramedullary pins, nails or other devices
    • A61B17/7233Intramedullary pins, nails or other devices with special means of locking the nail to the bone
    • A61B17/7241Intramedullary pins, nails or other devices with special means of locking the nail to the bone the nail having separate elements through which screws pass
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/72Intramedullary pins, nails or other devices
    • A61B17/7233Intramedullary pins, nails or other devices with special means of locking the nail to the bone
    • A61B17/725Intramedullary pins, nails or other devices with special means of locking the nail to the bone with locking pins or screws of special form
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/74Devices for the head or neck or trochanter of the femur
    • A61B17/742Devices for the head or neck or trochanter of the femur having one or more longitudinal elements oriented along or parallel to the axis of the neck
    • A61B17/744Devices for the head or neck or trochanter of the femur having one or more longitudinal elements oriented along or parallel to the axis of the neck the longitudinal elements coupled to an intramedullary nail

Abstract

[PROBLEMS] To provide a bone connecting tool capable of solving problems in a conventional bone connecting tool wherein one end of the base part of a small nail used at the proximal end side of an intramedullary nail is projected from the side face of the intramedullary nail and the intramedullary nail inserted into a cancellius bone is loosened. [MEANS FOR SOLVING PROBLEMS] This bone connecting tool is so formed that a through hole (3) is formed from the end face (2) of the intramedullary nail (1) at the proximal end side in a direction forming a specified angle relative to the centerline of the intramedullary nail (1), a conical part (8) gradually reduced in diameter from the inlet side to the outlet side is formed at the through hole (3), the small nail (4) having a conical part fitted to the conical part (8) of the through hole (3) is inserted into the through hole (3), and the small nail (4) is fixed by pressing from the inlet side of the through hole (3) by a small nail fixing means (12). Also, a soft portion formed of a small diameter part, a plate-like part, or a slit forming part is formed near the center part of the intramedullary nail in the major axis direction.

Description

Specification

Osteosynthesis device

Technical field

[0001] The present invention relates to an osteosynthesis instrument for use in the human body fracture treatment relates osteosynthesis device using the particular intramedullary nail. BACKGROUND

[0002] For the human body fracture treatment, the osteosynthesis device using the intramedullary nail, a screw on the side surface of the distal is fixed by set screws by inserting the pin from the side surface of the proximal intramedullary nail inserted, the pins and the screws that so as to thread into cancellous bone or cortical bone (e.g., see Patent Document 1), penetrating the nail member from the side at the proximal side of the nail member inserted into the femoral which was 揷入 the locking king screw distal nail member, a lag screw and locking screw was such that threaded into cancellous bone or hide bony is fixed by set screw to 揷入 the lag screw to (e.g., see Patent Document 2) are known. Moreover, those bored internal threads in the nail to secure the intramedullary nail (e.g., see Patent Document 3) are also known.

[0003] In this case, the lag screw also penetrates from the side of the proximal portion of the inserted intramedullary nail into the bone to the 揷入 locking screw in the distal portion, can the position and direction of the screw hole in direct no reason, there is a case of using the X-ray fluoroscope to using the guide device. Of this, the guide device, as it is said target device, also of a guide hole for guiding the locking screw targeting rail aiming strap coupled to the head of the intramedullary nail (e.g., Patent Document 7) it is known.

[0004] Further, when the insertion of the fixing screw at the distal end of the intramedullary nail inserted in the bone, because no direct view of the position and direction of the screw hole, the position 及 beauty of the screw hole with an X-ray fluoroscope to identify the direction, which was set to open a hole in the bone portion corresponding to the screw holes using radiolucent drill (e.g., see Patent Document 4) it is known.

[0005] Further, as a method for confirming the screw holes of the intramedullary nail using light, screw holes by observing the light Chikarari on the body surface to be provided by the arrangement light Emitta the intramedullary nail how to find the position (e.g., see Patent Document 5) and a method to 揷入 light Emitta 'element in the intramedullary nail, to detect the light from Emitta shining through the holes of the intramedullary nail by the optical sensor array (e.g. known see Patent Document 6).

[0006] Patent Document 1: JP 2002- 253566 JP

Patent Document 2: JP 2002-35000 JP

Patent Document 3: JP-T 2001-520071 Patent Publication

Patent Document 4: JP 5 - 3882 JP

Patent Document 5: US patent 5, 540, 691

Patent Document 6: JP-T 2002 - 516690 Patent Publication

Patent Document 7: JP-T 2000-513603 Patent Publication

Disclosure of the Invention

Problems that the Invention is to you'll solve

While [0007] and force, and have contact to the osteosynthesis device using a conventional intramedullary nail shown in Patent Documents 1 and 2, the pin from the proximal side of the intramedullary nail, when inserting the lag screw or screws , pin, because the method of the lag screw or screws are secured through the side surface of the intramedullary nail, pin, that one end of the base portion of the lag screw or screws protruding from the side surface of the bone intramedullary nail has been inserted there was a problem. Therefore, there can contribute to limited range or of the human body pain remaining joints including bone intramedullary nail has been inserted. The pin, for insertion from the side of the intramedullary nail lag screw or screws, were also problems that must be carried out anew skin incision.

[0008] Further, when the insertion of screws or locking screws in intramedullary nail, because no internal thread is present in the nail-side, cancellous screw portion of the screw or locking screw protruding to the opposite side through the intramedullary nail by screwing the bone or cortical bone, because it was intended to generate a securing force, not only can not exhibit a sufficient fixing force is weak bone with osteoporosis in the elderly, and the like 揷入 been threaded there is also a problem that missing come.

[0009] Further, in the conventional osteosynthesis instrument, even when drilling the internal thread within the intramedullary nail, a plurality of bone pieces exclusively fracture the Nag only used to fix the intramedullary nail idea that they fix the plurality of bone pieces in intramedullary nail if there did not exist. [0010] Further, when a hole in the bone to fit the screw hole of the intramedullary nail inserted in the bone, 及 beauty, in order to 揷入 fixing screws into screw holes, screw holes using X-ray fluoroscope in confirms the position and direction of, it has been les, cormorants problems if exposure dose of X-rays becomes larger to the operator and patient. Furthermore, this approach is difficult to procedure, the there is a problem that it takes time to treatment.

[0011] In addition, conventional intramedullary nail is of a cylindrical, der what flexibility is poor with respect to the bending ivy. However, the use of poor intramedullary nail flexibility, for example, fractures of the upper limbs, especially in the case of such humeral proximal fracture, the cancellous bone is weak, the pin or screw is inserted into the cancellous bone around stress is concentrated on the portion, the bone of the peripheral portion of the pin or screw may be destroyed. Therefore, there is a problem that the pin or screw slackens. Also, if the cancellous bone has sufficient strength, the stress caused by body movement, pin or screw there is a problem in that damage.

[0012] - How, in order was the insertion of the locking screw in the distal portion of the inserted intramedullary nail into the bone, when using the drill guide apparatus, the intramedullary nail into the bone when the intramedullary nail is long deflection caused by bending of the longitudinal when inserted, the position of the screw holes will vary, because the sleeve of the drill guide apparatus can not follow, to pass the locking scan clew exactly the intramedullary nail screw hole can not. Conventional guide device disclosed in Patent Document 7, since no consideration is given deflection of the intramedullary nail, the screw hole when the shoehorn locking screw into the screw hole of the nail longitudinal axis of the sleeve and the long axis is not Itase over, after all, there is a problem that can not be 揷入 the locking screw.

[0013] In the method using a radiolucent drill described in Patent Document 4, the procedure to involve difficulties, may take a long time, furthermore, exposure of X-rays to the surgeon and the patient also there is a problem that increases.

[0014] Further, in the one using a conventional optical Emitta shown in Patent Documents 5 and 6, since the light emission of optically Emitta in intramedullary nail is arranged, a medium after confirming a screw hole Les, such can when not taken out of the intramedullary nail, hit the drill emitters. At that time, when the sight of the position of the screw hole for some reason, there is a need to 揷入 again emitters in the intramedullary nail. Further, the light, since the scattered when passing through the bone, Les coincides with the screw hole position detection necessarily light, Rutoie a record, there is a case. It was not a thing to deal with the scattering of such light. Furthermore, if the intramedullary nail is not hollow body can not be 揷入 the light emitter into the intramedullary nail. Therefore, it was impossible to use the intramedullary nail of circumstances in such. When striking a drill screw hole is not enough confirmation of the position of the screw hole, it was not possible to deal with this force it is necessary to match the direction of the drill to the axial direction of the threaded hole .

[0015] The present invention has been made in view of such problems, one end of the root portion of the small nails used for proximal intramedullary nail has been eliminated the problem of protruding from the side surface of the intramedullary nail osteosynthesis device to provide. Also, easy insertion of the fixing screw for the nail, and is flexible further provides osteosynthesis instrument to exert sufficient fixing force. Moreover, providing a plurality of bone fragments fixation capable osteosynthesis instrument. Further, the detection of the position of the insertion portion of the fixing screw is easy, further, to provide a bone joining device which can control the direction of insertion. Furthermore, it is an object to provide an osteosynthesis device that can be opened easily in response to the position and orientation of the screw holes of the intramedullary nail, and a precise hole in the bone.

[0016] The "proximal portion" of the intramedullary nail which is used herein, the intramedullary nail refers to the portion of the nail near the bone hole to be inserted into the bone, the intramedullary nail " the distal portion "refers to the tip of the case of inserting an intramedullary nail to the bone. In the present specification, the term "fixing screw" refers to a fixing screw for fixing the distal portion of the intramedullary nail, Ru same meaning der the locking screw according to the prior art.

Means for Solving the Problems

[0017] In order to solve the above problems, bone junction according to claim 1 of the present invention,

The end portion of the proximal portion of the intramedullary nail, is characterized by providing towards the small nail fitting portion interpolating fit the small nails of the nail fixation in a direction crossing the longitudinal direction of the intramedullary nail .

According to this feature, by providing the small nail fitted 揷部 for inserted small nails to the end of the proximal portion of the intramedullary nail, pin for fixing the proximal portion of a conventional intramedullary nail, lugs screw or screws make it possible to fix the proximal portion of the sushi intramedullary nail such that using the technique of passing through the side surface of the intramedullary nail.

[0018] The osteosynthesis device of claim 2 of the present invention has a predetermined angle with the centerline of the intramedullary nail a osteosynthesis instrument from the end surface of the proximal side of the intramedullary nail according to claim 1 direction a through hole, the through hole is formed with a conical portion whose diameter is reduced toward the outlet side from the inlet side, a small nail having a conical portion for the conical portion and the fitting of the through hole in the through hole and 揷入, is characterized by fixing by pressing from the inlet side of the through-hole by the said small nail small nailing means.

According to this feature, the small nails, because it can rotate freely in the through-hole of the intramedullary nail, for example, be fixed in a desired orientation with small nails in the case of using a curved small nails, small nails the gripping force can be assured. Further, one end of the base portion of the small nail can be prevented pain to the human body because there is no possible to output collision from the side surface of the intramedullary nail remains, is necessary to perform a new skin incision for insertion of the small nail Absent.

[0019] The osteosynthesis device of claim 3 of the present invention is a bone joining device according to claim 1 or 2,

It is characterized in that the arcuate or helical shape having a twisted shape of the small nails. According to this feature, it is possible to employ a small nail optimal shape by site of the fracture, or small nails can be assured that the gripping force even when is inserted into cancellous bone

[0020] The osteosynthesis device of claim 4 of the present invention is a bone joining device according to any of claims 1 to 3,

The provided inside the through hole of the small nail fitted 揷部, the outlet side of the through hole binary through holes or provided with a partition wall to three minutes, the entrance side of the through hole for fixing the small nail small nail fixing screw is bored female threaded portion to be screwed, characterized in that the small nail which includes a hook that extends bifurcated or Sankkojo be expanded as the go ahead from the base portion According to this feature that the bone is musculoskeletal, it since it is premised, although intramedullary nail positioned in the bone is adapted to receive a force that varies, disposed in the through hole to move small nails that are found to be secured together in a manner that is pushed by the small nail fixing screws against the partition wall, there is no possibility that small nails loosened even small nail is subjected to fluctuation stress.

[0021] The osteosynthesis device of claim 5 of the present invention, inside the small nail fitting 揷部 a bone junction according to claim 1, the inlet side of the screw of the intramedullary nail fixation an accommodation hole for accommodating the head is provided, following the housing hole provided internal threads for screwing the screw, Les as characterized by the use of Flip sleep as a small nail, Ru.

According to this feature, since the head of the screw of the screw is configured as a small nail is accommodated in the accommodation hole, there is no problem that one end of the small nail protrudes from the side surface of the intramedullary nail, intramedullary nail 揷limited range of joint comprising inlet bone, or never contribute to the residual of the human body pain.

[0022] The osteosynthesis device of claim 6 of the present invention,

Small diameter portion near the center of the long axis of the intramedullary nail, Les as characterized by forming a soft soft component consisting of a plate-like portion or the slit forming section, Ru.

According to this feature, by providing the flexibility to intramedullary nail body, the slack and breakage of the small nail or fixing screws for fixing the intramedullary nail can be prevented at the proximal portion 及 beauty distal portion of the intramedullary nail .

[0023] The osteosynthesis device of claim 7 of the present invention is a bone joining device according to claim 6

Les is characterized in that a temporary reinforcement member for reinforcing via a hollow portion formed in the intramedullary nail detachably mounted flexible portion of the intramedullary nail, Ru.

According to this feature, by the detachably mounted via a hollow portion of the reinforcing member is formed in the intramedullary nail to temporarily reinforce the flexible portion of the nail, into the bone of the intramedullary nail it can be of the time 揷入 suppress the flexibility of the intramedullary nail keep wearing the reinforcing member to the intramedullary nail, to 揷入 fixing screws into the intramedullary nail in a state that prevents deflection of the nail.

[0024] The osteosynthesis device of claim 8 of the present invention,

At least one thread to more than the bored Tsu 1 screw holes with, forming the guide portion whose diameter increases conically at least one side of the screw hole between the proximal and distal ends of the intramedullary nail mounted in the osteosynthesis device, comprising a shaft rotating cap mounted on the base portion of the intramedullary nail, the shaft rotation key Yap, a rail formed in an arc shape around the screw holes of the intramedullary nail and, provided slidably drill guide member along the guide groove provided in said rail, said drill guide member is provided extending in a direction perpendicular to the arc tangent of the arcuate rail, the drill guide member is characterized in that guide holes for guiding a drill is provided on. According to this feature, as well as a facilitated insertion of fixing screws for the nail, sufficient can exhibit fixing force, also enables fixing a plurality of bone pieces, further, the screw holes of the intramedullary nail corresponding to the position and orientation easily and accurately can be a hole in the bone.

[0025] The osteosynthesis device of claim 9 of the present invention,

The nut member bored screw hole, attached to one or more rotating self standing between the proximal and distal ends of the intramedullary nail, at least one side of the nut member increases in diameter in a conical shape in osteosynthesis device forming the guide portion in the intramedullary nail, e Bei axial rotation cap mounted on the base portion of the intramedullary nail, the shaft rotation cap, an arc shape around the screw hole of the nut member the formed rail attached to, provided slidably drill guide member along the guide groove provided in the rail, said drill guide member extends in a direction perpendicular to the arc tangent of the arc-shaped rail provided Te, the drill guide member is characterized by a guide hole for guiding a drill is provided.

According to this feature, the insertion of the fixing screw against the intramedullary nail is easy and flexible, can exhibit a sufficient fixing force, also enables fixing a plurality of bone pieces, further intramedullary nail screws corresponding to the position and orientation of the holes can be drilled easily and accurately bore the bone.

[0026] The osteosynthesis device of claim 10 of the present invention, shall apply in osteosynthesis device of claim 9,

Magnet and its polarity mounted on both sides of the screw hole of the nut member so that the opposed external magnets so that the opposite, can control the the direction of the screw holes in the facing nut by utilizing the suction force of the magnet member and Les as characterized by, Ru.

According to this feature, in addition to the effect of the invention according to claim 9, can control orientation of the screw to the desired person direction.

[0027] The osteosynthesis device of claim 11 of the present invention,

The original portion of the nail, Ore the drill guide apparatus having a Kochikara sleeve extension building arm and the screw holes are parallel to the long axis direction of the fixed distance to intramedullary nail from the nail Te, the arm is characterized in that a stretchable elastic means in the longitudinal direction of the intramedullary nail is provided with the long axis parallel to the hinge of the sleeve.

According to this feature, by a structure that can be associated drill guide deflection by bending of the longitudinal intramedullary nail, the same direction as the axial direction of the threaded hole provided in the distal portion of the intramedullary nail It makes it possible to hit the drill while keeping.

[0028] The osteosynthesis device of claim 12 of the present invention,

A hollow drill guide for guiding a drill, a plurality photodetector for detecting the light emitter and reflecting emitted light, respectively, and the wavelength of light emitted from the plurality of light emitters are set to be different from It is characterized in that it comprises.

According to this feature, by providing a light emitter and light detector to the drill guide, the drill work industry is visible the position of the screw hole to complete.

[0029] The osteosynthesis device of claim 13 of the present invention, an osteosynthesis instrument der connexion according to claim 12,

Light emitted multiple light emitters force emitted by the pulsed les as characterized by being configured to shift the emission timing of the light emitted respectively, Ru.

According to this feature, possible force S to locate the exact screw hole even occur scattered light passing through the bone.

BRIEF DESCRIPTION OF THE DRAWINGS

[0030] is a front schematic view for explaining an example in which attained reduction of the fracture site using an intramedullary nail with respect to FIG. 1 fractures are called 3part with proximal humerus fractures .

[2] is a front view that shows the details for securing the small nail through hole provided in the base portion of the proximal side of the intramedullary nail.

3 is a view showing a modification of the shape of the small nails.

4 is a front schematic view for explaining a coupling relationship between the bone fragment fixing screw and the intramedullary nail.

It shows a modification of FIG. 5 FIG.

6 is a schematic diagram for explaining an example in which a relatively rotatable nut member with respect to the intramedullary nail.

[7] embedding a magnet in the nut member, magnetic force to act on the nut member from the outside, it is a schematic diagram for explaining a state of controlling the orientation of the screw holes. 8 is a schematic view for explaining a state in which embedded magnets around the screw hole of the nut member.

9 is a schematic illustration showing a guide device for passing a drill screw holes of the intramedullary nail.

[10] is a front view for explaining the example in which intramedullary nail was used to distal fracture of the radius.

11 is a front view for explaining the example in which intramedullary nail was used in calcaneus fractures.

[12] Ru FIG der which will be described the case of using a small nail when fixing the ends of the proximal portion of the intramedullary nail.

13 is a A- A sectional view of a small nail fitting 揷部 in FIG.

14 is a diagram showing a modified example of a small nail in FIG.

FIG. 15 is an explanatory view showing a modified example of a small nail for securing an end of the proximal portion of the intramedullary nail.

[FIG. 16] (a) is a front view of the intramedullary nail having a flexible, (b), the Ru side view der of the intramedullary nail.

[FIG. 17] (a) is a front view of the intramedullary nail having a flexible, (b), the Ru side view der of the intramedullary nail.

[FIG. 18] (a) is a front view of the intramedullary nail having a flexible, (b), the Ru side view der of the intramedullary nail.

19 is a diagram of the reinforcing member is shown to prevent deflection during insertion into the bone of the intramedullary nail having a flexible.

FIG. 20 is a diagram that shows the reinforcing member for preventing the deflection of at 揷入 into bone of the intramedullary nail having a flexible.

21 is a diagram illustrating a conventional general drill guide apparatus.

22 is a diagram illustrating a drill guide apparatus of the present invention.

FIG. 23 is an explanatory diagram showing an overview of the screw hole guide device.

[Figure 24] intramedullary nail is a schematic diagram showing an application of the proximal humerus fractures.

[Figure 25] intramedullary nail is a schematic diagram showing a case of applying the radial metaphyseal fractures.

DESCRIPTION OF SYMBOLS

1 intramedullary nail (osteosynthesis equipment)

Second end surface

3 through holes (small nails fitting portion) small nails

Intramedullary nail fixation screws

Bone fixation screws

Conical portion

The original part

Conical hole

Small nail fixing screws (Small nailing means) conical protrusion

Screw hole

a threaded hole

a guide portion

b screw hole

Nut member

External magnetic devices

Magnet (external magnet)

Drilling equipment

Humerus

a cortical bone

b cancellous bone

Bone pieces

Bone

Guide device

Axis rotation for the cap

Les - Norre

Guide groove

Drill guide member

The guide hole

Intramedullary nail end

Small nails

Small nails fitted 揷部

The through-hole

Barrier wall

hook

Small nails

b screw head

Housing hole

c the small-diameter portion

f the small-diameter portion

d plate-shaped portion

e slit hole (slit forming portion) g slit hole (slit forming section) i drill guide apparatus (osteosynthesis instrument) h attachment device

i arm

i sleeve

i hinge

i extension device

Drill guide (osteosynthesis equipment) Sakiyu

Light detector

Threaded hole guide device

Bone

The reinforcing member

Fitting recess

BEST MODE FOR CARRYING OUT THE reinforcing member INVENTION

[0032] with reference to the drawings described below with reference to the best mode embodiments for implementing the osteosynthesis device according to the present invention.

Example

[0033] Explaining with reference to the embodiment of the present invention with reference to the accompanying drawings, firstly Figure 1, aimed at reduction of the fracture site using intramedullary nail against fractures are called 3part with proximal humerus fractures is a front schematic view for explaining an example of a case was, 2 is a front view showing the details for securing the small nail proximally through-hole provided et the based portion of the intramedullary nail it is. Hereinafter, the upper side of FIGS. 1 and 2 and the proximal side of the intramedullary nail (original side), illustrating a lower side as a distal end side of the intramedullary nail (tip side).

[0034] Number 1 in Figure 1 is a intramedullary nail constituting the osteosynthesis device to which the present invention is applied. In FIG. 1, first, from the outside of the cuff to the humerus 30, the fracture site H the so as to straddle the intramedullary nail 1 is 揷入. Incidentally, humerus 30 is composed of a hard, dense cortical bone 30a constituting the peripheral portion of the bone, the cancellous bone 30b constituting a sponge structure constituting the interior of the bone. As shown in FIG. 1, the intramedullary nail 1 is adapted to be inserted into the site of the cancellous bone 30b of the humerus 30.

[0035] The through from the end face 2 of the proximal side of the intramedullary nail 1, as a small nail fitting portion in this embodiment is provided so as to face in a direction having a center line and fixed angle of the intramedullary nail 1 hole 3 is formed les, Ru. The through-hole 3 penetrates the side surface of the Zuinaikugi 1. Then, through the through-hole 3, a small nail 4 is inserted from the end surface 2 side, is fixed to the intramedullary nail 1 in a state in which the leading end portion of the small nail 4 is protruded from the side surface of the intramedullary nail 1. Since the small nail 4 grips the cancellous bone 30b, pins for fixing the proximal portion of a conventional intramedullary nail, ingredients intramedullary nail such that the use of our method that the lag screw or screws through the side surface of the intramedullary nail the proximal portion of 1 can be fixed within the humerus 30. Furthermore, the screw holes 5a formed on the distal side of the intramedullary nail 1, the intramedullary nail fixing screw 5 from the side is threaded, so that the intramedullary nail 1 is fixed to the cortical bone 30a .

[0036] Next, for example, when fixing the bone fragments 31 of the large nodules, previously formed a screw hole 16 that can 揷設 bone fragments fixing screw 6 before surgery the intramedullary nail 1, the intramedullary nail 1 the post 揷入 the humerus 30, the bone fragments 31 of greater tuberosity through bone fragments fixing screw 6, screwed the bone fragments fixing screws 6 into the screw holes 16 of the intramedullary nail 1. Thus, the bone fragment 31 is attracted to Zuinaikugi 1, it is adapted to be fixed to the reduction position.

[0037] As shown in FIG. 2, substantially at the center line monument of the through-hole 3, the longitudinal of the intramedullary nail from the end face 2 of the intramedullary nail 1

1

Oriented in a direction having an direction substantially center line / 3 constant angle theta, it is provided so as to penetrate from the end surface 2 of the intramedullary nail 1 to the side surface 7. Incidentally, substantially the centerline monument of the through-hole 3 are cross substantially central line j3 longitudinal intramedullary nail.

1

[0038] Further, in the through-hole 3 is formed with a conical portion 8 whose diameter is reduced toward the outlet side from the inlet side, the large diameter portion of the end surface 2 side of the conical portion 8 internal thread 9 is provided there. The outer surface of the base portion 10 of the small nail 4 which is inserted in the through hole 3 is formed in a conical shape to mate with the conical portion 8 of the through-hole 3, the base portion 10 freely in the through-hole 3 and has a rotation can structure. Therefore it can be disposed in a direction in which a desired small nail 4 can be made reliable gripping forces of cancellous bone 30b of the small nail 4. Further, the conical hole 11 is formed in the central portion of the original portion 10 of the small nail 4.

[0039] Furthermore, in order to secure the small nail 4 inserted into the through-hole 3, the small nail fixing screw 12 as small nail fixing means in the present embodiment is inserted into the through hole 3. This on the side surface of the small nail fixing screw 12, Le is male screw 15 so as to be engaged with the internal thread 9 of the through-hole 3 is formed, Rutotomoni, recess 12a which can be engaged with the driver first class is formed ing. Also, the small nail solid Teineji 12 has a conical convex portion 14 fitted into the conical hole 11 of the small nail 4. The diameter of the root portion of the conical protrusions 14 of the small nail solid Teineji 12 is formed slightly larger diameter than the maximum diameter of the conical hole 11, when screwed small nail fixing screw 12, the conical convex portion 14 a small nail 4 of a conical hole 11 so as to press axially 及 beauty radially les, Ru.

[0040] The small nail fixing screw 12 when screwed into the internal thread 9, the small nail fixing screw 12 the depth of the internal thread 9 of the through-hole 3 so as not to protrude from the end face 2 of the intramedullary nail 1 and dimensions of the height of the small nail fixing screw 12 is determined. Therefore, after 揷入 small nail 4 in the through-hole 3, when screwing the small nail fixing screws 1 2 conical outer surface of the small nail 4 is pressed against the conical portion 8 of the through-hole 3, a small nail 4 intramedullary nail 1 It will be rigidly fixed to.

[0041] small nail 4 shapes are others, those shown in FIG. 3 but bent in an arc shape as shown in FIGS. Figure 3 is a view showing a modification of the shape of the small nails. Small nail 4a shape shown in FIG. 3 (a), extends straight original portion 10a side, has a curve approximately in the middle from the front end side is twisted three-dimensional, this twisted portion is any direction force linear It has a shape that can not be seen to. As shown in FIG. 3 (b), the tip end portion 10b side is bent in a spiral shape. Shape of the small nail 4b shows another shape shown in FIG. 3, but in which optimum shape is employed by the fracture site, small nail 4b sterically twisted shape as shown in FIG. 3, for example, , even when allowed to 揷入 cancellous bone 30b of the humerus 30 femoral head, it can be the gripping force made reliable.

[0042] Next, a description will be given when securing the bone fragments 32a to reduction position. Figure 4 is a bone fixation screws

It is a front schematic view for explaining a coupling relationship between 6a and intramedullary nail la. In FIG. 4, a stool Yichun manner, showing a state in which the bone pieces 32a is fixed to the intramedullary nail la by bone fixing screws 6a

[0043] First, the body portion between the proximal and distal ends of the intramedullary nail la prior to surgery, keep bored screw hole 16a having an internal thread. The at least one side of the screw hole 16a to form the guide portion 17a whose diameter increases conically, are to facilitate guiding the bone fixation screws 6a into the screw hole 16a. To reposition a bone fragment 32a is a hole 33a with a drill (not shown) to the bone fragments 32a. Then, in a state of inserting the bone fixation screw 6a in the hole 33a,-out guide the bone fixation screws 6a into the screw hole 16a of the intramedullary nail la, bone fragments fixation screws 6a to the bone piece 32a is located in the reduction position so as to tighten. Then bone fragments 32a will be fixed situ Chikarari intramedullary nail la through the bone fixation screws 6a in reduction position. Further, by adjusting the tightness of the bone fixation screws 6a, the compression force is effective in the treatment of bone fractures may also be subjected to bone fragments 32a.

[0044] Thus, by employing a structure in screwing the fixing screws 6a into the screw hole 16a of the intramedullary nail la, compared fixing screws 6a to the conventional method screwed into cancellous bone or cortical bone, ensure only can be fixed to or, it is possible to prevent falling off of the fixing screws 6a.

[0045] Figure 5 shows a modification of FIG. 4, screw holes 18b are formed in the intramedullary nail lb is formed on the screw hole 18b, bone fixation screws 6b screwed thread force ^ one only that have been formed. On both sides of the screw hole 18b, the guide portion 17b, 17b is formed, even from the left or right side of the nail lb, as bone fragments fixing screw 6b which is 揷入 the bone fragment 32b can screwed into the screw hole 18b It has become. In this way, 揷入 fixing screws 6b for intramedullary nail lb together that it is easy, can exhibit a sufficient fixing force, also allows a plurality of bone pieces 32b fixed.

[0046] Next, a description will be given of another embodiment of a screw hole for fixing the bone fragments fixation screws. Figure 6 is a schematic schematic for explaining an example in which a relatively rotatable nut member 19 relative to the intramedullary nail lc. As shown in FIG. 6, the relatively rotatable nut member 1-9 provided for intramedullary nail lc, in which bored screw hole 16c so as to penetrate the nut member 19. The outer shape of the nut member 19, a sphere or a cylinder or the like, not particularly limited as long as the nut member 19 is free to change the direction of the sleep Flip hole 16c while being held by the intramedullary nail lc.

[0047] The nut member 19 of Figure 6 consists of cylindrical shape, which was fitted to a cylindrical hole 20 of the intramedullary nail 1 c formed in the direction perpendicular to the paper surface, the screw holes 16c is a nut member 19 times by moving, its orientation is summer to be changed freely in the direction of the arrow in FIG. 6. Threaded hole in the portion located on either side of 1 6c, guide portion 17c is formed whose diameter increases conically screw hole 16c of the orientation bone fixing screws 6c to be inserted into the bone fragment 32c changes are fittable It has become. In this way, the insertion of the fixing screw 6c is easy for the intramedullary nail lc, can exhibit a sufficient fixing force, also allows a plurality of bone pieces 32c fixed.

[0048] FIG. 7 is embedded magnets on nut member 19, by the action of magnetic force from the outside to the nut member 19 is a schematic diagram for explaining a state of controlling the orientation of the screw hole 16c. As shown in FIG. 7, the relatively rotatable nut member 19 relative to the intramedullary nail lc, it is possible to keep crowded padded magnets before surgery. Then, a magnetic force from the outside during surgery caused to act on the nut member 19 can be controlled so that the orientation of the screw hole 16c made in the desired direction. Therefore easily screwed fixing screws 6c described above into the screw hole 16c.

[0049] More specifically detail, reference numeral 21 shown in FIG. 7, two permanent magnets (external magnet) so that one surface of both sides of the screw hole 16c is N pole and the other face becomes S pole 23, 23 by placing an external magnetic apparatus that external force also exerts a force on the nut member 19. Incidentally, the external magnetic device 21 may use les are when forming a hole for bone fixation screws and the nail fixing screws into the bone. The external magnetic device 21 comprises two permanent magnets 23, 23 has a supporting § over arm 22 which is fixed to the end of, the support arm 22 is curved so as to be able to bypass the bone 34 or limbs there. The support arm 22, two magnets 23 direction of the magnetic field is between a predetermined distance away so that a straight line, 23 is disposed.

[0050] As shown in FIG. 7, the magnet 23, 23 by operating the external magnetic device 21 is arranged to be opposed so as to be positioned on opposite sides of the nut member 19, the magnet 23 of the external magnetic device 21, 23 and the nut since the different poles of the permanent magnets of section member 19 with each other with suction, the nut member 19 is rotated, external two magnets 23 of the magnetic device 21, 23 a connecting screw holes 16c so as to be positioned on the line of the axis it is possible to control the orientation in the desired direction.

[0051] Further, being a guide hole 26 you guide Dorinore 25 of Dorinore apparatus 24 to the two magnets 23, 23 of the external magnetic device 21 is formed, pushed through the guide holes 26 a drill 25 into the screw hole 16c directions it is thereby possible to open the aperture 28 in the bone 34. Therefore, it is possible to secure the fixing screws 6c described above through a hole 28 which forms the shape the bone 34 in the cortical bone.

[0052] In the present embodiment, by arranging the two magnets 23, 23 to the external magnetic device 21 on opposite sides of the nut member 19, it has been controlled to the axis of orientation of the screw hole 16c of the nut member 19 force the onset bright one magnet Nag are not limited to by placed on either side of the nut member 19, may control the axial orientation of the screw hole 16c. Also, the magnet 23 used in the external magnetic device 21 is not limited to permanent magnets, electromagnets or the like may be wearing wind-coil the drill guide member for guiding the drill 25.

[0053] FIG. 8 is a schematic diagram for explaining a state where crowded Tanme magnets 27 around the screw hole 16c of the nut member 19. Figure 8 is intended viewed nut member 19 from the axial direction of the screw holes 16c, around the roots Ji hole 16c, it shows an example in which the magnet 27 is written 3 KoTanme.

[0054] In this manner, by previously embedding the magnet 27 around the screw hole 16c 3 or more, For example, accurately measuring the position and direction of the screw hole 16c using a magnetic force sensor (not shown) be able to. Therefore, based on the measurement values ​​relating to the screw hole 16c which is measured, it is possible to drill a hole 28 in the bone 34 with an external or et drilling apparatus 24. Note that, in the screw holes 16a, 18 shown in FIGS. 4 and 5 described above, in order to detect the screw hole 16a, 18 by the magnetic force sensor (Fig 示略) is screw holes 16a, 18 around the intramedullary nail la , it is sufficient crowded Tanme a magnet to lb.

[0055] FIG. 9 is a schematic illustration showing a guide device 40 for passing the drilling 25 into the screw hole 16c of the intramedullary nail lc. In FIG. 9, together with controls the orientation of the screw holes 16c by an external magnetic device 21 shown in FIG. 7 shows the case of applying the guiding device 40, so in combination with an external force equipment 21 without simply be also applied child only guide apparatus 40 into the screw hole 16c of the intramedullary nail lc. Incidentally, the guide device 40 is used a hole for bone fixation screws and intramedullary nail fixing screw when forming the bone.

[0056] Guide device 40 includes a pivoting cap 41 mounted on the base portion of the intramedullary nail lc (end), in the pivoting cap 41, the center point of the screw hole 16c of the intramedullary nail lc fitted with a rail 43 formed in an arc shape to be slidably provided Dorinoregaido member 45 (sleeve) along the guide groove 44 provided on the rail 43, the drill guide member 45 is arc-shaped rail 4 3 arc provided to extend in a direction perpendicular to the tangent, Ru les, and hollow guide hole 46 is provided for guiding the Dorinore 25 to Dorinoregaido member 45.

[0057] That is, on the surface of an imaginary sphere centered point screw holes 16c of the intramedullary nail lc targeting can drill guide member 45 to move freely, the drill guide member 45 at any position guide holes 46 will be facing the center of the screw hole 16c that target.

[0058] Thus, by rotating the shaft rotating cap 41 as the rail 43 in the virtual sphere including the center axis line of the screw hole 16c of the intramedullary nail lc is position, the screw hole 16c of the direction and the drill guide member 4 if brought into sliding drill guide member 45 direction 5 of the guide hole 46 along the rails 43 to match, it will be located on a straight line from the screw hole 16c and the guide hole 46. Oite in this state, to insert the drill 25 of the drill 24 into the guide hole 46, if Oshisusumere the Dorinore device 24 toward the screw hole 16c, to form the aperture 28 in alignment with the screw hole 16c in the bone 34 be able to. In this way, it is possible to drill a hole 28 to facilitate or and accurately bone 34 corresponding to the position and orientation of the screw hole 16c of the intramedullary nail lc.

[0059] During this operation, the orientation of the screw holes 16c by means of an external magnetic device 21, for example, it is also possible to have controlled to face the reduction position of the bone fragments 32c, also, the magnet 23 guides According, even with aligning the guide hole 46 to hole 26.

[0060] FIG. 10 is a front view for explaining the example in which the intramedullary nail Id using the distal fracture of the radius 35. The proximal portion of the intramedullary nail Id small nail 4d are fixed, intramedullary nail fixing screw 5 d are threaded into the intramedullary nail 1 in the distal portion. The small nail 4d, bone fixation screws 6d are threaded by the same method as shown in FIGS. 4 to 6, securing attract bone fragments (not shown) to the small nail 4d.

[0061] FIG. 11 is a front view for explaining the example of using the intramedullary nail le fractures calcaneus 36. The proximal portion of the nail le small nail 4e is fixed, from the tip of the nail le, bone filling agent 37 through the slits in the portion intramedullary nail le (not shown) is supplied It is, is to ensure the fixation of the tip of the intramedullary nail le. In addition, the small nail 4e, bone fixation screw 6e is screwed by the same method as shown in FIGS. 4 to 6, securing attract bone fragments (not shown) to the small nail 4e.

[0062] Next, the small nails to secure the ends of the proximal portion of the nail will be described a further embodiment. Figure 12 is a diagram for explaining the case of using a small nail 53 when fixing the ends of the proximal portion of the intramedullary nail 51. In FIG. 12, the small nail fitting 揷部 54 for causing Hama揷 small nails 53 on the end 52 of the proximal portion of the intramedullary nail 51 is provided.

[0063] As shown in FIG. 12, in this embodiment, the small nail fitting 揷部 54 has a substantially cylindrical shape, the inlet side is slightly above to insert a small nail 53, the hook 58 of the small nail 53 outlet projecting is so slightly located below the longitudinal direction of the axis ct I intramedullary nail 51 of the small nail inserting portion 54

2

Axis; in a direction perpendicular to the 3, the predetermined angle theta (about 10 ° - 80 °) provided being inclined

twenty two

That. Intramedullary nail 51 and the small nail 53 is, for example, stainless steel, cobalt chrome alloys, titanium, or is formed of a titanium alloy material.

[0064] FIG. 13 is a alpha-Alpha sectional view of a small nail inserting portion 54 in FIG. 12. FIG. 13 shows a state in which the small nail 53 is inserted into the small nail fitting portion 54. The small nail fitting portion 54, cross section is formed circular through holes 55. A position bisecting the through hole 55 on the outlet side of the through hole 55 in cross-section substantially triangular partition walls 56 are fixed toward the distal end on the inlet side. The inlet side of the through hole 55, the female thread portion 57 has been drilled, the small nail fixing screws 59 into the female screw portion 57 of the through hole 55 is threaded.

[0065] Small nail 53 has its root portion has a circular cross section, bifurcated hook 58 which is expanded as the go ahead from the circular root portions are extended. Each hook 58 has a rectangular cross section of the plate is expanded in the short side of the rectangle, and is formed in an arc shape toward the direction of the long side.

[0066] As shown in FIG. 13, and 揷入 small nail 53 into the through hole 55 and screwed into the female screw portion 57 of the through hole 55 of the small nail fixing screw 59, the forked portion of the hook 58 of the small nail 53 is pressed against the partition wall 56, the small nail 53 is firmly secured to the intramedullary nail 51. At that time, the hook 58 of the small nail 53 has summer as hook 58 is widened spreads in cancellous bone by a partition wall 56. [0067] In addition, the bone is musculoskeletal, since the movement is premised, intramedullary nails placed in the bone is subjected to a force fluctuate. Therefore, conventional pins, when the method of fixing with lag screws or screws, pins, that lag screw or screws passing there is a (so-called phenomenon called backout), according to the present embodiment, the small nail 53 forces since fixed together in a manner that is pushed by the small nail fixing screw 59 against the partition wall 56, the small nail 53 will not sag as a small nail 53 is subjected to variations stress.

[0068] Furthermore, the shape of the hook 58, the other bifurcated shape shown in FIGS. 12 and 13, Yogu source unit in Sankko shape may be any shape previously branched integrally. Incidentally, the hook 58 in cross-section plate der because, the contact area with the bone widely summer.

[0069] FIG. 14 is a diagram showing a modification of the small nail 53 in FIG. Figure 14 shows the case where a small nail 53a with a hook 58a of Sankko, FIG. 14 (a), an overall perspective view of an intramedullary nail 51a, FIG. 14 (b), the small is a BB cross-sectional view of the small nail Hama揷 portion 54a of the intramedullary nail 51 a showing a state before inserting the nail 53a. As shown in FIG. 14 (b), the partition wall 56 to correspond to the hook 58a of Sankko has a triangular pyramid shape. When small nails 53a to the small nail fitting 揷部 54a is inserted, as shown in FIG. 14 (a), the hook 58a of the pushed Sankko is adapted to be expanded by 120 ° intervals.

[0070] FIG. 15 is a Ru explanatory view showing a modification of a small nail for securing an end of the proximal portion of the intramedullary nail 51b. In FIG. 15, using the screws to the small nail 60. Inside the small nail fitting 揷部 54b of the nail 51b, and a female screw portion 61 for screwing the small nail 60 (screw) is bored, the screw head on the inlet side of the female I Flip 61 accommodation hole 62 for accommodating the parts 60b are provided.

[0071] 髓内 nail 51, 51a shown in FIG. 12 of Rere to Figure 15, 51b of Tan咅 B power et / J, in which the nails 53, 53a, 60 to insert the small nail 53, 53a, 60 of the original portion of the one end intramedullary nail 51, 51a, since there is no problem that protrudes from the side surface of the 51b, the intramedullary nail 51, 51a, 51b bone is 揷入 range of motion including joint limits, or there is no possibility that contribute to the survival of the human body of pain. Further, a problem that must be performed a new skin incision for 揷入 small nail 53, 53a, 60 is also eliminated.

[0072] In addition, the intramedullary nail 51, 51a, since the original part of 51b can be seen with the naked eye, the small nail 53 from Nag possible to use other one target device in a conventional manner in a comfortable working, 53a, 60 leave in this transgression implanting.

[0073] Next, a description will be given intramedullary nail having flexibility. Conventionally, the use of poor intramedullary nail flexibility, pins for fixing the intramedullary nail, the cortical bone of the peripheral portion of the lag screw or screws are destroyed, pins, lag screw or screws is a problem that sags, and the pin , lag screw or there is a problem that the screw may be damaged. 16, 17, 18 show a structure with flexibility in the vicinity of the center of the long axis direction of the intramedullary nail.

[0074] 16 (a) is a front view of the intramedullary nail 51 c having flexibility, FIG. 16 (b) is a side view of the intramedullary nail 51c. The proximal portion of the intramedullary nail 51c and the small nail 53c that is inserted into a small nail fitting portion 54c in the (upper), fixing screw inserted through the screw hole 63c which is positioned in the distal portion (lower portion) (not shown) It is fixed to the bone by. In the vicinity of the center portion of the long axis of the intramedullary nail 51 c, the small-diameter portion 64c is formed with a smaller cross section than the proximal portion and the distal portion. Small-diameter portion 64c has a diameter and length are determined to exhibit flexibility against bending which act on the nail 5 lc.

[0075] 17 (a) is a front view of the intramedullary nail 51 d having flexibility, FIG. 17 (b) is a side view of the intramedullary nail 51d. Intramedullary nail 51d includes a proximal portion (top) and a distal portion in (bottom) has a cross-section substantially circular, is inserted into the small nail fitting portion 54d at the proximal portion of the intramedullary nail 51d (upper) is a small nail 53d, is secured to the bone by a fixing screw inserted through the screw hole 63d disposed in the distal portion (lower portion) (not shown). Near the center of the longitudinal direction of the intramedullary nail 51 d are cross-section a rectangular cross-sectional area smaller plate-shaped portion 65d than the both side portions are formed. The plate-like portion 65d is fixed screw mounting direction of the small nail 53d is wider and summer narrow taken with the direction of the fixing screw to be 揷通 the screw hole 63d (not shown) in, which is 揷通 the screw hole 63d You can have flexibility in mounting direction of (not shown).

[0076] FIG. 18 (a) is a front view of the intramedullary nail 51 e having flexibility, FIG. 18 (b) is a side view of the intramedullary nail 51e. Intramedullary nail 51e is a cross-section hollow circular, and a small nail 53e is 揷入 the small nail fitted 揷部 54e at the proximal portion of the intramedullary nail 51e (upper), disposed on the distal portion (lower portion) It is secured to the bone by a fixing screw (not shown) which is 揷通 the ball screw hole 63e is. In the vicinity of the center portion of the long axis of the intramedullary nail 51e, a slit hole 66e of the slit forming portion is formed in a pair in this embodiment on both sides. Therefore, intramedullary nail 51e can be made to have the flexibility in the mounting direction of the fixing screw (not shown) which is 揷通 the screw hole 63e. [0077] Thus, the nail 51c, 51d, by providing the flexibility to 51e, intramedullary nail 51c, 51 d, intramedullary nail 51c at the proximal and distal portions of 51e, 51d, 51e small nail 53c for fixing, 53d, loosening and breakage of 53e or fixing screws (not shown) can be prevented.

[0078] FIGS. 16 and 17, the intramedullary nail 51c of the flexibility granted where shown in FIG. 18, 51d, 51e is when it is inserted into the bone, which may deflect under the influence of the shape of the bone . Intramedullary nail 51c, 51d, the 51e deflects, when using the later-described guide device, the distal portion of the screw hole 63c, 63d, made for impossible 揷入 accurately fixing screws (not shown) to 63e, medullary inner nail 51c, 51d, upon insertion into 51e within bone, the intramedullary nail 51c, 51d, it is desirable to be able to prevent 51e deflection of.

[0079] FIG. 19 is a diagram showing a reinforcing member 95 for preventing the deflection of the time of insertion into the bone of the intramedullary nail 51f having flexibility. As shown in FIG. 19, the intramedullary nail 51f granted flexibility by the small-diameter portion 64f, a reinforcing member 95 for reinforcing the intramedullary nail 51f can be detachably mounted by utilizing the hollow portion of the nail it is obtained by way. The fitting recess portion 96 for fitting the reinforcing member 95 to the large diameter portion 75f of the upper and lower ends of the small diameter portion 64f of the intramedullary nail 51f formed, intramedullary nail 51f of the original unit force reinforcing member 95 intramedullary nail 5 the If and summer so that it can be attached to and detached from the.

[0080] Then, upon insertion into the bone attached to the reinforcing member 95 intramedullary nail 51f is suppressed flexibility of the nail 5 the If advance wearing the reinforcing member 95 to the intramedullary nail 5 the If, to prevent the deflection of the intramedullary nail 5 If. The state to insert the fixing screw 63f intramedullary nail 51f in, after insertion of the fixing screw 63f, remove the reinforcing member 95, to the state in which flexibility in intramedullary nail 5 [pi]. In this example, it has been described without the small nail fitted 揷部 described above in intramedullary nail 5 [pi], even those having a small nail fitted 揷部 described above in intramedullary nail 51f is not limited thereto It is not to say that can be applied.

[0081] FIG. 20 is a diagram showing a reinforcing member 97 for preventing the deflection of at 揷入 into bone of the intramedullary nail 51g having flexibility. As shown in FIG. 20, the intramedullary nail 51g granted flexibility by slits 66g of the slit forming portion in this embodiment, a hollow intramedullary nail the reinforcing member 97 for reinforcement of the intramedullary nail 51g parts are to be calculated and to be detachably attached by using a. The reinforcing member 97 has a shape that can be fitted into the slits 66 g, fitted from the hollow portion of the intramedullary nail 51g using a clamping tool (not shown) into the slit holes 66 g, or a shall be removable. [0082] Next, a description will be given drill guide apparatus. The drill guide apparatus, for example, the surgeon, even if that can not screw holes visually screw holes of the intramedullary nail, such as when driving a fixing screw to the distal portion of 揷 input has been intramedullary nail into the bone corresponding exactly to the position device for drilling a hole in bone, and refers to the this device for guiding a drill and fixing screw when screwing fixing screws into screw holes.

[0083] FIG. 21 is a diagram illustrating a conventional general drill guide apparatus 67h. Drill guide apparatus 67h to the original portion of the intramedullary nail 51h is attached. Dorinoregaido device 67h is provided with a mounting device 68h mounted on the original portion of the nail 51 h, large arm 69h rigid having a substantially L-shaped in the mounting device 68h is fixed. Arms 69h, after between predetermined distance away from the intramedullary nail 51h, has a shape which is bent to extend parallel to the longitudinal axis of the intramedullary nail 51h. The this arm 69h, the sleeve 70h of the drill guide member in this embodiment towards the center of rotation is provided so as to face the screw hole 71h of the intramedullary nail 51h.

[0084] Meanwhile, as shown in FIG. 21, when the intramedullary nail 51h was allowed to insert into the bone 84h, which may cause slight bending, as shown by a broken line in FIG 1. In this case, also it changes the position of the screw hole 71 h. The arm 69h is rotated even when moving the sleeve 7 Oh near a position of the screw holes 71h, since the axis of the axis and the sleeve 70h of the screw hole 71h does not match over the drill 72h drill device 86h screw hole 71h there is a problem that can not be driven in response to.

[0085] FIG. 22 is a diagram for explaining a drill guide apparatus 67i of the present invention. The arm 69i of the drill guide apparatus 67i constituting the osteosynthesis device in the present embodiment, the long axis parallel to the hinge 73i axis of the sleeve 70i of the drill guide member is provided in this embodiment. Incidentally, the arms 69i can rotate the mounting device 68i as the central axis, and it is possible to secure the rotation if necessary. The telescopic device 74i is provided which can be parallel to stretch the rotation center axis length of the arm 69 i. Hinge 73i are the same as known hinge, also telescopic device 74i is also the same as the known slide-type expansion device, by operating the set screw 75i that is engaged in the engaging groove 85i, the sleeve 70i it can be fixed to an appropriate position.

[0086] When the intramedullary nail 51i is allowed to 揷入 into the bone 84i, deflection when the force that may deflection occurs due to the bending as shown by the broken line in FIG. 22 is an deflection of the bending direction , I Gigli since not the direction of the deflection, the position of the screw hole 71i is not the long axis direction of the change in the varying force screw hole 71i. Therefore, the position of the sleeve 70i by combining the length adjustment by turning a fulcrum hinge 73i and the stretch apparatus 74i, it is possible to match the position of the screw hole 71i. Incidentally, hinge may be plurality optionally not limited to one. Furthermore, hinge 73i can also be fixed as necessary.

[0087] Thus, it is structured that the sleeve 70i of the drill guide apparatus 67i can accommodate deflection due to be longitudinal teeth of the intramedullary nail 51i, a screw hole provided in the distal portion of the intramedullary nail 51i 7 It makes it possible to strike a drill 72i while maintaining the same direction as the axial direction of li. In order to confirm the position of the screw hole 71i of disposed within the bone 84i intramedullary nail 51i, as described above, advance crowded Tanme magnets 27 around the screw holes 71i, using a magnetic sensor also may be configured to check the position of the screw holes 71i Te, with a screw hole guide device 87 to be described later, may be checked.

[0088] Next, a description will be given screw hole guide device 87. Threaded hole guide apparatus 87 according to the embodiment of the present invention, as can be clearly screw holes 71 of the intramedullary nail 51 k mounted within the bone 94 is irradiated with light from the outside of the bone 94 to the operator one in which the.

[0089] FIG. 23 is an explanatory diagram showing an overview of the threaded hole guide device 87. Around the front of the hollow drill guide 76 for guiding the drill 88 constituting the osteosynthesis device in the embodiment (sleeve) (tip side), a light emitter 77 which emits light, is inserted into the bone 94 and a photodetector 78 for detecting the light reflected by the intramedullary nail 51k are provided a plurality alternately. Light emitted from the plurality of light emitters 77 are set so that each wavelength is different, is configured to identify whether any light emitter 77 or al light emitted. Incidentally, a wavelength of light emitted plurality of light emitters 77 or al the same wavelength, and emits light as a pulsed, by shifting the light emission timing of the light, has been possible to identify whether the light emitted from any light emitter 77 it may be used as the method

[0090] emitting device shown in FIG. 23 77, that are respectively connected to the light source 80 through the optical fiber 79. Further, the photodetector 78 detects the light reflected from the intramedullary nail 51k, and transmits the signal to the calculator 82 via the Cape Le 81. Calculator 82 calculates the position of the screw hole 71, and displays on the di splay 83. The light detector 78, for example, can Rukoto force S using the position sensor of the spot light using the surface resistance of the photodiode, a CCD camera or photodetector array. Incidentally, the display 83 is provided on the drill guide 76, the user of the drilling device 8 8 has summer easily visually recognize the display 83.

[0091] In addition, the intramedullary nail is also intended not hollow, in which case, it is difficult the installation child a light emitter in the intramedullary nail. Also, a hollow intramedullary nail, it may be difficult to 揷入 a light emitter into place depending on the shape of the intramedullary nail.

[0092] If, intramedullary as used in the prior art, even can place emitters in the intramedullary nail, a light emitter in the intramedullary nail after confirming a screw hole If you do taken out of the nail, such can hit a fixing screw les. Further, when the sight the position of the screw hole while taking out the light emitter, it is necessary to set again emitters in the intramedullary nail.

[0093] However, according to the screw hole guide device 87 shown in FIG. 23, may not be disposed emitting the light to the inside solid intramedullary nail 51k, check the position of the screw hole 71 by an external light emitter 77 it is those that can be. In addition, the operator determines the direction in which the hit of the drill 88 while watching the display 83, it is possible to progress the work, it is possible to solve all the conventional problems.

[0094] According to the screw hole guide device 87 shown in FIG. 23, by providing a light emitter 77 and light detector 78 to the drill guide 76, you visible the position of the screw hole 71 until the drilling is completed . Additionally, or using light of different wavelengths in the light emitting device 77, by by shifting the firing timing Roh pulse light, also happening scattered light passing through the bone 94 to locate the exact screw hole 71 It can force S.

[0095] Figure 24, the proximal portion of the small nail fitted 揷部 54m in the fixed screw 63m small nails 53m in Yore ,, distal portion Yore, Te proximal humerus fractures of the intramedullary nail 51m It is a schematic view showing an application of the F

[0096] FIG. 25 is obtained by 揷入 screw 60η the through hole of the small nail fitting 揷部 54η intramedullary nail 51Ita, is a schematic view showing an application of the scull bone metaphyseal fracture G.

[0097] Although the embodiments of the present invention has been described with reference to the drawings, specific configurations are changes or additions without departing from the scope of the present such limited to these embodiments the invention there connexion also present invention include.

Claims

The scope of the claims
[1] to the end of the proximal portion of the intramedullary nail, that is provided toward a small nail fitting portion interpolating fit the small nails of the nail fixation in a direction crossing the longitudinal direction of the intramedullary nail osteosynthesis instruments and features.
[2] from the end surface of the proximal side of the nail with the centerline of the intramedullary nail the direction into the through-hole having a predetermined angle is provided, the through hole is conical portion whose diameter is reduced toward the outlet side from the inlet side are formed, characterized in that a small nail having a conical portion for the conical portion and the fitting of the through hole is inserted into the through hole, and fixed to pressing from the inlet side of the through-hole of said small nail by small nailing means osteosynthesis instrument serial placement in claim 1,.
[3] The osteosynthesis device of claim 1 or 2, characterized in that the arcuate or helical shape having a shape twisted in small nails.
[4] provided inside the through hole of the small nail fitted 揷部, the outlet side of the through hole binary through holes or
, Together with the provision of the partition to three minutes, the entrance side of the through hole is bored female thread small nail fixing screws for fixing the small nail is screwed, the small nail above the base portion claim 1 of les, teeth 3 Les, osteosynthesis device according to any displacement, characterized in that it comprises a widened by hooks extending bifurcated or Sankkojo as go.
[5] in the interior of the small nail fitting 揷部 the inlet side provided with accommodation hole for accommodating the screw head for intramedullary nailing, a female screw portion for screwing the screw following the accommodating hole provided, osteosynthesis device of claim 1, wherein the use of Flip sleep as a small nail.
[6] the small-diameter portion near the center of the long axis of the intramedullary nail, osteosynthesis device, characterized in that the formation of the soft soft component consisting of a plate-like portion or a slit forming portion.
[7] osteosynthesis according to claim 6, characterized in that the intramedullary nail of flexible reinforcing member temporarily reinforce the portion through the hollow portion formed in the intramedullary nail detachably mounted equipment
[8] drilled on more than Tsu 1 screw holes having at least one thread between the proximal and distal ends of the intramedullary nail, which expanded conically on at least one side of said screw hole guide in forming the osteosynthesis device the parts, comprising a shaft rotating cap mounted on the base portion of the intramedullary nail, the shaft rotation key Yap, formed in an arc shape around the screw holes of the intramedullary nail mounting rail, provided slidably drill guide member along the guide groove provided in said rail, said drill guide member is provided extending in a direction perpendicular to the arc tangent of the arc-shaped rail, drill osteosynthesis fixtures, wherein a guide hole for guiding a drill is provided in the guide member.
[9] The nut member bored screw hole, attached to one or more rotating self standing between the proximal and distal ends of the intramedullary nail, at least on one side conical said nut member in osteosynthesis instrument guide unit formed in the intramedullary nail whose diameter increases, e Bei axial rotation cap mounted on the base portion of the intramedullary nail, the shaft rotation cap, and the central screw hole of the nut member mounting the rail formed in an arc shape that is provided with a slidably drill guide member along the guide groove provided in the rail, said drill guide member is perpendicular to the arc tangent of the arc-shaped rail provided extending in the direction, osteosynthesis instrument is the drill guide member, characterized in that the guide hole for guiding a drill is provided.
[10] respectively mounted magnets on both sides of the screw hole of the nut member and its polarity was the to face the external magnet so that the opposite, the the direction of the screw holes in the facing nut member by utilizing the suction force of the magnet osteosynthesis device of claim 9, characterized in that the controllable.
[11] the original portion of the intramedullary nail, the drill guide apparatus Nio having a Kochikara cormorants sleeve extension building arm and the screw holes are parallel to the long axis direction of the fixed distance to intramedullary nail from the nail Les, Te, the arm, osteosynthesis device, characterized in that a stretchable elastic means in the longitudinal direction of the intramedullary nail is provided with the long axis parallel to the hinge of the sleeve.
[12] the hollow drill guide for guiding a drill, a light detector for detecting light emission unit and reflected light is emitted a plurality respectively, as the wavelength of light emitted from the plurality of light emitters are different osteosynthesis device, characterized in that set formed by.
[13] a plurality of light emitters force emitted light being emitted in a pulsed manner, bone junction according to claim 12, characterized by being configured to shift the emission timing of the light emitted respectively instrument.
PCT/JP2005/005487 2004-03-26 2005-03-25 Bone connecting tool WO2005092219A1 (en)

Priority Applications (4)

Application Number Priority Date Filing Date Title
JP2004-091086 2004-03-26
JP2004091086A JP3609825B1 (en) 2004-03-26 2004-03-26 Osteosynthesis device
JP2005-052283 2005-02-28
JP2005052283A JP2006230831A (en) 2005-02-28 2005-02-28 Bone connection tool

Publications (1)

Publication Number Publication Date
WO2005092219A1 true WO2005092219A1 (en) 2005-10-06

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Country Link
WO (1) WO2005092219A1 (en)

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EP1839611A2 (en) * 2006-03-31 2007-10-03 DePuy Products, Inc. Intramedullary nail implant assembly and kit
EP1839612A2 (en) * 2006-03-31 2007-10-03 DePuy Products, Inc. Variable angle intramedullary nail
EP1839607A2 (en) * 2006-03-31 2007-10-03 DePuy Products, Inc. Variable angle fixture and kit for use with intramedullary nail
EP1839608A2 (en) * 2006-03-31 2007-10-03 DePuy Products, Inc. Intramedullary nail implant assembly and kit
JP2009512522A (en) * 2005-10-21 2009-03-26 アキュームド・エルエルシー Orthopedic rod with a clamping opening
EP2166970A1 (en) * 2007-06-22 2010-03-31 Anthem Orthopaedics Van, LLC Intramedullary rod with pivotable fastener and method for using same
DE102009010328A1 (en) * 2009-02-25 2010-08-26 Dieter Marquardt Medizintechnik Gmbh Humerus nail for supporting fractures of humerus of patient, has retainer provided in stabilization element to retain section of fixing elements arranged in one of boreholes for connecting stabilization element with fixing elements
US7854767B2 (en) 2007-06-15 2010-12-21 Zimmer, Inc. Single entry portal implant
JP2012523930A (en) * 2009-04-15 2012-10-11 ジンテス ゲゼルシャフト ミット ベシュレンクテル ハフツング Arcuate fixing member
US8790343B2 (en) 2008-10-11 2014-07-29 Epix Orthopaedics, Inc. Intramedullary rod with pivotable and fixed fasteners and method for using same
JP2015042311A (en) * 2014-11-05 2015-03-05 エル・デ・エール・メデイカル Fixation device, intervertebral implant and transplantation instrument
JP2015093199A (en) * 2013-11-14 2015-05-18 ビーダーマン・テクノロジーズ・ゲゼルシャフト・ミット・ベシュレンクテル・ハフツング・ウント・コンパニー・コマンディートゲゼルシャフトBiedermann Technologies Gmbh & Co. Kg Bone anchor and bone anchor assembly comprising the same
EP2911616A4 (en) * 2012-10-29 2016-07-13 Ellipse Technologies Inc Adjustable devices for treating arthritis of the knee
US9445913B2 (en) 2009-04-15 2016-09-20 DePuy Synthes Products, Inc. Arcuate fixation member
US9861418B2 (en) 2012-02-08 2018-01-09 Epix Orthopaedics, Inc. Implant insertion device with continuously adjustable targeting assembly
US10105236B2 (en) 2009-04-15 2018-10-23 DePuy Synthes Products, Inc. Arcuate fixation member
US10123828B2 (en) 2013-03-15 2018-11-13 Epix Orthopaedics, Inc. Implantable device with pivotable fastener and self-adjusting set screw

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JP2009512522A (en) * 2005-10-21 2009-03-26 アキュームド・エルエルシー Orthopedic rod with a clamping opening
EP1839612A2 (en) * 2006-03-31 2007-10-03 DePuy Products, Inc. Variable angle intramedullary nail
EP1839607A2 (en) * 2006-03-31 2007-10-03 DePuy Products, Inc. Variable angle fixture and kit for use with intramedullary nail
EP1839608A2 (en) * 2006-03-31 2007-10-03 DePuy Products, Inc. Intramedullary nail implant assembly and kit
EP1839607A3 (en) * 2006-03-31 2008-08-20 DePuy Products, Inc. Variable angle fixture and kit for use with intramedullary nail
EP1839612A3 (en) * 2006-03-31 2008-08-20 DePuy Products, Inc. Variable angle intramedullary nail
EP1839608A3 (en) * 2006-03-31 2008-08-20 DePuy Products, Inc. Intramedullary nail implant assembly and kit
EP1839611A3 (en) * 2006-03-31 2008-08-27 DePuy Products, Inc. Intramedullary nail implant assembly and kit
EP1839611A2 (en) * 2006-03-31 2007-10-03 DePuy Products, Inc. Intramedullary nail implant assembly and kit
EP2002804B1 (en) * 2007-06-15 2014-06-11 Zimmer, Inc. Single entry portal implant
US7854767B2 (en) 2007-06-15 2010-12-21 Zimmer, Inc. Single entry portal implant
US9861403B2 (en) 2007-06-22 2018-01-09 Epix Orthopaedics, Inc. Method for pivoting a fastener
EP3153119A1 (en) * 2007-06-22 2017-04-12 Epix Orthopaedics, Inc. Intramedullary rod with control element for pivoting fastener
US8906023B2 (en) 2007-06-22 2014-12-09 Epix Orthopaedics, Inc. Intramedullary rod for pivoting a fastener
EP2166970A4 (en) * 2007-06-22 2013-07-24 Anthem Orthopaedics Van Llc Intramedullary rod with pivotable fastener and method for using same
EP2166970A1 (en) * 2007-06-22 2010-03-31 Anthem Orthopaedics Van, LLC Intramedullary rod with pivotable fastener and method for using same
US8790343B2 (en) 2008-10-11 2014-07-29 Epix Orthopaedics, Inc. Intramedullary rod with pivotable and fixed fasteners and method for using same
EP2258290A1 (en) * 2009-02-25 2010-12-08 Dieter Marquardt Medizintechnik GmbH Humeral nail for humerus fractures
DE102009010328A1 (en) * 2009-02-25 2010-08-26 Dieter Marquardt Medizintechnik Gmbh Humerus nail for supporting fractures of humerus of patient, has retainer provided in stabilization element to retain section of fixing elements arranged in one of boreholes for connecting stabilization element with fixing elements
US10105236B2 (en) 2009-04-15 2018-10-23 DePuy Synthes Products, Inc. Arcuate fixation member
US9925056B2 (en) 2009-04-15 2018-03-27 DePuy Synthes Products, Inc. Arcuate fixation member
US9445913B2 (en) 2009-04-15 2016-09-20 DePuy Synthes Products, Inc. Arcuate fixation member
JP2012523930A (en) * 2009-04-15 2012-10-11 ジンテス ゲゼルシャフト ミット ベシュレンクテル ハフツング Arcuate fixing member
US9861418B2 (en) 2012-02-08 2018-01-09 Epix Orthopaedics, Inc. Implant insertion device with continuously adjustable targeting assembly
AU2013338218B2 (en) * 2012-10-29 2017-05-04 Nuvasive Specialized Orthopedics, Inc. Adjustable devices for treating arthritis of the knee
RU2626961C2 (en) * 2012-10-29 2017-08-02 Нувэйсив Спешилайзд Ортопэдикс, Инк. Adjustable devices for knee arthritis treatment
EP2911616A4 (en) * 2012-10-29 2016-07-13 Ellipse Technologies Inc Adjustable devices for treating arthritis of the knee
US10130405B2 (en) 2012-10-29 2018-11-20 Nuvasive Specialized Orthopedics, Inc. Adjustable devices for treating arthritis of the knee
US10123828B2 (en) 2013-03-15 2018-11-13 Epix Orthopaedics, Inc. Implantable device with pivotable fastener and self-adjusting set screw
US9913674B2 (en) 2013-11-14 2018-03-13 Biedermann Technologies Gmbh & Co. Kg Bone anchor and bone anchoring assembly comprising the same
JP2015093199A (en) * 2013-11-14 2015-05-18 ビーダーマン・テクノロジーズ・ゲゼルシャフト・ミット・ベシュレンクテル・ハフツング・ウント・コンパニー・コマンディートゲゼルシャフトBiedermann Technologies Gmbh & Co. Kg Bone anchor and bone anchor assembly comprising the same
US10258397B2 (en) 2013-11-14 2019-04-16 Biedermann Technologies Gmbh & Co. Kg Bone anchor and bone anchoring assembly comprising the same
JP2015042311A (en) * 2014-11-05 2015-03-05 エル・デ・エール・メデイカル Fixation device, intervertebral implant and transplantation instrument

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