WO2005092219A1 - Outil de connexion osseuse - Google Patents

Outil de connexion osseuse 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
screw
intramedullary
Prior art date
Application number
PCT/JP2005/005487
Other languages
English (en)
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 claimed from JP2004091086A external-priority patent/JP3609825B1/ja
Priority claimed from JP2005052283A external-priority patent/JP2006230831A/ja
Application filed by Hirotaka Shimizu filed Critical Hirotaka Shimizu
Publication of WO2005092219A1 publication Critical patent/WO2005092219A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1725—Guides or aligning means for drills, mills, pins or wires for applying transverse screws or pins through intramedullary nails or pins
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1707—Guides or aligning means for drills, mills, pins or wires using electromagnetic effects, e.g. with magnet and external sensors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical 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
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/72—Intramedullary pins, nails or other devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical 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
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/72—Intramedullary pins, nails or other devices
    • A61B17/7233—Intramedullary pins, nails or other devices with special means of locking the nail to the bone
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical 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
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/72—Intramedullary pins, nails or other devices
    • A61B17/7233—Intramedullary pins, nails or other devices with special means of locking the nail to the bone
    • A61B17/7241—Intramedullary pins, nails or other devices with special means of locking the nail to the bone the nail having separate elements through which screws pass
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical 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
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/72—Intramedullary pins, nails or other devices
    • A61B17/7233—Intramedullary pins, nails or other devices with special means of locking the nail to the bone
    • A61B17/725—Intramedullary pins, nails or other devices with special means of locking the nail to the bone with locking pins or screws of special form
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical 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
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/74—Devices for the head or neck or trochanter of the femur
    • A61B17/742—Devices 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
    • A61B17/744—Devices 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

Definitions

  • the present invention relates to an osteosynthesis device used for treating a fracture of a human body, and particularly to an osteosynthesis device using an intramedullary nail.
  • osteosynthesis devices using an intramedullary nail include a pin inserted from the proximal side of the intramedullary nail, fixed with a set screw, and a screw on the distal side. Inserting and screwing pins and screws into cancellous bone or cortical bone (see, for example, Patent Document 1), and penetrating the nail member from the side on the proximal side of the nail member inserted into the femur The lag screw is inserted and fixed with a set screw, and a locking screw is inserted into the distal side of the nail member so that the lag screw and locking screw are screwed into cancellous bone or cortical bone. (See, for example, Patent Document 2). There is also known an intramedullary nail in which an internal thread is bored to fix the intramedullary nail (for example, see Patent Document 3).
  • a screw hole is observed by observing the lightness on the body surface provided by a light emitter arranged in the intramedullary nail.
  • Position of See, for example, Patent Document 5
  • a method of inserting a light emitter 'element into an intramedullary nail and detecting light from the emitter that shines through a hole in the intramedullary nail with an optical sensor array for example, see Patent Document 5
  • Reference 6 is known.
  • Patent Document 1 Japanese Patent Application Laid-Open No. 2002-253566
  • Patent Document 2 Japanese Patent Application Laid-Open No. 2002-35000
  • Patent Document 3 Japanese Patent Publication No. 2001-520071
  • Patent Document 4 Japanese Patent Laid-Open No. 5-3882
  • Patent Document 5 U.S. Patent 5,540,691
  • Patent Document 6 Japanese Patent Publication No. 2002-516690
  • Patent Document 7 JP-T-2000-513603
  • intramedullary nails have a cylindrical shape and have poor flexibility against bending.
  • an intramedullary nail with poor flexibility is used, for example, in the case of a fracture of the upper limb, especially in the case of a fracture of the proximal humerus, if the cancellous bone is weak, the area around the pin or screw inserted into the cancellous bone Stress is concentrated in the area, and bone around the pin or screw may be destroyed. Therefore, there is a problem that the pin or the screw is loosened.
  • the cancellous bone has sufficient strength, there is also a problem that a pin or a screw is broken by a stress caused by a movement of a human body.
  • Patent Document 7 does not consider the bending of the intramedullary nail, and therefore, when trying to push the locking screw into the screw hole of the intramedullary nail, the long axis of the screw hole and the sleeve are not There was a problem that the locking screw could not be inserted after all because the long axis did not match.
  • the method using a radio-lucent drill disclosed in Patent Document 4 involves technical difficulties and may require a long time, and furthermore, the amount of X-ray exposure is limited to the operator and the patient. Also increased.
  • the intramedullary nail is not hollow, the luminous body cannot be inserted into the intramedullary nail. Therefore, it could not be used for such a solid intramedullary nail.
  • the present invention has been made in view of such a problem, and has solved the problem that one end of the base of a nail used proximally of an intramedullary nail protrudes from the side surface of the intramedullary nail.
  • Provide an osteosynthesis device .
  • the present invention provides an osteosynthesis device that is easy to insert a fixing screw into an intramedullary nail, is flexible, and exhibits a sufficient fixing force.
  • the present invention provides an osteosynthesis device capable of fixing a plurality of bone fragments. Further, it is possible to provide an osteosynthesis device that can easily detect the position of the insertion portion of the fixing screw and can further control the insertion direction. It is still another object of the present invention to provide an osteosynthesis device that can easily and accurately drill a hole in accordance with the position and orientation of a screw hole of an intramedullary nail.
  • proximal portion of an intramedullary nail refers to a portion of the intramedullary nail close to a bone hole where the intramedullary nail is inserted into a bone.
  • distal part refers to the tip part when an intramedullary nail is inserted into a bone.
  • fixing screw refers to a fixing screw for fixing a distal portion of an intramedullary nail, and has the same meaning as a locking screw described in a prior document.
  • a nail insertion portion for inserting a nail for fixing an intramedullary nail is provided at an end of a proximal portion of the intramedullary nail in a direction intersecting the longitudinal direction of the intramedullary nail.
  • a pin or lug for fixing the proximal portion of the conventional intramedullary nail is provided by providing a nail insert portion for inserting the nail into the end of the proximal portion of the intramedullary nail. It makes it possible to fix the proximal part of the nail without using a screw or a technique in which the screw penetrates the side of the nail.
  • the osteosynthesis device according to claim 2 of the present invention is the osteosynthesis device according to claim 1,
  • a through-hole is provided from the proximal end surface of the intramedullary nail in a direction having a certain angle with respect to the center line of the intramedullary nail, and the through-hole is formed with a conical portion whose diameter decreases from the entrance side to the exit side.
  • a nail having a conical portion fitted into the conical portion of the through hole is inserted into the through hole, and the nail is pressed and fixed from the entrance side of the through hole by the nail fixing means. .
  • the nail can be freely rotated in the through-hole of the intramedullary nail.
  • the nail can be fixed in a desired direction, and The gripping force can be assured.
  • one end of the base of the nail does not protrude from the side of the intramedullary nail, it is possible to prevent pain from remaining in the human body, and it is necessary to make a new skin incision for inserting the nail. Absent.
  • An osteosynthesis device according to claim 3 of the present invention is the osteosynthesis device according to claim 1 or 2
  • the shape of the nail is formed in an arc shape or a spiral shape having a twist. According to this feature, it is possible to employ a nail having an optimal shape according to the fracture site, and it is possible to secure the gripping force even when the nail is inserted into the cancellous bone.
  • An osteosynthesis device according to claim 4 of the present invention is the osteosynthesis device according to any one of claims 1 to 3,
  • a through hole is provided inside the nail insertion portion, and a partition wall is provided on the exit side of the through hole so as to divide the through hole into two or three parts, and a nail is fixed on the entrance side of the through hole.
  • a female screw portion into which a small nail fixing screw is screwed is provided, and the small nail is provided with a hook which is expanded and extended in a bifurcated shape or a trifurcated shape from the base portion to the front.
  • the bone is a locomotor and it is assumed that it moves, so the intramedullary nail placed in the bone is subjected to fluctuating force, but it is placed in the through hole.
  • the nails are fixed together by being pushed into the bulkhead by the nail fixing screws, so that even if the nails are subjected to fluctuating stress, the nails will not be loosened.
  • An osteosynthesis device is the osteosynthesis device according to claim 1, A receiving hole for receiving the head of a screw for fixing an intramedullary nail is provided on the entrance side inside the small nail fitting portion, and a female screw portion for screwing the screw is provided following the receiving hole.
  • the feature is that screws are used as nails.
  • the head of the screw of the screw configured as a peg is housed in the accommodation hole, the problem that one end of the peg protrudes from the side surface of the intramedullary nail is eliminated. It does not limit the range of motion of the joint, including the inserted bone, or contribute to remaining human damage.
  • the osteosynthesis device according to claim 6 of the present invention comprises:
  • the intramedullary nail is characterized in that a soft portion consisting of a small-diameter portion, a plate-shaped portion, or a slit-formed portion is formed near the central portion in the longitudinal direction of the intramedullary nail.
  • the intramedullary nail main body flexible, it is possible to prevent loosening and breakage of the nail or the fixing screw for fixing the intramedullary nail at the proximal and distal portions of the nail. .
  • An osteosynthesis device according to claim 7 of the present invention is the osteosynthesis device according to claim 6,
  • the reinforcing member for temporarily reinforcing the flexible portion of the intramedullary nail is detachably attachable via a hollow portion formed in the intramedullary nail.
  • the reinforcing member that temporarily reinforces the flexible portion of the intramedullary nail can be detachably attached via the hollow portion formed in the intramedullary nail, so that it can be inserted into the bone of the intramedullary nail.
  • the reinforcing member is attached to the intramedullary nail, and the fixing screw can be inserted into the intramedullary nail in a state where the flexibility of the intramedullary nail is suppressed and the intramedullary nail is prevented from bending.
  • the osteosynthesis device according to claim 8 of the present invention comprises:
  • One or more screw holes having at least one thread are formed between the proximal end and the distal end of the intramedullary nail, and a conical expanding portion is formed on at least one side of the screw hole.
  • Osteosynthesis device provided with a shaft rotation cap to be attached to the base of the intramedullary nail, and attaching a rail formed in an arc shape centering on the screw hole of the intramedullary nail to the shaft rotation cap.
  • a drill guide member slidably provided along a guide groove provided in the rail; The member is provided so as to extend in a direction perpendicular to the tangent to the arc of the arc-shaped rail, and the drill guide member is provided with a guide hole for guiding a drill.
  • the fixing screw can be easily inserted into the intramedullary nail, a sufficient fixing force can be exerted, and a plurality of bone fragments can be fixed. Bone can be easily and accurately drilled according to position and orientation.
  • the osteosynthesis device according to claim 9 of the present invention comprises:
  • At least one nut member having a screw hole is pivotally mounted between the proximal end and the distal end of the intramedullary nail, and at least one side of the nut member is conically expanded on at least one side.
  • An osteosynthesis device having a guide portion formed on an intramedullary nail comprising a shaft rotation cap attached to the base of the intramedullary nail, wherein the shaft rotation cap has an arc shape centered on a screw hole of a nut member.
  • a drill guide member is slidably provided along a guide groove provided in the rail, and the drill guide member extends in a direction perpendicular to a tangent to the arc of the arc-shaped rail.
  • the drill guide member is provided with a guide hole for guiding a drill.
  • the fixing screw can be easily and flexibly inserted into the intramedullary nail, a sufficient fixing force can be exerted, and a plurality of bone fragments can be fixed. It is possible to easily and accurately make a hole in a bone according to the position and orientation of the hole.
  • An osteosynthesis device according to claim 10 of the present invention is the osteosynthesis device according to claim 9, wherein
  • External magnets are opposed to each other so that the polarity is opposite to the magnets mounted on both sides of the screw hole of the nut member, and the direction of the screw hole of the nut member can be controlled by using the attractive force of the facing magnet. It is characterized by doing.
  • the direction of the screw can be controlled to a desired direction.
  • the osteosynthesis device according to claim 11 of the present invention comprises:
  • a drill guide device equipped with an arm extending at a certain distance from the intramedullary nail and extending parallel to the longitudinal axis of the intramedullary nail and a counterforce sleeve in the screw hole,
  • the arm has a hinge parallel to the long axis of the sleeve and can be extended and contracted in the long axis of the intramedullary nail. It is characterized by providing a flexible telescopic device.
  • the drill guide has a structure capable of responding to bending caused by bending in the longitudinal direction of the intramedullary nail, so that the same direction as the axial direction of the screw hole provided at the distal portion of the intramedullary nail is provided. It is possible to drill while keeping it.
  • the osteosynthesis device according to claim 12 of the present invention comprises:
  • a hollow drill guide for guiding a drill is provided with a plurality of light emitters for emitting light and a plurality of light detectors for detecting reflected light, and the light emitted from the plurality of light emitters is set to have different wavelengths. It is characterized by becoming.
  • the drill guide with the light emitter and the photodetector, the position of the screw hole can be visually recognized until the drill operation is completed.
  • An osteosynthesis device according to claim 13 of the present invention is the osteosynthesis device according to claim 12, wherein
  • a plurality of light emitters are characterized in that the emitted light is emitted in a pulse shape and the emission timing of each emitted light is set to be shifted.
  • FIG. 1 is a schematic front view for explaining an example in which a fracture called a 3 part in a proximal humerus fracture is reduced using an intramedullary nail to reduce the fracture site. .
  • FIG. 2 is a front view showing details for fixing a small nail in a through-hole provided in a base portion on a proximal side of the intramedullary nail.
  • FIG. 3 is a view showing a modification of the shape of a nail.
  • FIG. 4 is a schematic front view for explaining a connection relationship between a bone fragment fixing screw and an intramedullary nail.
  • FIG. 5 shows a modification of FIG.
  • FIG. 6 is a schematic view for explaining an example in which a nut member rotatable relative to the intramedullary nail is provided.
  • FIG. 7 is a schematic diagram for explaining a state in which a magnet is embedded in a nut member and a magnetic force is applied to the nut member from the outside to control the direction of a screw hole.
  • FIG. 8 is a schematic diagram illustrating a state in which a magnet is embedded around a screw hole of a nut member.
  • FIG. 9 is a schematic explanatory view showing a guide device for passing a drill through a screw hole of an intramedullary nail.
  • FIG. 10 is a front view illustrating an example in which an intramedullary nail is used for a distal fracture of a radius.
  • FIG. 11 is a front view illustrating an example in which an intramedullary nail is used for a fracture of a calcaneus.
  • FIG. 12 is a diagram illustrating a case where a small nail is used to fix the proximal end of the intramedullary nail.
  • FIG. 13 is a cross-sectional view taken along the line AA of the nail insertion portion in FIG. 12.
  • FIG. 14 is a view showing a modified example of the nail shown in FIG. 12.
  • FIG. 15 is an explanatory view showing a modified example of a nail for fixing an end of a proximal portion of an intramedullary nail.
  • FIG. 16 (a) is a front view of a flexible intramedullary nail, and (b) is a side view of the intramedullary nail.
  • FIG. 17 (a) is a front view of a flexible intramedullary nail, and (b) is a side view of the intramedullary nail.
  • FIG. 18 (a) is a front view of a flexible intramedullary nail, and (b) is a side view of the intramedullary nail.
  • FIG. 19 is a view showing a reinforcing member for preventing a flexible intramedullary nail from bending when inserted into a bone.
  • FIG. 20 is a view showing a reinforcing member for preventing a flexible intramedullary nail from bending when inserted into a bone.
  • FIG. 21 is a view showing a conventional general drill guide device.
  • FIG. 22 is a diagram illustrating a drill guide device of the present invention.
  • FIG. 23 is an explanatory view showing an overall image of a screw hole guide device.
  • FIG. 24 is a schematic view showing a case where an intramedullary nail is applied to a fracture of a proximal humerus.
  • FIG. 25 is a schematic view showing a case in which an intramedullary nail is applied to a metaphyseal fracture of the radius.
  • Drill guide (osteosynthesis device)
  • FIG. 1 shows the use of an intramedullary nail to reduce a fracture site called a 3 part in a proximal humerus fracture.
  • FIG. 2 is a schematic front view for explaining an example of the case in which the nail is fixed. It is.
  • the upper side of FIGS. 1 and 2 will be described as the proximal side (base side) of the intramedullary nail, and the lower side will be described as the distal side (tip side) of the intramedullary nail.
  • Reference numeral 1 in Fig. 1 denotes an intramedullary nail constituting an osteosynthesis device to which the present invention is applied.
  • a fracture site H is placed in the humerus 30 from the outside of the rotator cuff.
  • the intramedullary nail 1 is inserted so as to straddle.
  • the humerus 30 is composed of a hard and dense cortical bone 30a forming a peripheral part of the bone and a cancellous bone 30b forming a sponge structure forming the inside of the bone.
  • the intramedullary nail 1 is designed to be inserted into the cancellous bone 30b in the humerus 30.
  • a penetration as a small nail insertion portion in the present embodiment provided so as to be directed from the proximal end surface 2 of the intramedullary nail 1 to a direction having a certain angle with respect to the center line of the intramedullary nail 1 Hole 3 is formed.
  • the through hole 3 penetrates the side surface of the nail 1.
  • the nail 4 is inserted into the through hole 3 from the end face 2 side, and is fixed to the intramedullary nail 1 in a state where the tip of the nail 4 projects from the side surface of the intramedullary nail 1.
  • an intramedullary nail without using a method in which a pin, a lag screw or a screw for fixing the proximal portion of the conventional intramedullary nail penetrates the side surface of the intramedullary nail is used.
  • One proximal portion can be fixed within the humerus 30.
  • an intramedullary nail fixing screw 5 is screwed into the screw hole 5a formed on the distal side of the intramedullary nail 1 from the side, so that the intramedullary nail 1 is fixed to the cortical bone 30a.
  • a screw hole 16 in which the bone fragment fixing screw 6 can be formed before the operation is formed in the intramedullary nail 1.
  • the approximate center line of the through-hole 3 extends from the end face 2 of the nail 1 to the length of the nail.
  • the nail is oriented so as to have a certain angle ⁇ with respect to the center line / 3 of the direction, and penetrates from the end face 2 to the side face 7 of the intramedullary nail 1.
  • the approximate center line of the through hole 3 intersects the approximate center line j3 in the longitudinal direction of the intramedullary nail.
  • the through hole 3 there is formed a conical portion 8 whose diameter decreases from the inlet side to the outlet side, and a female screw 9 is provided in a large diameter portion on the end face 2 side from the conical portion 8.
  • the outer surface of the base 10 of the peg 4 inserted into the through-hole 3 is formed in a conical shape so as to fit with the conical part 8 of the through-hole 3, and the base 10 is free in the through-hole 3. It has a structure that can rotate. Therefore, the nail 4 can be arranged in a desired direction, and the gripping force of the nail 4 on the cancellous bone 30b can be ensured.
  • a conical hole 11 is formed at the center of the base 10 of the peg 4.
  • a nail fixing screw 12 as a nail fixing means in this embodiment is inserted into the through hole 3.
  • a male screw 15 is formed on the side surface of the small nail fixing screw 12 so as to be able to be screwed with the female screw 9 of the through hole 3, and a concave portion 12 a which can be engaged with a driver or the like is formed.
  • the small nail fixing screw 12 has a conical convex portion 14 that fits into the conical hole 11 of the small nail 4.
  • the diameter of the base of the conical convex portion 14 of the nail fixing screw 12 is slightly larger than the maximum diameter of the conical hole 11, and when the nail fixing screw 12 is screwed in, the conical convex portion 14 becomes small.
  • the conical hole 4 of 4 is pressed in the axial and radial directions.
  • the depth of the female screw 9 of the through hole 3 is set so that the nail fixing screw 12 does not protrude from the end face 2 of the intramedullary nail 1.
  • the height of the nail fixing screw 12 is determined. Therefore, after inserting the peg 4 into the through hole 3 and screwing the peg fixing screw 1 2, the conical outer surface of the peg 4 is pressed against the conical portion 8 of the through hole 3, and the peg 4 becomes the intramedullary nail 1 Will be firmly fixed.
  • the shape of the nail 4 may be as shown in Fig. 3 in addition to the shape of an arc as shown in Figs. 1 and 2.
  • FIG. 3 is a view showing a modified example of the shape of the nail.
  • the nail 4a shape shown in Fig. 3 (a) is straight at the base 10a side, and three-dimensionally twisted at the tip side from almost the middle. This twisted part has a shape where no directional force appears to be a straight line. In the one shown in FIG. 3 (b), the tip portion 10b side is spirally bent.
  • an optimal shape is adopted depending on the fracture site.However, the nail 3b having a three-dimensionally twisted shape as shown in FIG. Even when the humerus 30 is inserted into the cancellous bone 30b, the gripping force can be ensured.
  • Figure 4 shows the bone fragment fixing screw
  • FIG. 7 is a schematic front view for explaining a connection relationship between 6a and an intramedullary nail la.
  • Fig. 4 shows a state in which the bone fragment 32a is fixed to the intramedullary nail la by the bone fragment fixing screw 6a for convenience.
  • a screw hole 16a having a female screw is formed in the body between the proximal end and the distal end of the intramedullary nail la. At least one side of the screw hole 16a is formed with a guide portion 17a that expands in a conical shape so that the bone piece fixing screw 6a can be easily guided to the screw hole 16a.
  • a hole 33a is made in the bone fragment 32a using a drill (not shown). Then, with the bone fragment fixing screw 6a inserted into the hole 33a, the bone fragment fixing screw 6a is guided to the screw hole 16a of the intramedullary nail la, and the bone fragment fixing screw 6a is inserted until the bone fragment 32a is in the reduced position.
  • the bone fragment 32a is firmly fixed to the intramedullary nail la via the bone fragment fixing screw 6a in the reduction position.
  • a compressive force that is effective in treating a fracture can be applied to the bone fragment 32a.
  • the fixing screw 6a is screwed into the screw hole 16a of the intramedullary nail la, the fixing screw 6a is more securely screwed into the cancellous bone or cortical bone than the conventional one. Not only can the fixing screw 6a be fixed, but also the falling off of the fixing screw 6a can be prevented.
  • FIG. 5 shows a modification of FIG. 4, in which a screw hole 18b formed in the intramedullary nail lb is formed, and the screw hole 18b is screwed with the bone fragment fixing screw 6b. Only one thread force is formed. Guide portions 17b, 17b are formed on both sides of the screw hole 18b so that the bone fragment fixing screw 6b inserted into the bone fragment 32b can be screwed into the screw hole 18b from either the left or right side of the intramedullary nail lb. It has become. In this way, the fixing screw 6b can be easily inserted into the intramedullary nail lb, a sufficient fixing force can be exerted, and a plurality of bone fragments 32b can be fixed.
  • FIG. 7 is a schematic diagram for explaining an example in which a nut member 19 that can rotate relatively to the inner nail lc is provided.
  • a nut member 19 rotatable relative to the intramedullary nail lc is provided, and a screw hole 16c is formed so as to penetrate the nut member 19.
  • the outer shape of the nut member 19 is not particularly limited, such as a sphere or a column, as long as the direction of the screw hole 16c can be freely changed while the nut member 19 is held by the intramedullary nail lc.
  • the nut member 19 in Fig. 6 has a cylindrical shape, and is fitted into a cylindrical hole 20 of an intramedullary nail 1c formed in a direction perpendicular to the paper surface, and a screw hole 16c turns the nut member 19.
  • Guide sections 17c are formed on both sides of the screw hole 16c so as to expand in a conical shape, so that the bone fragment fixing screw 6c inserted into the bone fragment 32c can be inserted even if the direction of the screw hole 16c changes. It has become.
  • the fixing screw 6c can be easily inserted into the intramedullary nail lc, a sufficient fixing force can be exerted, and a plurality of bone fragments 32c can be fixed.
  • FIG. 7 is a schematic diagram for explaining a state in which a magnet is embedded in the nut member 19 and a magnetic force is applied to the nut member 19 from the outside to control the direction of the screw hole 16c.
  • a magnet can be embedded in the nut member 19 which can be rotated relative to the intramedullary nail lc before the operation. Then, a magnetic force is applied to the nut member 19 from the outside during the operation, and the direction of the screw hole 16c can be controlled to be a desired direction. Therefore, it becomes easy to screw the above-mentioned fixing screw 6c into the screw hole 16c.
  • reference numeral 21 shown in Fig. 7 denotes two permanent magnets (external magnets) 23, 23 such that one surface on both sides of the screw hole 16c is an N pole and the other surface is an S pole.
  • This is an external magnetic force device in which an external force is applied to the nut member 19 by arranging the magnetic force.
  • the external magnetic force device 21 is used when a hole for a bone fragment fixing screw or an intramedullary nail fixing screw is formed in a bone.
  • the external magnetic device 21 has a support arm 22 having two permanent magnets 23, 23 fixed to the ends, and the support arm 22 is bent so as to be able to bypass a bone 34 or a limb. I have.
  • Two magnets 23 are arranged on the support arm 22 at a predetermined distance so that the direction of the magnetic field is on a straight line.
  • a guide hole 26 is formed in the two magnets 23, 23 of the external magnetic force device 21 for guiding the drenole 25 of the drenole device 24, and the drill 25 is pushed in the direction of the screw hole 16 c through the guide hole 26.
  • the hole 28 can be opened in the bone 34. Therefore, the fixing screw 6c described above can be fixed to the cortical bone through the hole 28 formed in the bone 34.
  • the direction of the axis of the screw hole 16c of the nut member 19 is controlled by disposing two magnets 23, 23 on both sides of the nut member 19 in the external magnetic force device 21.
  • the present invention is not limited to this.
  • the orientation of the axis of the screw hole 16c may be controlled by disposing one magnet on either side of the nut member 19.
  • the magnet 23 used for the external magnetic force device 21 is not limited to a permanent magnet, and may be an electromagnet in which a coil is wound around a drill guide member for guiding the drill 25.
  • FIG. 8 is a schematic diagram illustrating a state where the magnet 27 is carried around the screw hole 16 c of the nut member 19.
  • FIG. 8 shows the nut member 19 viewed from the axial direction of the screw hole 16c, and shows an example in which three magnets 27 are carried around the screw hole 16c.
  • the position and direction of the screw hole 16c can be accurately measured using a magnetic force sensor (not shown). be able to. Therefore, based on the measured value of the measured screw hole 16c, the hole portion 28 can be drilled from the outside using the drill device 24 or the like.
  • a magnetic force sensor not shown
  • an intramedullary nail lathe around the screw holes 16a and 18 is required. It is good to carry a magnet in lb.
  • FIG. 9 is a schematic explanatory view showing a guide device 40 for passing the drill 25 through the screw hole 16c of the intramedullary nail lc.
  • FIG. 9 shows the case where the guide device 40 is applied in addition to the case where the direction of the screw hole 16c is controlled by the external magnetic force device 21 shown in FIG. 7, but it is used together with the external magnetic force device 21. Instead, it is also possible to simply apply only the guide device 40 to the screw hole 16c of the intramedullary nail lc.
  • the guide device 40 has a hole for a bone fragment fixing screw or an intramedullary nail fixing screw. Used when forming bone.
  • the guide device 40 includes a shaft rotation cap 41 attached to the base (end) of the intramedullary nail lc.
  • the shaft rotation cap 41 has a screw hole 16c of the intramedullary nail lc at the center.
  • a rail 43 formed in an arc shape is attached, and a guide member 45 (sleeve) is provided slidably along a guide groove 44 provided in the rail 43.
  • the drill guide member 45 is an arc-shaped rail. 43 is provided so as to extend in a direction perpendicular to the tangent line of the arc, and the guide member 45 is provided with a hollow guide hole 46 for guiding the guide 25.
  • the drill guide member 45 can freely move on the surface of an imaginary sphere centered on the screw hole 16c of the target intramedullary nail lc, and the guide of the drill guide member 45 can be moved at any position. Hole 46 will point toward the center of the targeted screw hole 16c.
  • the cap 41 for rotating the shaft is rotated so that the rail 43 is positioned within the virtual spherical surface including the central axis of the screw hole 16c of the intramedullary nail lc, and the direction of the screw hole 16c and the drill guide member 4 If the drill guide member 45 is slid along the rail 43 so that the direction of the guide hole 46 of 5 coincides, the screw hole 16c and the guide hole 46 will be located on a straight line.
  • the drill 25 of the drill device 24 is inserted into the guide hole 46, and the drilling device 24 is pushed toward the screw hole 16c, so that the hole 28 aligned with the screw hole 16c is formed in the bone 34. be able to. In this way, the hole 28 can be easily and accurately formed in the bone 34 in accordance with the position and orientation of the screw hole 16c of the intramedullary nail lc.
  • the direction of the screw hole 16c can be controlled using the external magnetic force device 21 so as to be directed to, for example, the reduction position of the bone fragment 32c.
  • the guide hole 46 can be aligned with the hole 26.
  • FIG. 10 is a front view illustrating an example in which the intramedullary nail Id is used for a distal fracture of the radius 35.
  • a small nail 4d is fixed to the proximal portion of the intramedullary nail Id, and an intramedullary nail fixing screw 5d is screwed into the intramedullary nail 1 at the distal portion.
  • a bone fragment fixing screw 6d is screwed into the nail 4d in the same manner as that shown in FIGS. 4 to 6, and a bone fragment (not shown) is drawn and fixed to the nail 4d.
  • FIG. 11 is a front view illustrating an example in which the intramedullary nail le is used for a fracture of the calcaneus 36.
  • a small nail 4e is fixed to the proximal part of the intramedullary nail le.
  • a bone filler 37 is supplied through a slit (not shown) formed in the portion, and secures the tip of the intramedullary nail le.
  • a bone fragment fixing screw 6e is screwed into the nail 4e in the same manner as the method shown in FIGS. 4 to 6, and a bone fragment (not shown) is drawn and fixed to the nail 4e.
  • FIG. 12 is a diagram illustrating a case where a small nail 53 is used to fix the proximal end portion of the intramedullary nail 51.
  • a nail insertion portion 54 for inserting a nail 53 is provided at an end 52 of a proximal portion of the intramedullary nail 51.
  • the small nail fitting portion 54 has a substantially cylindrical shape, the entrance side for inserting the small nail 53 is slightly above, and the hook 58 of the small nail 53 is The axis ct I of the nail 51 in the longitudinal direction of the intramedullary nail 51 so that the exit side protruding is located slightly below
  • the axis is inclined at a predetermined angle ⁇ (approximately 10 ° to 80 °) in a direction perpendicular to the axis; 3.
  • the intramedullary nail 51 and the small nail 53 are formed of, for example, stainless steel, a cobalt chrome alloy, titanium, or a titanium alloy material.
  • FIG. 13 is a cross-sectional view of the nail insert section 54 in FIG. FIG. 13 shows a state where the small nail 53 has been inserted into the small nail insertion portion 54.
  • the nail insertion portion 54 has a through hole 55 having a circular cross section.
  • a partition wall 56 having a substantially triangular cross section is fixed to the exit side of the through hole 55 at a position where the through hole 55 is bisected.
  • a female screw portion 57 is formed on the inlet side of the through hole 55, and a small nail fixing screw 59 is screwed into the female screw portion 57 of the through hole 55.
  • the nail 53 has a circular cross-section at its base, and a bifurcated hook 58 that expands from the base of the circle and extends.
  • Each hook 58 has a plate shape with a rectangular cross section, is expanded on the short side of the rectangle, and formed in an arc shape toward one direction on the long side.
  • the forked portion of the hook 58 of the small nail 53 is The nail 53 is firmly fixed to the intramedullary nail 51 by being pressed against the partition wall 56. At this time, the hook 58 of the peg 53 is expanded by the partition wall 56 so that the hook 58 is expanded in the cancellous bone. [0067] Since the bone is a locomotor and is premised on movement, the intramedullary nail placed in the bone receives a fluctuating force.
  • the pin, lag screw or screw may come off (a phenomenon called backout).
  • the nails 53 are not loosened even if the nails 53 are subjected to the fluctuating stress because they are integrally fixed to the partition wall 56 by being pushed by the nail fixing screws 59.
  • the shape of the hook 58 may be a forked shape shown in FIG. 12 and FIG. Since the hook 58 has a plate-like cross section, the contact area with the bone is large.
  • FIG. 14 is a view showing a modification of the peg 53 in FIG. Fig. 14 shows a case where a small nail 53a having a three-pronged hook 58a is used.
  • Fig. 14 (a) is a perspective view of the entire intramedullary nail 51a
  • Fig. 14 (b) is a small nail.
  • FIG. 9 is a cross-sectional BB view of the small nail insertion portion 54a of the intramedullary nail 51a showing a state before the nail 53a is inserted.
  • the partition wall 56 has a triangular pyramid shape corresponding to the forked hook 58a.
  • FIG. 15 is an explanatory diagram showing a modified example of a nail that fixes the end of the proximal portion of the intramedullary nail 51b.
  • a screw is used for the peg 60.
  • a female screw portion 61 for screwing a small nail 60 (screw) is formed inside the small nail fitting portion 54b of the intramedullary nail 51b, and a screw head is provided at the entrance side of the female screw portion 61.
  • An accommodation hole 62 for accommodating the portion 60b is provided.
  • Fig. 12 shows the ends of the intramedullary nails 51, 51a, and 51b shown in Fig. 15, and the nails 53, 53a, and 60 are inserted into the nails 53, 53a, and 60. Since there is no problem that one end of the root of 60 protrudes from the side of the nail 51, 51a, 51b, the range of motion of the joint including the bone into which the nail 51, 51a, 51b is inserted, or It does not contribute to remaining human damage. Further, the problem that a new skin incision has to be made to insert the pegs 53, 53a, 60 is eliminated.
  • the bases of the intramedullary nails 51, 51a, and 51b can be seen with the naked eye, the nails 53, 53a, and 60 can be easily operated without using a target device as in the related art. Type It comes out.
  • FIG. 16 (a) is a front view of a flexible intramedullary nail 51c
  • FIG. 16 (b) is a side view of the intramedullary nail 51c.
  • a small nail 53c inserted into the small nail insertion part 54c and a fixing screw (not shown) inserted into a screw hole 63c arranged at the distal part (lower part) Is fixed to the bone.
  • a small-diameter portion 64c having a smaller cross-sectional shape than the proximal portion and the distal portion is formed.
  • the small diameter portion 64c is determined in diameter and length so as to exhibit flexibility against bending acting on the intramedullary nail 5lc.
  • FIG. 17 (a) is a front view of a flexible intramedullary nail 51d
  • FIG. 17 (b) is a side view of the intramedullary nail 51d.
  • the intramedullary nail 51d has a substantially circular cross section at the proximal part (upper part) and the distal part (lower part), and is inserted into the small nail insertion part 54d at the proximal part (upper part) of the intramedullary nail 51d. It is fixed to the bone by a small nail 53d to be inserted and a fixing screw (not shown) inserted into a screw hole 63d arranged at the distal part (lower part).
  • a plate-like portion 65d having a rectangular cross section and a smaller cross-sectional area than both sides is formed.
  • the plate-like portion 65d has a wide mounting direction for the peg 53d and a narrow mounting direction for a fixing screw (not shown) inserted through the screw hole 63d, and a fixing screw inserted through the screw hole 63d. It is possible to give flexibility to the mounting direction (not shown).
  • FIG. 18 (a) is a front view of a flexible intramedullary nail 51e
  • FIG. 18 (b) is a side view of the intramedullary nail 51e.
  • the intramedullary nail 51e has a hollow circular cross section, and is located at the proximal part (upper part) of the intramedullary nail 51e, at the small part 53e inserted into the small nail fitting part 54e, and at the distal part (lower part). It is fixed to the bone by a fixing screw (not shown) inserted through the screw hole 63e.
  • a pair of slit holes 66e as slit forming portions in the present embodiment are formed on both sides.
  • the intramedullary nail 51e can have flexibility in a mounting direction of a fixing screw (not shown) inserted through the screw hole 63e.
  • a fixing screw (not shown) inserted through the screw hole 63e.
  • the intramedullary nails 51c, 51d, and 51e are formed at the proximal and distal portions of the intramedullary nails 51c, 51d, and 51e.
  • the small nails 53c, 53d, 53e or the fixing screw (not shown) can be prevented.
  • the intramedullary nails 51c, 51d, and 51e provided with flexibility as shown in Figs. 16, 17, and 18 may be affected by the shape of the bone when inserted into the bone. . If the intramedullary nails 51c, 51d, and 51e bend, a fixing screw (not shown) cannot be accurately inserted into the screw holes 63c, 63d, and 63e at the distal portion when the guide device described later is used. It is desirable that the bending of the intramedullary nails 51c, 51d, and 51e be prevented when the inner nails 51c, 51d, and 51e are inserted into the bone.
  • FIG. 19 is a view showing a reinforcing member 95 for preventing the flexible intramedullary nail 51f from bending when inserted into the bone.
  • the reinforcing member 95 for reinforcing the intramedullary nail 51f can be detachably attached using the hollow portion of the intramedullary nail. It is like that.
  • a large-diameter portion 75f at the upper and lower ends is formed with a fitting recess 96 into which the reinforcing member 95 is inserted. It can be attached to and detached from.
  • the reinforcing member 95 is attached to the intramedullary nail 5If to suppress the flexibility of the intramedullary nail 5If.
  • Intramedullary nail 5 Prevents bending of If.
  • the fixing screw 63f is inserted into the intramedullary nail 51f.
  • the reinforcing member 95 is removed, and the intramedullary nail 5 ⁇ is made flexible. Note that, in this example, the case where the above-described nail insertion portion is not provided in the intramedullary nail 5 ⁇ is described. It goes without saying that it can be applied.
  • FIG. 20 is a diagram showing a reinforcing member 97 for preventing the flexible intramedullary nail 51g from bending when inserted into the bone.
  • the reinforcing member 97 for reinforcing the intramedullary nail 51g is replaced with the hollow of the intramedullary nail. It is designed so that it can be attached and detached using parts.
  • the reinforcing member 97 has a shape capable of being fitted into the slit hole 66g, and is fitted or removed from the hollow portion of the intramedullary nail 51g into the slit hole 66g using a not-shown holding tool.
  • the drill guide device can be used, for example, when an operator cannot see the screw hole, such as when a fixing screw is driven into the distal portion of an intramedullary nail inserted into a bone. And a device that guides a drill and a fixing screw when a fixing screw is screwed into a screw hole.
  • FIG. 21 is a diagram showing a conventional general drill guide device 67h.
  • a drill guide device 67h is attached to the base of the intramedullary nail 51h.
  • the Dorinore guide device 67h includes a mounting device 68h to be attached to the base of the intramedullary nail 51h, and a substantially L-shaped and highly rigid arm 69h is fixed to the mounting device 68h.
  • the arm 69h is bent at a predetermined distance from the intramedullary nail 51h and then extends parallel to the longitudinal direction of the intramedullary nail 51h.
  • a sleeve 70h as a drill guide member in the present embodiment is provided so as to face the screw hole 71h of the intramedullary nail 51h toward the center of rotation.
  • FIG. 22 is a diagram illustrating a drill guide device 67i of the present invention.
  • the arm 69i of the drill guide device 67i constituting the osteosynthesis device of the present embodiment is provided with a hinge 73i in parallel with the long axis of the sleeve 70i as the drill guide member of the present embodiment.
  • the arm 69i can rotate around the mounting device 68i as a central axis, and the rotation can be fixed if necessary.
  • a telescoping device 74i that can extend and contract the length of the arm 69i in parallel with the rotation center axis is provided.
  • the hinge 73i is the same as a known hinge
  • the extension device 74i is the same as a known slide-type extension device.
  • the intramedullary nail 51i When the intramedullary nail 51i is inserted into the bone 84i, there is a force that may bend as shown by the broken line in Fig. 22. In this case, the bending is bending in the bending direction.
  • the position of the screw hole 71i changes. There is no change in the long axis direction of the screw hole 71i. Therefore, the position of the sleeve 70i can be matched with the position of the screw hole 71i by combining the rotation with the hinge 73i as a fulcrum and the length adjustment by the expansion and contraction device 74i.
  • the number of hinges is not limited to one, and a plurality of hinges may be provided as necessary. Further, the hinge 73i can be fixed if necessary.
  • the sleeve 70i of the drill guide device 67i has a structure capable of coping with the bending due to the bending in the longitudinal direction of the intramedullary nail 51i, and the screw hole 7 provided in the distal portion of the intramedullary nail 51i. It is possible to hit the drill 72i while maintaining the same direction as the axial direction of li.
  • the magnet 27 is carried around the screw hole 71i, and a magnetic force sensor is used. The position of the screw hole 71i may be confirmed by using a screw hole guide device 87 described later.
  • the screw hole guide device 87 irradiates light from the outside of the bone 94 so that the screw hole 71 of the intramedullary nail 51 k mounted inside the bone 94 can be clearly indicated to the operator. It was done.
  • FIG. 23 is an explanatory diagram showing an overall image of the screw hole guide device 87.
  • a light emitting device 77 for emitting light and a light emitting device 77 inserted into the bone 94 are provided around a front side (tip side) of a hollow drill guide 76 (sleeve) for guiding a drill 88 constituting the osteosynthesis device in this embodiment.
  • a plurality of photodetectors 78 for detecting light reflected by the intramedullary nail 51k are provided alternately.
  • the light emitted from the plurality of light emitters 77 is set to have different wavelengths, so that it is possible to specify from which light emitter 77 the light is emitted.
  • the light emitted from the plurality of light emitters 77 is set to have the same wavelength, the light is emitted as a pulse, and the light emission timing is shifted, whereby it is possible to identify which light emitter 77 is emitted.
  • the light emitters 77 shown in FIG. 23 are each connected to a light source 80 via an optical fiber 79. Further, the light detector 78 detects the light reflected from the intramedullary nail 51k, and transmits the signal to the arithmetic unit 82 via the cable 81. The calculator 82 calculates the position of the screw hole 71 and displays it on the display 83.
  • the photodetector 78 for example, the surface resistance of a photodiode You can use a spot light position sensor, CCD camera, or photodetector array that uses a resistance.
  • the display 83 is provided in the drill guide 76 so that the user of the drill device 88 can easily view the display 83.
  • intramedullary nails are not hollow, and in that case, it is difficult to install a light emitter in the intramedullary nail. Further, even with a hollow intramedullary nail, it may be difficult to insert the luminous body at a predetermined position depending on the shape of the intramedullary nail.
  • the position of the screw hole 71 can be visually recognized until the drilling operation is completed. . Furthermore, by using light having different wavelengths for the light emitter 77 or by shifting the emission timing of the nose light, the position of the screw hole 71 can be accurately specified even if the light passing through the bone 94 is scattered. Power S can.
  • Fig. 24 shows the use of a small nail 53m for the small nail insertion part 54m at the proximal part of the intramedullary nail 51m, a fixing screw 63m for the distal part, and a fracture of the proximal humerus. It is a schematic diagram which shows the case applied to F
  • FIG. 25 is a schematic diagram showing a case where a screw 60 ⁇ is inserted into a through hole of a small nail fitting portion 54 ⁇ of an intramedullary nail 51 ⁇ and is applied to a fracture portion G of a metaphyseal radius.

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Abstract

[PROBLEMES] Fournir un outil de connexion osseuse capable de résoudre des problèmes dans un outil traditionnel de connexion osseuse dans lequel une extrémité de la partie de base d'un petit clou utilisé à l'extrémité proximale d'un clou intramédullaire fait saillie de la face latérale du clou intramédullaire et le clou intramédullaire inséré dans un os spongieux est desserré. [MOYENS POUR RESOUDRE L'INVENTION] Cet outil de connexion osseuse est formé de sorte qu'un trou de traverse (3) est formé depuis la face d'extrémité (2) du clou intramédullaire (1) à l'extrémité proximale dans une direction formant un angle spécifié par rapport à la ligne centrale du clou intramédullaire (1), une partie conique (8) de diamètre graduellement réduit depuis le côté entrée vers le côté sortie est formée sur le trou de passage (3), le petit clou (4) ayant une partie conique ajustée à la partie conique (8) du trou de passage (3) est inséré dans le trou de passage (3), et le petit clou (4) est fixé par pression depuis le côté entrée du trou de passage (3) par un moyen de fixation de petit clou (12). Ainsi, une portion tendre formée sur une petite partie de diamètre, une partie en forme de plaque ou une partie en forme de fente est formée prés de la partie centrale du clou intramédullaire dans la direction axiale majeure.
PCT/JP2005/005487 2004-03-26 2005-03-25 Outil de connexion osseuse WO2005092219A1 (fr)

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JP2004-091086 2004-03-26
JP2004091086A JP3609825B1 (ja) 2004-03-26 2004-03-26 骨接合器具
JP2005-052283 2005-02-28
JP2005052283A JP2006230831A (ja) 2005-02-28 2005-02-28 骨接合器具

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EP1839607A2 (fr) * 2006-03-31 2007-10-03 DePuy Products, Inc. Fixation à angle variable et kit pour usage avec clou intramédullaire
EP1839611A2 (fr) * 2006-03-31 2007-10-03 DePuy Products, Inc. Ensemble d'implant à clou intramédullaire et kit
EP1839612A2 (fr) * 2006-03-31 2007-10-03 DePuy Products, Inc. Clou intramédullaire à angle variable
EP1839608A2 (fr) * 2006-03-31 2007-10-03 DePuy Products, Inc. Ensemble d'implant à clou intramédullaire et kit
JP2009512522A (ja) * 2005-10-21 2009-03-26 アキュームド・エルエルシー 締付け開口を備えた整形外科用桿状体
EP2166970A1 (fr) * 2007-06-22 2010-03-31 Anthem Orthopaedics Van, LLC Tige intramédullaire avec pièce de fixation pivotante et procédé d'utilisation
DE102009010328A1 (de) * 2009-02-25 2010-08-26 Dieter Marquardt Medizintechnik Gmbh Humerusnagel zur Versorgung von Frakturen des Humerus
US7854767B2 (en) 2007-06-15 2010-12-21 Zimmer, Inc. Single entry portal implant
JP2012523930A (ja) * 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 弓状固定部材
US8790343B2 (en) 2008-10-11 2014-07-29 Epix Orthopaedics, Inc. Intramedullary rod with pivotable and fixed fasteners and method for using same
JP2015042311A (ja) * 2014-11-05 2015-03-05 エル・デ・エール・メデイカル 固定装置、椎間インプラント、および移植器具
JP2015093199A (ja) * 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 骨固定具、および骨固定具を備える骨固定アセンブリ
EP2911616A4 (fr) * 2012-10-29 2016-07-13 Ellipse Technologies Inc Dispositifs ajustables pour traiter l'arthrite du genou
US9445913B2 (en) 2009-04-15 2016-09-20 DePuy Synthes Products, Inc. Arcuate fixation member
JP2017524457A (ja) * 2014-07-15 2017-08-31 オーティ メディツィンテヒニック ゲーエムベーハー 長骨に髄内釘を固定する位置決め装置
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
WO2021068088A1 (fr) * 2019-10-09 2021-04-15 Kaj Klaue Clou à os
WO2021240242A1 (fr) * 2020-05-29 2021-12-02 Stryker European Operations Limited Trou d'entonnoir pour clou intramédullaire
US11207110B2 (en) 2009-09-04 2021-12-28 Nuvasive Specialized Orthopedics, Inc. Bone growth device and method
US12121452B2 (en) 2023-03-03 2024-10-22 DePuy Synthes Products, Inc. Arcuate fixation member

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EP1839607A2 (fr) * 2006-03-31 2007-10-03 DePuy Products, Inc. Fixation à angle variable et kit pour usage avec clou intramédullaire
EP1839611A2 (fr) * 2006-03-31 2007-10-03 DePuy Products, Inc. Ensemble d'implant à clou intramédullaire et kit
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EP1839608A3 (fr) * 2006-03-31 2008-08-20 DePuy Products, Inc. Ensemble d'implant à clou intramédullaire et kit
EP1839607A3 (fr) * 2006-03-31 2008-08-20 DePuy Products, Inc. Fixation à angle variable et kit pour usage avec clou intramédullaire
EP1839612A3 (fr) * 2006-03-31 2008-08-20 DePuy Products, Inc. Clou intramédullaire à angle variable
EP1839611A3 (fr) * 2006-03-31 2008-08-27 DePuy Products, Inc. Ensemble d'implant à clou intramédullaire et kit
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EP3169254B1 (fr) * 2014-07-15 2020-11-18 OT Medizintechnik GmbH Dispositif de positionnement pour fixer un clou intramédullaire dans un os long
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JP2015042311A (ja) * 2014-11-05 2015-03-05 エル・デ・エール・メデイカル 固定装置、椎間インプラント、および移植器具
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WO2021240242A1 (fr) * 2020-05-29 2021-12-02 Stryker European Operations Limited Trou d'entonnoir pour clou intramédullaire
US11819253B2 (en) 2020-05-29 2023-11-21 Stryker European Operations Limited Funnel hole for intramedullary nail
US12121452B2 (en) 2023-03-03 2024-10-22 DePuy Synthes Products, Inc. Arcuate fixation member

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