WO2006013624A1 - Appareil de fixation externe - Google Patents

Appareil de fixation externe Download PDF

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Publication number
WO2006013624A1
WO2006013624A1 PCT/JP2004/011093 JP2004011093W WO2006013624A1 WO 2006013624 A1 WO2006013624 A1 WO 2006013624A1 JP 2004011093 W JP2004011093 W JP 2004011093W WO 2006013624 A1 WO2006013624 A1 WO 2006013624A1
Authority
WO
WIPO (PCT)
Prior art keywords
pin
fracture
plate
proximal
distal
Prior art date
Application number
PCT/JP2004/011093
Other languages
English (en)
Japanese (ja)
Inventor
Koichi Yoshino
Original Assignee
Yoshino Industry, Co., Ltd.
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
Application filed by Yoshino Industry, Co., Ltd. filed Critical Yoshino Industry, Co., Ltd.
Priority to PCT/JP2004/011093 priority Critical patent/WO2006013624A1/fr
Priority to PCT/JP2005/009533 priority patent/WO2006013670A1/fr
Publication of WO2006013624A1 publication Critical patent/WO2006013624A1/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
    • A61B17/56—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
    • A61B17/60—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 for external osteosynthesis, e.g. distractors, contractors
    • A61B17/64—Devices extending alongside the bones to be positioned
    • A61B17/6425—Devices extending alongside the bones to be positioned specially adapted to be fitted across a bone joint

Definitions

  • the present invention relates to an external fixator used for fixing a fractured part, and more particularly to an external fixator suitable for a wrist joint fracture.
  • External fixators used for wrist joint fractures include the Bridge Type, which reduces and fixes bone fragments by pulling across the wrist joint, as shown in Fig. 12, and external fixation.
  • Non Bridge Type which fix bone fragments with small diameter pins without the cervix straddling the wrist joint.
  • Patent Document 1 discloses a non-bridge type external fixator that allows pin insertion from a plurality of directions.
  • Patent Document 1 Japanese Patent Laid-Open No. 2003-305049
  • Patent Document 2 JP 2002-172119 A
  • the advantage of the Bridge Type is that it does not apply pressure to the joint surface damaged by traction in consideration of damage to the joint surface of the wrist joint caused by fracture. And the cartilage on the joint surface By protecting, future degenerative arthritic changes can be prevented.
  • the disadvantage is that it requires a long towing period (about 6 to 18 weeks), and to restrict the movement of the wrist joint, the joint contracture of the wrist joint due to insect muscle ischemia etc. There was a problem of declining motor function and bone atrophy.
  • the advantage of the Non Bridge Type is that the bone fragment can be fixed with a pin and the joint surface of the wrist joint can be reduced, and the range of motion of the joint can be moved earlier.
  • the disadvantage is that the surgical assistant pulls the wrist joint by hand and fixes the bone fragment using a pin in the reduced position, so it cannot be pulled continuously. Therefore, there is a problem that pressure is applied to the damaged joint surface and the cartilage on the joint surface cannot be protected, so that there is no problem in the short term, but degenerative arthritic changes may occur in the long term.
  • the present invention has been made in view of the problems of the above-described conventional two types of external fixators, and enables early rehabilitation while preventing degenerative arthritic changes.
  • it aims to provide a hybrid type external fixator with a simple surgical technique.
  • the external fixator according to claim 1 includes a proximal pin that can be inserted into a rib
  • a distal pin that can be inserted into the phalange metalcarpal bone
  • a fracture pin that can be inserted into a bone fragment caused by a fracture of a wrist joint
  • the gist is that the distal pin is configured to be removable in the course of treatment.
  • a distal pin that can be inserted into the phalange metalcarpal bone
  • a fracture pin that can be inserted into a bone fragment caused by a fracture of a wrist joint
  • a proximal pin clamp capable of pinching and fixing the proximal pin
  • a distal pin clamp capable of pinching and fixing the distal pin
  • a plate-like member capable of arranging and fixing a number of the fracture portion pins
  • the gist is that the distal pin is configured to be removable in the course of treatment.
  • a distal pin that can be inserted into the phalange metalcarpal bone
  • a fracture pin that can be inserted into a bone fragment caused by a fracture of a wrist joint
  • a distal pin clamp capable of pinching and fixing the distal pin
  • a plate-like member capable of arranging and fixing a number of the fracture portion pins
  • the plate-like member has a protruding portion that is extended and can fix and fix the proximal pin, the distal pin clamp, and a rod-like member that connects and fixes the plate-like member. It is essential that the distal pin and the rod-like member are configured to be removable.
  • the external fixator according to claim 4 has the structure according to claim 2, and the plate-like member has a large number of screw holes or scissors for inserting the fracture pin.
  • the gist is that a number of the fracture pin can be arranged and fixed by providing a groove.
  • the external fixator according to claim 5 has the structure according to claim 3, and the plate-like member has a large number of screw holes or scissors for inserting the fracture pin. By providing a groove, it is possible to arrange and fix a large number of the fracture pin,
  • the gist of the invention is that the protruding portion is provided with a screw hole or an insertion groove for inserting the proximal pin so that the proximal pin can be disposed and fixed.
  • the external fixator according to claim 6 is the external fixator according to claim 4, wherein a number of screw holes for inserting the fracture pin are provided in the plate-like member. Forms a taper on the side of the pin head of the fracture pin,
  • a taper part having the same shape as the taper part is formed in the screw hole of the plate-like member, and the pin head of the fracture part pin is screwed into the screw hole of the plate-like member, so that the pin head of the fracture part pin is plate-like
  • the gist is that it does not protrude from the upper surface of the member.
  • the external fixator according to claim 7 is provided with a number of screw holes for inserting the fracture pin into the plate-like member, in addition to the external fixator according to claim 5. Installed and popping part When providing a screw hole for inserting a proximal pin,
  • a tapered part is formed on the pin head side surface of the fracture pin and the proximal pin
  • a taper part having the same shape as the taper part is formed in the screw hole of the plate-like member and the protruding part,
  • the gist is that the pin heads of the fracture pin and the proximal pin do not protrude from the upper surfaces of the plate-like member and the protruding portion, respectively.
  • the proximal pin that can be inserted into the radius and the distal pin that can be inserted into the phalange are provided, it is possible to apply pressure to the joint surface damaged by traction. Protecting the articular cartilage can prevent future degenerative arthritic changes. And since it has the fracture
  • the fracture portion pins can be inserted from a plurality of directions into a bone fragment caused by a fracture of the wrist joint portion. Therefore, it can be effectively used even when it is desired to use a large number of fracture pin pins for grinding fracture or the like.
  • the bone fragment can be reduced by towing, and the fracture pin can be easily driven in the bone reduction position.
  • FIG. 1 is a perspective view of an external fixator according to a first embodiment.
  • FIG. 2 (a) is a front view of a clamp and a support.
  • B It is a rear view of a clamp and a support body.
  • C It is a side view of a clamp and a support body.
  • D It is a top view of a clamp and a support body.
  • FIG. 3 is a side view of an arched plate and a support.
  • FIG. 4 (a) is a cross-sectional view of a fracture pin and an arched plate.
  • (B) It is a figure which shows the attachment condition of a fracture part pin.
  • FIG. 5 is a view showing a usage state of the external fixator according to the first embodiment.
  • FIG. 6 is a perspective view of an external fixator according to a second embodiment.
  • FIG. 7 is a view showing a usage situation of the external fixator according to the second embodiment.
  • FIG. 8 is a perspective view of an external fixator according to a third embodiment.
  • FIG. 9 is a top view of an arched plate.
  • FIG. 10 is a diagram showing a state of insertion of a fracture pin.
  • FIG. 11 is a view showing a modification of the external fixator according to the first embodiment.
  • FIG. 12 is a diagram showing a prior art.
  • the external fixator according to the present invention has a proximal pin and a distal pin, and is mounted across a fractured portion of the wrist joint (distal radius end). They are inserted into the ribs and phalanges (metacarpal bones). Two to three proximal and distal pins are provided.
  • the proximal pin and the distal pin are each held and fixed by a member such as a clamp, and further connected by a rod-like member. This makes it possible to reduce and fix the bone fragment of the fractured part by towing.
  • a “fracture pin” is disposed at a position intermediate between the proximal pin and the distal pin, that is, at the position of the fracture portion of the wrist joint, and inserted into the bone fragment generated by the fracture. .
  • many pins can be inserted, and preferably about 2 to 10 pins can be placed.
  • a plate-like member having a certain area is used, and means for inserting and fixing a large number of fracture pin pins such as screw holes and attachment grooves is provided on the member.
  • the plate-like member is formed as an arch-type plate that conforms to the shape of the wrist, it is preferable that a number of fracture pin can be inserted from a plurality of directions at different angles.
  • the plate-like member that holds and fixes the fracture pin is connected and fixed to the rod-like member, which eliminates the need for long-term traction, and about 2 to 3 weeks have passed since the fracture bone can be formed in the treatment process. Later, the distal pin inserted into the phalange (metacarpal bone) can be removed.
  • all or part of the plate-like member may be extended to the palm side, and a means for disposing and fixing the proximal pin to the extended portion may be provided.
  • a means for disposing and fixing the proximal pin to the extended portion may be provided.
  • proximal pin For the proximal pin, the distal pin, and the fracture pin, a durable material that has little influence on the human body such as titanium alloy and stainless steel is used.
  • the size (diameter) of each pin is preferably 3 to 4 mm for the proximal pin, 2 to 3 mm for the distal pin, and 1 to 4 mm for the fracture pin, taking into account the strength and location used.
  • the tip of the pin should be shaped like a screw to improve the fixation to the bone.
  • plate-like members are preferably formed using X-ray transparent materials such as carbon fiber and plastic.
  • the rod-shaped member, clamp, and other members may be of any material and shape as long as they can exhibit the function of the external fixator according to the present invention.
  • the external fixator (1) has two proximal pins (2) and a distal end at both ends of the rod-like member (11).
  • Two pins (3) are arranged via clamps (6) (7) and supports (8) (9), respectively, and a desired number of fracture pins (4 ) Is disposed via the arched plate (5) and the support (10).
  • the support (8) (9) is formed by a pair of clamping plates (21), and by fastening the fastening screw (23), It is fixed to the rod-shaped member (11).
  • the clamps (6) and (7) are also formed by a pair of clamping plates (20), and the fastening screws (22) are screwed to hold the pins (2) and (3) while holding the pins (2) and (3).
  • Fixed to (9). Grooves having a semicircular cross section are formed on the opposing surfaces of the clamping plates (20) and (21) so that the pin (2) (3) and the rod-shaped member (11) can be stably clamped. ing.
  • the supports (8) and (9) can be fixed at an arbitrary rotation angle with respect to the axial direction of the rod-shaped member (11), and the clamps (6) and (7) are fixed to the axial direction of the rod-shaped member (11). It can be fixed at an arbitrary rotation angle with respect to the vertical direction (axial direction of the fastening screw (22)). For this reason, the proximal pin (2) or the distal pin (3) can be inserted at various angles.
  • the arched plate (5) is a plate-like member having an arc shape with a central angle (0) within 180 ° and having a certain width and thickness.
  • the reason why the central angle (0) is set within 180 ° is that an angle larger than 180 ° is not necessary as a sufficient angle for inserting the pin from the back side in the wrist joint.
  • both ends of the arched plate (5) are bent to form fastening portions (24) and (24 ′), and as shown in FIG. 3, through the backing plate (25).
  • the arched plate (5) is fixed to the support (10) by screwing the fastening screw (27).
  • the support (10) is formed by a pair of clamping plates (26).
  • the fastening part (24) can be fixed at any rotation angle with respect to the direction perpendicular to the axial direction of the rod-like member (11) (axial direction of the fastening screw (27)).
  • the fracture pin (4) can be inserted.
  • the arched plate (5) may be screwed directly to the sandwiching plate (26) without going through the receiving plate (25).
  • the clamping plate (20) constituting the clamp (6) (7) and the receiving plate (25) of the arched plate (5), or the clamping plate (21) constituting the support body (8) (9) are supported. It is preferable to use a common member for the clamping plate (26) constituting the body (10) because the number of members can be reduced.
  • the arched plate (5) is provided with a plurality of screw holes (12) for fastening and fixing the fracture pin (4). In this embodiment, four rows of screw holes (12) are formed at equal intervals in a concentric manner.
  • a tapered portion (31) is formed on the side surface of the pin head (30) of the fracture pin (4), and a male screw is engraved on the tapered portion (31). .
  • the screw hole (12) that is drilled in the arched plate (5) is also formed with a tapered portion (32) having the same shape as the tapered portion (31) on the side surface of the pin head (30), so that the female screw is When the fracture pin (4) is inserted and screwed, the pin head (30) is flush with the top surface of the arched plate (5) as shown in Fig. 4 (b). To form a flat surface.
  • the pin head (30) is provided with a wrench groove (30a) so that it can be attached to and detached from the screw hole (12) using a dedicated wrench or the like.
  • an arched plate (5) is placed at the position of the wrist joint, and the fracture pin (4) is inserted into the rib (40) fragment caused by the fracture, and the arched plate is inserted. Fix it to the plate (5).
  • the necessary number of fracture pins (4) can be inserted into a desired position of the screw hole (12) of the arched plate (5) according to the fracture condition.
  • the rib (40) (proximal) and phalange (metacarpal) (41) (distal) are held by the clamp (6) (7) via the support (8) (9), respectively. Insert the proximal pin (2) and the distal pin (3), and reduce and fix them while pulling the hand joint. Approximately 2-3 weeks after the external fixator (1) was attached, callus formation at the fracture started and the bone fragment began to stabilize. The position pin (3), the clamp (7) holding it, and the support (9) can be removed.
  • the arrangement positions of the clamps (6), (7), the arched plate (5) and the like can be appropriately adjusted according to the patient's case.
  • the proximal pin (2) and the distal pin (3) in this embodiment may be arranged and fixed by the arched plate (5 '), like the distal pin in the second embodiment. ! ⁇ (see Figure 6).
  • each of the clamp (6) (7) and the arched plate (5) 1S The support (8), (9) and (10) can be fixed at a desired rotation angle, and the support (8), (9) and (10) can be fixed with respect to the rod-shaped member (11).
  • the proximal pin (2), distal pin (3), and fracture pin (4) can be inserted at various angles and can be reduced from various directions.
  • the arched plate (5) is provided with a large number of screw holes (12), it is possible to dispose the necessary number of fracture pins at the necessary positions.
  • the pin head (30) of the fracture pin (4) is screwed in without protruding from the upper surface of the arched plate (5), the safety of daily operations of the patient is improved.
  • FIG. 11 As shown in Fig. 11 as a modified example of the present embodiment, two to four fastening screws (22 ') are screwed together so that a pair of clamping plates (20') (20 '') Fracture pin (4) 2—Also hold and fix 3 pins.
  • the holding plate (20 ′) is formed in an L shape, and is fixed to the support (10) by screwing a fastening screw (27 ′ ′).
  • the fracture piece can be reduced and fixed by traction with the proximal pin (2) and the distal pin (3), and the fracture portion can be fixed. Since the pin (4) is inserted into the bone fragment of the fracture and fixed, long-term traction is not required, and the distal pin (3) inserted into the phalange (metacarpal bone), clamp (7) The support (9) can be removed during the treatment process!
  • the external fixator (1) has two distal pins (3) attached to one end of a rod-shaped member (11), an arched plate (5 ′), and a support ( 9), the proximal end of the rod-shaped member (11), 3 proximal pins (2), and a desired number of fracture pin (4), arched plate (5), support (10) is provided.
  • the external fixator (1) is configured such that a part of the arched plate (5) is partly parallel to the rod-like member (11) on the back side.
  • the projecting portion (50) is formed by extending to.
  • three screw holes (51) are drilled in parallel with the rod-shaped member (11), and the pin head of the proximal pin (2) protrudes in the same manner as in FIG. It is configured to be screwable so as to be flush with the upper surface of the portion (50).
  • the distal pin (3) is disposed and fixed using an arched plate (5 '). As with the fracture pin (4) and the proximal pin (2), the distal pin (3) is configured so that the pin head does not protrude.
  • the arched plate (5) (5 ') is formed by screwing the fastening part (24) (24 ") to the support (10) (9) by the fastening screw (27) (27'), respectively.
  • the rod-like member (11) is fixed.
  • FIG. 7 is a diagram illustrating a usage example of the external fixator (1) according to the present embodiment.
  • the proximal pin (2) and the distal pin (3) were inserted into the radius (40) and the phalange (metacarpal) (41), respectively, to the wrist joint. Reduce and fix while towing.
  • the distal pin (3) inserted into the phalange (metacarpal) (41), the arched plate (5 ') holding it, and the support (9) are removed. Since the proximal pin (2) is fixed integrally with the arched plate (5), the rod-shaped member (11), the support (10) of the arched plate (5), the receiver The plate (25) can also be removed.
  • the arched plate (5) according to the present embodiment is provided with fastening portions (24) and (24 ') at both ends, and a protruding portion (50) is formed at the center, which is symmetrical. Because it is configured, it can be used by wearing even if it is a left or right hand.
  • the distal pin (3), the arched plate (5 '), the backing plate (25'), about 2-3 weeks after the external fixator (1) is mounted The support (9), backing plate (25), and rod (11) can be removed, and the patient can do the remaining weeks for the arched plate (5) and the proximal pin (2) that is clamped to it. Since it is sufficient to wear only the fracture pin (4), the troublesomeness is reduced. And since the pin head of any of the proximal pin (2), the distal pin (3), and the fracture pin (4) does not protrude, the convenience and safety of daily operation of the patient are markedly improved. Will be up.
  • an external fixator that can be attached to either the left or right hand with the same member can be provided, which is very convenient.
  • the external fixator (1) has two distal pins (3) clamped at one end of a rod-like member (11) (7) and a support (9). And place the desired number of proximal pins (2) on the other end of the rod-shaped member (11).
  • the fracture pin (4) is disposed through the arched plate (5) and the support (10).
  • the external fixator (1) replaces the screw hole (12) (51) of the arched plate (5) and the protruding portion (50) with the fastening groove (60) ( 61).
  • the grooving groove (60) through which the fracture pin (4) can be passed is a notch of the arched plate (5) with a width approximately equal to the diameter of the fracture pin (4), as shown in Fig. 8. These are arranged in a direction perpendicular to the rod-like member (11).
  • the fitting groove (61) through which the proximal pin (2) can pass is a bar-like member having a notch in the protruding portion (50) with a width corresponding to the diameter of the proximal pin (2). (11) are arranged in parallel.
  • the fracture pin (4) inserted into the attachment groove (60) is provided with a screw provided on the side surface of the arched plate (5) and the inner surface of the attachment groove (60). It is fixed by a tightening force generated by screwing a tightening screw (62) and a nut (63) disposed through the holes (66) (66 '). That is, the arched plate (5) is elastically deformed by the tightening force, and the fracture pin (4) is clamped and fixed in the fastening groove (60).
  • the proximal pin (2) is also fastened by being threaded through the screw holes (67) (67 ') provided in the side surface of the protruding portion (50) and the inner surface of the fitting groove (61). It is clamped and fixed in the fitting groove (61) by the tightening force generated by the screwing of the screw (64) and the nut (65).
  • the arched plate (5) and the protruding portion (50) are elastic as described above by the tightening force of the tightening screws (62) (64) and nuts (63) (65).
  • a material eg, carbon fiber or plastic that deforms and can be used to clamp and fix the fracture pin (4) and proximal pin (2) is used.
  • the fracture pin (4) and the proximal pin (2) are fixed as described above, the fracture pins (60) (61) in the perforation grooves (60) (61) that do not interfere with the tightening screws (62) (64) are provided. If it is a position, it can be placed at any position.
  • the insertion angle can be varied for each pin.
  • the fracture pin (4) and the proximal pin (2) are respectively connected to the fixation groove (60).
  • the insertion angle can be changed for each pin, it can be adjusted according to the patient's symptoms. Correspondence becomes possible.
  • the present invention solves the problems of the conventional external fixator of the Bridge Type and Non Bridge Type wrist joints, enables early reintegration, prevents degenerative arthritic changes, and is a surgical technique. Provides a simple external fixator and has industrial applicability.

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Biomedical Technology (AREA)
  • Engineering & Computer Science (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

Appareil de fixation externe de type hybride pouvant réaliser une réhabilitation sociale précoce, prévenir tous les changements de type arthropathie régressive et faciliter l’exercice de la chirurgie. Il est fourni un appareil de fixation externe comprenant une broche proximale capable de percer le radius; une broche distale capable de percer l’ossa digitorum (os métacarpien); une broche de portion de fracture capable de percer toute pièce d’os résultant d’une fracture du poignet; un étrier de broche proximale capable de maintenir et immobiliser la broche proximale; un étrier de broche distale capable de maintenir et immobiliser la broche distale; un élément de plaque capable de disposer et maintenir une multiplicité de broches de portion de fracture; et un élément en forme de tige capable de verrouiller et immobiliser l’étrier de broche proximale, l’étrier de broche distale et l’élément de plaque, desquels au cours de la thérapie, la broche distale peut être enlevée.
PCT/JP2004/011093 2004-08-03 2004-08-03 Appareil de fixation externe WO2006013624A1 (fr)

Priority Applications (2)

Application Number Priority Date Filing Date Title
PCT/JP2004/011093 WO2006013624A1 (fr) 2004-08-03 2004-08-03 Appareil de fixation externe
PCT/JP2005/009533 WO2006013670A1 (fr) 2004-08-03 2005-05-25 Dispositif médical de fixation externe

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/JP2004/011093 WO2006013624A1 (fr) 2004-08-03 2004-08-03 Appareil de fixation externe

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WO2006013624A1 true WO2006013624A1 (fr) 2006-02-09

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PCT/JP2005/009533 WO2006013670A1 (fr) 2004-08-03 2005-05-25 Dispositif médical de fixation externe

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Cited By (2)

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Publication number Priority date Publication date Assignee Title
EP2063792A1 (fr) * 2006-09-21 2009-06-03 Henrik Hansson Dispositif de fixation d'une fracture osseuse
JP2010193954A (ja) * 2009-02-23 2010-09-09 Akira Honjo 骨折部固定器具

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US5591169A (en) * 1994-06-14 1997-01-07 Benoist; Louis Device and method for positioning and holding bone fragments in place
JPH10509627A (ja) * 1994-12-05 1998-09-22 スミス アンド ネフュー インコーポレイテッド 末端橈骨骨折用外部固定具
US6056748A (en) * 1998-02-20 2000-05-02 Weiner; Lon S. Modular fixator assembly
JP2004512090A (ja) * 2000-10-25 2004-04-22 エスディージーアイ・ホールディングス・インコーポレーテッド 非金属製インプラント装置と、術中に組み立ておよび固定する方法

Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP2063792A1 (fr) * 2006-09-21 2009-06-03 Henrik Hansson Dispositif de fixation d'une fracture osseuse
EP2063792A4 (fr) * 2006-09-21 2012-10-17 Henrik Hansson Dispositif de fixation d'une fracture osseuse
US8372125B2 (en) 2006-09-21 2013-02-12 Henrik Hansson Device for fixation of a bone fracture
JP2010193954A (ja) * 2009-02-23 2010-09-09 Akira Honjo 骨折部固定器具

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