WO2010005076A1

WO2010005076A1 - Bone connecting device

Info

Publication number: WO2010005076A1
Application number: PCT/JP2009/062590
Authority: WO
Inventors: 英智中村
Original assignee: 学校法人久留米大学
Priority date: 2008-07-11
Filing date: 2009-07-10
Publication date: 2010-01-14
Also published as: JPWO2010005076A1

Abstract

Provided is a bone connecting device which can prevent postoperative discomfort experienced by an operated patient, shows little postoperative morphological change and can prevent the application of a non-inherent restriction on the movable range of the elbow joint due to the deformation of the articular surface morphology of the trochlear notch that is caused by a morphological change. A bone connecting device (A) comprising an intramedullary nail (1) which can be inserted into the ulnar marrow, a fixing washer (2) provided with a spike (21) which can be set up on the outer face in the olecranal side of the ulna, a base fixing screw (3) and top fixing screws (4) and auxiliary screws (5) each in a required number. In the intramedullary nail (1), a screw hole (11), which is formed in the basal end part and in which the base fixing screw (3) can be screwed, and a top fixing screw-through hole (12), which is formed in the front end side and penetrates in the direction crossing the lengthwise direction, are formed. In the fixing washer (2), a base fixing screw-through hole (22), through which the base fixing screw (3) passes, and an auxiliary screw-through hole (23), through which the auxiliary screw (5) passes, are formed.

Description

Osteosynthesis

The present invention relates to a bone connector. More specifically, the present invention relates to an osteosynthesis device used for fixing and reducing each bone portion so as to have the original bone shape when the elbow head side of the ulna is fractured.

The ulna is a long tubular bone inside the forearm alongside the radius. The ulna is thick on the elbow head side and thin on the ulna head side. On the elbow head side of the ulna, there is a pulley notch that is recessed so as to cut deeply from the upper front, and this portion forms a joint with the humeral pulley. In the center of the pulley notch, a height corresponding to the depression of the humeral pulley runs vertically.

The lower end of the pulley notch protrudes forward to form a hook-like protrusion, and the rear surface of the notch is thickened to form an elbow head. In addition, there is a rib notch in contact with the articular ring surface of the rib on the outer side of the pulley notch. As described above, the shape of the ulna on the elbow head side is complicated, and the joint form between the humerus and the radius has an extremely delicate relationship.

On the other hand, there are unexpectedly many cases where the ulna elbow is fractured. In particular, it can be easily imagined that fractures due to elbows that fall when an elderly person falls tend to increase in the present age of aging and will increase further in the future.
Hereinafter, an outline of a conventional method for treating a fracture of the ulna elbow head as described above will be described with reference to Non-Patent Document 1.

The “plate fixing method” shown in FIG. 3 uses a stainless steel plate 61 and screws 62 that are curved so as to follow the shape of the bone fragment after reduction, and the plate 61 includes, for example, a bone fragment. This is a method in which the bone piece is firmly fixed using a plurality of screws 62 by being applied along the bone rear surface side.

In addition, the “tension band wiring method” shown in FIG. 4 uses two stainless steel insertion wires 63 and a fastening wire 64. The insertion line 63 is inserted parallel to the medulla to fix the bone fragment, and the fastening line 64 is passed through the horizontal hole 65 drilled in the bone piece corresponding to the distal end side of the insertion line 63, and this is crossed once at the intermediate part. It is a method of turning around the base ends of the both insertion lines 63 coming out from the bone pieces, and fixing the both ends by twisting.

However, the conventional methods have the following problems.
The “plate fixation method” is unnatural to the skin because the plate 61 is fixed to the outer surface side of the ulna, that is, the side where there is no muscle and the subcutaneous tissue is thin in the forearm. . In addition, even the patient who was treated was uncomfortable due to the movement of the subcutaneous tissue when the arm was moved, or uncomfortable when the raised part of the plate 61 touched clothes or a table.

In the “tension band wiring method”, there is a case where the insertion line 63 inserted into the bone gradually comes out when the fastening line 64 for fastening the wire is loosened and the tension is weakened, and re-operation is required. Further, if the force for fastening each insertion line 63 by the fastening line 64 is too strong, each insertion line 63 is bent and the joint surface of each bone fragment is separated, and the joint surface (curved surface) shape of the pulley notch is the original. Therefore, there is a possibility that a restriction different from the original may occur in the range of motion of the elbow joint.
In addition, in any of the above methods, the skin of the corresponding part has to be largely incised in the operation, and there is a great physical burden on the patient such as an increased risk of causing an infection.

In the case of treating fractures in the middle part of long bones such as the ulna, other humerus, and femur, a method using an intramedullary nail is also employed. In this method, an intramedullary nail is inserted into the bone marrow so as to pass between both fractured bone fragments, and a bone screw and an intramedullary nail are passed through both bone fragments, and a fixing screw is screwed. However, this method cannot be used for reduction of the ulna elbow head, which includes the end of the complex shape as described above and is brittle in strength.

(Object of the present invention)
An object of the present invention is an osteosynthesis tool used for fixing and reducing each bone portion so as to have the original bone shape when the ulna of the ulna is fractured. An object of the present invention is to provide a bone joint device that can prevent or alleviate a feeling of incongruity after the operation of the patient and that has a small physical burden on the patient.

Another object of the present invention is that the shape of the joint is less likely to change after the operation, and the range of motion of the elbow joint is unrestricted due to the deformation of the joint surface shape of the pulley notch caused by the change in shape. It is to provide a bone joint that can be prevented from occurring.

The means taken by the present invention in order to solve the above problems are as follows.

The present invention is an osteosynthesis device used to fix and reduce each bone fragment when the ulna of the ulna is fractured, and has a required length with a thickness that can be passed through the medullary ulna. An intramedullary nail, a fixing washer having a required number of sharp elements capable of standing on the outer surface of the ulna on the elbow head side, a base fixing screw, and a required number of tip fixing screws, respectively, Are formed with a screw hole provided in the length direction from the base end portion to which the base fixing screw can be screwed and a through hole for a tip fixing screw provided on the tip side and penetrating in the direction intersecting the length direction. The bone washer is formed with a through hole for a base fixing screw through which the base fixing screw is passed.

The present invention is an osteosynthesis device used to fix and reduce each bone fragment when the ulna of the ulna is fractured, and has a required length with a thickness that can be passed through the medullary ulna. An intramedullary nail, a fixing washer having a required number of sharp elements that can stand on the outer surface of the ulna of the ulna, a base fixing screw, and a required number of tip fixing screws and auxiliary screws, respectively, The intramedullary nail is provided with a screw hole provided in the length direction from the base end portion to which the base fixing screw can be screwed, and a thread for the tip fixing screw provided on the tip side and penetrating in the direction crossing the length direction. The bone fastener is formed with a hole, and a base fixing screw through hole through which the base fixing screw passes and an auxiliary screw through hole through which the auxiliary screw passes are formed in the fixing washer.

In the present invention, the substrate constituting the fixing washer may be formed in a rectangular shape, and sharp elements may be provided at the four corners of the substrate.

In the above invention, the fixing washer having the required number of sharp elements that can stand on the outer surface of the ulna on the elbow head side can be inserted into the outer surface of the ulna on the elbow head side.

In the present specification and the claims of the present application, in the expression “can be stood on the outer surface of the ulna of the ulna” relating to the fixing washer that is a component of the invention, the word “standing” means “stab” "Or" install "is used in the meaning including the expression.

(Work)
The operation of the bone joint device according to the present invention will be described. Here, the constituent elements used in the description are assigned in correspondence with the reference numerals given to the respective parts in the embodiments to be described later. These reference numerals are the same as the reference numerals described in the claims of the claims. Similarly, it is only for the purpose of facilitating understanding of the contents, and the meaning of each component is not limited to the above-described parts.

Hereinafter, the case where the ulna is fractured on the elbow head side and divided into a central bone fragment at the end of the elbow head, a long bone fragment on the arm tip side, and a bone fragment therebetween will be described. In this case, the operation using the bone connector is performed as follows.

A partial incision is made in the skin of the elbow, and an insertion hole through which the intramedullary nail (1) can be inserted is formed through the dense part of the bone at the proximal end of the central bone fragment.
The bone pieces including the central bone piece and the long bone piece are returned to their original positions before fracture, and the joint surfaces of the bone pieces are aligned. In this state, insert the intramedullary nail (1) through the insertion hole of the central bone fragment, pass through the bone marrow of the central bone fragment and other bone fragments, and insert the tip side into the bone marrow of the long bone fragment . At this time, the intramedullary nail (1) is inserted so that the base end portion is substantially flush with the outer edge surface of the insertion hole of the central bone fragment.

Using a dedicated device, specify the position corresponding to each tip fixing screw through hole (12) of the intramedullary nail (1) in the bone marrow of the ulna. Then, the skin of the part is cut open, the tip fixing screw 4 is screwed into the dense part of the long bone fragment, and the tip fixing screw (4) is inserted into each tip fixing screw through-hole (12) of the intramedullary nail (1). ) And screwed from the inside so as to penetrate the dense part on the opposite side, and fix the intramedullary nail (1) to the long bone fragment.

Standing washer for fixation (2) stands on a tendon where each sharp element (21) is connected to the central bone fragment of the posterior end of the central bone fragment or to the central bone fragment of the triceps (can be inserted into the tendon or crimped to the tendon) Then, the base fixing screw (3) is passed from the outside of the fixing washer (2) through the base fixing screw through hole (22) and screwed into the base fixing screw screw hole (11) of the intramedullary nail (1).
Further, if necessary, the auxiliary screw (5) is passed from the outside of the fixing washer (2) through the auxiliary screw through hole (23) and screwed to the rear end side of the central bone piece and tightened. As a result, the fixing washer (2) is fixed to the central bone fragment.

By tightening the base fixing screw (3), the fixing washer (2) is drawn toward the intramedullary nail (1) fixed to the long bone fragment, and each bone fragment is firmly attached to the joint surface and firmly fixed. Is done. It should be noted that the base fixing screw (3) is appropriately tightened while checking the fit of each bone fragment. After that, the joint surfaces of the bone fragments are connected and reduced with the passage of time, and the entire ulna is integrated. The bone fastener (A) remains fixed to the ulna after reduction.

In this way, the bone connector (A) is designed to hold a large portion of the central bone fragment fixed by the sharp element (21) by tightening the fixing washer (2), Since the force is dispersed, the central bone fragment is difficult to break, and further, it can be integrated so that each bone fragment is connected in the length direction of the intramedullary nail by tightening the fixing washer (2). As a result, there is almost no portion that appears on the surface of the ulna after the operation other than the fixing washer (2), and it is possible to prevent or alleviate a feeling of discomfort after the operation in the patient who has been operated.
In addition, as described above, the portion for incising the skin in the operation is smaller than before, the risk of causing infection is reduced, and the physical burden on the patient is reduced.

In addition, since the bone joint (A) is firmly integrated with the ulna, the shape of the bone joint (A) is less likely to change after the operation, and the shape of the joint surface of the ulnar pulley notch resulting from the change in shape Can be prevented from being deformed into a shape different from the original shape, and a restriction different from the original in the range of motion of the elbow joint can also be prevented.

(A) The osteosynthesis device of the present invention is configured to hold the central bone fragment at the end of the ulna with a sharp element by tightening the fixing washer, so that the force is dispersed. The bone fragments are not easily damaged, and can be integrated so that the bone fragments are connected in the length direction of the intramedullary nail by tightening the fixing washer. As a result, there is almost no portion that appears on the surface of the ulna after the operation other than the fixing washer, and it is possible to prevent or alleviate the feeling of discomfort in the patient who has been operated after the operation.
In addition, the part for incising the skin in the operation is smaller than before, the risk of causing infection is reduced, and the physical burden on the patient is reduced.

(B) Since the osteosynthesis device of the present invention is firmly integrated with the ulna by performing the operation, the shape of the osteosynthesis device is difficult to change after the operation, and the joint of the ulnar pulley notch resulting from the change of the configuration It is possible to prevent the surface shape from being deformed to a shape different from the original shape, and to prevent a restriction different from the original from occurring in the range of motion of the elbow joint.

Explanatory drawing which shows the structure of the bone fastener which concerns on this invention, and the treatment state. The perspective view which shows the structure of the washer which comprises a bone fastener. Explanatory drawing of the plate fixing method which is the conventional treatment method. It is explanatory drawing of the tension band wiring method which is the conventional treatment method, (a) is side view explanatory drawing, (b) is rear view explanatory drawing.

A bone joint 1 intramedullary nail, 10 guide part, 11 screw hole for base fixing screw, 12 through hole for tip fixing screw,
2 fixing washers, 20 substrates, 21 spikes, 22 base fixing screw through holes, 23 auxiliary screw through holes,
3 base fixing screws, 30 heads,
4 Tip fixing screw,
5 Auxiliary screws, 50 head,
7 ulna, 70 central bone fragment, 71 intermediate bone fragment, 72 long bone fragment, 73 dense part, 74 insertion hole, 75 bone marrow part,
8 triceps, 80 tendons

The present invention will be described in detail based on the embodiments shown in the drawings.
FIG. 1 shows a structure of a bone joint device according to the present invention, and is an explanatory view of a treatment state thereof. FIG. 2 is a perspective view showing a structure of a washer constituting the bone joint device.

The bone connector A is composed of an intramedullary nail 1, a fixing washer 2, one base fixing screw 3, two tip fixing screws 4, and two auxiliary screws 5. These materials include titanium (Germany: Titan, Tatsuhide: Titanium), which has a high affinity with living tissues, has the property of binding to bone, and has excellent mechanical properties (light weight and high strength) and corrosion resistance. Although it is preferable to use it, the present invention is not limited to this, and other metal materials or plastics such as stainless steel can also be adopted.

The intramedullary nail 1 is a round bar having a required length and a thickness that enters the medullary ulna. In the present embodiment, the length of the intramedullary nail 1 is about 100 mm, which is half the standard length of an adult ulna, but is not limited thereto. It is preferable to set a plurality of types of intramedullary nails 1 having different sizes. Moreover, the guide part 10 is formed so that the front-end | tip part of the intramedullary nail 1 may taper off by chamfering.

At the base of the intramedullary nail 1, a screw hole 11 for base fixing screw is formed at a required depth in the direction of the central axis from the base end face. Further, near the tip of the intramedullary nail 1, through-holes 12 for tip fixing screws are formed at two locations with a required interval in the longitudinal direction of the intramedullary nail 1. Each tip fixing screw through hole 12 is formed to be parallel to each other in the diameter line direction of the intramedullary nail 1. In addition, the number of screw holes is not limited to two places, and can be provided at one place or three places or more.

The fixing washer 2 is formed of a plate and has a rectangular substrate 20. The substrate 20 is curved so as to swell slightly toward the upper surface side in FIG. 2, and the strength against bending is increased. At the four corners of the substrate 20, spikes 21 that are sharp elements are integrally provided so as to protrude in the length direction of the substrate 20. The tip of each spike 21 is sharpened so that the width is slightly narrowed and the thickness is thinned, and is further bent downward substantially at a right angle in FIG. In the present embodiment, the number of spikes 21 is four, the width is about 1 mm, and the length is about 5 mm. However, the present invention is not limited to this, and can be set as appropriate.

A base fixing screw through hole 22 through which the base fixing screw 3 is passed is formed near one end in the length direction of the substrate 20. The base fixing screw through-hole 22 is a long hole that is long in the width direction of the substrate 20 so that the fixing position of the fixing washer 2 can be adjusted, and the base fixing screw 3 hits the head portion 30 so that it cannot pass through. Is formed. Note that the hole of the base fixing screw through-hole 22 may be recessed so that the base fixing screw 3 does not protrude from the surface of the substrate 20.
In addition, circular auxiliary screw through holes 23 are provided at two locations side by side in the width direction near the other end in the length direction of the substrate 20. The auxiliary screw through hole 23 has a diameter through which the auxiliary screw 5 can pass and cannot be passed through when the head portion 50 hits.

In the present embodiment, since the portion pressed by the fixing washer 2 is anatomically long, the shape of the substrate 20 is rectangular. However, the shape is not limited to this, and for example, circular or elliptical Various polygonal shapes can also be employed.

The base fixing screw 3 has a head portion 30 and can be screwed into the screw hole 11 for the base fixing screw of the intramedullary nail 1. The tip fixing screw 4 has a wood screw shape and can be passed through the tip fixing screw through hole 12 of the intramedullary nail 1. The tip fixing screw 4 is formed to have a length about three times the diameter of the intramedullary nail 1 (the length of the tip fixing screw through hole 12). The auxiliary screw 5 has a head portion 50 in the form of a wood screw and can be passed through the auxiliary screw through hole 23 of the fixing washer 2.

(Work)
A surgical method for treating a fracture of the ulna elbow head using the bone connector A of the present embodiment will be described below.
The ulna 7 is fractured at two locations on the elbow head side, and is divided into a central bone piece 70 at the elbow head end, an intermediate bone piece 71 at the middle part, and a long long bone piece 72 at the arm tip side.

(1) Partially incising the skin of the elbow, penetrating each layer of periosteum, dense and endosteal (collectively referred to as dense part 73 for convenience of explanation) at the proximal end of the central bone piece 70, An insertion hole 74 into which the intramedullary nail 1 can be inserted is formed. At this time, the tendon 80 of the triceps surae 8 connected to the central bone fragment 70 is not damaged as much as possible.

(2) The central bone piece 70, the intermediate bone piece 71, and the long bone piece 72 are returned to their original positions before fracture, and the joint surfaces of the bone pieces are aligned.

(3) In this state, the intramedullary nail 1 is inserted from the insertion hole 74 of the central bone piece 70, passes through the bone marrow part 75 of the central bone piece 70 and the intermediate bone piece 71, and the bone marrow of the long bone piece 72 is on the front side. It is inserted into the part 75. At this time, the intramedullary nail 1 is inserted so that the base end portion is substantially flush with the outer edge surface of the insertion hole 74 of the central bone piece 70.

(4) Using a dedicated device, the position corresponding to each tip fixing screw through hole 12 of the intramedullary nail 1 in the bone marrow part 75 in the ulna 7 is specified. Then, the skin of the part is cut open and the two tip fixing screws 4 are screwed into the dense portion 73 of the long bone piece 72, and each tip fixing screw 4 is passed through each tip fixing screw through hole in the intramedullary nail 1. 12 and screwed from the inside so as to penetrate the dense portion 73 on the opposite side, and the intramedullary nail 1 is fixed to the long bone piece 72.

(5) The fixing washer 2 is set so that each spike 21 stands (or is pierced) on the rear end surface of the central bone piece 70 or the tendon 80 of the triceps 8 connected to the central bone piece 70, and The fixing screw 3 is passed from the outside of the fixing washer 2 through the base fixing screw through hole 22 and screwed into the base fixing screw screw hole 11 of the intramedullary nail 1. Further, the two auxiliary screws 5 are passed through the auxiliary screw through hole 23 from the outside of the fixing washer 2 and screwed to the rear end side of the central bone piece 70 and tightened.

Thus, the fixing washer 2 firmly holds the central bone piece 70, is firmly fixed to the central bone piece 70, and is integrated with the central bone piece 70 to increase its strength. Further, by fastening the base fixing screw 3, the fixing washer 2 is drawn toward the intramedullary nail 1 fixed to the long bone piece 72, and each

bone piece

70, 71, 72 is brought into close contact with the joint surface and firmly Fixed.

It should be noted that the base fixing screw 3 is appropriately tightened while observing the fit of each

bone piece

70, 71, 72. In some cases (for example, when the ulna is cut with an electric saw to reduce the humerus), in order to adjust the length of the bone to the original length, between each

bone piece

70, 71, 72 in advance It is also possible to provide a slight gap corresponding to the thickness lost by cutting. After that, the tissue of the joint surface of each

bone piece

70, 71, 72 is regenerated as time passes, and the ulna 7 is reduced as a whole. The osteosynthesis tool A remains fixed to the ulna 7 even after reduction, but can be removed after seeing the progress.

Thus, the bone connector A is configured to hold the central bone piece 70 at the end of the ulna 7 with the four spikes 21 by tightening the fixing washer 2 and hold the force. Since the central bone piece 70 is not easily damaged due to the dispersion, the

bone pieces

70, 71, 72 can be integrated in the longitudinal direction of the intramedullary nail 1 by tightening the fixing washer 2.

Thereby, by using the bone connector A, there is almost no part that appears on the surface of the ulna 7 after the operation other than the fixing washer 2, and it is prevented or alleviated that the treated patient himself feels uncomfortable after the operation. Surgery using an intramedullary nail is possible.
Further, as described above, the portion for incising the skin in the operation is smaller than before, the risk of causing an infection is reduced, and the physical burden on the patient is reduced.

Further, since the bone fastener A is firmly integrated with the ulna 7, the shape of the bone joint A is less likely to change with time after the operation, and the shape of the joint surface of the pulley notch of the ulna 7 resulting from the change of the shape. Can be prevented from being deformed into a shape different from the original shape, and a restriction different from the original in the range of motion of the elbow joint can also be prevented.

Note that the terms and expressions used in this specification are merely explanatory and are not limiting at all, and terms and expressions equivalent to the features described in this specification and parts thereof. There is no intention to exclude. It goes without saying that various modifications are possible within the scope of the technical idea of the present invention.

(A) According to the osteosynthesis device of the present invention, the portion where the central bone fragment of the end of the ulna is fixed by the sharp element is held by tightening the fixing washer, and the force is dispersed. Therefore, the central bone fragment is difficult to break, and further, it can be integrated so that each bone fragment is connected in the length direction of the intramedullary nail by tightening the fixing washer. As a result, there is almost no portion that appears on the surface of the ulna after the operation other than the fixing washer, and it is possible to prevent or alleviate the feeling of discomfort in the patient who has been operated after the operation.
In addition, the part for incising the skin in the operation is smaller than before, the risk of causing infection is reduced, and the physical burden on the patient is reduced.
(B) Further, according to the osteosynthesis device of the present invention, since it is firmly integrated with the ulna by performing the operation, the shape of the osteosynthesis device is hardly changed after the operation, and the ulna pulley caused by the change of the configuration It is possible to prevent the joint surface shape of the notch from being deformed to a shape different from the original shape, and to prevent a restriction different from the original from occurring in the movable range of the elbow joint.

Claims

An osteosynthesis device used to fix and reduce each bone fragment when the ulna of the ulna fractures,
An intramedullary nail (1) with the required length and thickness that can be passed through the medullary ulna,
A fixed washer (2) having the required number of sharp elements (21) that can stand on the outer surface of the ulna on the elbow head side;
It is equipped with a base fixing screw (3) and a required number of tip fixing screws (4) respectively.
In the intramedullary nail (1), a screw hole (11) provided in the length direction from the base end portion to which the base fixing screw (3) can be screwed, and provided in the front portion side and intersects the length direction. A through hole (12) for a tip fixing screw penetrating in the direction is formed,
The fixing washer (2) is formed with a base fixing screw through hole (22) through which the base fixing screw (3) is passed.
Osteosynthesis.
An osteosynthesis device used to fix and reduce each bone fragment when the ulna of the ulna fractures,
An intramedullary nail (1) with the required length and thickness that can be passed through the medullary ulna,
A fixing washer (2) having the required number of sharp elements (21) that can stand on the outer surface of the ulna on the elbow head side;
It has a base fixing screw (3) and a required number of tip fixing screws (4) and auxiliary screws (5) respectively.
In the intramedullary nail (1), a screw hole (11) provided in the length direction from the base end portion to which the base fixing screw (3) can be screwed, and provided on the front side and intersects the length direction. A through hole (12) for a tip fixing screw penetrating in the direction is formed,
The fixing washer (2) is formed with a base fixing screw through hole (22) through which the base fixing screw (3) is passed and an auxiliary screw through hole (23) through which the auxiliary screw (5) is passed. Yes,
Osteosynthesis.
The fixing washer (2) has a rectangular substrate (20), and the sharp elements (21) are provided at the four corners of the substrate (20).
The osteosynthesis tool according to claim 1 or 2.
The fixing washer (2) having the required number of sharp elements (21) that can stand on the outer surface of the ulna on the elbow head side is capable of being stabbed on the outer surface of the ulna on the elbow head side.
The osteosynthesis tool according to claim 1 or 2.